Why Scars Form — And What We Can Do About It
Whenever our skin is injured — by surgery, cesarean section, accident, acne, or a burn — the body begins a complex healing process that often results in a scar . In most cases, the scar is normal and gradually fades away. In 30-50% of surgical procedures , however, the scar becomes hypertrophic or keloid [1] — that is, raised, red, and often aesthetically or functionally disturbing.
In this complete guide from the Traumacare Medical Group you will learn:
- The 4 types of scars and how to recognize them
- The 3 phases of healing and when to intervene
- The modern treatments (silicone, cortisone, laser, cryotherapy, surgery, pressure)
- Why Askina Scar Repair (B Braun) silicone sheets are the No.1 first line of treatment
- How to prevent a bad scar from day one
- When to see a dermatologist or plastic surgeon
The 4 Types of Scars — How to Recognize Them
1. Mature Scar
Characteristics: Flat or slightly raised, pale or pink (not red), within the boundaries of the original injury, asymptomatic.
Timeline: Forms 6-12 months after injury.
Prognosis: Good. No specific treatment needed — only sun protection to prevent darkening.
2. Hypertrophic Scar
Characteristics: Raised (up to 4mm), red or pink, within the boundaries of the original wound. May be itchy or painful.
Incidence: In ~50% of cesarean sections and many abdominal/thoracic surgeries.
Prognosis: May improve or even disappear with 6-12 months of silicone therapy.
➡️ Read more about hypertrophic scars
3. Keloid Scar
Characteristics: Highly raised, dark red/purple/brown , extends beyond the boundaries of the original wound. Itching, pain, aesthetic problem.
Risk factors: Genetic predisposition, dark skin (Fitzpatrick III-VI), young age, sternum/shoulder/ear areas.
Prognosis: More difficult. Combination of silicone + cortisone injections + laser. In severe cases surgical removal + radiation.
➡️ Full article: Hypertrophic vs Keloid
4. Atrophic Scar
Characteristics: Deep (below the skin level). Typically from acne or chickenpox.
Subtypes: Ice-pick (narrow deep), Boxcar (wide with clear boundaries), Rolling (wavy).
Prognosis: Not treated with silicone. Microneedling, laser ablative, dermal fillers, or subcision are needed.
How a Scar Forms — The 3 Phases of Healing
Phase 1 — Inflammation | Days 0-3
Once an injury occurs, the body sends platelets and white blood cells. The area is red, swollen, warm . Normal .
Phase 2 — Proliferation | Days 3-21
Fibroblasts rapidly produce type III collagen. granulation tissue is formed. The skin closes.
🎯 Critical phase for intervention: This is where silicone sheeting begins (after healing and suture removal). Prevention > treatment.
Phase 3 — Remodeling | Months 1-18
Type III collagen is converted to type I (same as normal skin). The scar matures — becoming flatter, less red.
When this balance is disrupted (collagen overproduction), a hypertrophic or keloid scar is formed [3] .
➡️ Detailed article on the 3 phases of healing
Modern Scar Treatments (2026)
1. Silicone Sheets — The FIRST Choice (Level I Evidence)
As mentioned, silicone is the first line for the prevention and treatment of hypertrophic/keloid scars. 65-90% improvement in clinical studies [4] .
How Does It Work? Creates an impermeable film over the scar. Maintains stable hydration , regulates collagen production, and reduces inflammation.
Duration of treatment: 12-24 hours/day · 2-6 months (fresh scars) or 6-12 months (old scars).
B Braun's Askina Scar Repair Series
Askina Scar Repair are medical-grade silicone adhesive sheets with CE Class IIa certification under MDR 2017/745. Available in 4 different sizes to suit every type of scar:
- 2x14cm (15 pcs) — ideal for caesarean section scar (Pfannenstiel)
- 5x7.5cm (5 pcs) — small surgical scars, shoulders, acne
- 4x30cm (5 pcs) — elongated scars (colostomy, scoliosis, post-colostomy)
- 10x18cm (5 pcs) — large areas (burns, mastectomy)
➡️ Complete Askina Scar Repair User Guide
➡️ How to choose the right Askina size for your scar
2. Cortisone Injections (Triamcinolone)
Intralesional corticosteroid injections. A dermatologist or plastic surgeon does it. Every 4-6 weeks for 3-5 sessions. Recommended for keloids or hypertrophic scars that do not respond adequately to silicone.
Combined therapy: Silicone + Cortisone = better results than either treatment alone [5] .
3. Laser Therapy
Pulsed Dye Laser (PDL) — for red/vascular scars. Fractional CO2 — for atrophic scars. Usually 3-6 sessions, cost €100-300/session, not covered by EOPYY.
4. Cryotherapy
Cryotherapy with liquid nitrogen. Effective for small keloids . 2-3 sessions every 4-6 weeks.
5. Surgical Removal + Radiation
For large, resistant keloids. Surgical removal alone has a high risk of recurrence (50-100%) without concomitant therapy. Usually combined with radiation or silicone post-op.
6. Pressure Therapy (Compression Garments)
Ideal for burns and large scars. 23 hours/day for 6-12 months. It is combined with silicone.
Why Choose Askina Scar Repair
Askina Scar Repair stands out for 7 main reasons:
- ✅ B Braun German engineering — one of the leading medical device companies since 1839
- ✅ CE Class IIa certification — strict clinical standards under MDR 2017/745
- ✅ 4 different sizes — fits every scar
- ✅ Self-adhesive — no additional tape needed
- ✅ Reusable (3-7 days per sheet) — economical
- ✅ Thin, discreet, waterproof — worn under clothes, shower-safe
- ✅ 5-15 pcs/pack — covers 2-3 months of continuous treatment
How to Use
- Clean and dry the scar area
- Cut the sheet into a shape that extends 1-2cm beyond the scar
- Remove the protective film and stick
- Wear 12-24 hours/day for 2-6 months (continuously, not intermittently)
- Clean the sheet with water and mild soap 1 time/day
- Replace when it loses its stickiness (usually 5-7 days)
➡️ Complete step-by-step user guide with photos
Scar Prevention — What to Do from Day One
Prevention is easier than cure. If you are going to have surgery (cesarean section, colostomy, cystectomy, plastic surgery), start:
- Healing phase (Weeks 0-2): Cleansing with Prontosan or saline. No alcohol.
- After stitches (Weeks 2-4): Start silicone (Askina Scar Repair). 12-24h/day.
- Sun protection (months 0-12): SPF 50+ daily. Sun darkens the scar permanently.
- Massage (after month 1): Light circular massage 2 times/day for a flattened scar.
- Avoiding tension (months 0-6): No strenuous exercise, weights, or stretching in the area.
- Hydration & nutrition: Protein, vitamin C, zinc for collagen.
➡️ Complete Guide to Scar Prevention
Special Cases — Where We Focus
Cesarean Section
50% of women experience hypertrophic scars after cesarean section [6] . Askina Scar Repair 2x14cm (15 pcs) is specially designed for the specific size of the Pfannenstiel incision.
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➡️ Complete guide to caesarean scar
Acne Scars
Atrophic scars (ice-pick, boxcar, rolling). Silicone does NOT treat them — microneedling, fillers, or laser are needed. For inflammatory acne scars on shoulders and back, Askina 5x7.5cm can help.
➡️ Complete guide to acne scars
Burn Scars
More aggressive. Combination of silicone (Askina 10x18cm for large areas) + pressure garments + regular monitoring.
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➡️ Complete Guide to Burn Scars
Scars after Abdominal Surgery (Ostomy/Colostomy)
Patients who have had a colostomy, ileostomy, or cystectomy often have an elongated abdominal scar. Askina 4x30cm ideally covers this length.
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➡️ Scars after Surgery · Colostomy Cluster
Facial Scars
Discretion is critical. The thin Askina 5x7.5cm can be worn at night under makeup during the day. Sun protection mandatory.
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➡️ Facial Scars
When to See a Doctor
A dermatological or plastic surgeon evaluation is recommended if:
- The scar is rapidly growing or extends beyond the boundaries of the injury (possible keloid)
- It is intensely painful or constantly itchy
- It is infected (red, swollen, pus-filled)
- Does not improve after 3 months of properly applied silicone
- You have a history of keloids (genetic predisposition)
- Is in a functionally critical area (joints, lips, eyelids)
Ostomy Patients — Cross-Cluster Connection
If you are a patient with a colostomy, ileostomy, or ureterostomy , your abdominal surgical incision is an ideal case for Askina silicone. Hypertrophic scarring occurs in 30-50% of these procedures and may contribute to the development of parastomal hernia if left untreated.
➡️ See also: Parastomal Hernia: Prevention with Ally Belt
References
- Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1-2):113-25. PubMed: 20927486
- Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. 2014;67(8):1017-25. PubMed: 24888226
- Berman B, Maderal A, Raphael B. Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment. Dermatol Surg. 2017;43 Suppl 1:S3-S18. PubMed: 27347634
- Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110(2):560-71. PubMed: 12142678
- Sproat JE, Dalcin A, Weitauer N, Roberts RS. Hypertrophic sternal scars: silicone gel sheet versus Kenalog injection treatment. Plast Reconstr Surg. 1992;90(6):988-92. PubMed: 1448532
- Wagner W, Alfrink M, Micke O, et al. Results of prophylactic irradiation in patients with resected keloids. Strahlenther Onkol. 2000;176(7):315-9. PubMed: 10930941
- Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg. 2008;32(1):82-92. PubMed: 17968615
- Bleasdale B, Finnegan S, Murray K, et al. The use of silicone adhesives for scar reduction. Adv Wound Care. 2015;4(7):422-430. PubMed: 26155385
- O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013;(9):CD003826. PubMed: 24030657
- British Association of Plastic Surgeons. Scar Management Guidelines. 2023.
- B. Braun Medical. Askina Scar Repair Technical Documentation & Clinical Studies. 2024.
Editor & Editor
Author: Traumacare Medical Group — exclusive representatives of B Braun Avitum Greece since 2003. Specializing in wound care & scar management.
Last updated: May 2026 · Disclaimer: The article is informative and does not replace the advice of a dermatologist or plastic surgeon. Always consult your treating physician.
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The entire Scar & Keloid Cluster
- #1S — What is a scar? (4 types)
- #2S — How a scar forms (3 phases)
- #3S — Hypertrophic vs Keloid Scar
- #4S — Scar Prevention from Day One
- #5S — Silicone: How It Works
- #6S — Askina Scar Repair: Complete Guide
- #7S — How to Choose the Right Askina Size
- #8S — Cesarean Scar
- #9S — Acne Scars
- #10S — Burn Scars
- #11S — Post-Surgery Scars
- #12S — Children's Scars
- #13S — Old Scars
- #14S — Facial Scars