A hypertrophic scar is healing that overshot: raised, red, but confined to the original wound and often settling with time. A keloid is healing that never received the stop signal: scar tissue growing beyond the wound's borders, months or years after the injury, and — critically — prone to returning larger if simply cut out.
WhatsApp Dr Sin Yong →Both scars are collagen overproduction — fibroblasts that kept building after the repair was done. The international algorithms distinguish them by behaviour: hypertrophic scars rise within the wound, peak, and often regress partially over a year or two; keloids grow beyond the original borders, rarely regress, and can continue expanding for years [1]. Genetics deals the hand — keloid tendency runs in families and is substantially more common in Asian skin — and mechanical tension plays dealer, which is why the chest, shoulders and jawline lead the statistics while the eyelid almost never keloids.
Excision alone answers a keloid with the one thing keloids love: a fresh wound in keloid-forming skin. The systematic reviews report high recurrence after solo excision — frequently with the new keloid outgrowing the old — which is why every modern algorithm permits surgery only with immediate adjuvant therapy: corticosteroid injection, pressure, silicone, and in selected cases superficial radiotherapy [1,2]. The same logic warns against casual procedures in keloid-prone patients: each piercing and elective excision on high-risk anatomy is a coin flip that should be an informed decision, not an accident.
A ladder, matched to the scar and climbed with patience [1,2]. Fresh, raised scars: silicone sheeting or gel with pressure — unglamorous, evidence-backed, and the base of every algorithm. Established scars: intralesional corticosteroid injections, the workhorse, softening and flattening over a course of sessions — combined with 5-fluorouracil in resistant disease. Vascular laser calms redness; fractional approaches help texture as adjuncts. Excision is reserved, always chaperoned by immediate adjuvant treatment. Itch and pain — real features of active keloids — respond as the scar quiets. This pathway runs through Dr Sin Yong's keloid treatment programme; raised acne scarring on the jaw and chest is assessed alongside the atrophic scar types, since many faces carry both directions of scarring at once.
Waiting for a keloid to fade — regression is the exception, expansion the pattern. Scar creams and oils on an established keloid — massage-grade intervention for a structural overgrowth. Cutting it off at a general clinic without an adjuvant plan — the recurrence literature is unambiguous. Home remedies — from apple cider vinegar to thread ligation — which add inflammation to tissue that answers inflammation with growth. And piercing the other ear to 'test' — keloid tendency is systemic; the test result is another keloid.
“Cutting a keloid without an adjuvant plan is offering it a fresh wound — the recurrence isn't bad luck, it's the biology you invited.”
— Dr Sin Yong
Borders and timeline: a scar confined to the original wound that peaked and is slowly settling is hypertrophic; one growing beyond the wound's footprint months later is a keloid. The distinction changes the treatment plan.
The injection stings briefly — modern technique, fine needles and topical anaesthesia keep it very tolerable, and sessions are minutes long.
Courses run over months — keloids flatten by degrees, not appointments. Honest plans are stated in courses, and response is reviewed along the way.
Sometimes — but only with immediate adjuvant therapy planned in advance, because excision alone carries documented high recurrence. Surgery is a chapter in a plan, never the whole plan.
Active keloids are biologically busy — inflamed, growing tissue with its own nerve involvement. Itch and pain typically settle as treatment quiets the scar.
On high-risk anatomy — earlobes, chest, shoulders, jaw — yes, or proceed only with a prevention plan. Every elective wound in keloid-prone skin deserves a deliberate decision.