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Hypertrophic Scarring and Keloids


We all worry about whether a scar is going to heal into a fine - white line. 

There are some major key factors to remember about a scar healing:

  • Good genetics

  • Good surgical skill by your surgeon with closure of the incision

  • Minimal tension or movement of the surgical incision

  • Keeping the incision clean - showing no signs of a infection

  • No smoking

  • No sunlight or UV light

  • Tape pressure

By maintaining constant pressure on the wound with special bandages/tape or silicone sheeting pads. According to several studies, coverings like these help to flatten scars-including keloids - which are scars with ropy tissue that grows uncontrollably over their natural boundaries.




Hypertrophic scars occur due to an abnormal response to trauma or injury. After a wound or an incision from surgery has occurred to the epidermis, both skin cells and connective tissue cells called fibroblasts begin multiplying to repair the damage.  All scars are made up of “connective tissue” and fibroblasts to help close the wound. 

The hypertrophic scar is one that is widened, but yet does not extend beyond the original boundaries of the wound or incision Hypertrophic scars tend to reach a certain size in which they eventually stabilize or revert and eventually they might fade with time.  Hypertrophic scars normally do not get as big as keloids either, and can be present in all racial groups.  Treatments for hypertrophic scars include Silicone Sheeting and creams that seem to help with the appearance of the scar, and it usually takes 3 months or more to see an improvement.



Keloids on the other hand are not as common as hypertrophic scars and only affect 10% of the people are considered benign tumors.  These keloids appearance is raised red growths above the surface of the epidermis and form large mounds of scar tissue Keloids are nothing more than abnormal scar tissue that grows beyond the boundaries of the original site of the skin injury the fibroblasts continue to multiply even after the wound is filled in.  The upper chest area, shoulders, and upper back are all areas where keloids tend to form. 

The main trigger for a keloid scar is inflammation.  Anytime the skin is injured in some way - either from a cut, surgical incision or infection, the healing process begins.  When the healing process starts, it involves a complex array of cells.  These mast cells produce and release "histamine" early in the healing process.  It is the histamine that attracts the fibroblasts.  Fibroblasts are cells within our body that is responsible for the production of collagen.  And collagen is the body's building block for scar formation.

The difference between a person that has normal scar formation and a person that is proned to keloid scars is that the process where there histamine release occurs from the mast cells is finished within six weeks.  But in a person that has a tendency for keloids, the histamine signal never stops.  This is the reasoning on why a keloid will itch, because the histamine production is never turned off completely. 




  • Various symptoms of Hypertrophic and Keloid Scarring

Symptoms associated with Keloids and Hypertrophic scars include:

  • pigmentation of the skin

  • pain

  • itchiness

  • redness

  • raised dome shape shiny scars

  • color of the scar can range from pink, red or purple


Treatment of Keloid and Hypertrophic scars include:




Areas of the body that are involved with high movement, such as the knees and shoulders - are more likely to develop keloids than other parts of the body.  The upper portion of the chest area (décolleté) is also another area that has a predilection for keloid production.  If keloids develop in these prone areas the chances are that you developing keloids in the facial and neck area are probably much less.





Difference Between Hypertrophic and Keloid Scarring


Hypertrophic Scars


   Keloid scars

Develop soon after injury

   May have delayed development after injury

Subside with time

    Rarely subside with time

Limited boundary

   Overgrows wound boundary

Size proportional to injury

 Minor injury may produce a large scar

Occurs across areas of motion/tension

Occurs in any areas

Improve with surgery

    Often worsened by surgery



                                                               Hypertrophic Scarring

                         Hypertrophic Scar from breast reduction

                                           2010 Copyright ©


                                                   Hypertrophic Scarring

                         Hypertrophic scar from breast reduction

                                              2010 Copyright ©


                                                                       Keloid Scarring

                         Keloid Scar from Breast Lift

                                          2010 Copyright ©


                                                                     Keloid Scarring

                         Keloid Scar from Breast Lift

                                          2010 Copyright ©


See More Scar Photos here




Hypertrophic scars normally do not get as big as keloids, and can be present in all racial groups.  Keloids however tend to target racial groups which have a lot of melatonin in their skin, such as African American, Asian or Pacific Islander.





                         Dr. Lam talks about the difference of Hypertrophic Scarring and Keloids




Different treatments available to treat problematic scars


The best and first line treatment of a Keloid is to inject long-acting cortisone. Kenalog and Celestron Soluspan are steroids that are injected once a month. After several injections with cortisone, the keloid usually becomes less noticeable and flattens out within three to six months time. 



5-FU injections can also be used alone or in combination with corticosteroid injections into keloid scars. This treatment stops fibroblasts from making new scar tissue. 5-FU is also used as a chemotherapy agent normally.



This can be risky with a patient that is prone to keloids.  If surgery with a scar revision is considered, some surgeons like to inject steroids or apply a pressure dressing to the wound site after cutting away the affected keloid.  Radiation is also considered after the excision of the affected area, so the keloid will not grow back.



Liquid Nitrogen is used to destroy tissue of both benign and malignant lesions by the freezing and re-thawing process.  Applying liquid nitrogen does flatten out the keloid scar and is effective, but the side effect of this treatment is hyper-pigmentation after the fact.



Interferon is being used with some success with keloid scars.  Interferon has been evaluated for efficacy in managing many diseases that involve the immune system. Injections of interferon into the actual keloid have shown promise in reducing the size of keloids, though it's not yet certain whether that effect will be a permanent result.



Pulse-dye lasers are also another method of reducing the sign of the keloid scar.  These lasers tend to soften up the excessive scar tissue with making the scar flattened and less red.  This treatment is very safe and not very painful; however it might take several treatments to see an improvement.



Silicone sheeting has helped many patients with their keloid scarring, however this method of treatment takes several months of wearing a sheet of silicone gel.  Some doctors prefer “compression bandages” which have helped some see a positive end result.  Both methods require a lot of time and patience on the part of the patient. 

Silicone Sheeting has been around since the early 1980’s, and some patients have seen a remarkable difference in the appearance of keloid or hypertrophic scarring.  Silicone sheeting is soft and pliable and will mold to any part of the body. 

ReJuveness Silicone Sheets can also last up to 6 months or has been proven effective on old raised red scars (up to 20 years old) as well as newly formed scars.






Silicone Sheeting for the Treatment of Scars


                           Scar Site - Silicone Gel Sheeting

                                                              Image courtesy of Scar Site

                                                        Image of how Silicone Sheeting works


ReJuveness silicone sheets are made of USP medical grade six-silicone which can be cut to any size and shape. ReJuveness is soft and pliable and easily conforms to any body part. ReJuveness is proven effective at healing and preventing hypertrophic and keloid scars resulting from burns, plastic surgery procedures, surgeries, acne, cuts and abrasion.


                                         Rejuveness Silicone Sheeting

                                                               Image courtesy of Rejuveness



Oleeva Clear Transparent Silicone Sheeting is a silicone sheeting offering transparency and remarkable stretch and conforming characteristics.

Oleeva Fabric Silicone Sheeting with Fabric Backing is a silicone sheeting with a fabric backing.  The silky fabric backing makes it easy to wear under clothing, it also reduces shear force and edge roll-up when used under pressure garments. 

Oleeva Scar Shapes Precut Shapes for Scar Management Following Surgery are made from Oleeva Fabric and shaped specifically to treat scarring from breast, abdominal and other surgical procedures. The designs of these products ensure proper placement and coverage.


                                          Oleeva Scar Management Sheeting

                                             Image courtesy of Oleeva Scar Management Sheeting



Syprex scar treatment sheet is the most cost effective scar care product available when compared to other scar management methods. Made in the USA of pure medical grade silicone, 0.6mm thick (the thickness of a credit card), soft and flexible.


                                                    Syprex Silicone Sheeting

                                              Image courtesy of Syprex Silicone Sheeting

                                                      Syprex Silicone Sheeting



Soft, reinforced silicone gel shapes that have been developed to soften and lighten hypertrophic and keloid scars.  The GelShapes are specifically designed for the treatment of scars resulting from breast lifts, breast reduction, abdominoplasty, TRAM flap and C-section procedures.


                                              PMT Corp Silicone Sheeting for Scar Treatment

                                             Image courtesy of PMT Corp Silicone Sheeting



ScarEase Sheets and ScarEase Gel are indicated for use in the management of hypertrophic and keloid scars. When used following surgical procedures, ScarEase may prevent hypertrophic and keloid scarring.  ScarEase Sheets may work better in certain cases, but have use limitations. Since ScarEase Sheeting is self adhering, it supplies gentle mechanical pressure on the skin surface. This is a benefit!


                                                  Scar East Silicone Sheeting and Gel for Scar Treatment

                                                    Image courtesy of ScarEase



The thin, flexible layer of silicone in NEOSPORIN® SCAR SOLUTION® Silicone Scar Sheets covers and protects your scar like normal, healthy skin, significantly improving the appearance of scars.


                                                Neosporin Scar Solution - Silicone Scar Sheets

                                                   Image courtesy of Neosporin Scar Solution


Clinically proven. Reduces raised, colored and keloid scars. Virtually invisible. Curad Scar Therapy Clear Pads are virtually invisible. They are perfect for any skin color as they blend with your natural skin tone.


                                               Curad Scar Therapy for Scar Management

                                                     Image courtesy of Curad Scar Therapy





Over the Counter Scar Treatments


Scar Guard offers four different treatments for the management of scars (old and new) – and is the most powerful and effective treatment developed.  It is a clear liquid that forms a fine flexible film within a few seconds after painting it onto the scar.  This film helps to protect the scar from irritation while delivering silicone cortisone and vitamin E throughout the day.


                                             ScarGuard - Scar Therapy

                                                 Image courtesy of ScarGuard



BiioCorneum is the only 100% Silicone Scar Treatment with an SPF providing UVA/UVB Protection.  It minimizes the appearance of scars while protecting them from harmful rays from the sun.  This product is only sold in physician offices and medspas,  and comes in different product sizes 10g, 20g and 50g gel.  BioCorneum dries within minutes forming an invisible silicone sheet over the affected area.  This breathable, flexible, waterproof layer binds with the stratum corneum (the outer layer of dead skin cells) -  providing hydration and protection to underlying tissue allowing the scar to mature through normal collagen synthesis cycles.

Proven clinical efficacy in both prevention and treatment, with over 1,800 patients in published clinical trials.

                                               BioCorneum Scar Therapy

                                                       Image courtesy of BioComeum




Kelo-cote is a patented topical silicone gel for the management and prevention of abnormal scars in the form of hypertrophic scars and keloids.


                                             Kelo-cote Scar Gel for scar treatment

                                                   Image courtesy of Kelo-cote



In 1998, ScarFade was introduced in the form of a topical silicone gel which is applied like a cream. It forms a micro-thin layer of silicone on the scar.


                                             ScarFade Scar Gel

                                                      Image courtesy of ScarFade



ScarEase Gel can be used to manage both old and new scars resulting from burns, surgical procedures and traumatic events.  Most people like ScarEase Gel better than ScarEase Sheets because it is "easier to use."


                                             ScarEase Gel for scar treatment

                                                Image courtesy of ScarEase Gel



Syprex Scar Cream works to help flatten, even, and fade dark or discolored skin while providing healing qualities for scars - old or new, caused by acne, surgery or trauma to the skin and stretch marks. Results are permanent and may be seen in as little as 4-6 weeks with full results in 3-9 months.


                                                        Syprex Scar Cream for scar treatment

                                               Image courtesy of Syprex Scar Cream



ReJuveness Cream is a combination of recent advancements in lipid and trans-dermal technology. Post surgical patients and clinicians are reporting accelerated healing and in many a near scar-less appearance at the lesion site.  


                                   ReJuveness Scar Cream

                                               Image courtesy of ReJuveness






Other Types of Topical Scar Treatments:


Mederma comes as a silicone gel and also a new cream, which has a SPF-30 in it to protect the scar from the sun.  The main ingredient is Cepalin, which is a proprietary botanical extract which comes from onions. 

                                                Mederma Scar Treatment

                                                Image courtesy of Mederma

According to a small pilot study evaluating topical onion extract as treatment for post-surgical scars – published by PubMed – August 25, 1999, authors B.A. Jackson and A.J. Shelton, found that this main ingredient in Mederma concluded the following: 

“Topical onion gel extract was ineffective in improving scar erythema and pruritus in our patients.”  Most patients who have tried Mederma have suffered some sort of allergic reaction to it because of the onion extract, making the scars more angry looking than before treatment.”



helps by working on the collagen fibers and makes a scar softer and more pliable.  However, in a double blind study, found that Vitamin E was indeed ineffective in reducing the symptoms of a hypertrophic scar or keloid. 


                                                Vitamin E for Scar Treatment

                                     Licensed image for

                                                   Vitamin E Capsules


Bio-Oil is a specialist skin care product that is recommended for scars, stretch marks, uneven skin tone, aging, and dehydrated skin. It is formulated for use on both the face and body. product has improved the appearance of regular scars tremendously; however has very little effect on hypertrophic scars or keloids.


                                             Bio-Oil - improves the appearance of regular scars

                                                 Image courtesy of Bio-Oil



Retinoic Acid or Tretinoin is derived from Vitamin A.  Retinol, which is a less potent form of Retin-A also has some very strong medical studies backing the effectiveness of this type of topical cream to help with scar formation. 


                                        Retin A Micro - or Tretinoin - helps with scar formation

                                           Image courtesy of Retina-A Micro/Ortho



Retin-A or Retinoic Acid is a prescription formulation of Vitamin A. 

It is marketed under the brand names of:

There is also the less potent over the counter products called Retinol.  After your surgical wound has closed up completely, applying Retin-A to the scar fades out the redness it might have and helps with exfoliating the area. 

At first, Retin-A can actually make the area look worse with redness, flakiness and peeling, for up to eight weeks.  But by 24 weeks, patients will see dramatic marked improvements. Retin-A along with the application of steri-strips helps with keeping tension off of the incision site, so a thin scar will form.




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