Medically reviewed by Dr Sin Yong · Last reviewed · 3 min read
Published 13 October 2026 · Reviewed by Dr Sin Yong
Tethered scar is the term for a depressed scar that is held down from below by a fibrous band anchoring the skin to the deeper tissue, so that the surface cannot sit level however much it is resurfaced. Tethered scars are recognised by the stretch test: a scar that flattens completely when the skin is pulled apart is a surface problem, while one that stays pinned, or deepens when you smile, is being held down.
Key facts
Mechanism
A fibrous band in the subcutaneous plane pulls the scar floor downwards
Stretch test
Stays pinned while the surrounding skin stretches; may deepen on animation
Which scars
Rolling scars almost always; boxcar scars when the base is tethered
Usually approached by
Subcision to divide the band, before filler, laser or RF microneedling
Where it fits
Tethering is the reason scar journeys so often plateau: the surface scars improve and the few that were tethered stay put, because lasers and radiofrequency act on the dermis from above and the tether sits beneath it. Dr Sin Yong examines scar by scar, with the face at rest and in movement and the skin stretched under directed light, to separate tethered scars from surface ones; a tether is found by stretch and animation, and neither shows in a photograph. Release by subcision is the foundation step of his 4D Scar Reconstruction programme: tethers are divided first, volume support follows where a deficit sits beneath the scar, and the walls and surface texture are treated afterwards. The scar types are set out on the acne scar treatment guide.
Frequently Asked Questions
Place a finger either side of the scar and stretch the skin gently apart. A scar that flattens completely is mainly a surface problem; one that stays pinned while the skin around it stretches is being held down from below. It is a screening observation, not a diagnosis.
It can be, but the tether keeps pulling it down, so the laser remodels a dimple in the position it finds it. Release comes first; resurfacing follows once the skin is free.
