Scars form as the body repairs an injury or surgical wound. Most flatten and fade, but some become raised, thickened, widened or attached to deeper structures. Hypertrophic scars and keloids involve excess scar tissue, while tethered scars restrict movement or create indentation. Correctly identifying the scar type is important because treatments and recurrence risks differ.

Hypertrophic and keloid scars

A hypertrophic scar remains within the original wound boundary and may gradually improve. A keloid extends beyond the original injury and can continue to grow. Both may be itchy, painful, firm and darker or lighter than surrounding skin. Keloid tendency is influenced by genetics, skin tone and body location.

Tethered and widened scars

A tethered scar attaches to deeper tissue and may pull during movement or create an uneven contour. A widened scar is often associated with tension during healing. Pain can also arise from irritated nerves, retained sutures or an underlying recurrent condition, so symptoms should not automatically be attributed to the visible scar.

Assessment

Your clinician will review how the scar developed, whether it is changing and any previous treatment. Examination evaluates boundaries, thickness, colour, flexibility, tenderness and deeper attachment. A changing lump, persistent ulceration or discharge may require biopsy or imaging to exclude another diagnosis.

Treatment options

Options include silicone therapy, steroid injections, pressure treatment, fractional CO2 laser and surgical revision. Keloids often require combination treatment because excision alone can lead to recurrence. Tethered scars may need surgical release. Laser can improve selected texture and flexibility concerns but cannot erase a scar.

Risks and expectations

Risks include pigment change, skin irritation, infection, delayed healing and recurrence. Keloids can return larger after treatment. The aim is to improve symptoms and appearance, with a plan tailored to scar biology, skin tone and location.

Frequently asked questions

What is the difference between a hypertrophic scar and a keloid? A hypertrophic scar stays within the original wound; a keloid grows beyond it.

Can keloids be permanently removed? Recurrence is common, so treatment focuses on control and improvement rather than a guaranteed cure.

Can tethering be treated without surgery? Some mild symptoms may improve with therapy, but significant deep attachment may require release.