Hypertrophic and Keloid
Hypertrophic & Keloid Scar Treatment in Melbourne
Specialist care for raised, symptomatic, and progressive scars.
Hypertrophic and keloid scars occur when the normal wound-healing process becomes dysregulated, leading to excessive collagen deposition, persistent inflammation, and abnormal scar growth. These scars may be raised, firm, itchy, painful, or cosmetically distressing, and in the case of keloids, may continue to enlarge beyond the original wound.
At The Skin Doctor, we provide expert hypertrophic and keloid scar treatment in Melbourne, using a multimodal, evidence-based approach that combines prevention, injectable therapies, and advanced laser techniques. Treatment plans are individualised based on scar biology, location, skin type, and patient risk factors.
Hypertrophic and Keloid
Hypertrophic vs Keloid Scars: What’s the Difference?
Although often grouped together, hypertrophic and keloid scars behave differently and require different management strategies.
Hypertrophic Scars
- Raised and thickened scars
- Confined to the original wound edges
- Often appear within weeks of injury
- May gradually soften or flatten over time
Keloid Scars
- Extend beyond the boundaries of the original wound
- May continue to grow for months or years
- Rarely resolve without medical treatment
- Commonly occur on the chest, shoulders, upper back, jawline, neck, and earlobes
Both scar types are driven by excess collagen production, prolonged inflammation, abnormal fibroblast activity, and mechanical tension on the wound (1,2).
Not All Hypertrophic or Keloid Scars Are Surgical
While surgery is a common trigger, abnormal scarring can develop after many forms of skin injury, including:
- Vaccinations and medical injections
- Acne lesions (especially chest, back, jawline)
- Cuts, burns, or traumatic wounds
- Ear and cartilage piercings
- Insect bites and inflammatory skin conditions
In genetically predisposed individuals, even minor skin trauma can result in pathological scarring (1,3).
Hypertrophic and Keloid
Who Is at Higher Risk?
Risk factors for hypertrophic and keloid scarring include:
- Personal or family history of keloids
- Previous keloid formation after minor injury
- High-risk anatomical sites:
○Chest or sternum
○Shoulders and upper back
○Jawline, neck, earlobes
- High wound tension or scars crossing joints
- Delayed healing or wound infection
- Younger age
- Darker skin phototypes
Identifying these factors early allows preventative strategies to be implemented before abnormal scarring becomes established (1,2).
Hypertrophic and Keloid
Prevention Begins at the Time of Surgery
The strongest evidence consistently shows that prevention is the most effective scar treatment (1).
Meticulous Surgical Technique
Where surgery is performed, we focus on:
- Layered wound closure to reduce dermal tension
- Careful incision planning along relaxed skin tension lines
- Minimising inflammation and mechanical stress
Reducing tension and inflammation at the outset significantly lowers the risk of hypertrophic and keloid scarring (1,4).
Early Scar Care and Silicone Therapy
Once the surface skin has healed, we strongly recommend:
- Silicone gel or silicone sheeting
- Consistent daily use for several months
- Protection from friction, stretching, and sun exposure
Silicone therapy is considered first-line, non-invasive management and has strong evidence for reducing scar thickness, erythema, and symptoms such as itch (1,4).
Hypertrophic and Keloid
Who Is at Higher Risk?
Risk factors for hypertrophic and keloid scarring include:
- Personal or family history of keloids
- Previous keloid formation after minor injury
- High-risk anatomical sites:
○Chest or sternum
○Shoulders and upper back
○Jawline, neck, earlobes
- High wound tension or scars crossing joints
- Delayed healing or wound infection
- Younger age
- Darker skin phototypes
Identifying these factors early allows preventative strategies to be implemented before abnormal scarring becomes established (1,2).
Hypertrophic and Keloid
Preventative Steroid or 5-Fluorouracil Injections (Selected Cases)
In carefully selected high-risk patients, early intralesional therapy may be considered.
Options include:
- Triamcinolone (TAC)
- 5-Fluorouracil (5-FU)
These agents suppress fibroblast proliferation and excessive collagen synthesis. However, they are not routine, as they may impair wound healing or increase skin fragility. Decisions are always individualised (2,5).
Treatment of Established Hypertrophic & Keloid Scars
Once a raised scar is established, combination therapy consistently outperforms single-modality treatment (2,6).
Intralesional Injection Therapy
Steroid (Triamcinolone) Injections
Triamcinolone remains a first-line treatment for raised scars and can:
- Reduce scar thickness
- Improve pliability
- Decrease itch and pain
Response rates range from 50–90%, but recurrence is common when steroids are used alone (1,6).
5-Fluorouracil (5-FU)
5-FU inhibits fibroblast proliferation and collagen synthesis without causing tissue necrosis.
Systematic reviews and meta-analyses show that:
- TAC + 5-FU is significantly more effective than either agent alone
- Combination therapy improves scar height, pliability, and symptoms
- Side-effect rates are lower than steroid monotherapy (6,7)
Botulinum Toxin (Selected Scars)
Recent network meta-analyses suggest that botulinum toxin combined with TAC may be among the most effective injectable combinations for pathological scars, likely due to tension reduction and fibroblast modulation (8).
Hypertrophic and Keloid
Laser Treatment for Hypertrophic & Keloid Scars
Laser therapy plays a central role in modern scar management and is rarely used in isolation.
What the Evidence Shows
A 2024 systematic review and network meta-analysis evaluating laser treatments for hypertrophic and keloid scars concluded that fractional ablative laser combined with intralesional therapy produced the greatest improvements in Vancouver Scar Scale (VSS) scores and scar thickness (9).
Laser therapy works by:
- Reducing abnormal vascularity
- Inducing controlled collagen remodelling
- Improving scar pliability and texture
Enhancing penetration and effectiveness of injectable agents (laser-assisted drug delivery)
Hypertrophic and Keloid
Fractional Ablative Laser
Fractional CO₂ and Er:YAG lasers create microscopic treatment channels that:
- Stimulate collagen remodelling
- Increase fibroblast apoptosis
- Reduce TGF-β–driven fibrosis
When combined with intralesional therapies (especially 5-FU or TAC), fractional lasers consistently outperform monotherapy in reducing scar height and stiffness (9,10).
Hypertrophic and Keloid
Vascular Lasers (PDL, Nd:YAG)
Vascular lasers reduce erythema and scar vascularity and are particularly useful in:
- Early hypertrophic scars
- Red, inflamed, symptomatic scars
They are often combined with fractional lasers or injections as part of a staged plan (1,4).
Hypertrophic and Keloid
Personalised Scar Treatment Plans in Melbourne
There is no single treatment that suits every hypertrophic or keloid scar.
Effective management often involves:
- Early prevention and monitoring
- Timely escalation to injections or laser therapy
- Combination treatments rather than monotherapy
- Long-term follow-up with realistic expectations
Our goal is meaningful, durable improvement, not aggressive overtreatment.
Hypertrophic and Keloid
Book a Hypertrophic or Keloid Scar Consultation
You may benefit from assessment if you have:
- A raised, itchy, painful, or growing scar
- A history of keloid scarring
- Concerns about scarring after surgery, acne, injury, or injections
FAQs
Frequently Asked Questions
What causes hypertrophic and keloid scars?
They result from excessive collagen production driven by inflammation, wound tension, and genetic predisposition (1).
Will my scar go away on its own?
Hypertrophic scars may gradually improve. Keloid scars rarely resolve without treatment and may continue to grow (1,2).
Are steroid injections effective?
Yes, but recurrence is common when used alone. Combination therapy provides better outcomes (6).
What is the role of 5-FU?
5-FU suppresses fibroblast activity and is particularly effective when combined with steroids or laser therapy (6,7).
Can laser treatment help raised scars?
Yes. Laser therapy improves redness, thickness, pliability, and enhances injectable treatments (9).
Can these scars be prevented?
Often, yes — especially with tension reduction, silicone therapy, and targeted prevention in high-risk patients (1,4).
Will my scar completely disappear?
Treatment aims to significantly improve appearance and symptoms. Complete disappearance is uncommon.
Hypertrophic and Keloid
References
1.Elsaie ML. Update on management of keloid and hypertrophic scars: A systematic review. J Cosmet Dermatol. 2021.
2.Murakami T, Shigeki S. Pharmacotherapy for keloids and hypertrophic scars. Int J Mol Sci. 2024;25:4674.
3.Ogawa R. Pathological scarring and genetic risk factors. Exp Dermatol. 2021.
4.Gold MH et al. Updated international clinical recommendations on scar management. Dermatol Surg. 2014.
5.Ledon JA et al. Intralesional treatments for keloids and hypertrophic scars. Dermatol Surg. 2013.
6.Wu W et al. Comparing efficacy of injected drugs for hypertrophic and keloid scars: Network meta-analysis. Aesth Plast Surg. 2023.
7.Ren Y et al. TAC vs TAC+5-FU for hypertrophic scars and keloids: Meta-analysis. Int Wound J. 2017.
8.Wu W et al. Botulinum toxin–based combination therapy for pathological scars. Aesth Plast Surg. 2023.
9.Foppiani JA et al. Laser therapy in hypertrophic and keloid scars: Systematic review and network meta-analysis. Aesthetic Plast Surg. 2024.
Elsaie ML et al. Fractional laser platforms and laser-assisted drug delivery in scars. J Drugs Dermatol. 2010.