Understanding Hypertrophic, Atrophic & Keloid Scars

When you hear bad scar, you probably picture something raised, red, or very visible. But in medical terms, good vs. bad scars aren't about judgment, it’s about how the scar behaves, feels, and responds to treatment.

Understanding hypertrophic scars, atrophic scars, and keloid scars can help you know when a scar is part of normal healing and when it’s time to involve a specialist, adjust your scar-care routine, or both.

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What Is a Good Scar?

A good scar is one that heals in a way that blends into the surrounding skin over time:

• Flat or slightly thin
  
  
• Soft and flexible
  
  
• Similar color to nearby skin (or gently lighter)
  
  
• Not painful, itchy, or tight
  
  

Most surgical scars, when well cared for, follow this path, they start out pink or red, feel a bit firm, and then gradually flatten and fade over 12–18 months as collagen remodels.

Topical support like silicone-based scar cream, hydration, UV protection, and gentle massage can help guide this kind of good healing, especially in the first year after surgery.

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What is a Bad Scar?

A scar starts to be considered “bad” (clinically, problematic or pathologic) when it:

• Becomes very raised or thickened
  
  
• Sinks in or leaves a pitted indentation
  
  
• Grows beyond the original wound edges
  
  
• Feels tight, painful, or very itchy
  
  
• Interferes with movement or draws unwanted attention
  
  

The three common types of “bad” scars people ask about are:

1. Hypertrophic scars – raised scars within the original wound.
   
   
2. Keloid scars – overgrown scars that extend beyond the wound.
   
   
3. Atrophic scars – sunken or depressed scars, often from acne or volume loss.
   
   

Let’s break them down.

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What Are Hypertrophic Scars and How Do You Recognize Them?

Hypertrophic scars are:

• Thick, raised, and sometimes red or pink.
  
  
• Confined to the exact footprint of the original incision or injury.
  
  
• Common after surgery, burns, or wounds in high‑tension areas (chest, shoulders, joints).
  
  

They often appear within weeks of the injury. The key features:

• Raised and firm, but not spilling past the scar line
• May itch or feel tight
  
  
• Can slowly improve or flatten over time
  
  

Treatment options for hypertrophic scars often include:

• Silicone gel or silicone sheets
  
  
• Pressure therapy or taping to reduce tension
  
  
• Intralesional corticosteroid injections
  
  
• Laser treatments (especially vascular lasers if the scar is red)
  
  

Hypertrophic scars are more responsive to treatment than keloids, but they still require the right strategy and often in-office care.

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How Do I Know If My Scar Is a Keloid?

Keloid scars are the “overachievers” of scar tissue:

• Raised, thick, often shiny
  
  
• Grow beyond the original wound edges into surrounding normal skin
  
  
• Can appear after piercings, acne, minor cuts, or surgery
  
  
• More common on chest, shoulders, jawline, earlobes and in darker skin types
  
  

Unlike hypertrophic scars, keloids:

• May continue growing for months or years
  
  
• Rarely regress on their own
  
  
• Can be painful, tender, or intensely itchy
  
  

Because they’re biologically more aggressive, keloid treatment is usually multi-step:

• Steroid injections, often combined with other drugs like 5‑fluorouracil (5‑FU)
  
  
• Cryotherapy (freezing) for smaller keloids
  
  
• Laser therapy to reduce redness and symptoms
  
  
• Surgical removal only with strict post‑op protocols (compression, injections, sometimes radiation) to reduce recurrence 

Keloids are a classic example of a scar that is considered “bad” not just cosmetically, but because of symptoms, emotional impact, and high recurrence risk.

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What Are Atrophic Scars and How Can You Identify Them?

Atrophic scars are the opposite of hypertrophic and keloid scars:

• They are sunken or pitted, not raised
  
  
• Caused by a loss of collagen and tissue volume
  
  
• Common after acne, chickenpox, or certain injuries
  
  

Well‑known atrophic patterns include:

• Ice pick scars – narrow, deep pits
  
  
• Boxcar scars – wider, sharp‑edged depressions
  
  
• Rolling scars – soft, wavy depressions
  
  

Topical creams alone usually can’t rebuild lost volume, but they can help with:

• Texture at the surface
  
  
• Redness or discoloration
  
  
• Overall skin quality
  
  

For more significant atrophic acne scars, dermatologists may recommend:

• Microneedling
  
  
• Subcision
  
  
• Fractional laser
  
  
• Chemical peels
  
  
• Fillers or biostimulatory injectables
  
  

Here, the “bad” part of the scar is mainly the indentation and shadow it casts, which often requires procedural treatment.

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Can Scar Creams Fix “Bad” Scars?

Scar creams and silicone-based products are an important part of scar care, but it’s important to set realistic expectations:

• They can support moisture balance, barrier repair, and collagen remodeling
  
  
• They tend to work best for fresh surgical scars, flat or slightly raised scars, and color/texture issues
  
  
• They are less effective alone for large keloids or deep atrophic acne scars, which typically need in‑office procedures
  
  

This is exactly how Scar Protocol positions its system: it’s a cosmetic, topical support strategy for surgical scars not a cure for every type of scar.

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Where Scar Protocol Fits In

Scar Protocol is a 5‑phase, one‑year scar cream system designed specifically for newer surgical scars (think tummy tuck, breast surgery, C‑section, orthopedic incisions, gender‑affirming procedures, etc.). Each phase targets a different stage of healing, from early closure through longer‑term remodeling, using ingredients like hydrating agents, antioxidants, and supportive “actives”. 

A few key points to stay aligned with Scar Protocol’s own guidance:

• Scar Protocol is formulated for surgical scars, especially when started within the first six months after surgery.
  
  
• The system cannot prevent or treat hypertrophic or keloid scars; those require physician‑directed care.
  
  
• It is a cosmetic product, not an FDA‑approved drug, and does not treat medical conditions.
  
  

Where it does make a difference is in helping a typical surgical incision trend toward that “good scar” profile:

• Keeping the area well‑hydrated and supported through the long scar healing timeline.
  
  
• Supporting collagen remodeling as the scar matures.
  
  
• Complementing in‑office treatments like microneedling when your provider recommends both.
  
  

If you’re planning surgery or are within a few months of your operation, Scar Protocol can be part of a structured, proactive scar-care plan alongside your surgeon’s instructions.

You can learn more or purchase directly at scarprotocol.com, or reach the team at 425.864.3777 if you have questions about whether your scar is a good candidate for the system. 

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