Keloid vs. Hypertrophic Scar: What's the difference?
Both are caused by an overproduction of collagen, but they behave very differently.
Hypertrophic Scars
These are raised, red, and firm scars that stay **strictly within the boundary of the original wound**. For example, a C-section scar that becomes thick and raised along the incision line is hypertrophic. They often flatten slightly on their own over several years.
Keloid Scars
Keloids are much more aggressive. They grow **beyond the boundaries of the original wound**, invading surrounding healthy skin like a tumor (though they are completely benign). A tiny ear piercing can result in a massive, marble-sized Keloid on the earlobe. They are often genetic and rarely shrink without medical intervention.
flowchart TD
A["Skin Trauma\n(Surgery, Piercing, Acne)"] --> B["Body triggers healing response"]
B --> C["Fibroblasts overproduce Collagen"]
C --> D{"Patient Genetics"}
D --> E["Hypertrophic Scar\n(Stays within wound bounds)"]
D --> F["Keloid Scar\n(Grows beyond wound bounds)"]
E --> G["Patient seeks surgical excision"]
F --> G
G --> H["New trauma triggers\neven larger scar growth!"]
style C fill:#fefcbf,stroke:#d69e2e,stroke-width:2px
style H fill:#fed7d7,stroke:#e53e3e,color:#c53030
Clinical Flattening Protocols
Because cutting a Keloid causes more trauma, our primary approach is non-surgical suppression of the collagen-producing cells.
| Treatment Method | How It Works |
|---|---|
| Intralesional Steroid Injections (Kenacort) | This is the gold standard. We inject a highly concentrated corticosteroid directly into the hard core of the scar. This immediately stops the intense itching/pain, shuts down collagen production, and causes the dense tissue to soften and flatten out over several sessions. |
| Silicone Gel Sheets | Medical-grade silicone sheets or heavy gels are applied over the scar daily. This creates intense hydration and static pressure, which tricks the body into down-regulating collagen production. It is highly effective for new surgical scars to prevent hypertrophy. |
| Pressure Therapy (Earlobes) | For earlobe keloids after injection, we may recommend wearing specialized pressure earrings. The constant physical compression starves the scar tissue of blood flow, preventing it from regrowing. |
Dr. Manali's Advice
"If you know you have a genetic tendency to form Keloids (e.g., you have one on your shoulder or chest), you must strictly avoid unnecessary skin trauma. This means no tattoos, no elective cosmetic surgeries unless medically necessary, and absolutely no new piercings. If you do need a surgery, you must tell your surgeon beforehand so they can apply preventative silicone/pressure therapy immediately after."