Keloid vs. Hypertrophic Scars: What’s the Difference and How to Treat Them

If you've ever noticed a raised scar that seems to grow beyond the original wound, or a thick, rope-like scar that won't flatten no matter what you try, you're likely dealing with either a keloid or a hypertrophic scar. These two types of scars are often confused — even by patients who've had them for years — but they behave differently and require slightly different approaches to treatment.

This guide breaks down the key differences and, more importantly, explains what you can do at home to treat both effectively.

What Is a Hypertrophic Scar?

A hypertrophic scar is a raised, thick scar that forms when the body overproduces collagen during the healing process. Unlike normal scars, hypertrophic scars are raised above the surface of the skin — but they stay within the boundaries of the original wound.

Common characteristics:

• Raised above surrounding skin
• Red, pink, or dark in color
• Stays within the wound margins
• May be itchy or tender
• Often improves on its own over time (though this can take years without treatment)
• Very common after surgical procedures, burns, and deep cuts

Hypertrophic scars are extremely common after surgeries like C-sections, tummy tucks, and BBL procedures. They respond very well to silicone scar therapy.

What Is a Keloid Scar?

A keloid is a type of scar that goes rogue — it grows beyond the boundaries of the original wound and continues to expand over time. Keloids are caused by an overactive healing response in which the body keeps producing collagen long after the wound has closed.

Common characteristics:

• Raised and often shiny or rubbery in texture
• Extends beyond the original wound edges
• Continues to grow over time
• Can be itchy, painful, or tender
• More common in people with darker skin tones (though anyone can develop them)
• Genetic component — if a parent had keloids, you're more likely to develop them
• Common on earlobes, shoulders, chest, and surgical sites

Keloids are more challenging to treat than hypertrophic scars, but silicone therapy is one of the few non-invasive approaches with clinical evidence supporting its effectiveness.

Key Differences at a Glance

Why Does Your Body Form These Scars?

Both hypertrophic scars and keloids are the result of an overactive wound healing response. Normally, when your skin is injured, the body produces collagen to repair the damage and then gradually remodels that collagen into smoother, flatter scar tissue. In hypertrophic and keloid scars, this remodeling process goes wrong — the body either produces too much collagen or fails to stop producing it.

Risk factors that increase your chances of developing these scars include:

• Family history of keloids
• Dark or medium skin tones
• Younger age (skin is more reactive)
• Wound location (chest, shoulders, and earlobes are high-risk areas)
• Wound tension (surgical incisions under tension are more likely to scar)
• Infection or slow healing at the wound site

How to Treat Hypertrophic Scars at Home

The good news about hypertrophic scars is that they respond very well to conservative, non-invasive treatment. The earlier you start, the better your results will be.

1. Silicone Scar Therapy

Medical-grade silicone is the gold standard first-line treatment for hypertrophic scars — recommended by dermatologists and plastic surgeons worldwide. Silicone works by:

• Hydrating the scar tissue to reduce excess collagen production
• Gently compressing the scar to flatten raised tissue
• Creating a microenvironment that accelerates healthy remodeling

Apply medical-grade silicone scar tape for 12–23 hours per day. Most patients see visible flattening and color improvement within 4–8 weeks of consistent use.

2. Scar Massage

Once your wound is fully healed (not before), gentle scar massage can help break up fibrous tissue and improve the texture and flexibility of the scar. Use two fingers to apply firm but gentle circular pressure for 2–5 minutes, 1–2 times per day. Massage is most effective when combined with silicone therapy.

3. Sun Protection

Sun exposure can permanently darken scar tissue and stimulate additional collagen production, making hypertrophic scars worse. Apply SPF 30+ to any exposed scar, or keep it covered, year-round.

4. Avoid Wound Tension

Where possible, minimize tension on healing wounds. For surgical patients, this means following your surgeon's activity restrictions carefully. Excess tension stretches the wound edges apart, triggering a more aggressive healing response.

How to Treat Keloid Scars

Keloids are more stubborn than hypertrophic scars, and in severe cases may require professional treatment. However, silicone therapy remains a valuable component of any keloid management plan.

1. Silicone Scar Therapy

Multiple clinical studies have shown that silicone therapy reduces the height, width, itching, and discoloration of keloid scars over time. Results take longer than with hypertrophic scars — expect to commit to 4–6 months of consistent use for meaningful improvement.

The key with keloids is to not stop early. The scar may look the same for weeks before you begin to see changes — this is normal. Keep going.

2. Professional Treatments (for severe keloids)

For keloids that don't respond adequately to silicone therapy alone, a dermatologist may recommend:

• Corticosteroid injections: Injecting a steroid directly into the keloid can reduce inflammation and flatten the scar. Often used in combination with silicone therapy for best results.
• Cryotherapy: Freezing the keloid can help reduce its size. More effective on smaller keloids.
• Laser therapy: Pulsed dye laser can reduce redness and flatten keloid tissue.
• Surgical removal: Keloids removed surgically often return — and can come back larger. Surgery is usually only considered when combined with other treatments like radiation or steroid injections to prevent recurrence.

3. Prevention Is Key for Keloid-Prone Patients

If you know you're prone to keloids, the best strategy is prevention. Start silicone scar therapy on any wound as soon as it closes — even minor cuts, piercings, or small procedures. Getting ahead of the keloid formation process is far more effective than trying to reverse it.

The Role of Silicone in Clinical Guidelines

It's worth emphasizing that silicone therapy isn't a folk remedy — it's backed by decades of clinical research and is included in the official treatment guidelines of multiple dermatology and plastic surgery organizations worldwide, including the International Advisory Panel on Scar Management.

The mechanism is well understood: silicone creates a hydrated environment that prevents the transepidermal water loss that drives excess collagen production. This is why it works for both hypertrophic scars and keloids — both conditions involve dysregulated collagen synthesis.

Frequently Asked Questions

Can I have a hypertrophic scar and a keloid at the same time?

Yes. Along a single surgical incision, some areas may behave as hypertrophic scars (staying within the wound) while others become keloid-like (extending beyond). Treat the entire scar consistently with silicone therapy.

How do I know if my scar is getting better?

Signs of improvement include: the scar becoming flatter, lighter in color, less itchy or painful, and softer to the touch. These changes happen gradually — take monthly photos to track your progress.

Can silicone tape help with old scars?

Yes — silicone therapy works on scars of any age, though older scars may take longer to respond (4–6 months vs 4–8 weeks for new scars). Scar tissue never fully stops remodeling, which means there's always an opportunity for improvement.

Is there any scar that silicone therapy won't help?

Silicone therapy is most effective on raised (hypertrophic or keloid) scars. For sunken (atrophic) scars like deep acne scars or ice-pick scars, silicone therapy is less effective and professional treatments like microneedling or fillers are typically more appropriate.

Final Thoughts

Whether you're dealing with a hypertrophic scar from a recent surgery or a keloid that's been bothering you for years, you have options. Medical-grade silicone scar therapy is safe, evidence-based, and something you can do at home — without needles, clinics, or expensive procedures.

The most important thing is to start, be consistent, and give your skin the time it needs to remodel. Scars are living tissue, and with the right support, they can change significantly.

Explore the Invisible Silicone Scar Tape collection by DR. CARDENAS 305 — used by thousands of post-surgical patients for treating hypertrophic and keloid scars effectively at home.