Hypertrophic Scars: Understanding Causes and Treatment Options

Silicone is applied to the skin as a gel or a sheet. The goal is to reduce how raised the scar is and improve its flexibility or colour, although these changes cannot be predicted in advance. The benefits for flexibility and colour remain uncertain, and it is also uncertain whether sheets work better than most other treatments. Gel and sheets are two different forms: a result obtained with a sheet is not guaranteed with a gel. The purpose of the assessment is to choose an option that is appropriate for your skin, not to predict its result.

After a burn, gels, with or without silicone, can form a covering that holds in moisture and limits water loss. However, this covering does not guarantee that the scar will flatten. A moisturizer can help keep the skin hydrated; hydration should not be confused with treating the raised area.

Silicone must only be applied to skin that has healed over, never to an open wound. Stop using it if a rash appears. After a burn, gels can also cause irritation, itching or maceration, especially in hot weather. Before you start, ask for instructions on which form to use, how long to apply it and which skin changes to report.

Pressure therapy uses tight elastic garments worn over the scar once the wound is considered to have healed enough. After a burn, its benefits and risks remain very uncertain compared with other treatments. As a result, flattening cannot be promised, and no single duration of wear can be specified for all scars.

Wearing a tight garment must fit into your daily routine. Before choosing this option, ask how to check that the garment fits properly, how long you would wear it and what to do if you find it hard to tolerate or if your skin becomes irritated. The doctor checks how well you tolerate it during follow-up; no universal schedule is given here.

After a burn, massage can provide short-term improvement, but it has not been established that it changes the scar in a lasting way. This immediate relief is therefore not proof that the raised area is disappearing.

After a burn, avoid firm massage early in healing, on an inflamed scar or on a scar that reopens. For a scar that has healed over, ask whether massage is appropriate, which technique to use and when to stop. Creams, oils and so-called natural treatments do not guarantee that the raised area will disappear either: “natural” does not mean effective or free of irritation. Hydrating the skin and treating a thick scar are two separate goals.

An injection into the scar delivers a prescribed treatment directly into the raised area. The goal is to make the scar less noticeable and reduce its symptoms, without promising that it will flatten completely. It can be combined with silicone. It is performed by a physician, or a nurse injector supervised by a physician, after an assessment.

At the injection site, bleeding, bruising, infection or delayed healing are possible. Later, the skin can become thinner or lighter, or small blood vessels can become visible. Changes in the raised area and in itching are monitored through reassessments, without predicting an individual outcome.

Before choosing this option, ask how pain during the procedure would be managed, whether another injection might be needed and which changes would lead to a decision to continue or stop. The number of sessions and the time between them still need to be clarified for your situation; no standard interval is given.

Cryotherapy uses cold to freeze a skin lesion. Cold does not guarantee that a hypertrophic scar will flatten. Before considering it, ask what could be improved in your case and why this option would be preferable to another.

The skin can react as it would after a burn: redness, swelling or blisters, followed by a scab. Its colour can become lighter or darker, especially on brown or black skin; this change often improves over time, but it can persist.

The size of the raised area and your skin tone are among the points to discuss before choosing cryotherapy. Also ask what pain to expect, how it would be relieved, how many sessions might be considered and what care to expect while the skin heals. There is no set healing time or number of sessions that applies to all scars.

Ablative fractional laser treatment uses heat to create tiny treatment zones that reach below the surface and stimulate collagen remodelling. The fractional CO2 laser works this way: it treats small columns of skin. The goal is to improve the scar, although it cannot be promised that laser treatment alone will make it less raised. Improvement in flexibility or symptoms is not certain, and no laser guarantees that the scar will disappear. The examination is used to determine whether this option is appropriate for your scar.

It is a medical procedure, performed by a physician, or a nurse supervised by a physician. Before laser treatment on a scar, the doctor takes into account your skin type, the characteristics of the scar and your general health; having fair skin is not enough to say that laser treatment is appropriate. A tan or a recent sunburn increases the risk of burns and changes in skin colour.

Before committing, ask how many sessions might be needed, what recovery would be like and what to apply to the skin at home. Ask for an explanation of the expected reactions, including redness or swelling, and of those that would justify calling the professional. No recovery timeline is given that applies to all scars.

After the session, protect the treated skin from the sun until it has healed: sun exposure can cause a new scar. The risks include changes in colour, burns and a new scar. Skin that is warm to the touch, very severe pain, persistent bleeding or a wound that opens requires medical advice right away. When it comes to planning your recovery days, what to expect after facial laser treatment matters as much as the goal of the treatment when making your choice.

No option is the best for everyone. The scar can also flatten over time; an improvement after a treatment is therefore not necessarily due to the treatment alone.

If the scar persists or comes back, an examination is an opportunity to review the goal and how the scar has responded to the treatments already tried. Other prescribed treatments can be injected into the scar, alone or in combination; this does not mean they are better suited to every case. Before combining treatments or making a change, ask about the intended benefit, the risks specific to each product, the pain of the procedure and the follow-up. The risks of one injection do not automatically carry over to another. Waiting and watching how the scar changes can also be discussed. No treatment guarantees complete flattening or that the scar will not come back.