What do keloids look like?
Two overshoots, one spectrum
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.
What is a hypertrophic scar, and will it flatten on its own?
A hypertrophic scar is a raised, firm, often red scar that stays within the line of the original wound. It forms when the healing skin lays down more collagen than it needs. Unlike a keloid, it usually rises in the first months after the injury and then tends to soften and flatten partly as the scar matures, although it may not settle completely.
Why hypertrophic scars form
- Tension across the wound, as on the chest, shoulders and over joints.
- Slow healing, from infection, a wound that reopened or a burn.
- Deep injuries, including surgical incisions, deep acne and burns.
- Skin type and family tendency, with raised scars more common in Asian and darker skin.
How a doctor tells it apart from lookalikes
The key question is the border. A hypertrophic scar stays inside the wound; a keloid grows beyond it, often months later. A doctor also considers a stitch reaction or small granuloma along a surgical scar, a dermatofibroma (a firm button-like bump, often on the legs), and, rarely, a skin cancer within an old scar, which shows as a sore that will not heal, bleeds or keeps growing. The timeline, the edge and the feel of the scar usually settle it at examination; the full comparison is in keloid vs hypertrophic scar.
In Asian skin
Raised scars are more common, and the scar often passes through a red phase and then a brown phase of post-inflammatory pigment, so the colour can bother people as much as the height.
What you can do at home, and what you cannot
Silicone gel or sheeting is the usual first step, and a Cochrane review found it may help, although the evidence is of low certainty. Keeping tension off a healing wound, protecting the scar from the sun and not picking also help. Onion-extract and vitamin E creams have little evidence. You cannot inject or cut a scar at home, and home remedies that inflame it can make it worse.
When it needs a doctor
See a doctor if the scar is spreading beyond the wound, itches or hurts, is tight across a joint and limits movement, followed a burn, or breaks down. Persistent raised scars are commonly treated with corticosteroid injection, and timing for scars after surgery is set out in the surgical scar timing guide.
Why is cutting a keloid off the classic mistake?
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.
What actually works for keloids?
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.
Hypertrophic scar treatment and laser scar removal: what each option does
Scar treatment for a hypertrophic scar or keloid is layered, and laser is an adjunct rather than a removal: fractional CO2 laser, at a wavelength of 10,600 nm, makes columns of controlled injury that remodel thick scar, while vascular lasers target the redness. No laser lifts a raised scar off the skin on its own, so laser scar removal is weighed alongside silicone, pressure and injection rather than instead of them.
The evidence supports that order. A 2025 systematic review and meta-analysis of seven studies, covering 404 patients and 506 scars, found fractional CO2 laser improved overall Vancouver Scar Scale scores more than other lasers, but found no significant difference from them in colour, pliability, height, vascularity or patient satisfaction. A 2025 systematic review of 14 studies in darker skin types found that combining silicone gel sheeting, corticosteroid injection, laser and pressure was generally more effective for hypertrophic scars, and flagged hyperpigmentation as a side effect to weigh.
| Option | What it does | Suits | Not for | Page |
|---|---|---|---|---|
| Silicone gel or sheeting, with pressure | Covers and hydrates the scar and eases tension on it | Fresh or early raised scars; scars after surgery | Flattening an established, bulky keloid on its own | Surgical scar timing |
| Corticosteroid injection, sometimes with 5-fluorouracil | Softens and flattens thick scar tissue and settles itch | Hypertrophic scars that stay raised; most keloids as the first step | Flat, depressed or purely red scars | Keloid steroid injection |
| Vascular laser | Targets the small vessels behind a red, active scar | Red raised scars, as an adjunct | Flattening a bulky scar by itself | Vascular lasers compared |
| Fractional CO2 laser | Controlled columns of ablation that remodel thick or tight scar | Thick, tight or textured hypertrophic scars, as an adjunct | Inflamed or freshly tanned skin; replacing injection in a keloid | Fractional CO2 laser |
| Excision with adjuvant treatment | Removes the scar, then protects the fresh wound from regrowth | Selected keloids and scars that fail other steps, by referral to a plastic surgery specialist | Keloids cut out with no adjuvant plan | Keloid treatment |
| Treatment for depressed scars | Resurfacing, subcision and staged plans for scars below the skin surface | Acne scars and sunken surgical scars | Raised scars | Scar removal Singapore |
Which steps apply depends on the age, site, size and colour of the scar and on your skin type, so the scar is examined at the clinic on Orchard Road, Singapore, before any plan is made.
What doesn't work for keloids?
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
Dr Sin Yong’s Viewpoint
The keloid patients I meet have usually been offered the one thing keloids love: excision without a plan. Surgery alone answers a keloid with a fresh wound in keloid-forming skin, and the recurrence statistics are unforgiving. My approach is the evidence ladder — injections, patience, staged decisions — and surgery only ever chaperoned by adjuvant treatment.
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