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Hypertrophic Scars

Hypertrophic scars are raised, firm, often red scars that stay within the borders of the original wound. They are the opposite of atrophic scars: instead of too little collagen, the body made too much. The fact that they stay within the wound's edges is what separates them from keloids, which spread beyond.

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Too much repair material

During healing, repair cells produce collagen to close a wound. In a hypertrophic scar, they overproduce it, and the remodelling phase that should flatten and reorganize the excess does not fully do its job. The surplus collagen builds up above the skin, firm and often reddish from the small vessels within it, but it stays inside the original wound.

How do hypertrophic scars develop?

Hypertrophic scars come from collagen overproduction during healing, encouraged by tension and prolonged inflammation. Where a wound sits and how smoothly it heals both influence the outcome. Understanding these factors explains why some areas are more prone and why, unlike keloids, these scars often soften over time.

1
Collagen overproduction

The defining feature is too much collagen. Repair cells keep producing it beyond what is needed, and the remodelling that should trim the excess falls short. The result is a raised, firm scar. Because the problem is surplus rather than deficit, treatment aims to flatten and soften, the opposite direction from a depressed scar.

2
Tension on the wound

Skin under mechanical tension is more likely to scar this way. Areas that stretch and move, the shoulders, chest and skin over joints, pull on a healing wound and stimulate ongoing collagen production. This is why hypertrophic scars favour these sites, and why reducing tension during healing can lower the risk.

3
Prolonged inflammation

A wound that takes a long time to close, becomes infected or stays inflamed feeds collagen overproduction. The longer the repair process runs, the more excess collagen can accumulate. This is why careful wound care that supports clean, timely healing helps reduce the chance of a raised scar forming.

4
A scar that can soften

Unlike keloids, hypertrophic scars often improve partly on their own over months to years, flattening and fading somewhat. They also tend to carry small vessels that give the red colour, which is why a vascular component is part of the picture. This natural softening shapes realistic, patient expectations for care.

How to Prevent
1

Reduce tension while healing

Because tension drives collagen overproduction, supporting a wound so it is not constantly pulled helps. Measures that ease mechanical stress on a healing area, used under guidance, can lower the risk of a raised scar, especially over the chest, shoulders and joints where movement constantly tugs at the skin.

2

Support clean, timely healing

Since prolonged inflammation feeds the excess, helping a wound heal cleanly and promptly matters. Keeping a healing area protected and avoiding re-injury reduce how long the repair process runs. The shorter and calmer the healing, the less opportunity for surplus collagen to build into a raised scar.

3

Silicone and gentle care

Silicone sheets or gels are a well-recognized supportive measure for healing scars, helping hydrate the skin and regulate the remodelling that flattens excess collagen. A gentle routine that avoids irritation supports the same goal. These steps work best early and consistently, while a scar is still maturing.

4

Seek guidance for raised scars

Because raised scars can be confused with keloids and respond to specific approaches, a professional assessment helps. It confirms the scar stays within the wound, rules out a keloid tendency, and matches care to the scar's age and the redness involved, since early intervention often works better than waiting.

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