Hypertrophic Scar
A hypertrophic scar is a red, firm scar that thickens within the original wound boundary after the wound heals. Myongji Best Plastic Surgery Clinic in Myeongji-dong, Busan, explains how it differs from a keloid, its causes, silicone, pressure, injection, and laser treatment, and how it changes over time.
At a glance
- Main symptoms
- A red, firm, raised scar within the wound boundary, itching or discomfort, tightness over joints
- Causes
- Deep wounds, inflammation and tension during healing, individual predisposition
- Related conditions
- Keloid (a scar that grows beyond the wound edge and does not fade on its own)
- Treatment methods
- Silicone sheets or gel, pressure therapy, injection treatment, laser treatment, excision if needed
- Course
- Tends to improve over time, but this can take months to 2 years or more
- Department
- Plastic surgery
What is a hypertrophic scar?
A hypertrophic scar forms when excess collagen is produced after a wound heals, making the scar red, firm, and thick within the original wound boundary. The UK NHS describes it as usually raised and firm but not growing bigger than the original wound, and usually fading and flattening over time.
The American Academy of Dermatology notes that a hypertrophic scar appears one to two months after the injury and that the scar tissue does not grow beyond the wound. Although both are raised scars, a keloid grows beyond the wound edge and follows a different course and treatment plan, so the two must be distinguished first.
Why do hypertrophic scars form?
A hypertrophic scar forms when more collagen than needed is produced while a wound that reached the dermis heals. It is more likely when inflammation lasts during healing, in areas where the skin is pulled often, and in people whose scars tend to thicken.
Deep wounds
Wounds that damage the dermis, such as surgical incisions, deep injuries, and burns, are the trigger.
Inflammation and tension during healing
Scars thicken more easily when inflammation lasts during healing or in areas such as joints where the skin is pulled often.
Individual predisposition
The same wound can thicken to different degrees depending on the person.
What does a hypertrophic scar look like, and how is it distinguished from a keloid?
A hypertrophic scar rises red and firm within the wound boundary, may itch or feel uncomfortable, and may pull during movement over a joint. A keloid grows beyond the original wound edge into surrounding skin, and the American Academy of Dermatology explains that, unlike a hypertrophic scar, a keloid does not fade with time.
| Feature | Hypertrophic scar | Keloids |
|---|---|---|
| Scar extent | Hypertrophic scarStays within the original wound boundary | KeloidsGrows beyond the original wound edge into surrounding skin |
| Time of appearance | Hypertrophic scarOne to two months after the wound | KeloidsMay appear months after the wound |
| Change over time | Hypertrophic scarUsually tends to fade and flatten | KeloidsOften does not fade or flatten without treatment |
| Common sites | Hypertrophic scarAround joints, surgical incisions, burn sites | KeloidsEar piercing sites, center of the chest, shoulders, jawline, upper back |
How is a hypertrophic scar diagnosed?
A hypertrophic scar is usually diagnosed by examining the scar's extent, thickness, color, texture, and when it appeared. Comparing the original wound edge with the current scar extent is the key to distinguishing it from a keloid, and a biopsy can confirm the diagnosis when it is unclear.
Compare the extent
Check whether the scar stays within the original wound boundary or has grown beyond the edge.
Timing and changes
Check when the scar thickened after the wound and whether it has since faded or grown.
Thickness, color, and tightness
Check the thickness and redness and whether the scar affects joint movement.
How is a hypertrophic scar treated?
Because hypertrophic scars tend to improve over time, silicone, pressure, injections, and laser are combined step by step according to thickness, redness, symptoms, and when the scar appeared. The updated international scar management recommendations (2014) concluded that a combination of multiple modalities provides the maximum potential for successful treatment of hypertrophic scars and keloids.
| Treatment methods | Main role | What to consider |
|---|---|---|
| Silicone sheets or gel | Main roleManage the scar environment after the wound closes; reduce thickness and color | What to considerMust be worn daily for months; evidence level is low |
| Pressure therapy | Main roleReduces thickening of the scar during healing | What to considerMainly used on joints and burn sites; not an option on the face |
| Injection treatment | Main roleReduces thickness, redness, and itching | What to considerMay need to be repeated; skin thinning and color change are possible |
| Laser treatment | Main roleManages redness and surface texture | What to considerEvidence level is low, so it is considered alongside other treatments |
| Surgical excision | Main roleCorrects thick scars that limit joint movement | What to considerConsidered when other treatments have not worked |
The level of published evidence differs by treatment. A Cochrane systematic review (2013, 20 trials, 873 people) found that silicone gel sheeting improved scar thickness and color but rated the evidence as weak because of poor study quality, and a Cochrane review (2022, 15 randomized trials, 604 participants) concluded that there is insufficient evidence to support or refute laser therapy for hypertrophic and keloid scars. The American Academy of Dermatology notes that corticosteroid injections into the scar can reduce its size by 50% or more, but most people need more than one treatment. Myongji Best Plastic Surgery Clinic has no published statistics of its own treatment results.
How does Myongji Best Plastic Surgery Clinic treat hypertrophic scars?
Myongji Best Plastic Surgery Clinic in Myeongji-dong, Gangseo-gu, Busan, sets the treatment direction by checking the scar's depth, adhesion, surface irregularity, pulling of surrounding tissue, and color change. For raised scars, it first distinguishes a hypertrophic scar from a keloid by whether the scar has grown beyond the original wound boundary, and advises considering injection treatment, laser treatment, pressure therapy, or silicone sheets according to the scar's condition.
- STEP 01
Diagnose the scar structure
Check the extent, thickness, color, tightness, and when the scar appeared.
- STEP 02
Distinguish hypertrophic scar from keloid
Compare the original wound edge with the current scar extent.
- STEP 03
Select treatment methods
Choose among silicone, pressure, injections, and laser according to the scar's condition.
- STEP 04
Adjust intensity and interval
Consider skin type, risk of pigmentation, previous treatment history, and available recovery time.
- STEP 05
Monitor progress
Adjust the next treatment based on changes in thickness, color, and symptoms.
How does a hypertrophic scar change over time?
A hypertrophic scar usually tends to lose its redness and flatten over time, but the UK NHS notes that fading can take 2 years or more. Meanwhile, follow the silicone and pressure instructions, protect the scar from the sun, and watch whether it thickens further or spreads.
What to do
Once the wound has fully closed, use the recommended silicone and pressure consistently and apply sunscreen of SPF 30 or higher when going out.
What to avoid
Avoid scratching or repeatedly pulling the scar, strong sun exposure, and forcibly removing scabs.
Changes to watch
Check whether thickness, redness, itching, and joint movement improve or whether the scar spreads.
When should I contact the clinic right away?
If the scar starts to grow beyond the original wound boundary or keeps thickening and reddening after several months, get a consultation to check for a keloid. Also contact the clinic right away if a scar over a joint limits movement or if the scar develops pain, warmth, or discharge.
The course of a hypertrophic scar and its response to treatment vary with its location, thickness, timing, and skin type, so the medical team confirms the treatment plan after a consultation.
How is the cost of hypertrophic scar treatment determined?
The clinic's published non-covered fee list shows scar laser combined with PN (polynucleotide) injection at 100,000 KRW per cm, and does not list separate fees for injection or pressure therapy of hypertrophic scars. The actual cost depends on the scar's length and thickness, the chosen treatment, and the number of sessions, and non-covered fees are subject to change.
A note from Myongji Best Plastic Surgery Clinic
Because hypertrophic scars tend to improve over time, distinguishing them from keloids is the starting point of treatment. Tell us what caused the scar, when it appeared, and how it has changed so far, and we will work out together what needs care now and what can be given time.
Frequently asked questions
Do hypertrophic scars go away on their own
Unlike keloids, hypertrophic scars tend to fade and flatten over time, but the UK NHS notes that fading can take 2 years or more. The redness and thickness usually decrease rather than disappearing completely, and a scar that keeps thickening after several months should be checked in a consultation.
When should I start silicone sheets for a hypertrophic scar and for how long
The American Academy of Dermatology advises using silicone gel sheets after the wound closes and wearing them every day, often for months, to get results. A Cochrane review (2013) found that silicone sheets improved scar thickness and color, but rated the evidence as weak because of poor study quality.
How many injections does a hypertrophic scar need
The American Academy of Dermatology notes that corticosteroid injections into the scar can reduce its size by 50% or more, but most people need more than one treatment. The number and interval are set according to thickness and response, and because skin thinning or color change at the injection site can occur, these are reviewed in a consultation.
My surgical scar has become thick and raised; is it a keloid
If the scar thickened within the incision line 1 to 2 months after surgery, it may be a hypertrophic scar; if it grows beyond the incision edge into surrounding skin, a keloid is suspected. The two are distinguished by comparing the extent, timing, and later changes during examination, so keeping dated photos of the scar is helpful.
About the clinic behind this article
Myongji Best Plastic Surgery Clinic is a board-certified plastic surgery clinic in Myeongji-dong, Gangseo-gu, Busan. Dr. Hyungseok Noh, board-certified plastic surgeon and medical director, provides care.
- Address
- Units 302–305, Building 1, 3 Myeongji-gukje 2-ro 28beon-gil, Gangseo-gu, Busan
- Main Line
- 051-711-7991
- Clinic Hours
- Weekdays AM 10:00 ~ PM 07:30Saturday AM 10:00 ~ PM 03:00Sundays & Public Holidays Closed
- Treatment guide
- View the scar treatment page
- Booking
- Naver Booking
REFERENCES
References
This article uses the clinic’s published information together with authoritative medical sources.
- Myongji Best Plastic Surgery ClinicScar treatment guide
Supports: Scar assessment items (depth, adhesion, surface irregularity, pulling, color change), criteria for adjusting treatment intensity and interval, post-treatment precautions, repeated treatment and follow-up
- Myongji Best Plastic Surgery ClinicKeloid treatment guide
Supports: Definition of keloids and common sites; injections, laser, pressure therapy, silicone sheets, and excision considered according to the scar's condition
- Myongji Best Plastic Surgery ClinicNon-covered fee guide
Supports: Per-cm fee for scar laser combined with PN injection
- American Academy of DermatologyKeloid scars: Overview
Supports: When hypertrophic scars appear, how they stay within the wound, their tendency to fade over time, and how they differ from keloids
With time, a hypertrophic scar often becomes less noticeable. Unlike a hypertrophic scar, a keloid doesn't fade with time.
- American Academy of DermatologyScars: Diagnosis and treatment
Supports: Effect size and need for repeated corticosteroid injections, when and how long to use silicone sheets, the role of pressure therapy, and SPF 30+ sun protection
Studies show that it can reduce the size of a scar by 50% or more. To get results, most people need more than one treatment.
- NHSScars
Supports: Distinguishing hypertrophic scars from keloids, how long scars take to fade, sun protection and moisturizing care
Usually raised and firm, it does not grow to be bigger than the original wound; the area where the scar is may be uncomfortable or difficult to move; it usually fades and flattens over time
- PubMedSilicone gel sheeting for preventing and treating hypertrophic and keloid scars
O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013;2013(9):CD003826. doi:10.1002/14651858.CD003826.pub3. PMID 24030657
Supports: Improvement in scar thickness and color with silicone gel sheeting and the low level of evidence (20 trials, 873 people)
Trials evaluating silicone gel sheeting as a treatment for hypertrophic and keloid scarring showed improvements in scar thickness and scar colour but are of poor quality and highly susceptible to bias.
- PubMedLaser therapy for treating hypertrophic and keloid scars
Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2022;9(9):CD011642. doi:10.1002/14651858.CD011642.pub2. PMID 36161591
Supports: Level of evidence for laser therapy of hypertrophic and keloid scars (15 randomized trials, 604 participants)
There is insufficient evidence to support or refute the effectiveness of laser therapy for treating hypertrophic and keloid scars.
- PubMedUpdated international clinical recommendations on scar management: part 2
Gold MH, McGuire M, Mustoe TA, et al. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment. Dermatol Surg. 2014;40(8):825-31. doi:10.1111/dsu.0000000000000050. PMID 25068544
Supports: A combination approach to treating hypertrophic scars and keloids
A combination approach using multiple modalities provides the maximum potential for successful treatment of hypertrophic scars and keloids.
Published 2026.10.23Last updated 2026.10.23