Tethered scar:
what the term means

Where tethered scars matter on this site

In cross-section a tethered scar is a dip in the surface with a fibrous cord running from its floor down into the subcutaneous plane. Because the cord sits beneath the dermis, it explains why some scars survive every laser, and the term therefore appears on every page where this site explains sequencing.

If the scar stays pinned when I stretch the skin, the laser is not the next step; the band is.— Dr Sin Yong

• Subcision: the release step, dividing the band beneath the scar so the surface can sit level.
• Subcision with filler: support placed beneath a released scar when the floor stays low.
• 4D Scar Reconstruction: Dr Sin Yong's programme, built on release first, support second, walls and surface last.
• Rolling scars treatment: the scar shape that is almost always tethered.
• Tethered scars and subcision guide: how to do the stretch test at home and what it does and does not tell you.

The subcision vs laser comparison is the shortest route to understanding why the two are not alternatives but a sequence.

Not to be confused with

Tethering is a mechanism rather than a shape, which is why it is confused with the shapes it produces.

• Rolling scar. The usual tethered shape: broad, shallow, sloping. Most rolling scars are tethered; not every tethered scar is rolling.
• Boxcar scar. Usually a surface problem, but a boxcar whose base stays down on stretching has a tethered component and is released first.
• Ice-pick scar. Deep and narrow, with no band to divide; it is treated at the floor with TCA CROSS.
• Bound-down surgical scar. A scar from surgery or injury that is stuck to deeper tissue behaves like a tethered acne scar and may be released the same way, but it is assessed on the scar repair programme page rather than as acne scarring.
• Volume loss. A hollow can mimic a tethered field. Ultrasound mapping separates missing fat from a cord.

The stretch test and animation decide it: a scar that flattens fully when the skin is pulled apart is not tethered, however deep it looks at rest.

What decides whether a tethered scar matters for you

A tether only matters if it is the reason a scar is not responding, so the assessment is built to find out.

• The stretch test. Done scar by scar under directed light. Pinned means tethered; flattened means surface.
• Animation. A scar that deepens on smiling is being pulled by the band as the muscle moves.
• What sits beneath. Ultrasound shows whether a volume deficit will remain once the cord is cut, which decides whether support follows release.
• Skin type. Subcision bruises, and bruising can leave pigment in Fitzpatrick III to V skin, so the pigment risk is managed from the first visit.
• Previous treatment. A history of lasers that improved everything except a few scars is itself a clue that those few are tethered.

Dr Sin Yong examines with the face at rest and in movement, because neither the tether nor the animation shows in a photograph.

Tethered scars by scar type at a glance

Tethering is a mechanism, not a shape. This is how it shows up in each scar type on this page, and the step that follows.