Hypertrophic Scar Treatment: Prevention and Management Strategies

When your body heals a wound, it sometimes produces too much collagen, creating a raised, firm scar that stays within the original injury borders. These hypertrophic scars differ from keloids, which grow beyond wound edges and rarely shrink on their own. Whether you’re recovering from surgery, a burn, or an injury, these prominent scars can be concerning. The good news: with the right hypertrophic scar treatment approach started early, most scars can be significantly improved. 

What Exactly Is a Hypertrophic Scar? 

A hypertrophic scar forms when your body’s normal wound-healing process goes into overdrive during the remodeling phase. Instead of producing just enough collagen to close and strengthen the wound, your fibroblast cells manufacture excessive amounts of this structural protein. The result is a raised, often red or pink scar that remains confined to the boundaries of the original injury. 

Unlike normal scars that flatten and fade over 12–18 months, hypertrophic scars can remain elevated for years without intervention. These scars most commonly appear after surgery, burns, deep lacerations, or other injuries that affect the deeper dermal layers of the skin. Timing matters: hypertrophic scars typically develop within 4–8 weeks after injury, reaching their maximum height around 3 months post-injury. 

Collagen Overdrive: How Excess Fibers Form 

Understanding the wound-healing timeline helps explain why some scars become hypertrophic. Routine healing progresses through four overlapping phases: hemostasis (immediate clotting), inflammation (days 1–6), proliferation (days 4–21), and remodeling (3 weeks to 2 years). 

During the proliferative phase, fibroblast cells migrate into the wound bed and begin synthesizing collagen to rebuild tissue strength. In balanced healing, collagen production and breakdown exist in equilibrium. However, when this phase becomes exaggerated due to infection, mechanical tension, or genetic factors, fibroblasts deposit collagen faster than enzymes can break it down and reorganize it. 

This imbalance creates thick bundles of disorganized collagen fibers arranged in a wavy pattern, rather than the parallel basket-weave structure of normal skin. Blood vessels proliferate to support this active tissue, giving the scar its characteristic red or purple color. The scar rises above the surrounding skin surface as these collagen deposits accumulate, but crucially, they respect the original wound margins. 

Key Differences: Hypertrophic vs. Keloid vs. Normal Scar 

While hypertrophic scars and keloids both result from excessive collagen production, they behave quite differently. A hypertrophic scar remains within the original wound boundaries and often improves spontaneously over 1–2 years, though it rarely returns to completely normal skin. A keloid scar, by contrast, invades healthy tissue beyond the injury site, continues growing for months or years, and almost never regresses without treatment. 

Normal scars follow a predictable pattern: they start pink or red, gradually flatten, and fade to a color close to the surrounding skin within 12–18 months. Hypertrophic scars plateau in height and color intensity but resist natural flattening. Keloids show no plateau. They can expand indefinitely and have a recurrence rate of 50–100% after surgical removal without adjunctive therapy. 

Key takeaway: If your scar stays within the original wound edges and begins to improve after 6 months, it’s likely hypertrophic and has a good prognosis with appropriate treatment.

Who Is Most at Risk? 

Several factors increase your likelihood of developing hypertrophic scars. Genetics plays a significant role: if blood relatives form raised scars, your risk increases substantially. Age matters too, with young people between 10 to 30 years old showing higher rates due to more active fibroblast activity and faster collagen turnover. 

Skin pigmentation significantly influences scar formation. Individuals with darker skin tones, particularly Fitzpatrick skin types IV–VI, face a 15–20 times higher risk of both hypertrophic scars and keloids than lighter skin types. This reflects differences in how melanocytes and fibroblasts respond to injury. 

Anatomical location creates variable tension on healing wounds. Scars forming over high-tension areas, such as the chest, shoulders, upper back, knees, ankles, and joint lines, experience constant mechanical stress, which stimulates ongoing collagen production. Hormonal factors contribute, too. Pregnancy and puberty correlate with increased hypertrophic scar formation, likely due to elevated hormone levels that influence fibroblast behavior. 

Prevention Starts on Day One 

The most effective hypertrophic scar treatment is prevention. Great scars begin with great wound care, starting from the moment of injury or surgical incision. The biological window for scar prevention opens immediately after wound closure and remains critical for the first 3 months. 

Optimal Wound Closure & Moist Healing

Proper wound closure sets the foundation for minimal scarring. Whether your wound was sutured, stapled, or closed with adhesive strips, the goal is to approximate skin edges with minimal tension and no gaps. Deep wounds benefit from layered closure that distributes tension across multiple tissue planes rather than placing all stress on the surface. 

Once closed, maintaining a moist healing environment proves crucial. Contrary to the old “let it breathe” advice, keeping wounds appropriately moist speeds healing by 25–50% and reduces scar height. Modern wound dressings create this ideal environment while preventing infection, a critical consideration since infected wounds almost always form worse scars. 

Keep the wound covered with the dressing your healthcare provider recommends for at least 7–10 days. After that, you may transition to silicone-based products that continue providing moisture balance while adding mechanical benefits. 

Early Tension Management (Steri-Strips, Silicone Taping)

Mechanical tension is one of the strongest stimuli for hypertrophic scar development. Every time you move, the skin around the healing wound stretches, triggering fibroblasts to produce more collagen to strengthen the area. Reducing this tension early changes the biological signals your cells receive. 

Steri-strips or paper tape applied perpendicular to the wound immediately after closure provide external support that offloads tension from the healing tissue. Keep them in place continuously, replacing them if they peel off, for at least 2–3 weeks, or as directed by your surgeon. 

After initial healing, transition to silicone tape or specialized scar-prevention tapes. These products maintain hydration, apply gentle pressure, and shield the scar from stretching forces. This simple intervention can reduce final scar height by 30–50% in high-risk locations. 

UV & Sunlight Shielding to Curb Pigmentation

Sun exposure doesn’t directly cause hypertrophic scars to form, but it dramatically worsens their appearance through hyperpigmentation. Ultraviolet radiation stimulates melanocytes in healing tissue to produce excess pigment, creating dark red, brown, or purple discoloration that can persist for years even after the scar flattens. 

Shield all healing wounds and new scars from direct sunlight for at least 1 year. Use a broad-spectrum SPF 30 or higher sunscreen, reapplying every 2 hours when outdoors. Physical blockers containing zinc oxide or titanium dioxide work exceptionally well on scars since they’re less likely to irritate. Wide-brimmed hats protect facial scars, while lightweight long sleeves cover arm and shoulder incisions. 

Nutrition & Hydration for Balanced Collagen

Your body cannot build healthy tissue without proper building blocks. Collagen synthesis requires specific nutrients, and deficiencies in any of these can prolong healing and increase scar formation. 

Protein provides the amino acids that form collagen’s basic structure. Aim for at least 0.8–1.0 grams of protein per kilogram of body weight daily, increasing to 1.2–1.5 grams if you’re healing a large wound or recovering from surgery. Vitamin C serves as an essential cofactor for collagen synthesis. Without adequate vitamin C, your body produces weak, disorganized collagen regardless of protein intake. Consume at least 90 milligrams daily through citrus fruits, berries, bell peppers, and leafy greens. 

Zinc supports immune function and collagen cross-linking. Hydration matters too because collagen remodeling occurs in a water-rich environment. Aim for at least 8–10 cups of fluid daily. 

First-Line Home Treatments (Weeks 2–12)

Once your wound has closed and initial healing is complete, typically after 10–14 days, you can begin active scar management at home. These recommendations are based on the strongest available evidence, with silicone products serving as the gold standard for non-invasive care of hypertrophic scars. 

Silicone Gel Sheets & Silicone Ointments

Silicone products are the most widely studied and proven treatments for hypertrophic scar prevention and management. Multiple systematic reviews confirm that silicone gel sheets reduce scar height, redness, and stiffness when used consistently for at least 12 weeks. They are considered first-line therapy for virtually all patients with elevated scars or those at high risk for developing them. 

The mechanisms behind silicone’s effectiveness are still being fully understood, but current evidence points to several factors. Silicone creates an occlusive barrier that maintains optimal hydration at the skin surface, which appears to downregulate fibroblast activity and reduce excessive collagen production. 

For silicone gel sheets, cut the sheet slightly larger than your scar and apply it to clean, dry skin. Wear the sheet for 12–24 hours daily, removing it only for cleaning. Wash the sheet daily with mild soap and water, let it air dry, and reapply. Most sheets remain adhesive for 1–2 weeks before requiring replacement. You should see measurable improvement in scar appearance after 8–12 weeks, though continue use for at least 6 months for maximum benefit. 

Silicone gel ointments offer an alternative for irregular surfaces, large areas, or patients who cannot tolerate the occlusion of sheets. Apply a thin layer twice daily and allow it to dry, forming a flexible, breathable film. The evidence strongly supports silicone: studies show 30–86% improvement rates in scar appearance, with the best results in patients who begin treatment early and maintain consistent use. 

Daily Scar Massage & Mobilization Techniques 

Scar massage helps reorganize collagen fibers, improve tissue flexibility, and may reduce excessive thickness through mechanical signals that downregulate fibroblast activity. Begin massage once the wound is fully closed and any scabs have fallen off naturally, which typically occurs 2–3 weeks post-injury. 

Step-by-step technique: 

• Ensure the scar is clean and apply a small amount of unscented moisturizer or silicone gel to reduce friction. 
• Using your fingertips or thumb, apply firm but comfortable pressure directly to the scar. The pressure should blanch (whiten) the tissue without causing pain. 
• Massage in small circular motions for 30–60 seconds in each spot, working along the entire length of the scar. 
• Next, perform linear massage by stroking across the scar perpendicular to its length, then parallel to it. Use firm, consistent pressure, repeating each direction 10–15 times. 
• Perform this routine 2–3 times daily for at least 5 minutes per session. Most patients notice improved softness and flexibility within 4–6 weeks, with continued improvement over months of consistent practice. 

Pressure Garment Therapy: When and How Long?

Pressure garments provide continuous mechanical compression that reduces hypertrophic scar formation, particularly on large surface areas such as burns or extensive surgical sites. The mechanism involves decreasing local blood flow and oxygen tension in the scar tissue, which appears to reduce fibroblast proliferation and collagen synthesis while promoting more organized fiber alignment. 

Pressure therapy works best when initiated early, ideally as soon as the wound has fully healed and no open areas remain, and worn consistently for 12–18 months. The garments must provide at least 15–25 mmHg pressure to be effective, which means they should fit snugly without cutting off circulation or causing pain. The garments should be worn 23 hours daily, removing them only for bathing and garment cleaning. 

It’s important to have realistic expectations. Pressure garments can reduce scar height by 20–30% and significantly improve scar softness, but they won’t eliminate scars completely. The benefits are most dramatic for burn scars and very large hypertrophic scars, where other treatments may be impractical. 

Onion-Extract & Other OTC Topicals: Truth vs. Hype 

Walk into any pharmacy and you’ll find numerous over-the-counter scar treatments promising dramatic improvement. The evidence behind these products varies widely, so it’s important to separate marketing claims from scientific reality. 

Onion extract, marketed under brands such as Mederma and Contractubex, is among the most heavily promoted topical scar treatments. However, clinical evidence is disappointing. Multiple controlled studies comparing onion extract to petrolatum or silicone have found no significant difference in scar appearance. 

Vitamin E, another popular ingredient, has similarly failed to demonstrate benefit in controlled trials. In fact, one-third of study participants who applied vitamin E developed contact dermatitis, an allergic skin reaction, with no improvement in scar appearance compared to untreated scars. Avoid vitamin E application on healing wounds and scars due to its high irritant potential without proven benefit. 

Balanced recommendation: Stick with evidence-based treatments, such as silicone products, for your foundation therapy. The most essential ingredients in any scar treatment are your consistency and patience, not exotic botanical extracts or miracle compounds. 

Professional Medical Interventions 

While home treatments can significantly improve many hypertrophic scars, some cases require professional intervention for optimal results. Consult a dermatologist, plastic surgeon, or wound care specialist if your scar hasn’t responded to 3 to 6 months of consistent home therapy, if it’s causing functional limitations, or if you’re experiencing significant pain or itching. 

Healogics wound care solutions include expert evaluation of problematic scars and coordination with appropriate specialists when advanced interventions are needed. 

Corticosteroid or Steroid + 5-FU Injections (Protocols & Side Effects)

Intralesional corticosteroid injections represent the most common professional intervention for hypertrophic scars. The medication, typically triamcinolone acetonide at concentrations of 10–40 mg/mL, is injected directly into the scar tissue where it reduces inflammation, suppresses fibroblast activity, and promotes collagen breakdown. Response rates range from 50–100%, with the best results in newer, more vascular scars. 

The typical protocol involves injections every 4–6 weeks for a series of 3–6 treatments. Common side effects include temporary pain or stinging at injection sites, skin atrophy (thinning) if doses are too high, and hypopigmentation (lightening) that may be permanent, particularly in darker skin tones. 

For scars that respond poorly to steroids alone, combining triamcinolone with 5-fluorouracil (5-FU), a chemotherapy agent that inhibits fibroblast proliferation, can enhance results. This combination shows promise for resistant hypertrophic scars and may reduce keloid recurrence rates. 

Laser & Light Therapies (PDL, Fractional CO₂, IPL)

Laser treatments target different aspects of hypertrophic scar pathology depending on the wavelength and mechanism. Pulsed dye laser (PDL) specifically targets the small blood vessels that give hypertrophic scars their red color. Over a series of 3–6 treatments spaced 4–8 weeks apart, PDL can significantly reduce redness, thickness, and symptoms like itching. 

Fractional CO₂ laser takes a different approach, creating thousands of microscopic columns of controlled thermal damage through the scar tissue. This ablative process removes damaged collagen and triggers controlled wound healing, ideally producing more organized, flatter tissue. Treatment requires 3–5 sessions spaced 4–6 weeks apart, with significant downtime in between. Expect redness, swelling, and crusting for 7–10 days after each session. 

The results from fractional CO₂ can be dramatic, with 30–70% improvement in scar texture and height, but the treatment is more aggressive than PDL and carries a higher risk of hyperpigmentation in darker skin types. Strict sun avoidance and sun protection for several months after treatment are mandatory. 

Cryotherapy & Cryoshape for Thick Fibrous Tissue

Cryotherapy uses controlled freezing to damage hypertrophic scar tissue, reducing its height and vascularity through selective cell death and inflammation. Surface cryotherapy involves applying liquid nitrogen for 10–30 seconds per site, sometimes repeated 2–3 times in a single session. Treatments are typically repeated every 4–6 weeks for 3–6 sessions. 

Intralesional cryotherapy delivers more aggressive freezing directly to the scar’s core, making it suitable for very thick, fibrous hypertrophic scars that haven’t responded to other treatments. Expected outcomes include a 20–50% reduction in scar height after a full treatment series. 

The main risk is hypopigmentation, which is a permanent lightening of the treated skin. This occurs because melanocytes (pigment cells) are more sensitive to cold damage than fibroblasts. Discuss this trade-off with your provider before recommending cryotherapy, particularly for visible scars in individuals with Fitzpatrick skin types IV–VI. 

Surgical Scar Revision: Timing, Risks, Post-Op Care

Surgical scar revision involves excising the hypertrophic scar and re-closing the wound with meticulous technique to create a thinner, less noticeable scar. This option is appropriate when hypertrophic scars cause functional limitations, when they’re wide or poorly positioned, or when other treatments have failed. 

Timing is critical. Wait at least 12–18 months after the original injury before considering revision, to allow the scar to fully mature and soften on its own. Layered closure is essential; your surgeon will close the wound in multiple layers, placing absorbable sutures deep in the tissue to eliminate tension on the skin surface. 

Low-Dose Radiation for Refractory Scars (When Benefits Outweigh Risks)

Low-dose radiation therapy represents a powerful but carefully considered option for hypertrophic scars that have proven resistant to all other treatments. External beam radiation or brachytherapy delivers targeted radiation to the scar tissue, inhibiting fibroblast proliferation and collagen synthesis at a cellular level. 

The typical protocol involves delivering radiation within 24–48 hours after surgical excision, before wound healing fully activates fibroblasts. Success rates for preventing keloid recurrence after surgical excision reach 80–90% with appropriate radiation. For hypertrophic scars specifically, radiation is reserved for exceptional cases where functional limitation or severe symptom burden justifies the intervention. 

Emerging & Adjunctive Approaches

Medical research continues to advance our understanding of hypertrophic scar formation and to develop new treatment modalities. While some of these approaches remain experimental or have limited clinical data, they offer promising options for patients who don’t respond adequately to standard treatments. 

Microneedling With or Without PRP

Microneedling, also called percutaneous collagen induction, uses a device with fine needles to create hundreds of microscopic punctures in the scar tissue. This controlled injury triggers a wound-healing response that ideally produces more organized collagen and improves scar texture. Early study outcomes show promising results, with 30–50% improvement in scar appearance after 3–6 sessions spaced 4–6 weeks apart. 

Botulinum Toxin for Tension Reduction 

Injecting botulinum toxin (Botox, Dysport) around healing wounds or established scars represents an innovative approach to reducing mechanical tension, one of the key drivers of hypertrophic scar formation. The toxin temporarily paralyzes muscles surrounding the wound, reducing movement and tension across the healing tissue for approximately 3–4 months. Small-study results are encouraging, with improvements of 20–40% in standardized scar scales. 

Stem-Cell & Regenerative Therapies on the Horizon

The frontier of scar treatment involves harnessing regenerative medicine to fundamentally alter how wounds heal. Researchers are investigating cultured fibroblasts, adipose-derived stem cells, and bioengineered matrices that could someday prevent hypertrophic scars from forming or reverse established ones at a cellular level. While promising in animal models and early human trials, these technologies remain years away from routine clinical use. 

Lifestyle & Self-Care for Ongoing Remodeling (Months 3–24)

Scar maturation is a marathon, not a sprint. While the first three months are critical, the remodeling phase continues for 1 to 2 years after injury. During this extended period, your daily choices regarding activity, stress, sleep, and self-care continue to influence the final scar appearance. 

Tracking Progress: Photo Logs & Scar-Scale Apps

We encourage a photo documentation regime. Take standardized photographs monthly using consistent lighting, distance, and angles. Use natural daylight rather than harsh artificial lighting. Store these photos chronologically in a dedicated folder or app where you can easily compare them. Review photos from three and six months prior rather than comparing to last month. This longer timeframe makes improvements much more apparent. 

Stress, Sleep, and the Cortisol-Collagen Link

Your body’s stress response directly impacts wound healing and scar remodeling. Chronic psychological stress elevates cortisol and other stress hormones that impair collagen organization, prolong inflammation, and may worsen hypertrophic scar formation. Sleep quality matters too. During deep sleep, your body releases growth hormone and other factors that support tissue repair. 

Two practical stress-management techniques we recommend: First, practice deep breathing exercises for five minutes twice daily. Second, establish a consistent sleep schedule with a wind-down routine that begins thirty minutes before bed; dim lights, avoid screens, and consider light stretching or reading. 

Clothing Choices & Friction Control

Mechanical irritation from clothing can perpetuate inflammation in remodeling scars, particularly those over mobile areas like shoulders, chest, or joints. We recommend choosing soft, smooth fabrics like cotton, bamboo, or moisture-wicking athletic materials that reduce friction against healing tissue. For scars along bra lines, waistbands, or other areas where elastic comes into contact, consider using soft cotton fabric as a protective barrier. 

Moving Forward with Confidence

Managing hypertrophic scars requires patience, consistency, and the right combination of preventive care and targeted interventions. While we cannot always prevent these scars from forming, early action that begins with optimal wound care and continues through months of silicone therapy, massage, and lifestyle support can make a meaningful difference in the final appearance and function. Trust the process, track your progress, and remember that meaningful scar maturation can continue for up to 2 years after injury. 

When to Seek Specialist Help

Seek specialist consultation if your scar shows rapid thickening despite treatment, particularly if it begins growing beyond the original wound borders. Progressive functional limitation, such as increasing difficulty moving a joint crossed by the scar or tightness that worsens rather than improves over time, warrants evaluation for possible wound debridement or surgical release. 

Severe or worsening pain and pruritus (itching) that interfere with sleep or daily activities deserve professional attention. If you’ve been consistently following a comprehensive home treatment program for three to six months without measurable improvement, it’s time to consult a specialist about advanced wound care. 

At Healogics, our mission is FIND. TREAT. HEAL.™. If you have any questions about your healing journey, please click here to schedule an appointment at a Wound Care Center® near you. 

Frequently Asked Questions (FAQ) 

Can a hypertrophic scar turn into a keloid over time?

No, hypertrophic scars do not transform into keloids. These are distinct entities with different biological behaviors. Hypertrophic scars stay within original wound boundaries and often improve with time, while keloids invade healthy tissue beyond injury margins and rarely regress spontaneously. However, if you’re genetically predisposed to keloids, a new injury can trigger keloid formation independent of any existing hypertrophic scar. 

How long before I see results from silicone gel sheets?

Most patients notice initial improvements in scar softness and redness within six to eight weeks of consistent daily use. A meaningful reduction in scar height typically takes 12 to 16 weeks. The maximum benefit usually appears after 6 to 12 months of continuous use. Remember that silicone gel sheets work best when worn for at least 12 hours daily, preferably 24, so consistency directly impacts how quickly you’ll see results. 

Are laser treatments safe for darker skin tones?

Laser treatments can be safe for darker skin when performed by experienced providers using appropriate settings and wavelengths. The pulsed dye laser works well across all skin types with appropriately adjusted parameters. Ablative lasers, such as fractional CO₂, carry a higher risk of hyperpigmentation in Fitzpatrick skin types IV through VI but can still be used cautiously. Always seek providers with specific experience treating darker skin to minimize complications. 

What side effects can occur with steroid injections?

Common side effects include temporary pain at injection sites, skin thinning (atrophy), and hypopigmentation that may be permanent, especially in darker skin. You might also develop small visible blood vessels called telangiectasias. Rarely, steroids can cause fat atrophy beneath the injection site, creating a depression. These risks increase with higher doses and more frequent treatments, which is why injections are carefully spaced four to six weeks apart. 

Is there any way to completely remove a hypertrophic scar?

Complete removal, meaning skin returns to its absolutely normal appearance, is rarely achievable with current treatments. However, we can often improve hypertrophic scars by seventy to ninety percent, making them significantly less noticeable. Combination approaches using silicone therapy, injections, laser treatments, and sometimes surgical revision yield the best results. The goal is optimization rather than perfection, creating scars that are soft, flat, and closely match the surrounding skin in color.