In short. A hypertrophic scar is raised, red, and confined to the original wound. It is the healing response turned up too high, and it usually flattens over one to two years on its own. Treatment shortens that curve and improves the result, but it flattens and softens rather than returning skin to its pre-injury state. Silicone therapy is the best-evidenced first-line measure.
Key points
- Hypertrophic scars stay within the wound; keloids grow beyond it.
- Most hypertrophic scars improve over 12–24 months without treatment.
- Silicone gel or sheets, worn for months, is the first-line non-invasive treatment.
- Corticosteroid injections are the mainstay for raised, symptomatic scars.
- Surgery is reserved for mature scars and combined with adjuvant measures.
What is a hypertrophic scar?
It is a raised, red, sometimes itchy or tender scar that grows within the boundaries of the original wound. It is the body’s healing response turned up too high: too much collagen laid down for too long. Unlike keloids, hypertrophic scars usually stabilise and flatten on their own over one to two years, but treatment shortens that road.
How is it different from a keloid?
| Hypertrophic scar | Keloid | |
|---|---|---|
| Border | Stays within the wound | Grows beyond the wound |
| Natural course | Often flattens over 1–2 years | Rarely regresses |
| Treatment path | Silicone, injections, laser | Different, often more aggressive |
| Recurrence after surgery | Lower with adjuvant therapy | Higher |
Why do they form?
Any wound can heal hypertrophically, but risk rises with tension across the closure, delayed healing, infection, wounds crossing joints, burns, and a personal or family tendency toward raised scars. Chest, shoulders, and upper arms are classic sites. Darker skin types are more prone. Surgeons plan closures in these areas with extra tension control precisely because of this.
What does the treatment ladder look like?
- Silicone therapy — gel or sheets worn for months; first-line and best-evidenced.
- Pressure therapy — garments or pads for burns and large areas.
- Scar massage and sun protection — simple measures that change outcomes.
- Corticosteroid injections — the mainstay for raised, symptomatic scars, given in a series.
- Laser and light — targets redness and texture between or instead of injections.
- Surgery — reserved for mature scars with structural problems, always combined with the measures above.
What can treatment not promise?
Non-surgical treatment flattens and softens; it rarely returns skin to its pre-injury state. Injections can cause skin thinning, pigment change, or small vessel dilation with repeated use. Surgery on an active hypertrophic scar can produce a worse scar if timing and adjuvant therapy are wrong, which is why revision usually waits for maturity.
What is the natural timeline?
Hypertrophic scars characteristically improve: red and raised at three months, softer by six to twelve, flatter by eighteen to twenty-four. Treatment compresses this curve. Patients who understand the timeline stay in treatment; those expecting week-by-week change often stop early and lose the benefit.
When should it be assessed?
- It itches or hurts enough to disturb sleep, or limits joint movement.
- It grows beyond the original wound edge, suggesting a keloid.
- It shows recurrent breakdown or infection.
Sources
- NICE — guidance on scar management
- Cochrane Library — reviews of silicone and pressure therapy for scars
- International Advisory Panel on Scar Management — consensus guidance
Internal links
Frequently asked questions
How is a hypertrophic scar different from a keloid?
A hypertrophic scar stays within the boundaries of the original wound and usually stabilises and flattens on its own over one to two years. A keloid grows beyond the wound edge and rarely regresses, so it follows a different treatment path.
What is the first-line treatment for a raised scar?
Silicone therapy, as gel or sheets worn for months, is the best-evidenced non-invasive first-line treatment. It is combined with pressure therapy, scar massage and sun protection, with corticosteroid injections for raised, symptomatic scars given as a series.
How long does a hypertrophic scar take to settle?
It characteristically improves on its own: red and raised at three months, softer by six to twelve, flatter by eighteen to twenty-four. Treatment compresses this curve, but non-surgical treatment flattens and softens rather than returning skin to its pre-injury state.
Risks & Limitations
- Reconstruction is usually staged — more than one operation is normal, and the plan may change as healing progresses.
- Donor-site scarring and discomfort, including after rib cartilage harvest.
- Partial or complete failure of a flap or graft, which may require further surgery.
- Scars are permanent. They mature and fade but never disappear.
- Asymmetry and the inherent limits of matching a normal side.
- Altered sensation, numbness or weakness in the operated area.
- Contracture, which may need release procedures later.
- Final assessment is made at 6–12 months, and longer in growing children.
When to Seek Care
- A flap or graft that turns dark, cold, black or stops bleeding when pricked.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- New or worsening pain, swelling or fluid leakage from the operative site.
- Bleeding that does not stop with gentle pressure.
- Any change in a reconstructed area that concerns you, however minor.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery guidance
- World Health Organization (WHO) — burn and trauma care resources
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
- Cochrane Library — systematic reviews in wound and reconstructive care
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.