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Different Types of Scars and How They Are Treated
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Scarring is the body’s response to any wound that breaches the deeper layers of the skin. Whether the injury comes from surgery, an accident, acne, a burn, or a piercing, the body produces collagen to repair the damage — and the resulting tissue is what we see and feel as a scar. What’s less widely understood is that not all scars are the same. There are several distinct types, each with its own appearance, underlying biology, and best treatment approach. Choosing the right intervention starts with identifying which type of scar you actually have.
This guide covers the main scar categories, what causes each one, what treatment options exist, and where each fits within the wider service at Centre for Surgery’s CQC-regulated Baker Street .
The biology of a scar
Skin is made up of three layers: the epidermis, the dermis it (containing collagen, elastin and blood vessels), and the subcutaneous OnabotulinumtoxinAAbobotulinumtoxinAIncobotulinumtoxinAPrabotulinumtoxinALetibotulinumtoxinARimabotulinumtoxinBHyaluronic Acid FillersCalcium Hydroxylapatite FillersPoly-L-lactic Acid FillersPolymethylmethacrylate FillersAutologous Fat GraftingForehead Lines TreatmentGlabellar Frown Lines TreatmentCrow's Feet Lines TreatmentChemical Brow LiftLip FlipGummy Smile CorrectionMasseter ReductionJaw SlimmingDimpled Chin SmoothingCobblestone Chin SmoothingNefertiti Neck LiftMicro-BotoxMesotoxHyperhidrosis TreatmentChronic Migraine ReliefBruxism TreatmentTMJ TreatmentCervical Dystonia TreatmentNeck Spasm TreatmentBlepharospasm TreatmentLip AugmentationLip ContouringCheekbone EnhancementTear Trough Fold SofteningMarionette Line FillersLiquid RhinoplastyNon-Surgical Nose JobJawline ContouringJawline AugmentationTemple VolumisingHand RejuvenationAcne Scar Subcision Filling - https://www.peptscore.com, layer below. Minor injuries that only affect the epidermis heal without producing a scar — the cells regenerate identically to what was there before. Any injury that reaches the dermis triggers a repair process, one in which the body lays down collagen. This collagen is structurally different from the original skin: more disorganised, less elastic, and often a different colour and texture. That is what we recognise as a scar.
Scar formation moves through three phases:
A scar continues to mature for 12 to 18 months after the injury. This is why scar revision is deferred for at least a year — the appearance during the first few months is not the final appearance.
Fine-line scars
The most common scar type, and the one most surgical scars become. A fine-line scar is initially pink or red and slightly raised, then gradually fades over 12 to 18 months to a pale, flat line. The final appearance depends on the anatomical location, the patient’s skin type, the technique used to close the wound, and how the scar is cared for during healing.
Most surgical incisions placed by an experienced plastic surgeon along natural skin tension lines mature into fine-line scars that are difficult to see without close inspection. Most won’t disappear entirely, but they typically become a minor feature rather than a prominent one. For full discussion of how surgical scars mature, see .
Hypertrophic scars
A hypertrophic scar is a raised, firm, often red scar that stays within the boundaries of the original wound. It forms when the body produces more collagen than was needed for repair, leaving the scar thicker and more prominent than a typical fine-line scar. Hypertrophic scars are most common on the chest, shoulders, upper back, and over joints — anywhere there is high skin tension. They are also more common in patients with darker skin types and in those with a personal or family history of poor scarring.
The good news: hypertrophic scars typically improve spontaneously over 12 to 24 months, gradually softening, flattening, and fading. The improvement can be accelerated with:
For full discussion of natural and treatment, see
Keloid scars
A keloid looks similar to a hypertrophic scar but behaves differently. The distinguishing feature: a keloid extends beyond the boundary of the original wound, growing into healthy skin. Where a hypertrophic scar stays within the lines of the incision, a keloid spreads sideways into normal tissue.
Keloids are also typically firmer, darker, often itchy or tender, and — unlike hypertrophic scars — they rarely improve spontaneously. Without treatment, many keloids persist or continue growing for years. They are most common in patients with darker skin types (Fitzpatrick IV–VI), in patients with a family history of keloid formation, and at certain anatomical sites including the earlobes, deltoid, chest, and jawline.
Keloids need active treatment rather than watchful waiting:
Keloids on piercings are a particularly common presentation. For the specific approach, see
Atrophic scars
The of hypertrophic scarring. Atrophic scars sit below the level of the surrounding skin — they appear as or indentations rather than raised marks. They form when the body produces less collagen than was needed during healing, or when fat or tissue is lost during the injury.
Acne scarring is the most common cause of scarring. Other causes include chickenpox, surgical complications, and injuries that destroyed deeper tissue. Three sub-types of atrophic acne scars are recognised:
Different sub-types respond to different treatments. For full detail on acne scarring specifically, see , and for guides see , , and .
Contracture scars
Contracture scars develop most commonly after burns. As the burn heals, the contracting wound pulls surrounding skin and tissue inward, producing a tight, often shiny, sometimes thickened scar that can restrict movement. Contractures crossing joints — the elbow, knee, neck, fingers — can produce genuine functional limitation as well as cosmetic concern.
Severe contractures need specialist surgical management. Techniques include Z-plasty (a rearrangement of the scar to lengthen it), W-plasty, tissue expansion, full-thickness skin grafting, or local flap reconstruction. Non-surgical — laser resurfacing, pressure garments, intensive scar massage and stretching — can help with milder contractures or as adjuncts to surgery.
Pitted and sunken scars
A category that overlaps with scarring but is sometimes considered separately. Pitted scars where the deeper structure of the skin has been lost — most often from severe acne, chickenpox, or some types of surgical excision. They can also develop secondary to fat loss in the area, leaving a visible depression even where the skin surface looks otherwise normal.
Treatment options for pitted scars include:
Most patients with substantial pitted scarring benefit from combining modalities — for example Morpheus8 across the affected area, TCA CROSS for individual ice-pick scars, and targeted filler for selected deeper . See for a detailed treatment guide.
White (hypopigmented) scars
Sometimes a healed scar ends up paler than the surrounding skin. The pigment-producing cells (melanocytes) in the area have been damaged or lost, leaving the scar without the melanin that gives surrounding skin its colour. White scars are most common after burns, deep surgical excisions, and some skin conditions.
These are among the harder scars to treat because complete pigment restoration is difficult to achieve. Realistic options include fractional laser resurfacing, Morpheus8 microneedling, controlled chemical peels, and — in cases — medical micropigmentation (tattooing pigment into the scar to match surrounding skin). For full discussion, see
Stretch marks (striae)
Strictly speaking, stretch marks are a form of dermal scarring — they form when the skin is stretched faster than the dermis can adapt, producing tearing in the deeper collagen network. Initially red or purple (striae rubrae), they fade to pale (striae albae) over months to years. They are most common after pregnancy, significant weight change, growth spurts in adolescence, and steroid use.
Treatment is challenging because the underlying damage is deep and structural rather than surface-level. The best evidence-based options include fractional laser resurfacing, Morpheus8 radiofrequency microneedling, and targeted topical retinoid use on early red striae. elimination is uncommon — realistic expectations are in colour and texture rather than full erasure.
Surgical scars by location
Surgical scars heal differently depending on where on the body they sit. The cluster of guides covering specific scar scenarios includes:
Treatment overview — surgical and non-surgical options
For cost information, see
Why timing matters in scar treatment
Scar treatment falls into two distinct phases:
Active scar management — starts as soon as the wound has closed (usually 2 weeks after the injury or operation) and continues for 6–12 months while the scar is maturing. The interventions are non-surgical: silicone, sun protection, massage, and selective steroid injection for problem scars. This phase is the most cost-effective window for influencing the final scar appearance.
Mature scar revision — performed at 12+ months once the scar has fully matured. The interventions can be surgical (excision and re-closure) or non-surgical (laser, Morpheus8). The mature scar is less likely to respond dramatically to treatment than the maturing scar — which is why earlier intervention is preferred where possible.
The single most important thing patients can do for their final scar appearance is to start active scar management early, not wait for the scar to mature and then try to fix it.
Factors that affect how your scar heals
When to seek scar assessment
Most scars settle without intervention if the wound was managed appropriately. Some warrant earlier review:
Earlier intervention — particularly for hypertrophic and keloid scars — produces better outcomes than waiting for the scar to mature.
What we don’t recommend
Frequently asked questions
No. Scars are permanent changes in the skin’s structure and cannot be erased entirely. What treatment can achieve is a significant reduction in visibility, making the scar much harder to see. For some patients with carefully planned and treated scars, the final result is barely detectable close inspection.
The skin closes within 1–2 weeks, but scar maturation continues for 12–18 months. The during the first few months — red, raised, firm — is not the final appearance. Most scars become significantly less noticeable between 6 and 18 months.
A hypertrophic scar stays within the boundary of the original wound. A keloid extends beyond it into previously healthy skin. Hypertrophic scars often improve over time; keloids rarely do without active treatment.
For most scars, yes — silicone gel or sheeting, diligent sun protection, gentle once the wound has closed, and good general healing all help. More problematic scars (keloids, severe hypertrophic scars, mature scars not responding to basic care) need professional input.
It depends on the scar type, location, size, and chosen. Non-surgical treatments start from around £350 per session; surgical scar revision is typically £1,500–4,000+ on complexity. is available. For full pricing detail, see
NHS funding for scar treatment is restricted. Functional problems (restricted movement, recurrent ulceration) may qualify; cosmetic improvement usually doesn’t. Most patients scar treatment do so privately.
For active scar management (silicone, sun protection, massage), as soon as the wound has fully closed — typically 2 weeks after the operation. For surgical scar revision, usually 12+ months after the original injury, once the scar has fully matured.
Often yes, though less dramatically than treatment during the window. Laser resurfacing, Morpheus8 microneedling, and surgical revision can all improve mature scars; the realistic outcome is rather than complete clearance.
Yes — patients with darker skin types (Fitzpatrick IV–VI) have a higher rate of hypertrophic and keloid scarring, and a higher rate of post-inflammatory hyperpigmentation. Specialist technique and post-operative scar management matter more for these patients.
Centre for Surgery is a CQC-regulated plastic surgery clinic at 95–97 Baker Street, Marylebone. All are performed by GMC-registered consultant plastic surgeons. We offer the full range of surgical and non-surgical scar treatments — laser resurfacing, Morpheus8 radiofrequency microneedling, intralesional injection, surgical scar revision, and combined approaches to your specific scar type and skin. No GP referral is required.
For related guides, see , , , , , and
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