What’s the Difference Between a Keloid and a Hypertrophic Scar?
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. Others aren’t sure if what they’re seeing is normal healing. 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.
But sometimes, the healing process goes beyond what’s needed — and that’s where keloid and hypertrophic scars come in.
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
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 gentle regenerative treatments, microneedling, or silicone-based products.
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.
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 |
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.
That’s why identifying the type of scar — and listening to the skin — is always the first step.
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)
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
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.
With love,
Natalia Mejia
✨ Specializing in scar regeneration, camouflage, and confidence restoration.
📍 Based in New York City