Keloid vs Hypertrophic Scars: How to Tell Them Apart and What Helps After 45
Quick summary
Hypertrophic scars and keloids are both raised scars caused by too much collagen. The simple test: a hypertrophic scar stays inside the line of the original wound, while a keloid grows past it into normal skin.
Hypertrophic scars often flatten slowly over one to two years, and silicone gel or sheets are a first-line home option. Keloids rarely shrink on their own and usually need a doctor, often with steroid injections, though silicone can help with itch and redness.
At Genova Skincare we make a silicone scar gel, so our own product is mentioned in this guide. Results vary from person to person.
A scar that stays thick, red or itchy months after surgery can be worrying. Is it healing badly? Will it keep growing? The answer depends on which kind of raised scar you have, and the two main types behave very differently.
At Genova Skincare, we hear from many women over 45 with raised scars from surgery, a C-section, an injury or old acne. This guide explains how to tell a keloid from a hypertrophic scar, what each one is likely to do, and what realistically helps.
Keloid vs hypertrophic scar: what is the difference?
At Genova Skincare, the first question we suggest asking is simple: does the scar stay inside the original cut? Both types form when the body lays down too much collagen while a wound closes. The difference is where that extra tissue goes.
A hypertrophic scar is raised, firm and often red or pink, but it stays within the borders of the original wound. It usually appears within the first few months and may slowly flatten over one to two years.
A keloid is raised and firm too, but it spreads beyond the edges of the wound into healthy skin. It can keep growing for years, often itches or feels tender, and rarely shrinks on its own. StatPearls, a medical reference published by the US National Library of Medicine, notes that hypertrophic scars may regress over time while keloids do not.
DermNet, the New Zealand skin reference, notes that both are harmless and do not turn into skin cancer. That said, any lump that is changing should still be looked at by a doctor.
Hypertrophic scar vs keloid compared
| Feature | Hypertrophic scar | Keloid |
|---|---|---|
| Shape | Stays inside the wound line | Spreads beyond the wound edges |
| When it appears | Within weeks to a few months | Months, sometimes a year or more later |
| Colour | Red or pink, fading with time | Pink, red or darker than surrounding skin |
| Does it flatten on its own? | Often, slowly over 1–2 years | Rarely |
| Common places | Surgical scars, burns, joints | Chest, shoulders, upper back, earlobes, jawline |
| First steps | Silicone gel or sheets, sun protection, time | See a GP or dermatologist; silicone as support |
| Comes back after removal? | Less likely | Often, if cut out alone |
If you are not sure which you have, compare the scar to where the original cut or wound was. A photo taken soon after surgery helps.
What causes raised scars, and who is most at risk after 45?
A review in the International Journal of Molecular Sciences by Ogawa describes both types as the result of ongoing inflammation deep in the skin, which keeps collagen production switched on. Anything that adds tension or inflammation to a healing wound can raise the risk.
- Skin tone and family history. Keloids are much more common in people with darker skin and run in families.
- Where the wound is. The chest, shoulders, upper back and earlobes are high-risk areas for keloids.
- Tension. Skin that stretches with movement, such as over a joint or the breastbone, is more likely to scar thickly.
- The type of wound. Burns, infected wounds, slow-healing wounds, piercings and acne on the chest or back all raise the risk.
Keloids most often start between the teens and 30s, so new keloids are less common after 45. Hypertrophic scars, though, can form at any age after surgery, and many women in their 40s and 50s are having procedures for the first time. Our guide to hypertrophic scars after 45 explains how healing changes with age.
What helps hypertrophic scars: silicone gel and sheets
Silicone is the most studied home option for raised scars. International scar guidelines published in Dermatologic Surgery by Gold and colleagues list silicone gel or sheeting as first-line care for both preventing and treating hypertrophic scars. Updated European guidelines in the European Journal of Dermatology by Meaume and colleagues say the same.
It is worth being honest about the evidence. A Cochrane review by O'Brien and Jones found silicone sheeting improved scar thickness and colour, but the authors judged the studies to be of poor quality. So silicone is a reasonable, low-risk first step, not a sure fix.
Silicone appears to work by covering the scar and keeping it hydrated, which seems to calm the cells making excess collagen. Gels and sheets both work this way. Our comparison of silicone gel vs sheets can help you choose.
Genova Silicone Scar Gel for raised scars after 45
Genova Silicone Scar Gel is one option for healed hypertrophic scars. It is a silicone gel with added peptides, squalane and vitamin D3, made in Australia. It dries clear, so it suits places where sheets are awkward, such as the chest, shoulders, neck and face. A 30ml tube is $52.95, and a 12-week two pack is $94.95 for longer scars.
Pros and cons of silicone gel for raised scars
Pros:
- First-line home option in international scar guidelines
- Clear, flexible finish that works on curved or moving areas
- Can ease itch and redness in both scar types
Cons:
- Slow: needs twice-daily use for at least 12 weeks
- Evidence quality is modest, and results vary
- Will not flatten an established keloid on its own
Who it is for, and who needs more
It may suit you if your scar is hypertrophic, fully healed and under a year or two old, or you have a stable keloid and want to ease itch and redness alongside your doctor's care.
See a doctor first if your scar is growing past the wound line, painful, limiting movement, bleeding or changing, or if a keloid has come back after removal. Do not use silicone on open wounds or broken skin.
Realistic expectations
With twice-daily silicone, many people notice less itch within a few weeks. Changes in height, firmness and colour of a hypertrophic scar take 8–12 weeks or longer, and scars keep maturing for 12–18 months.
Silicone will not remove a scar, and it will not shrink an established keloid on its own. Results vary from person to person.
What helps keloids: when to see a doctor
Keloids are harder to treat. The most common first treatment is a corticosteroid injection into the scar, repeated every few weeks, which can flatten and soften it. Doctors may also use cryotherapy, laser, pressure, or surgery combined with steroid injections or radiotherapy.
Cutting a keloid out on its own is usually avoided, because keloids often come back, sometimes larger. That is why a GP, dermatologist or plastic surgeon should plan keloid care. Silicone can then help as a daily support for itch and redness. Our article on keloid scars after 45 goes into this in more detail.
How to use silicone gel on a raised scar: step by step
- Wait until the skin is fully closed. No scabs, stitches or weeping, usually two to three weeks after surgery.
- Clean and dry the scar. Use a gentle cleanser and pat dry.
- Apply a thin layer. Cover the whole scar and a little of the skin around it.
- Let it dry. Give it a minute or so before clothing or sunscreen.
- Protect from the sun. Use SPF 50+ over the gel on any exposed scar for at least 12 months.
- Repeat twice a day for at least 12 weeks. Take a photo every month in the same light to track change.
Raised scar questions women over 45 ask most
How can you tell the difference between keloid and hypertrophic scars?
Look at the edges. A hypertrophic scar stays within the original wound line. A keloid grows past it into normal skin and often keeps growing. If you are unsure, a GP can tell you.
Can a hypertrophic scar go away?
It usually will not disappear completely, but many hypertrophic scars flatten and fade a lot over one to two years. Silicone and sun protection may help the process along.
How do you flatten a hypertrophic scar at home?
Silicone gel or sheets used twice daily for at least 12 weeks are the main home option, along with sun protection and gentle massage once the scar is stable. If there is little change after three months, see a doctor.
What are the hardest scars to treat?
Keloids are generally the hardest, because they can keep growing and often return after treatment. Deep pitted acne scars and large burn scars can also be difficult.
Can silicone gel shrink a keloid?
It can ease itch, redness and discomfort and may help stop further growth, but it rarely flattens an established keloid by itself. Most keloids need a doctor's care.
Raised scars can feel permanent, but most hypertrophic scars improve with time, silicone and sun protection. Keloids are more stubborn, and the best results come from working with a doctor. For more help, see how long different scars take to settle in our guide to scar fading timelines, or our full guide to fading scars with silicone gel.
Silicone scar gel for healed raised scars
Dries clear, sits under clothing and sunscreen, and ships from Australia.
12-Week Course, 2 pack
2 x 30ml. Enough for a full course on a longer scar.
Made in Australia. For fully healed skin only. Results vary from person to person.
Individual results vary. Genova Silicone Scar Gel is a cosmetic product designed to support the appearance of healed scars. It does not treat keloids, and it is not a substitute for advice from your GP, dermatologist or surgeon. Have any scar that is growing, painful or changing checked by a doctor.
Sources:
- Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. International Journal of Molecular Sciences. 2017;18(3):606.
- Gold MH, Berman B, Clementoni MT, et al. Updated international clinical recommendations on scar management: part 2, algorithms for scar prevention and treatment. Dermatologic Surgery. 2014;40(8):825-831.
- Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. European Journal of Dermatology. 2014;24(4):435-443.
- O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews. 2013;(9):CD003826.
- Commander SJ, et al. Update on postsurgical scar management. Seminars in Plastic Surgery. 2016;30(3):122-128.
- Carswell L, Borger J. Hypertrophic scarring keloids. StatPearls. NCBI Bookshelf, 2023.
- DermNet. Keloid and hypertrophic scar. dermnetnz.org, accessed 25 September 2026.
