Tight scars

Tight scars, or scar ‘contractures’, are a particularly bothersome type of scarring that typically occurs following an injury to a large area of skin, such as a burn. When there is damage to the skin, it repairs itself using its own healing mechanism, which will inevitably result in scarring. The scar is formed by the laying down of connective tissues, such as collagen, and the regeneration of skin cells to repair the broken skin. This process aims to restore the integrity and function of the skin. If the initial damage occurs over a larger area of skin, as the scar forms, sometimes the edges of damaged skin are pulled together, causing the resultant scarring to have a higher degree of tension than the surrounding skin and feel tight.

This contracture within the skin can be unsightly, cause a number of distressing symptoms and limit the function of the underlying muscles and joints. The tighter skin can also cause long term pain or itching.

Mr Ioannis Goutos is a top London-based plastic surgeon with a special interest in helping people who are suffering from scars and burns. He is a skilled surgeon who places particular attentions on all aspects of patient care: physical, social and psychological. With his prominent academic profile in the area of scars and burns, he is well placed to provide gold standard advice and a range of treatment options and aftercare individual to you and your skin.

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About this condition

Contracture scar tissue typically contains a higher proportion of the tough collagen tissue than regular scarring; this, combined with the shortening of the scar tissue over a wider area, results in scar tissue which is tough and tight. It can also involve some of the deeper layers of tissue under the skin, such as the myofascial layer (tissue that attaches the skin to the muscle) and surrounding nerves and blood vessels. This can result in mechanical shortening and loss of elasticity in the skin meaning that the movement of the underlying muscle groups and joints becomes restricted. This can be painful, and also have effects on the circulation of blood flow and lymphatic drainage of that area. If these additional structures are affected by tight scarring, treatment can become extremely difficult and requires specialist input, usually from a multidisciplinary team with experience in managing challenging scars.

Physiotherapy is key to maintaining function whilst healing from significant burn injuries that may result in contracted scarring. By exercising and stimulating low force but repetitive tension, this can help to improve the overall flexibility in the final scarring and retain a good range of movement in any affected joints. There are additional surgical options that can help to improve the appearance and function of tight scars:

Tissue expander – a device which is used to help stretch the target area of skin over a period of weeks to months.
Incision through the contracture, with the option of moving neighbouring skin into the gap created in the scar, called a flap.
Surgical removal (excision) of the tight scar, also with the option of skin grafting.
Z-plasty – cutting through the tight scar tissue in a ‘z’ pattern to allow the scar tissue to be interposed with normal skin. This aims to reduce the tension within the scar
Isolated skin grafting or free flap coverage.

The management of tight or contracted scars is highly specialised and it is key to ensure that you consult with an experienced clinician. They may recommend particular treatments or a combination of strategies guided by your skin, symptoms and goals.

Testimonials

Mr Goutos is delighted to share some of his patient and peer feedback on their experiences of his services.

Louise Steel

2023-08-16

Mr Goutos performed keloidectomy surgery on both my earlobes, and I am so grateful to have been referred to him. From the first consultation, through surgery, and now my 3-month follow-up, I have nothing but good words to say.

Luke Ward

2023-07-10

This man is an extremely intelligent, professional gentleman. He will set realistic expectations from the beginning and will not ‘beat around the bush’ so-to speak. From the initial consultation to post-surgery, it has been a rollercoaster ride. However the high level of expertise & professionalism Mr Goutos maintained has been impeccable. All I can say to any other individual considering treatment with Mr Goutos, is that you are in incredibly safe hands. And on top of this, he has a great sense of humour. I wish nothing but the best for this man, and the best results for his future patients.

Mauricio Lucas

2023-07-06

Outstanding Doctor - Exceptional Expertise I recently had the pleasure of consulting and also going through surgery. Dr. Goutos removed a large class of keloids from my back and chest, and without a doubt, I can confidently say that he is the best doctor I have ever had the privilege of seeing. From the moment I entered his practice, I was immediately struck by his professionalism, knowledge, and exceptional bedside manner. Dr. Goutos possesses an extraordinary level of expertise in his field, and his technical skills are truly remarkable. His ability to diagnose and treat medical conditions is unparalleled, and I have personally witnessed his remarkable success in improving the health and well-being of countless patients. What sets Dr. Goutos apart is his genuine care and concern for his patients. He takes the time to listen attentively, ensuring that he understands every aspect of the medical issue at hand. He communicates clearly and effectively, explaining complex medical concepts in a way that is easy to comprehend, which greatly helps in alleviating any concerns or fears. One aspect that impressed me greatly was Dr. Goutos' commitment to staying updated with the latest advancements in his field. He incorporates cutting-edge techniques and treatments into his practice, ensuring that his patients receive the highest standard of care available. This dedication to continuous learning and improvement is a testament to his unwavering dedication to his profession. Additionally, the support staff at Dr.Goutos' practice deserves recognition for their exceptional service. They are friendly, compassionate, and highly efficient, ensuring that appointments run smoothly and patients feel comfortable throughout the entire process. Overall, I cannot emphasize enough how fortunate I feel to have found Dr.Goutos' exceptional skills, genuine care, and unwavering commitment to his patients make him a truly outstanding specialist. I wholeheartedly recommend him to anyone seeking top-notch medical care.

Kashmala Khan

2023-01-26

Mr. Goutos and his team did an amazing job reversing a scar I had on my forehead. This was a very old scar and had bothered for many years. The laser treatment and fat transfer procedure has changed my life and given me so much confidence. I would definitely recommend him, he is a fantastic and very skilled surgeon. Thank you so much!

Javier

2023-01-14

Mr Goutos and his team removed some lipomas from my arms. The initial consultation right through to the aftercare was professional, sensitive and genuine. Mr Goutos put me at ease right from the start, discussing my history and background and then discussing the various options for the incisions and sutures. The incisions were quick, efficient and professional. I felt completely at ease knowing I was in expert hands. The incisions were extremely neat and have closed and scared really well. I had a number of questions after the operation and one of the sutures became infected. Mr Goutos was quick to make an appointment for me, see me and deal with the infection and offered for me to see him again if the infection didn’t calm down. He was genuinely empathetic to my needs and took time to check each scare, explain things and assure me along the way. He didn’t at any point, make me feel I was asking silly questions or too many. I highly recommend Mr Goutos for his exceptional incisions and suturing as well as his professional conduct, caring approach and after care. The whole experience was smooth and easy and I am very grateful for what he has done for me.

Ieva Lihovida-Yarlett

2022-12-07

We came to see Dr Goutos a few month ago to remove invasive spider nevus on my 9 year old sons nose . After a lovely consultation with Dr Goutos , he suggested to do several laser treatment sessions. After a few sessions we already noticed a massive improvement. On the final laser treatment session the spider nevus was completely gone. Thank you to the Dr Goutos for tackling the problem so rapidly and with great results!

Amy Munson

2022-10-27

We took our 4yr old daughter to Mr Goutos following an accident which resulted in a small burn scar on her cheek. Mr Goutos gave us various options and we went for laser treatment. After 4 appointments the scar has gone! The care that Mr Goutos gave us was exceptional and so good with children. He made us feel very comfortable and confident in his ability. I would recommend him to anyone if they were looking for a doctor in that particular field. Can't thank him enough.