Understanding Keloid vs Hypertrophic Scars

Lamar| The Foot Aftercare Institute
Dec 15, 2025
5 min read

Updated: Jan 8

Scars are a natural part of the healing process after skin injuries, but not all scars are created equal.

Two common types of scars that can cause concern are keloid and hypertrophic scars.

For those dealing with either condition, it’s essential to understand the key differences, how they form, and what treatment options are available.

After surgery, scar appearance often changes over the postoperative period.

Keloid vs Hypertrophic Scars: Key Differences After Surgery

Keloid scars are raised and can extend beyond the original injury site. These knots of scar tissue form due to excessive collagen production during the healing process.

On the other hand, hypertrophic scars are also raised but remain contained within the boundaries of the initial injury.

When comparing keloid vs hypertrophic scars, both types can be itchy or uncomfortable, but their appearance and treatment options differ significantly.

Hypertrophic scar presenting as a raised, firm scar that remains within the borders of the original wound — Hypertrophic scar characterised by raised, thickened scar tissue confined to the original wound area.

How Do These Scars Occur?

Keloid and hypertrophic scars typically develop after skin trauma, such as surgery, cuts, or acne.

They can also occur after body piercings or burns—the primary difference in how these scars form lies in the body's response during the healing process.

Keloid Scars: People predisposed to keloid formation may have a genetic predisposition:

When the skin is injured, the body produces collagen to repair it.
In keloid scars, excess collagen is created, resulting in raised scars that can be much larger than the original wound.
They can occur anywhere on the body but are more common on the chest, shoulders, and earlobes.

Hypertrophic scars arise from the same healing process but are limited to the site of injury:

They are often firmer and less mobile than keloids, but are still raised.
Their formation typically results from the body's normal wound-healing response, which overproduces collagen without excessive accumulation, as seen in keloids.

In some cases, healing skin can thicken or harden, leading to issues like a callus forming over a scar

Keloid scar with raised, thickened tissue growing beyond the orginal injury site, commonly seen after skin trauma or surgery — Keloid Scar showing excessive scar tissue growth extending beyond the orginal wound boundary

Why Do They Form?

The exact mechanisms underlying the formation of keloids and hypertrophic scars remain incompletely understood.

However, factors contributing to their development include:

Genetics: Keloid formation tends to run in families, suggesting a heritable component. A family history of keloids increases the likelihood of developing them.

Skin Type: Individuals with darker skin tones are statistically more likely to develop keloids.

Age and Gender: Keloids are more common in younger individuals and affect both genders equally. However, hormonal changes during puberty or pregnancy may influence their development.

Location and Injury Type: Areas of the body that experience more tension or movement, such as the chest or back, are more susceptible to both types of scars.

Understanding these factors can provide insight into the risk of keloid or hypertrophic scar formation and inform treatment options.

Many misconceptions around scarring persist, which we address in our guide on what actually works after foot surgery.

Treatment Options Available for Keloid and Hypertrophic Scars

Several treatment modalities are available for both keloid and hypertrophic scars.

While none guarantee complete removal, many can reduce their appearance.

Keloid Treatment Options

Corticosteroid Injections: These can reduce inflammation and flatten keloids. Regular injections may be required for noticeable improvement.
Surgery: Surgical removal of keloids is an option; however, there is a risk of recurrence. Often, post-surgery treatments, such as radiation therapy or steroid injections, are recommended to prevent reformation.
Silicone Gel Sheets: These help flatten the scar over time. They are available for purchase and can be used at home.
Cryotherapy: This involves freezing the keloid with liquid nitrogen to reduce its size.

Hypertrophic Scar Treatment Options

Silicone Sheets or Gels: Just like keloids, hypertrophic scars respond well to silicone treatment, which helps soften and flatten the scar.

Corticosteroid Injections: Similar to keloids, these can help reduce the size and discomfort of hypertrophic scars.

Laser therapy can help diminish the colour and texture of hypertrophic scars. It typically requires multiple sessions for optimal results.

Pressure therapy may be recommended, particularly for recent scars. Wearing pressure garments can inhibit the scar's growth during the healing process.

Silicone treatments work best when paired correctly and at the right stage of healing

an illustration of somebody using the Recovery Tracker from the Foot Aftercare Guide — The Foot Aftercare Institute Recovery Tracker is useful for keeping track of progress

Living with Scars: Coping Strategies

Living with keloid or hypertrophic scars can be challenging.

Many individuals experience emotional distress or self-consciousness about the appearance of their scars. Here are some strategies to cope:

Education: Understanding your scars can help alleviate anxiety. Knowledge about their formation and treatment options empowers individuals.

Support Groups: Connecting with others who also have scars can be comforting. Sharing experiences and coping strategies can be instrumental in the emotional healing process.

Self-Care: Routine skincare can improve skin health.
Use gentle products and avoid picking at scars to prevent irritation or infection.

Seek Professional Help: Consult a dermatologist or a medical professional specialising in scar management. They can provide tailored treatment options.

If you are seeking products tailored for scar treatment, consider visiting the shop page of The Foot Aftercare Institute.

They provide a variety of resources and products designed to improve overall skin health and scar appearance.

Final Thoughts on Keloid and Hypertrophic Scars

Navigating the world of keloid and hypertrophic scars can feel daunting. Still, armed with knowledge and appropriate treatments, individuals can significantly improve the appearance of their scars and their overall self-esteem.

Remember, it is always best to consult with a healthcare professional to explore the most appropriate treatments for your specific situation.

Whether you're just beginning to explore treatment options or already following a regimen, understanding keloid and hypertrophic scars is the first step toward effective management.

Embrace your journey toward healing and always prioritise self-care and emotional well-being.

For a structured, step-by-step approach, you can access our free foot surgery aftercare sample guide.