Raised and firm
The scar is higher than the surrounding skin and firm to the touch, but stays within the wound or suture boundaries.
CONDITION / SKIN AND SCARS
Hypertrophic scar.
Hypertrophic scar — a thick, dense scar that rises above the skin but remains within the wound boundaries. It appears after burns, surgeries, and injuries, often flattens on its own over time, and treatment helps make it softer and less noticeable.
CONCEPTUAL VISUALIZATION- What it is
- A scar in which too much scar tissue has formed: it is thick, dense, and raised.
- Border
- Remains within the wound boundaries. If the scar grows beyond them — it is a keloid.
- run over
- Often fades and flattens over time; scars change up to 2 years and longer.
- Who treats it
- Dermatologist and plastic surgeon; after burns — together with a rehabilitation specialist.
01 / WHAT IS ITWhat is
What is
hypertrophic scar.
After a deep wound, the skin heals with a scar. A scar is called hypertrophic when too much scar tissue forms after skin injury. It is firm, raised above the skin, and often red or purple.
It differs from a keloid by its border: a hypertrophic scar does not extend beyond the edges of the original wound and often fades and flattens over time. A keloid becomes larger than the wound itself and usually does not flatten without treatment. Distinguishing them can be difficult even for a doctor, and this affects the treatment.
Such a scar is not only noticeable. It can cause pain and itching, and near a joint — interfere with bending and straightening the arm, leg, or neck. Examinations report that such scars often reduce quality of life.
A hypertrophic scar can appear anywhere: on the body, arms, neck, or face. There is a separate page about the specifics of scars on the face.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow to recognize
How to recognize
hypertrophic scar.
A scar appears at the site of a wound, burn, or suture. Here is what you should pay attention to.
Color
The scar is pink, red, purple, or darker than the skin; over time the color often fades.
Itching and pain
The scar itches, hurts, or interferes with wearing clothes.
Difficulty moving
A scar near a joint pulls and hinders bending or straightening. If it tightens the skin after a burn, this is a contracture.
Post-burn contractureGrows beyond the wound
If the scar extends onto healthy skin and continues to grow, this is most likely a keloid.
Keloid scarCracks or oozes
A scar that constantly cracks or is covered with sores is a separate condition, an unstable scar; it should be shown to a doctor.
Unstable scar03 / REASONSWhy scar
Why scar
thickens.
Reviews identify several groups of factors: local (tension on the wound or scar), general (for example, high blood pressure), hereditary, and lifestyle. After burns, the length of wound healing also matters.
Burns
In a systematic review of 48 articles, the frequency of hypertrophic scars after burns in different studies ranged from 32 to 72%. Risk factors include dark skin, female gender, young age, burns of the neck or hand, severity of the burn, and multiple surgeries.
Cicatricial deformation of the bodyLong healing
In a study of 337 children with scald burns, the scar became hypertrophic in 0% of those whose wound healed in less than 10 days, in 20% — in 15–21 days, and in 92% — if healing lasted more than 30 days.
Operations
In a study of 4,238 patients after thyroid surgery, a thick scar on the neck was associated with younger age, higher body mass index, scar location less than 1 cm from the jugular notch, and a history of keloids.
Tension
Tension on a wound or scar is one of the local factors that contribute to scar thickening. Therefore, guidelines recommend reducing tension on a fresh scar, for example with tape.
The face
A scar on the face is especially noticeable, so there are specific approaches to treatment there.
Hypertrophic facial scars
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A hypertrophic scar usually does not require urgent care: it is a planned situation. But if the wound or burn is fresh, help may be needed immediately.
103 immediately if:
- bleeding from a wound that does not stop;
- blood beats in a stream;
- the wound is very large or deep;
- loss of sensation near the wound or difficulty moving a part of the body;
- a fragment or glass is stuck in the wound - do not remove it yourself;
- the burn is large or deep;
- burn on the face, genitals, or buttocks;
- acid, other chemical or electric burn.
Do not delay a visit to the doctor:
On the same day: the scar or wound is swollen, red, and increasingly painful, warm to the touch, or oozing pus; you were bitten by a person or animal. Planned: the scar is thickening, itching, has been painful or aching for a long time, interferes with movement, or simply bothers you — make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to do with the scar.
- Conversation
After what the scar appeared, how long the wound took to heal, whether the scar is still growing, whether there were keloids before.
- Review
The thickness, color, and density of the scar, its borders, whether it hinders joint movement.
- Differentiate from a keloid
Treatment depends on this. Guidelines also recommend differentiating the scar from similar skin formations, including tumors.
- Photos and measurements
To see how the scar changes during treatment.
06 / TREATMENTHow we treat
How we treat
hypertrophic scar.
The main question is whether the scar tightens the skin. If the tightening is strong, surgery is the first choice; if not, non-surgical treatment. International guidelines recommend combining methods: according to experts, results seem better this way.
01
Without surgery
The basis of treatment while the scar matures.
- Silicone
- Silicone sheets or gel are considered the first choice according to guidelines. In a Cochrane review, they improved scar thickness and color; in a meta-analysis of 18 studies, liquid silicone gels helped both for prevention and treatment. However, both reviews included many low-quality studies.
- Compression garments
- Guidelines recommend it for large scars, especially after burns. A Cochrane review of 15 studies (1,179 participants) did not find sufficient evidence of its benefit for prevention; the authors suggest taking the patient’s preference into account.
- Injections into the scar
- The steroid is injected directly into the scar. In a meta-analysis of 13 studies, the combination of a steroid with 5-fluorouracil more often gave a good result than each agent alone. Steroid at concentrations of 20 or 40 mg/ml more often than 5-fluorouracil or some other agents thins the skin and causes vascular "spider veins," so the dose is selected by the doctor.
- Laser
- An international group of experts notes that over 10 years the laser has moved from a new method to a leading one. In a meta-analysis of 28 studies (919 patients), laser treatment of hypertrophic scars showed a response in 68%; fractional CO2 laser improved burn scars, and reports of side effects were very few.
- Care
- Massage with cream — only on a fully healed scar; sun protection for at least a year and a cream with SPF 30 or higher.
02
Surgery
When the scar pulls the skin, restricts movement, or remains coarse despite treatment.
- Excision
- A narrow scar is excised and sutured without tension.
- Z-plasty and flaps
- The scar is incised and the tissues are rearranged to relieve tension — especially when the scar pulls across a joint.
- Skin grafting
- If there is a lack of skin, the area is covered with a skin graft.
- And after surgery
- Invasive treatment guidelines recommend combining it with silicone, injections, or laser.
03
Deadlines
- The scar matures slowly
- Scars change for up to 2 years or longer, and the full effect of any treatment may be seen only after approximately 18 months.
- Long-term monitoring
- After any treatment, a scar should be shown to a doctor over a long period of time.
- mood
- If the scar depresses the mood, talking to a psychotherapist also helps - you can tell the doctor about it.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Hypertrophic scars at the Valikhnovskyi Institute of Surgery are treated under the "Rehabilitation after aesthetic surgeries" program — regardless of where you had surgery. Scars from burns and scars that restrict movement are handled together with the "Reconstruction after burns" program.
CLINIC SERVICE
Rehabilitation after aesthetic surgery
Laser and IPL for scars, lymphatic drainage, physiotherapy, and dermatologist supervision after plastic surgeries.
View service
What we do for this condition
- Fractional CO2 laser — so that the scar becomes smoother, softer, and less noticeable; the number of sessions is determined by the doctor.
- IPL — intense pulsed light for redness and pigmentation of the scar.
- Scar care — the dermatologist will select silicone gel, sheets, or tape and explain how to use them.
- Monitoring scar maturation — the doctor monitors the scar during follow-up check-ups and promptly recommends laser or other treatment if it begins to thicken or darken.
- Compression and injections — compression garments and injections into the scar — for large scars, especially after burns.
- Excision and Z-plasty — when the scar does not respond to treatment without surgery or restricts movement.
- Skin grafting and expander — for large scars — staged excision, expander, skin grafting, or dermal matrices.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a close-up and distance photo of the scar and mention what caused it.
- ConsultationExamination of the scar, differentiation from keloid, assessment of movement if the scar is near a joint.
- PlanSilicone, laser, injections, or compression — and whether surgery may be needed later.
- TreatmentProcedures can be done separately or in combination, in several sessions with intervals.
- SupervisionFollow-up reviews: the plan is adjusted while the scar matures.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How does a hypertrophic scar differ from a keloid?
A hypertrophic scar stays within the boundaries of the wound and often flattens over time. A keloid grows beyond the wound and usually does not flatten on its own. A doctor can accurately distinguish them.
Will the scar go away on its own?
Often it fades and flattens over time, but scars change for up to 2 years and longer. Treatment helps make the scar softer and less noticeable.
Why did the scar become thick after surgery?
Among the reasons are tension on the suture, prolonged healing, heredity, and a predisposition to keloids. The location of the scar also matters. Show the scar to a doctor: they will advise where to start.
Is it necessary to wear compression garments?
They are recommended for large scars, especially after burns. But evidence of their benefit for prevention is still insufficient, so the decision is made together with the doctor, taking your preferences into account.
Will laser help?
Laser is one of the leading methods: it can make the scar flatter, softer, and less noticeable, but does not remove it completely. The number of sessions is determined by the doctor.
When is surgery necessary?
When the scar strongly tightens the skin, limits movement, or remains coarse despite treatment. After surgery, silicone, injections, or laser are usually continued.
I had surgery at another clinic. Can I come to you?
Yes. Take the description of the operation and your surgeon’s recommendations — the doctor will make a scar treatment plan.
Sources
18 sources · international guidelines, Cochrane reviews, meta-analyses, and NHSshowCollapse
- The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years AgoPlastic and Reconstructive Surgery, 2022doi:10.1097/PRS.0000000000008667 ↗
- Diagnosis and Treatment of Keloids and Hypertrophic Scars — Japan Scar Workshop Consensus Document 2018Burns & Trauma, 2019doi:10.1186/s41038-019-0175-y ↗
- Updated international clinical recommendations on scar management: part 1--evaluating the evidenceDermatologic Surgery, 2014pubmed.ncbi.nlm.nih.gov/25068543 ↗
- Updated scar management practical guidelines: non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
- Insights into the Pathophysiology of Hypertrophic Scars and Keloids: How Do They Differ?Advances in Skin & Wound Care, 2018doi:10.1097/01.ASW.0000527576.27489.0f ↗
- Silicone gel sheeting for preventing and treating hypertrophic and keloid scarsCochrane Database of Systematic Reviews, 2013doi:10.1002/14651858.CD003826.pub3 ↗
- The use of fluid silicone gels in the prevention and treatment of hypertrophic scars: a systematic review and meta-analysisBurns, 2022doi:10.1016/j.burns.2022.03.004 ↗
- Epidemiology and impact of scarring after burn injury: a systematic review of the literatureJournal of Burn Care & Research, 2012doi:10.1097/BCR.0b013e3182374452 ↗
- Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injuryBurns, 2006doi:10.1016/j.burns.2006.02.007 ↗
- Analysis of Risk Factors to Predict Occurrence and Prognosis of Postsurgical Hypertrophic Scar Development: A Review of 4238 CasesYonsei Medical Journal, 2023doi:10.3349/ymj.2023.0003 ↗
- Pressure-garment therapy for preventing hypertrophic scarring after burn injuryCochrane Database of Systematic Reviews, 2024doi:10.1002/14651858.CD013530.pub2 ↗
- Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysisBurns, 2021doi:10.1016/j.burns.2020.10.026 ↗
- Laser therapy for prevention and treatment of pathologic excessive scarsPlastic and Reconstructive Surgery, 2013doi:10.1097/PRS.0b013e3182a97e43 ↗
- Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-AnalysisPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010867 ↗
- The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysisBurns, 2021doi:10.1016/j.burns.2021.02.013 ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Burns and scaldsNHS, 2026nhs.uk/conditions/burns-and-scalds ↗
The figures on the page are from these sources.
The scar is thickening
Is it restricting movement?
Send a photo of the scar and briefly describe when it appeared. The doctor will say where to start.