Keloid vs Hypertrophic Scars: What Helps and What Doesn't

Why Some Scars Stay Raised

Most wounds fade into a flat, pale scar within 6 to 12 months. Some do not. Around 5 to 15 per cent of wounds develop into hypertrophic or keloid scars, usually visible within the first few months.

Both are caused by the body overproducing collagen while the wound closes. Normal scar tissue lays down roughly the right amount in an organised pattern. Hypertrophic and keloid scars deposit far more, forming a disorganised tangle above the skin.

The difference is whether the scar stays inside the original cut. That single fact changes how it behaves and what realistically helps.

The Difference Between Hypertrophic and Keloid Scars

Hypertrophic scars. Raised, firm, and often red or pink, but they stay within the borders of the original wound. They usually peak at 6 months and may slowly flatten over 1 to 2 years, especially with consistent care.

Keloid scars. Raised, firm, often darker than surrounding skin, and they grow beyond the original wound edges. They do not tend to shrink on their own and may continue to spread for years. Keloids can itch, tug, or feel sore.

Hypertrophic scars are far more common. Keloids are more stubborn, harder to soften, and more likely to return after removal.

Who Is Most at Risk of Raised Scars

Several factors raise the chance of developing a hypertrophic or keloid scar.

Skin tone. Keloids are significantly more common in people with darker skin, including African, Asian, Pacific Islander, and some Mediterranean heritage.

Family history. If a parent or sibling has a severe scar, your chance is higher. Genetics play a meaningful role.

Age. Both types are more common between 10 and 30, though they can appear at any age.

Location on the body. Chest, shoulders, upper back, earlobes, and jawline are high-risk zones. Hands and faces rarely form keloids.

Tension on the wound. Skin pulled tight during movement or recovery is more likely to scar thickly.

Type of injury. Burns, piercings, acne on the back or chest, and surgery in high-risk areas all increase the risk.

If you know you are prone, early and consistent care matters more than it would for someone with a low-risk profile.

What the Research Says About Silicone for Raised Scars

Silicone is the most researched non-invasive option for both hypertrophic and keloid scars and has been recommended by international scar management bodies for over 30 years. It works by forming a semi-occlusive layer over the scar, holding water in the upper skin and supporting more normal collagen turnover.

A review in Aesthetic Plastic Surgery found silicone gel and sheeting reduced scar thickness, colour, and discomfort in most patients when used consistently for 2 to 3 months. Silicone works better on hypertrophic scars than keloids, but can still soften keloid itch and redness.

Other home options exist. Pressure garments may help on limbs. Onion extract and vitamin E have mixed evidence. For active keloids, professional input is often needed alongside home care.

How Genova Silicone Scar Gel Fits Raised Scar Care

Australian-made Genova Silicone Scar Gel is one evidence-based option for hypertrophic and keloid scars. It combines silicone with Vanistryl, researched for supporting even scar colour, and Ecoskin Probiotic, which helps the barrier around the scar stay calm. The gel dries quickly, sits under clothing, and does not sting.

For anyone prone to raised scars, early and consistent use matters most. A gel is easier than sheeting on visible areas like the chest, shoulders, and jawline. Genova is manufactured locally under TGA-compliant standards for stability in heat and UV.

Silicone works best alongside sun protection, gentle massage once the scar is stable, and professional input for keloids.

Who Silicone Scar Care Suits and Who Needs More

It may suit you if:

• Your scar is hypertrophic, recent (under 12 months), and still remodelling
• You want a low-risk option you can apply at home
• Your keloid is stable and you want to soften itch, redness, or height
• You can apply it twice a day for 2 to 3 months

You may need professional input if:

• Your keloid is growing, painful, or affecting movement
• The scar is causing itch or discomfort that disrupts sleep
• You have had a keloid return after previous removal
• The scar sits in a high-tension zone like the chest or shoulder

Realistic Expectations for Raised Scar Care

Used consistently, silicone may help reduce itch and redness within 3 to 4 weeks, soften height and colour in hypertrophic scars over 8 to 24 weeks, and reduce symptom bother in keloids even when the scar does not visibly shrink. Results vary depending on skin tone, genetics, scar age, and location.

What silicone cannot do is remove a keloid. Established keloids usually need professional intervention to flatten, and they can still return. For hypertrophic scars, silicone plus time often gives a real, visible improvement. For keloids, the goal is usually symptom relief and preventing further growth rather than full flattening.

Pros and Cons of Silicone for Raised Scars

Pros: strongest home-use evidence, suits sensitive skin, dries fast, works on old and new scars, reduces itch and redness, no consumables beyond the gel.

Cons: slow, requires twice-daily use for months, less effective on established keloids than hypertrophic scars, will not flatten keloids alone.

How to Use Silicone Gel on a Raised Scar

1. Wait until the wound is fully closed, usually 2 to 3 weeks after surgery or injury.
2. Clean the scar with a gentle, fragrance-free cleanser and pat dry.
3. Apply a thin layer of silicone gel along the raised scar, covering the scar and 1 to 2 millimetres of surrounding skin.
4. Let it air dry for 4 to 5 minutes before clothing.
5. Repeat twice daily for at least 12 weeks.
6. Cover with high-SPF sunscreen any time the scar sees sun, for at least 12 months.
7. Add a gentle massage from around week 6, using small circles for 2 to 3 minutes a day, to support flexibility.

Myths About Keloid and Hypertrophic Scars

Myth: Keloids and hypertrophic scars are the same thing.
They look similar but behave differently. Keloids spread beyond the wound; hypertrophic scars do not.

Myth: You can only help raised scars in the first few weeks.
Early care gives the best results, but silicone can still help older hypertrophic scars and active keloid symptoms months or years later.

Myth: Vitamin E oil will fix raised scars.
Research on vitamin E is mixed, and some studies show it can cause contact dermatitis. Silicone has stronger, more consistent data.

Myth: Removing a keloid surgically is the answer.
Keloids often return after excision alone. Professional care usually combines several approaches to reduce recurrence.

Frequently Asked Questions About Raised Scars

How do I know if my scar is a keloid or hypertrophic?
Check whether it stays within the original wound line. If yes, it is hypertrophic. If it has grown beyond the edges, it is likely a keloid.

Can silicone gel shrink a keloid?
It can reduce itch, redness, and discomfort, and may slow further growth. It rarely flattens an established keloid on its own.

Are piercings likely to keloid?
Earlobes and upper ears are common keloid sites, especially in people with a family history. Consider risk before new piercings if you are prone.

Can I use silicone gel with other scar products?
Silicone is usually the base layer. SPF goes over it during the day. Avoid layering with strong actives on the scar itself.

How long should I keep using silicone?
Most women benefit from at least 12 weeks of daily use. Some continue for 6 months on high-risk scars or known keloid-prone areas.

Do raised scars ever flatten on their own?
Hypertrophic scars often do, slowly, over 1 to 2 years. Keloids usually do not.

References

1. Meaume, S., Le Pillouer-Prost, A., Richert, B., Roseeuw, D., and Vadoud, J. (2014). Management of scars: updated practical guidelines and use of silicones. European Journal of Dermatology, 24(4), 435-443.
2. Ogawa, R. (2017). Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. International Journal of Molecular Sciences, 18(3), 606.

Raised scars can feel like a fixed part of your appearance, but they are rarely as fixed as they look. Hypertrophic scars often soften with time and care. Keloids are more stubborn, but even they can become calmer, less itchy, and easier to live with. Gentle, consistent care and some patience quietly do a lot of work.

Individual results vary. Skincare products are cosmetic and not intended to address underlying skin conditions. If your scar is growing, painful, or affecting movement, please consult a qualified skin professional. The information in this article is general in nature and does not replace professional advice.