Scar Types
Keloid vs Hypertrophic Scars: How to Tell the Difference
Both are raised scars, but they behave very differently — and that difference changes how they should be treated.
Read articleWhy Do Some Scars Become Raised, Red or Dark?
Why does one incision fade into a barely-visible line while another becomes thick, red, or dark? Scarring is influenced by a mix of factors — some about the wound, some about the person. Understanding them explains why prevention and care matter.
1. Too much collagen
A raised scar (hypertrophic or keloid) forms when the body lays down more collagen than it needs during healing. In a keloid, this over-production keeps going and the scar spreads beyond the original wound. Genetics strongly influence this tendency.
2. Tension on the wound
Skin that is stretched or constantly moving — over the chest, shoulders, or a joint — pulls on the healing wound. This mechanical tension is one of the biggest reasons scars become wide and raised. Reducing tension, both surgically and by avoiding strenuous movement early, helps.
3. Skin tone and pigment
People with richer, darker skin tones are more prone to keloids and to post-inflammatory hyperpigmentation — a scar that heals darker than the surrounding skin. This is why sun protection and careful technique are especially important for darker skin.
4. Sun exposure
A new scar has little natural protection. Ultraviolet light can cause it to darken permanently. Keeping a scar covered or protected with sunscreen during its first year is one of the simplest ways to avoid lasting discolouration.
5. Wound complications
Infection, delayed healing, or a wound that reopens all increase inflammation and the risk of a poor scar. Good wound care in the early days pays off later.
6. Location and depth
Deeper wounds and certain sites — the central chest and upper back are notorious — simply tend to scar more prominently, regardless of how careful everyone is.
The short version: genetics, wound tension, skin tone, sun, and complications all push a scar toward becoming raised, red, or dark. You can't change your genes, but you can reduce tension, protect from the sun, and care for the wound — and that changes outcomes.
If a scar has already turned prominent
A scar that is already thick, red, or dark is not the end of the story. Silicone, injections, laser, and — for structural problems — surgical revision can all improve a prominent scar. The right combination depends on why the scar became prominent in the first place.
Considering scar revision? Dr. Erdal offers a free, no-obligation assessment — send a photo of your scar on WhatsApp for an honest opinion on what can realistically be improved.