Massage for Scars

Looking for a recommendation for a masseuse, more from the physical therapist angle, to treat thick scars from a recent surgery by breaking up the tissues with appropriate massage techniques. Any knowledge or recommendations?

If your surgery was done here in Taiwan, I would expect your surgeon to refer you to a doctor specializing in physical rehab, who will in turn prescribe treatment by a physical therapist. For scar tissue remodeling, the therapy would include both massage and sonogram (ultrasound).

If you have NHI, this will be a very inexpensive route, as you only pay for one physician’s visit for 6 sessions with the physical therapist. At least that’s the way it works at the hospitals; not sure about the clinics. Going this route means the qualifications and reputation of the actual doctor means almost nothing, since his/her role is basically a glorified gatekeeper who screens for access to the physical therapists. The actual quality of care you get will depend mostly on the skill of whichever therapist gets assigned to you, and at the hospitals anyway I suspect that depends a lot on whose schedule is not already full. At the one I’ve used for convenience of location (Changgeng), one of the more senior therapists seems to get handed the foreign patients, probably because the others are intimidated about communicating in English. She’s great, but I won’t recommend her particularly for scar tissue massage as it requires a stronger touch. How strong depends on how deep the scar tissue goes.

Since the therapy you need will take many sessions over the course of weeks or months, I’d suggest just starting with a hospital/clinic that’s convenient for you to visit two or three times per week, and see how you feel about the care you get with the therapists there. If you don’t care about how well the therapist speaks English, let the person assigning you know that, and if the scar tissue is not just near the surface, tell them you’d like someone with the strength to do deep tissue massage.

I’m no expert, but I’m smart enough to win consistently at Crazy 8.

If these are scars from a recent surgery, has the proper healing already taken place? I can’t imagine deep tissue massage being the answer for a scar from a recent surgery. Please tell me if my intuition is wrong (again).

Sincerely, The King of Crazy 8

The surgery is not recent at all, but the scars are still maturing as they normally are expected to do for 12-18 months after the injury. The incident occurred 10 month ago, severe burns 2nd and 3rd degree over 25% of the body. My care was supposedly the best one can receive in Taipei at NTUH. The head of the burn ward was my doctor and operating surgeon. I was hospitalized for a month, one week of which was spent in the ICU. The surgery was intended to be a grafting procedure to the torso and the forearm. Once the operation was underway, the doctor opted to remove an area of skin across the abdomen and stretch adjacent skin to close the wound area. Grafting occurred elsewhere, on the forearm and upper torso.

I have given this recovery period all my energy and been extremely attentive taking every measure to assure the best possible recovery. I’ve been to see my doctor regularly after discharge, for the first 4-5 months. As you may or may not know, the most difficult time for burn patients after the initial injury, is actually about 3-4 months afterwards. It was during this time that my will and positive attitude had been somewhat affected. Surviving the original incident and hospitalization was quite honestly not the most difficult period by comparison. Looking back, I suppose the doctor and staff did not inform me adequately of what lay ahead while in the hospital. Their English and my Chinese were not up to the task, but I did not question their intentions or expertise at all, fulling trusting them, entirely preferring to stay in Taipei rather than return to the US for treatment.

I have inquired on several occasions about massage treatment, and was the first to raise the subject, not my doctor. With but one possible exception, I cannot recall my doctor here mentioning seeing a therapist. Similarly, when visiting home in California 6 months post surgery, a family doctor and I discussed massage. There was no great push on his part to see a therapist.

As a burn injury, the scarring is not deep, but it is nonetheless very thick. About 6 weeks after discharge from NTUH, my doctor noted that the healing did not go as well as he had hoped - there seemed to have been an explosion, a multiplication of fibroblasts, beyond what would be helpful. On a later occasion when I raised the massage issue again, I asked specifically about electric handheld devices which have capabilities to move and vibrate in a way that human hands cannot. His response, as it often is, was somewhat equivocal. He couldn’t point to training, research, studies, etc supporting the use of handheld devices, but merely said that some of his patients indicated this seemed to help. At best I’ve been encouraged to massage the areas on my own for a few minutes a day, rather aggressively.

Despite all my efforts to get this right and follow the advice of experts, I feel that there have been no particularly clear answers at all. I gather that the affected areas are particularly difficult to treat. Scars along the torso do not lend themselves to compression garments as one must, after all, continue to breathe, expanding the rib cage - so compression is best suited to limbs.

It’s entirely possible to go see my doctor now and demand a recommendation for a therapist.

Wow!

I can’t imagine the pain you 've been through, and in Taiwan they are so stingy with pain meds.

Hope you get exactly what you need.

Well, this is the first and only time I’ve ever spent in a hospital - quite lucky at my age - and the pain was managed very well during the stay. Hardcore drugs. Post hospital, they were not hesitant to supply me with ample medication. Part of the issue becomes, however, that the pain meds used are not indicated for use longer than a couple months. I’m past the discomfort stage now. Thank you for your concern. I must admit that the hospital stay was not an entirely negative experience - I was well cared for at NTUH.

I hope you are able to find the proper care you need.

My own experience was based two different orthopedic problems, one of which involved surgery. I’m not sure whether a physician will be prevented by NHI or hospital policy from prescribing the same sort of physical therapy for conditions that do not limit movement. I suspect if they consider it “only” cosmetic in nature, that could be an obstacle to that sort of prescription at least under NHI. Hopefully your surgeon will be willing to help you navigate whatever the requirements are to get into therapy. I suspect it may help to emphasize any life-limiting aspects of the condition when you talk to the doctor about getting into a therapy program.

Thank you - caught your message literally just a couple minutes before seeing the doctor. Stepping into consultation now…

You’ll perhaps find this somewhat odd, but my doctor, the head of the burn ward at Tai-Da Hospital, has no prior experience with using massage therapists for treating scars. He never refers patients out to PTs for this, but merely advocates self-massage (and his description of the technique is very simple- seemingly no more involved than applying heavy pressure and using a lotion. I feel there should be more advanced techniques that a professional should be aware of). Furthermore, regarding sonograms, he’s familiar with research demonstrating this to be effective, but again, in his practice, he has never used them.

His treatments for scars then are time, pulse-dye lasers, and cortisone injections. I’m headed back tomorrow for a preliminary test of the laser on a small area. The injections will be effective for some of the suture scars’ thickness, I know, but not the larger legions.

I fully expected to receive a recommendation for a therapist, and perhaps someone for sonograms from him, a head doctor at a top university hospital, so you can imagine how this doesn’t seem right.

Hi silas, I’m getting here a bit late but I was wondering if you’d found someone to massage your scars? I had surgery on my leg a couple of years ago (here in TW), and the scar tissue did not heal well (left a big, rather painful, bump on my leg, basically a big permanent bruise on half my tibia). The surgeon who did the surgery was no help at all (“it’ll get better, just exercise your leg”), so I stopped bothering after a while. I went to see a couple of other doctors (Chinese and Western medicine) but they were useless too, and normal masseuse do not know how to deal with that. The biggest help I got was from a friend’s gym trainer, who was the first person to explain to me about breaking the tissues - he showed me a few simple massages to do myself, which has greatly improved the situation, but not completely solved it yet.
So if you’ve found someone who actually specialises in that here in Taipei, I’d be very interested!

who boss,
I will let you know if I succeed in that, but as of now, I’ve not found anyone and my doctor, sadly, hasn’t the experience in any of the above mentioned techniques. In the meantime and after a fair amount of consideration, I’ve purchased an electronic hand-hand massage device, one which is more of the vibrating type than large movement kind. I’ve just begun using it, and am a bit cautious now at the start, giving my skin a day’s rest in between. It’s surprising how little info is out there, or how difficult it is for search engines to locate, on this specific area of post burn care. As with all things, the info is out there online somewhere, and eventually we’ll come across what we need: a video demonstration of massage techniques for breaking up scar tissue, and information on the use of handheld devices. It is probably important to point out that mature scar tissue from a burn may exhibit some differences to deep wound scars which call for other massage techniques, though I do have both scars now due to the surgery which took place during my stay in the burn ward.

I might as well ask who the gym trainer is/which gym? Could you try to explain the technique which has had some benefit for you?

who boss,
I will let you know if I succeed in that, but as of now, I’ve not found anyone and my doctor, sadly, hasn’t the experience in any of the above mentioned techniques. In the meantime and after a fair amount of consideration, I’ve purchased an electronic hand-hand massage device, one which is more of the vibrating type than large movement kind. I’ve just begun using it, and am a bit cautious now at the start, giving my skin a day’s rest in between. It’s surprising how little info is out there, or how difficult it is for search engines to locate, on this specific area of post burn care. As with all things, the info is out there online somewhere, and eventually we’ll come across what we need: a video demonstration of massage techniques for breaking up scar tissue, and information on the use of handheld devices. It is probably important to point out that mature scar tissue from a burn may exhibit some differences to deep wound scars which call for other massage techniques, though I do have both scars now due to the surgery which took place during my stay in the burn ward.

I might as well ask who the gym trainer is/which gym? Could you try to explain the technique which has had some benefit for you?

who boss,
I will let you know if I succeed in that, but as of now, I’ve not found anyone and my doctor, sadly, hasn’t the experience in any of the above mentioned techniques. In the meantime and after a fair amount of consideration, I’ve purchased an electronic hand-hand massage device, one which is more of the vibrating type than large movement kind. I’ve just begun using it, and am a bit cautious now at the start, giving my skin a day’s rest in between. It’s surprising how little info is out there, or how difficult it is for search engines to locate, on this specific area of post burn care. As with all things, the info is out there online somewhere, and eventually we’ll come across what we need: a video demonstration of massage techniques for breaking up scar tissue, and information on the use of handheld devices. It is probably important to point out that mature scar tissue from a burn may exhibit some differences to deep wound scars which call for other massage techniques, though I do have both scars now due to the surgery which took place during my stay in the burn ward.

I might as well ask who the gym trainer is/which gym? Could you try to explain the technique which has had some benefit for you?

(And how to delete inadvertent multiple replies – anyone?)