Hypertrophic Scar vs. Atrophic Scar: What’s the Difference?

The difference between a hypertrophic scar and an atrophic scar is collagen: a hypertrophic scar forms when the skin produces too much collagen during healing, so it is raised and thick, while an atrophic scar forms when the skin produces too little, so it is sunken or indented. Hypertrophic scars are common after surgeries such as tummy tucks, breast lifts, or C-sections, and atrophic scars are common with acne, chickenpox, and healed stretch marks.

Scars are a natural part of healing, but not all scars heal or look the same. Many of my clients feel confused or discouraged about what kind of scar they have, or why it isn’t improving with time or creams. Understanding the difference between these two types is the first step to choosing the right treatment, because how a scar looks often reflects what is happening beneath the surface.

Hypertrophic vs. Atrophic Scar: A Quick Comparison

What Is a Hypertrophic Scar?

A hypertrophic scar is a raised, thickened scar that forms when your body produces too much collagen during healing. Your skin’s natural repair process creates collagen to close the wound, but sometimes, because of inflammation, tension, or genetic factors, it produces more than needed. The scar then grows upward and becomes firm or rubbery.

A hypertrophic scar is usually:

• Raised and thick.
• Red, pink, brown, or dark, depending on your skin tone.
• Within the original wound boundary.
• Firm, itchy, or tight.
• Common in surgical scars, such as those from tummy tucks, breast lifts, or C-sections.

What Is an Atrophic Scar?

An atrophic scar is the opposite: it forms when your skin doesn’t produce enough collagen during healing. The tissue underneath isn’t fully rebuilt, so the scar looks sunken or indented, like a small dip, a hollow, or even a hole in the skin. I explain this in more detail in my article on why atrophic scars don’t fill in.

An atrophic scar is usually:

• Flat or depressed.
• Thin or wrinkled in texture.
• Lighter than the surrounding skin.
• Visible as pits or an uneven surface.
• Common with acne scars, chickenpox, or healed stretch marks.

Some stretch marks also fall into the atrophic category. For them, my stretch mark camouflage and regeneration protocol may be ideal.

Why Do These Scars Form So Differently?

It all comes down to collagen balance: hypertrophic scars have too much collagen, and atrophic scars have too little. Many factors affect this balance:

• Your skin type and tone.
• Your genetic background.
• The type of injury or surgery.
• How much inflammation or tension was present.
• Whether the skin was supported with hydration and protection during healing.

The same person can even develop different types of scars on different parts of the body.

How Can You Tell Which Type of Scar You Have?

If you’re not sure what kind of scar you have, ask yourself:

• Does it feel raised and firm? It is likely hypertrophic.
• Does it feel sunken or hollow? It is likely atrophic.
• Is it red, pink, or pigmented? It could be either, depending on your skin tone.
• Does it feel tight, itchy, or stretched? This is more common with hypertrophic scars.
• Does it look like a dent or an uneven dip? This is more common with atrophic scars.

I assess every scar individually, because some scars are a combination of both types or have changed over time.

Can Topical Creams or Oils Help?

Topicals may reduce inflammation, soothe the skin, or hydrate the surface, but they often can’t reach deep enough to correct the structure of the scar. This is especially true for atrophic scars, which need deeper collagen stimulation, and for hypertrophic scars, which may need physical remodeling or resurfacing. That is why I use regenerative techniques that address both the surface and the deeper layers of the skin.

How Do I Treat Hypertrophic Scars?

My approach always starts with regeneration, because pushing pigment or pressure onto a raised scar can make it worse. I often use:

• Microneedling with regenerative serums to remodel thick tissue.
• Peels and hydration treatments to soften the texture and calm the pigment.
• Plasma or light therapy for deep cellular repair.
• Scar camouflage tattooing, only once the scar is flat and stable.

How Do I Treat Atrophic Scars?

For atrophic scars, the goal is to stimulate collagen production and rebuild lost volume. I focus on:

• Microneedling with collagen-boosting serums.
• Hydration therapies to plump the skin.
• Peels to smooth the surface and fade discoloration.
• In some cases, camouflage tattooing to even out the tone, once the skin is more stable.

What If You Have Both Types of Scars?

It’s very common. A tummy tuck scar may have a raised area near the incision (hypertrophic) and a hollow indentation in the center (atrophic). A stretch mark may look sunken while its edges are thickened from inflammation, and a post-acne scar may mix several textures. In these cases, I create a tailored plan that treats both patterns at the same time.

How Many Sessions Will You Need?

It depends on the age and depth of the scar, your skin type and tone, the area of the body, and how the scar responds to the first treatments. On average:

• Most clients begin to see visible changes within 2 to 4 sessions.
• Milder cases may improve significantly in 6 sessions.
• More complex or older scars may take 8 to 18 sessions.

I adjust the plan based on your progress, always following your skin’s rhythm.

Frequently Asked Questions

What is the difference between an atrophic and a hypertrophic scar?

A hypertrophic scar has too much collagen, so it is raised and thick. An atrophic scar has too little collagen, so it is flat, sunken, or indented.

What causes atrophic scars?

Atrophic scars form when the skin doesn’t produce enough collagen during healing. They are common with acne, chickenpox, and healed stretch marks.

Can a scar be both hypertrophic and atrophic?

Yes. For example, a tummy tuck scar may be raised near the incision and indented in the center. I treat both patterns at the same time.

Do creams work on atrophic or hypertrophic scars?

Topicals may soothe and hydrate the surface, but they often can’t reach deep enough to correct the structure of the scar.

How many sessions does it take to improve these scars?

Most clients see visible changes within 2 to 4 sessions. Milder cases may improve significantly in 6 sessions, while complex or older scars may take 8 to 18 sessions.

Your Scar Deserves to Be Understood

Whether your scar rises above the skin or sinks below it, it tells a story. Hypertrophic or atrophic, new or old, scars can be softened, improved, and cared for. My care is gentle and regeneration-first, with a treatment plan designed for your specific scar and a warm, non-judgmental space. Whether your scar comes from surgery, acne, trauma, or pregnancy, book a consultation, and we will walk this journey together. If your scar is part of your breast reconstruction story, I also offer 3D areola tattooing.

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Natalia Mejía
Scar Specialist and Paramedical Tattoo Artist | Manhattan