Keloids and hypertrophic scars are abnormal responses to skin injury in which excessive scar tissue forms during the healing process. While both conditions involve raised scars, they differ in behavior, appearance, and clinical course. Hypertrophic scars remain confined to the original wound boundaries and may gradually improve over time, whereas keloids extend beyond the original injury margins and tend to persist or progressively enlarge. These scars can develop after surgery, trauma, burns, acne, piercings, or even minor skin injuries.

The exact cause of keloid and hypertrophic scar formation is not fully understood, but it is believed to involve dysregulated collagen production during wound healing. Genetic predisposition plays a significant role, with higher prevalence seen in individuals with darker skin tones and in certain families. Common anatomical sites include the chest, shoulders, upper back, earlobes, jawline, and neck—areas prone to tension and movement.

Symptoms vary in severity and may include firm, raised scar tissue, redness or dark pigmentation, itching, tenderness, pain, and a feeling of tightness. Beyond physical discomfort, keloids and hypertrophic scars often cause psychological distress due to their visible and sometimes disfiguring nature. Patients may feel self-conscious, avoid social situations, or experience reduced quality of life.

Evaluation involves clinical assessment of scar size, thickness, location, duration, symptoms, and prior treatments. Understanding scar behavior over time is essential, as early scars may still evolve, while mature scars require different management strategies. Patient expectations must be carefully discussed, as treatment focuses on improvement rather than complete elimination.

Management of keloids and hypertrophic scars is challenging and often requires a multimodal approach. Early intervention may reduce progression, while established scars often need structured treatment plans. Surgical excision alone carries a high recurrence risk, particularly for keloids, and is usually combined with adjunctive therapies to improve outcomes.

The goal of treatment is to reduce scar volume, relieve symptoms, improve flexibility, and enhance appearance. Long-term follow-up is essential, as recurrence can occur months or even years later. With careful planning and individualized management, plastic surgery can significantly improve comfort, appearance, and confidence in patients affected by problematic scarring.