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The Skin Doctor

Specialist hypertrophic and keloid scar care at The Skin Doctor combines prevention, intralesional injections (triamcinolone, 5-FU, sometimes botulinum toxin), fractional ablative laser with laser-assisted drug delivery, and vascular lasers for erythema. Staged across multiple sessions, tailored to scar biology, skin type and risk factors. Keloids are managed long-term, not cured.

Scar specialists

Hypertrophic & Keloid Scar Treatment

Specialist hypertrophic and keloid scar care at The Skin Doctor combines prevention, intralesional injections (triamcinolone, 5-FU, sometimes botulinum toxin), fractional ablative laser with laser-assisted drug delivery, and vascular lasers for erythema. Staged across multiple sessions, tailored to scar biology, skin type and risk factors. Keloids are managed long-term, not cured.

Portrait of Dr Christopher Irwin

By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA

Last reviewed 2026-06-06 · Editorial policy

Quick definition

Hypertrophic and keloid scar treatment at The Skin Doctor is multimodal, doctor-led care for raised, itchy, painful or progressive scars. Combines prevention strategies (silicone gel, tension reduction, early intervention in high-risk patients), intralesional injections (triamcinolone, 5-FU, sometimes botulinum toxin), and advanced laser (fractional ablative CO₂/Er:YAG with laser-assisted drug delivery, plus vascular PDL/Nd:YAG for erythema). Treatment is staged over multiple sessions with long-term follow-up. The realistic goal is meaningful, durable improvement and symptom relief — not erasure. Keloids in particular are managed long-term, not cured; surgical excision alone has very high recurrence rates.

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 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 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:

  • 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)

Who is at higher risk?

  • personal or family history of keloids
  • previous keloid formation after minor injury
  • high-risk anatomical sites — chest / sternum, shoulders and upper back, jawline / neck / earlobes
  • high wound tension or scars crossing joints
  • delayed healing or wound infection
  • younger age
  • darker Fitzpatrick skin phototypes

Identifying these factors early allows preventative strategies to be implemented before abnormal scarring becomes established. (1,2)

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)

Preventative steroid or 5-FU injections (selected cases)

In carefully selected high-risk patients, early intralesional therapy may be considered. Options include triamcinolone (TAC) and 5-fluorouracil (5-FU). These agents suppress fibroblast proliferation and excessive collagen synthesis. However, they are not routine — they may impair wound healing or increase skin fragility, and decisions are always individualised. (2,5)

Treatment of established hypertrophic and 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, and 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, with improved scar height, pliability and symptoms, and lower side-effect rates 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)

Laser therapy

Laser therapy plays a central role in modern scar management and is rarely used in isolation.

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)

Fractional ablative laser (CO₂ or Er:YAG) creates microscopic treatment channels that stimulate collagen remodelling, increase fibroblast apoptosis, and reduce TGF-β–driven fibrosis. When combined with intralesional therapies (especially 5-FU or TAC), fractional lasers consistently outperform monotherapy. (9,10)

Vascular lasers (PDL, Nd:YAG) reduce erythema and scar vascularity and are particularly useful in early hypertrophic scars and red, inflamed, symptomatic scars. Often combined with fractional lasers or injections as part of a staged plan. (1,4)

A note on surgical excision of keloids

Excision of a keloid without adjunctive treatment has very high recurrence rates — often 50–100%, with the recurrence frequently larger than the original. Excision can have a role in selected large or pedunculated keloids — but only when combined with immediate post-excision intralesional therapy, often plus radiotherapy or extended steroid courses, and lifelong silicone / pressure / monitoring. Excision is rarely the first option and almost never the only one. This is discussed in detail at consultation.

Personalised, staged scar treatment 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.

Book a hypertrophic or keloid scar consultation

If you have a raised, itchy, painful or progressive scar, or a history of keloid scarring, a medical scar consultation can clarify what type of scar you have and what realistic improvement looks like. The booking panel in the sidebar takes you to the consultation.

You may also find these helpful:

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.
  10. Elsaie ML et al. Fractional laser platforms and laser-assisted drug delivery in scars. J Drugs Dermatol. 2010.

What to expect

  1. Scar consultation

    Doctor-led review of scar history, biology (hypertrophic vs keloid), location, Fitzpatrick skin type, prior treatments and risk factors. A staged, individualised written plan is developed.

  2. Prevention and early scar care

    Where prevention is the goal — silicone gel or sheeting for several months, tension reduction (taping, pressure garments where applicable), strict sun protection, and in selected high-risk cases early intralesional therapy (triamcinolone or 5-FU).

  3. Intralesional injection therapy

    For established raised scars — triamcinolone (TAC), 5-fluorouracil (5-FU), or combination TAC + 5-FU at carefully spaced intervals. Botulinum toxin combinations are considered in selected cases. Doses and intervals are titrated to response.

  4. Fractional ablative laser (CO₂ or Er:YAG)

    Creates microscopic treatment channels that stimulate collagen remodelling, reduce TGF-β–driven fibrosis and enhance penetration of injectable agents (laser-assisted drug delivery / LADD). Frequently combined with intralesional therapy in the same session.

  5. Vascular laser (PDL / Nd:YAG)

    Reduces erythema and scar vascularity — particularly useful in early hypertrophic scars and red, inflamed, symptomatic scars. Often combined with fractional laser or injections as part of a staged plan.

  6. Long-term follow-up and maintenance

    Treatment is staged across multiple sessions over many months. Recurrence is monitored (particularly for true keloids) and management adjusted with realistic expectations — keloid care is a long-term relationship, not a single course.

Results timeline

  • Days after first injection Itch and discomfort often improve within days of the first TAC injection — symptom relief is frequently the first noticeable change, before visible flattening.
  • Weeks to 3 months Early flattening, softening and reduction in erythema after the first cycle of injections. Pliability improves with combination protocols.
  • 3–6 months Progressive flattening, improved texture and pliability; fractional laser collagen remodelling becomes visible; scar height and Vancouver Scar Scale scores measurably improve.
  • 12+ months Cumulative improvement with combination therapy; final cosmetic result becomes clear. Maintenance sessions added based on response and recurrence risk.
  • Long-term True keloids are managed long-term with periodic review — recurrence remains possible and is addressed early with re-injection or laser top-ups. Silicone and tension reduction continue.

Ideal candidate

  • Patients with raised, itchy, painful or progressive hypertrophic or keloid scars
  • Personal or family history of keloid scarring — after surgery, injury, acne, ear piercings, vaccinations or minor trauma
  • High-risk anatomical sites — chest / sternum, shoulders, upper back, jawline, neck, earlobes
  • Patients with raised post-acne scarring across the chest, back or jawline (acne-driven keloids are common in these areas)
  • Patients planning surgery in high-risk sites who want pre-operative planning + structured post-op silicone and tension reduction
  • Patients with scars after ear piercing, vaccination or injection where keloid is already forming
  • Patients who have had keloid recurrence after prior excision elsewhere
  • Patients prepared to engage with combination therapy and long-term follow-up — the goal is durable management, not a single visit

Frequently asked questions

  • What's the difference between a hypertrophic scar and a keloid?
    Hypertrophic scars are raised and thickened but stay within the original wound edges. They often appear within weeks of injury and may gradually soften over months to years. Keloid scars extend beyond the boundaries of the original wound, may continue to grow for months or years, and rarely resolve without treatment. Both are driven by excess collagen production, prolonged inflammation, abnormal fibroblast activity and wound tension — but the management strategy and long-term expectations are different.
  • What causes hypertrophic and keloid scars?
    Both result from excessive collagen production driven by inflammation, wound tension, and genetic predisposition. In genetically predisposed individuals, even minor skin trauma — including acne, vaccinations, ear piercings, insect bites or shaving cuts — can result in pathological scarring. High-risk anatomical sites (chest, shoulders, upper back, jawline, earlobes) are more prone, as are darker Fitzpatrick skin phototypes. Younger age, wound infection and delayed healing also increase risk.
  • Will my scar go away on its own?
    Hypertrophic scars may gradually improve over months to years, particularly with silicone therapy and tension reduction. Keloid scars rarely resolve without treatment and may continue to grow over time. Even hypertrophic scars in high-risk patients often benefit from early treatment to prevent progression and reduce symptoms (itch, pain, irritation) along the way.
  • How soon after surgery should I start scar prevention?
    Once the surface skin has fully healed — typically 2–3 weeks after surgery, and only once any sutures or staples have been removed and there is no open wound or infection. Silicone gel or sheeting is started at that point and continued consistently for at least 3–6 months, alongside tension reduction (taping where appropriate), strict sun protection, and avoidance of stretching across the scar. In selected high-risk patients (personal or family history of keloids), early intralesional therapy may be considered — this is individualised at consultation.
  • Are steroid (triamcinolone) injections effective on their own?
    Yes, but recurrence is common when steroids are used alone. Triamcinolone (TAC) is first-line for raised scars and produces response rates of 50–90% in reducing scar thickness, improving pliability and decreasing itch and pain — but combination therapy outperforms monotherapy in most network meta-analyses. TAC is often combined with 5-FU (which has lower side-effect rates than TAC alone) and frequently paired with fractional laser. Steroid side effects (hypopigmentation, skin thinning, fat atrophy) are minimised by careful dose titration.
  • What is the role of 5-FU (5-fluorouracil)?
    5-FU suppresses fibroblast proliferation and collagen synthesis without causing tissue necrosis. Systematic reviews and meta-analyses show that TAC + 5-FU combination is significantly more effective than either agent alone, with lower side-effect rates than steroid monotherapy. It improves scar height, pliability and symptoms. 5-FU is contraindicated in pregnancy, breastfeeding, and patients with significant bone marrow suppression — these are assessed at the consultation.
  • Can keloid scars be removed by surgery alone?
    Generally no — and this is one of the most important things to understand about keloids. Surgical excision of a keloid without adjunctive treatment has very high recurrence rates (often 50–100%), and the recurrence is frequently larger than the original. Excision can have a role in selected large or pedunculated keloids — but only when combined with immediate post-excision intralesional therapy (TAC, 5-FU or both), often plus radiotherapy or extended steroid courses, and lifelong silicone / pressure / monitoring. Excision is rarely the first option and almost never the only one.
  • Will my scar completely disappear?
    Treatment aims to significantly improve appearance and symptoms — complete disappearance is uncommon, particularly with keloids. Realistic outcomes from a thorough combination plan include substantial flattening, softening, colour matching to surrounding skin, and resolution of itch / pain / irritation. For hypertrophic scars the cosmetic result can be very satisfying; for true keloids the result is durable management with periodic maintenance rather than cure. We are honest about this at the consultation rather than after.

References

  1. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids — a 2020 update. Plast Reconstr Surg. 2022.DOI: 10.1097/PRS.0000000000008667
  2. Advances in scar management — prevention and management of hypertrophic scars and keloids. Curr Opin Otolaryngol Head Neck Surg. 2016.DOI: 10.1097/MOO.0000000000000268

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Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA · Last reviewed 2026-06-06 · Editorial policy