Hypertrophic scar and keloid: why medical history matters
Quick facts
- Hypertrophic scar
- Raised scar that stays within the limits of the wound and tends to improve over time.
- Keloid
- Scar that grows beyond the limits of the wound, does not regress on its own and often comes back after removal.
- Tendency
- Family predisposition; keloids are more frequent in higher phototypes and in certain areas of the body.
- In the medical history
- Ask about keloids after ear piercings, surgeries, acne and vaccines.
- Relevance in HOF
- Weighs on the decision about procedures that injure the skin, such as threads and microneedling.
Hypertrophic scars and keloids are two forms of healing with excess collagen. A hypertrophic scar is raised, but it stays within the limits of the wound and usually improves over months. A keloid grows beyond the limits of the original wound, invades the surrounding skin, does not regress on its own and tends to come back after removal. In orofacial harmonization (HOF), what matters is asking about this in the medical history, because the predisposition changes how procedures that injure the skin are assessed.
What is the difference between the two?
| Feature | Hypertrophic scar | Keloid |
|---|---|---|
| Limits | Stays within the wound area | Goes beyond the wound area |
| Onset | Usually in the first weeks | May appear months later |
| Course | Tends to flatten and fade with time | Does not regress on its own; may grow |
| After removal | Recurrence less common | Recurrence frequent |
| Symptoms | Itching and tenderness, usually mild | Itching, pain and tenderness are common |
| Predisposition | Wound tension, infection, slow healing | Strong individual and family component |
Who is more prone?
- Personal or family history of keloids is the main warning sign.
- Higher phototypes: keloids are described more often in Black and Asian skin. See Fitzpatrick phototype.
- Body areas: the earlobe, chest, shoulders and jaw area are among the most cited.
- Age and hormones: adolescence, pregnancy and young adults account for more cases.
Why does it matter in HOF?
- Threads: thread lifts, such as PDO threads, involve entry points in the skin and sometimes small incisions.
- Microneedling and techniques with many punctures: they injure the skin at many points. The topic is covered in microneedling with biostimulator or HA.
- Filler with a needle or cannula: the punctures are small, but the predisposition is still recorded.
- Differential: a firm raised area at the site of an injectable can also be a product nodule or a granuloma, which have a different origin and management.
- Discoloration: in higher phototypes, post-inflammatory hyperpigmentation is another skin reaction to consider.
How do you ask during the assessment?
- "Have you ever had a scar that grew beyond the cut or came back after being removed?"
- Ear piercings, surgeries, C-section, acne and vaccines are good clues.
- Examine visible scars and record them with photos.
- Ask about previous scar treatments, such as injections or surgery.
The topic of a scar already present in the area to be treated is covered in scar and filler.
Also called: keloid (spelled "quelóide" in old Portuguese orthography), hypertrophic scar, raised scar.
Frequently asked questions
Can someone with keloids have filler?
A keloid is not, by itself, an absolute contraindication to every injectable, but the predisposition must be recorded and weighed case by case, especially in procedures with many punctures or with threads. The decision belongs to the qualified professional, after an assessment, and sometimes with input from a dermatologist.
What is the difference between a hypertrophic scar and a keloid?
A hypertrophic scar is raised but respects the limits of the wound and usually flattens over months. A keloid invades the surrounding skin, does not regress on its own and tends to come back after being removed.