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Hypertrophic Scar: What it is and what is the best way to deal with it

Hypertrophic scar, unlike keloids, is successfully treated in percentages that now reach 90% thanks to gels and silicone sheets.

Hypertrophic scars are not dangerous or painful but for many people, they are a major aesthetic issue. Science continues to study them as the exact reason for their creation hasn’t yet been determined so that it can eliminate them. However, there are a variety of treatments that can minimize their size and appearance.

If you are looking for a way to stop or get rid of a hypertrophic scar as quickly as possible, then you are looking for gel and silicone sheets as the vast majority of studies show a 65% to 90% improvement.

What is a hypertrophic scar?

The Scarring is not something that can be avoided as it is an integral part of the wound healing process.

In order for a scar to form, the deeper layers of the skin must have been damaged, causing changes in both its structure and functionality. So, deep wounds lead to scars. The scar tissue that forms has significant differences in both quality and texture compared to the surrounding skin tissue in the wound area.

During the last stage of normal healing of a wound, our body produces and deposits collagen in the scar area. Often, however, for reasons that science has not yet determined, there is overproduction of collagen by fibroblasts and the scars that form become hypertrophic and then can develop into keloids.


  1. Hypertrophic scars are flat or protrude slightly (not more than 4mm) above normal skin
  2. They never exceed the limits of the original scar, ie they don't extend beyond the traumatic surface
  3. They usually have the color of the skin but sometimes they are slightly reddish or darker
  4. They are asymptomatic, completely painless and are never accompanied by itching
  5. They rarely go away over time without treatment
διαφορες χηλοειδων και υπερτροφικων ουλων

What causes it

In general, we can not predict whether an injury will lead to hypertrophic scarring. But what has been observed and all research agrees is that those who have had a hypertrophic scar in the past are more likely to develop a hypertrophic scar.

More specifically, genetic predisposition probably plays the most decisive role since the fact that hypertrophic scars and keloids are 15 times more likely to occur in people with darker skin shows genetic influences. They are also more common in the female population. However, no gene has been identified that correlates them.

Usually a hypertrophic scar is formed after:

Although they can occur at any age, they tend to develop during and after adolescence and are rare in young children and the elderly. This must be related to the skin of young people which is more elastic than the skin of older people.

They have also been linked to endocrine factors as menopause causes remission of hypertrophic scars and keloids, while the complete opposite occurs during pregnancy.

If it is a postoperative scar then the surgeon skills play a very important role since the incision and its direction in relation to the skin shows that sometimes it favours the development of the postoperative scar into hypertrophic.

Of course, science continues to research the complete and thorough justification of hypertrophic scars.

Treatment of hypertrophic scars

Hypertrophic scars are much more successful and improved than keloids in various treatments. Of course, since science is still unable to eradicate them completely, our realistic goal is to improve their image as much as possible, making them flatter, less visible and aesthetically acceptable.

Non-invasive treatments

1. Gel and silicone dressing sheets

There are several non-surgical options for treating hypertrophic scars but one has stood out from the early 1980s to the present and is the use of gel and silicone sheets..

Scientists are still trying to understand why this treatment has such spectacular results..

Most studies agree that the pressure exerted onto the scar reduces tissue metabolism and increases the degradation of collagen within the wound. On the other hand, recent research shows that you may not only owe it to the pressure but to the hydration of the wounds due to the accumulation of moisture on the surface of the skin under the silicone sheet.

Whoever proves to be the action mechanism of silicone sheets, it is certain that they are the best and most economical means of prevention against the formation of hypertrophic scars and their treatment. They have better results:

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2. Pressure garments

You can apply extra pressure to the scar area with pressure garments, bandages or tape to help weaken the scar tissue. Of course, pressure garments are usually recommended in burn scars treatment.

3. Massage

Although massage has traditionally been considered beneficial for scar management in general, recent research shows that it can only work on mature scars. The same is suggested by the British Skin Foundation.

4. Hypertrophic scar creams

It should be noted that there are not enough clinical studies to certify the effects of creams for hypertrophic scars.

Many people recommend creams with vitamin E (alpha-tocopherol) considering that its antioxidant properties will prevent scars. However, many patients develop dermatitis that actually delays healing.

A very popular choice in recent years are gels and creams with onion extract which are believed to help with scar healing. However, most research shows that they are not effective except perhaps to reduce redness. The same goes for the various Bio Oils in the market.

Moisturizing creams with active substances from plant extracts such as vetasitosteroli, centella asiatica and the bulbine frutescens is likely to have some benefits for wound healing. All manufacturers of such products, of course, emphasize their preventive use and make it clear that they have no effect on well-established hypertrophic scars and keloids.

Invasive treatments

1. Corticosteroid injections

The most popular mild invasive treatment for hypertrophic scars. With steroid injections on the scar every 4-6 weeks it can soften the area. Unfortunately, injection of corticosteroids is painful even in small doses and many patients experience side effectssuch as hypochromatosis, cutaneous and subcutaneous fat atrophy and telangiectasias.

This is why there is always a limit to the number of injections while several times the treatment is ineffective or the hypertrophic scar returns after a while.

2. Laser

Laser treatment flattens the scar by burning it. It is more effective in recent and small hypertrophic scars than in older scars and sometimes has absolutely no effect on them.

Of course, this is a type of surgery and requires local anesthesia. It has mild side effects such as pain, swelling, redness and temporary oozing but usually disappear within a few days. 

Βέβαια Hypertrophic scars laser treatment is quite expensive, always depending on the size and number of scars, while it is always accompanied at least with gel or silicone sheets for better results.

3. Cryotherapy

Another alternative surgery that requires anesthesia is cryotherapy for hypertrophic scars. It works similar to a laser except that the doctor or dermatologist doesn’t burn but freezes the scar tissue with liquid nitrogen to minimize it.

Cryotherapy is a new method of treating scars and is considered safe, non-toxic and well-tolerated in some small studies. It is also expensive and must be combined with non-invasive treatments.

4. Plastic Surgery

Plastic surgical removal and repair of a hypertrophic scar is not always possible. But if conditions allow then it rarely recurs. The new scar takes time to show its final form but for better results and to minimize the risk of developing a new scar, doctors strongly recommend the use of gel and silicone sheets postoperatively..

Useful tips for the prevention and treatment of hypertrophic scars

Consult your doctor

Your personal doctor is best placed to advise you on the care and management of scars after knowing your full medical background.

Take good care of your scar

Keep the scar area dry and clean. It is the best way to prevent inflammation and irritation, achieving normal healing.

Use gel and silicone sheets

All clinical studies and doctors recommend it as the first line therapy for effective treatment of hypertrophic scars. Where there is difficulty in applying the sheets, the gap fills the gel.

Protect yourselves from the sun

Exposure to sunlight causes hyper-pigmentation of the scars increasing the chances of hypertrophy. If the scar is not covered by clothes or a silicone sheet then sunscreen with high SPF is your best friend.

Don't smoke

Smoking does nothing good but in this case reduces the amount of oxygen that reaches the skin, hindering healing. Quitting smoking plays a very important role in the proper and fast healing of a scar..

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