Hypertrophic Scar vs Keloid, What’s the Difference Between Both?
What’s the Difference Between a Keloid and a Hypertrophic Scar?
At Natalia Mejia Skin, I meet so many clients who come in feeling unsure about the scars on their body. Some have been told they have a keloid, while others wonder should you tattoo over keloids safely. Others aren't sure if what they're seeing is normal healing or need to understand what does a hypertrophic scar look like to differentiate between scar types properly. And many are just looking for clarity, reassurance, and a path forward.
One of the most common questions I get is:
“How do I know if I have a keloid or a hypertrophic scar?”
Let’s walk through this together — gently and clearly — so you can better understand your skin and feel more empowered to care for it.
First, what is a scar?
A scar is your body’s natural response to skin injury. When the skin is wounded — whether from surgery, a burn, acne, or even a scratch — the body starts healing by producing collagen to close and strengthen the area. In most cases, the scar fades and flattens over time, following predictable scar healing over time patterns. Understanding scar heal time variations helps patients recognize when healing deviates from normal and may indicate hypertrophic or keloid formation.
But sometimes, the healing process goes beyond what's needed — and that's where keloid and hypertrophic scars come in. Understanding hypertrophic scar causes and treatment options helps identify risk factors and early intervention opportunities.
Understanding Hypertrophic Scars
Hypertrophic scars are raised scars that stay within the boundaries of the original wound. They’re a bit thicker than flat scars and may appear red, pink, or dark brown depending on your skin tone.
Common characteristics of hypertrophic scars:
Raised and firm to the touch
May feel itchy or tender, especially at first
Stay within the limits of the original injury
Often improve with time and treatment, particularly when patients understand hypertrophic scar healing stages and whether hypertrophic scars go away naturally. Unlike keloids, hypertrophic scars typically show improvement when compared to hypertrophic scar vs atrophic scar healing patterns.
More common on areas with tension or movement (shoulders, chest, back, joints)
In simple words, a hypertrophic scar is like a scar that’s trying a bit too hard to protect you — but it doesn’t “invade” healthy skin around it. These scars often respond very well to regenerative treatments, microneedling, or silicone-based products. Proper preparation of scars before camouflaging is essential for optimal treatment outcomes with hypertrophic scars.
Common Locations for Hypertrophic Scars After Surgery
Hypertrophic scars frequently develop after surgical procedures, particularly in areas of tension. Breast reduction scars commonly develop hypertrophic characteristics, especially around incision lines subject to movement and tension.
Similarly, liposuction scars can become hypertrophic when proper healing protocols aren't followed. Understanding the 5 most common complications after liposuction includes recognizing when normal scars progress to hypertrophic formation.
Understanding Keloid Scars
Keloids go one step further. They’re the overachievers of the scar world — but not in a good way.
A keloid scar grows beyond the original wound. It spreads into surrounding healthy skin, often becoming larger than the initial injury. Keloids are much more unpredictable and may continue growing for months, even after the wound is closed.
Common characteristics of keloid scars:
Raised, shiny, and firm
Can be itchy, painful, or sensitive to the touch
Grow beyond the borders of the original injury
Often have a smooth surface and irregular shape
May darken or remain pink depending on skin tone
More common in darker skin tones, and often run in families
Can form spontaneously, even from small injuries like piercings or bug bites
Keloids are not dangerous, but they can be emotionally and physically uncomfortable. Treating them requires a gentle and personalized approach — because they can react poorly to trauma, including tattooing or aggressive needling. This is why should you tattoo over keloids is such an important safety consideration, and why understanding how to prevent hyperpigmentation after surgery becomes crucial for keloid-prone individuals.
Hypertrophic vs. Keloid: A Quick Comparison
| Feature | Hypertrophic Scar | Keloid Scar |
|---|---|---|
| Growth pattern | Stays within original wound | Grows beyond original wound |
| Texture | Raised and firm | Raised, shiny, thick |
| Color | Red, pink, or brown | Pink, purple, or darker brown |
| Tendency to shrink over time | Often yes, especially with help | Rarely — may continue growing |
| Response to treatments | Responds well to regenerative care | Needs cautious, tailored plan |
| Risk factors | Tension in healing area | Genetics, darker skin tones |
Critical Timing Considerations for Treatment
The timing of intervention differs significantly between hypertrophic scars and keloids. The importance of long-term scar care becomes particularly relevant for hypertrophic scars, which often show improvement during this critical window.
For keloids, timing is even more crucial as they can continue growing well beyond the normal healing timeline. Understanding when intervention is safe versus when it might trigger additional growth requires specialized expertise and careful assessment.
How to Tell What You Have
Here are some gentle questions to ask yourself if you’re trying to figure out which type of scar you may be dealing with:
✨ Did the scar stay within the edges of the original injury?
— If yes, it’s more likely hypertrophic. If it spread out beyond, keloid is more likely.
✨ Did it keep growing months after the wound closed?
— Keloids can keep growing. Hypertrophic scars usually stop and begin to flatten over time.
✨ Is the scar tender, itchy, or shiny-looking?
— Both types can be itchy, but keloids are more likely to feel painful or tight, especially as they grow.
✨ Do you have a history of keloids?
— If you’ve had one before, there’s a higher chance it could happen again — even from a small injury like a piercing or vaccine shot.
✨ Are you unsure?
— If you’re not sure, you’re not alone. Many people confuse the two, and that’s completely normal.
You don’t have to figure this out by yourself.
Why This Difference Matters
At Natalia Mejia Skin, I always take the time to evaluate the scar before choosing any treatment path. The reason is simple:
Keloids and hypertrophic scars may look similar — but they behave very differently.
Treatments that work beautifully for a hypertrophic scar (like microneedling or camouflage tattooing) can trigger a keloid to grow worse if not handled properly. This is why understanding what is paramedical tattooing and what is camouflage tattoo procedures becomes essential before considering any intervention.
That’s why identifying the type of scar — and listening to the skin — is always the first step.
Supporting Healing Through Proper Care
Both hypertrophic scars and keloids benefit from optimal healing conditions. The benefits of hydration during the healing process apply to both scar types, though keloids require more cautious approaches to any intervention.
Understanding the role of nutrition in skin healing and scar reduction helps support the body's natural healing processes while minimizing the risk of excessive scar formation in predisposed individuals.
What Can Be Done?
If you’re dealing with either type of scar, there is help available. But it’s not one-size-fits-all.
For Hypertrophic Scars:
At Natalia Mejia Skin, I work with a regenerative approach using:
Microneedling with growth factors or stem cells
Organic peels to improve texture and color
Plasma energy to stimulate repair
Scar camouflage tattooing (once the tissue is stable), which can address both texture and color concerns. Understanding the popularity of scar camouflage tattoos and their psychological benefits helps patients appreciate the comprehensive approach to scar improvement.
Many clients see wonderful improvements in texture, pigmentation, and overall skin confidence with just a few sessions.
For Keloid Scars:
We take a more cautious, personalized route. I do not tattoo directly over keloids. Instead, I often recommend:
Gentle regeneration to reduce color and thickness
Topical support to soothe inflammation
Referrals to dermatologists for cortisone or laser if needed
Emotional support and realistic goals — because not all keloids disappear, but they can often become more manageable and less noticeable
Special Considerations for Reconstruction Cases
Patients undergoing reconstructive procedures must be especially vigilant about keloid formation. Areola tattoo reconstruction requires careful assessment for keloid tendency, as 3D areola tattoo design involves multiple punctures that could trigger keloid formation.
For reconstruction patients, understanding nipple reconstruction vs nipple tattoo options includes evaluating keloid risk as part of the decision-making process. Skin tone matching for realistic nipple simulation may require modified approaches for keloid-prone individuals.
Hypertrophic and Keloid Considerations for Stretch Mark Treatment
Patients considering stretch mark tattoo camouflage must be evaluated for hypertrophic and keloid tendencies. Understanding the healing process for stretch mark camouflage includes assessing individual scar formation patterns.
The cost of camouflage stretch marks may include additional safety protocols for patients with hypertrophic or keloid tendencies, and understanding potential stretch mark camouflage side effects becomes particularly important for these patients.
A Gentle Reminder
It’s easy to feel frustrated when your scar doesn’t look or feel the way you hoped. Especially if it’s large, raised, or reminds you of a difficult experience.
But please know — your scar is not a flaw.
It’s a sign that your body tried to heal you. And now, there are ways to help that process along, lovingly and professionally.
You Deserve to Feel Good in Your Skin
Whether you’re just starting to explore treatment options or have tried other solutions that didn’t work, I’m here to help guide you. Every scar is a story — and every story deserves to be heard and honored.
If you’re unsure about what type of scar you have or how to treat it safely, I invite you to book a consultation. I'll take the time to assess your skin and explain what we can do, step by step. Whether you need scar camouflage tattoo, scar revision, stretch marks treatment, or nipple and areola reconstruction, proper scar type identification is the foundation of safe, effective treatment.
With love,
Natalia Mejia
✨ Specializing in scar regeneration, camouflage, and confidence restoration.
📍 Based in New York City