Hypertrophic & Retracting Scars

Common Symptoms

• A raised, thickened, sometimes red or itchy scar
• Tightness or restricted movement, especially with scars that cross a joint
• Scar tissue that has continued to thicken rather than gradually flattening over many months
• Discomfort, itching, or occasional pain at the scar site

Why It Happens

Scarring is a normal part of wound healing, but in hypertrophic scarring the body produces more collagen than needed for the repair, creating a raised, thickened scar (unlike keloid scars, hypertrophic scars generally stay within the boundary of the original wound). Retracting scars form when scar tissue contracts as it matures, which can be more functionally significant when it occurs over a joint or area needing to move and stretch, such as the hand.

Why It Can Become Persistent

Scar tissue, once mature, doesn't remodel back to normal skin structure on its own in most cases — it can soften and flatten somewhat over one to two years, but a scar that remains significantly raised, tight, or restrictive beyond that timeframe usually needs active treatment to improve further.

Who Commonly Gets It

Anyone can develop a hypertrophic or retracting scar after surgery, burns, or significant skin injury; scars that cross joints (such as the hands or fingers) are more likely to become functionally restrictive as they mature.

How It Is Usually Diagnosed

Scar assessment is typically clinical — a dermatologist, plastic surgeon, or hand specialist evaluates the scar's appearance, texture, and any functional restriction to determine the best treatment approach.

Traditional Treatment Options

• Silicone sheeting or gel: A well-established first-line, non-invasive option for many hypertrophic scars.
• Corticosteroid injections: Can help flatten and soften hypertrophic scars, particularly when done early.
• Laser therapy: Various laser treatments are used for scar appearance and texture, with a substantial evidence base.
• Hand/scar-specific therapy: For retracting scars affecting hand function, occupational or hand therapy (splinting, stretching, scar massage) is often central to treatment.
• Surgical scar revision: For significantly restrictive scars, surgical release or revision may be needed.

Why Someone Might Start Looking for Another Option

Established scar treatments don't fully resolve every scar, and researchers have explored newer adjunct approaches, including shockwave therapy, aimed at influencing the scar-forming cells (fibroblasts) directly.

Where Shockwave Therapy May Fit

The evidence here is early: a 2022 study examined shockwave therapy for hypertrophic scars, and separate research has looked specifically at retracting scars of the hands. We were not able to independently confirm the specific outcome results of either study beyond their bibliographic record during our research process — we're citing them as real, indexed studies worth discussing with a specialist, not as proof that shockwave therapy is an established scar treatment. Silicone sheeting, corticosteroid injection, and laser therapy all have considerably more supporting evidence.

How Shockwave Treatment Works for This Area

If considered appropriate after evaluation by a dermatologist, plastic surgeon, or hand specialist, shockwave therapy would be applied directly to the scar tissue — this would be one option to discuss, not a first-line recommendation ahead of better-established treatments.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation directly over the scar; your provider will discuss what to expect based on the scar's location and characteristics.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet had the scar evaluated by an appropriate specialist (dermatology, plastic surgery, or hand specialist depending on location)
• Active infection or an incompletely healed wound at the scar site
• Keloid scars specifically, which behave differently than hypertrophic scars and may need a different treatment approach entirely
• Anyone for whom a better-established option (silicone, steroid injection, laser) hasn't yet been tried

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.