Types of Scars: How to Tell Them Apart and What Each One Needs

In this guide19 sections

Key Points
Why Scars Form
How a Scar Matures
The First Question: Raised or Depressed?
Raised Scars: Hypertrophic vs Keloid
Depressed Scars: The Three Atrophic Subtypes
Fine-Line Scars
Contracture Scars
Hypopigmented (White) Scars
Stretch Marks (Striae)
What the Evidence Actually Supports
The Timing Strategy Most People Get Wrong
What Affects How Your Scar Heals
What We Don’t Recommend
Costs
When to Seek Assessment
Frequently Asked Questions: Types of Scars
Scar Assessment at Centre for Surgery
Related Reading

Key Points

There are eight recognised types of scar. Which one you have determines the treatment — and the wrong treatment for the wrong type wastes money and can make things worse.
The first question is whether the scar is raised or depressed. That single distinction splits the treatment pathway in two before anything else is considered.
Hypertrophic scars stay inside the wound; keloids grow beyond it. Hypertrophic scars often settle on their own. Keloids rarely do.
A scar takes 12 to 18 months to mature. What you see at three months is not the final result.
Silicone has the strongest evidence of any topical treatment. Vitamin E does not, despite its popularity.
The most valuable window is the first year, while the scar is still forming. Preventing a bad scar is far easier than revising one.

Why Scars Form

Skin has three layers: the epidermis on top, the dermis beneath it, and subcutaneous fat below.

Injuries confined to the epidermis heal without a scar. The cells regenerate exactly as they were — which is why a graze that only takes off the surface leaves nothing behind.

Anything reaching the dermis is different. The dermis cannot regenerate itself, so the body patches it with replacement collagen. That collagen is laid down in parallel bundles rather than the original basket-weave, which makes it less elastic, differently textured, and usually a different colour.

That patch is the scar. It is repair tissue, not regenerated skin, and it never becomes identical to what was there before.

Every scar is permanent. The question is never whether it can be erased, but how far its appearance can be improved.

How a Scar Matures

Timeline showing the four stages of scar maturation from inflammatory through to mature at twelve months, Centre for Surgery London — Never judge a scar before twelve months.

Days 0–7, inflammatory. The wound clots, infection is controlled, and repair cells arrive.

Weeks 1–6, proliferative. Fibroblasts lay down new collagen and the wound contracts. The scar looks red, raised and firm. This is the stage that alarms people, and it is entirely normal.

Months 2–18, remodelling. Collagen is gradually reorganised. The scar softens, flattens and fades.

Month 12 onwards, mature. This is the final appearance.

The practical consequence is the single most useful thing on this page: a scar at three months looks considerably worse than the same scar at twelve. Judging it early — or demanding revision early — leads to unnecessary intervention on a scar that would have improved on its own.

The First Question: Raised or Depressed?

Before naming any scar type, establish which side of this line it falls on. The treatment pathways barely overlap.

Raised scars — hypertrophic and keloid — involve too much collagen. Treatment aims to reduce and flatten: silicone, steroid injection, pressure, and sometimes excision.

Depressed scars — atrophic, including all acne scarring — involve too little collagen or lost tissue. Treatment aims to rebuild or resurface: microneedling, laser, subcision, filler, fat transfer.

Applying a raised-scar treatment to a depressed scar achieves nothing, and steroid injection into an atrophic scar makes the depression worse. This is why self-diagnosis from photographs online is unreliable and why the scar type is established before any treatment is chosen.

Raised Scars: Hypertrophic vs Keloid

Comparison of fine-line, hypertrophic and keloid scars showing that keloids grow beyond the original wound boundary, Centre for Surgery London — Hypertrophic scars often settle. Keloids rarely do.

Hypertrophic scars

Raised, firm and often red, but staying within the boundaries of the original wound. Caused by collagen overproduction during healing.

Common sites: chest, shoulders, upper back, and over joints — anywhere skin is under tension.

Natural history: most improve spontaneously over 12 to 24 months, softening and flattening. This matters, because it means watchful waiting with silicone is often the right first answer rather than immediate intervention.

Treatment: silicone gel or sheeting daily for several months, intralesional steroid injection every 4–6 weeks, pulsed-dye or fractional laser, pressure therapy, and surgical revision only in selected mature cases.

See do hypertrophic scars go away? for the full natural history.

Keloid scars

Also raised and collagen-driven, but extending beyond the original wound into previously healthy skin. That single feature is the diagnosis.

Keloids are typically firmer, darker, frequently itchy or tender, and — critically — they rarely resolve on their own. Untreated, many persist or continue growing for years.

Higher risk: Fitzpatrick skin types IV–VI, a family history of keloid formation, and certain sites — earlobes, deltoid, chest, jawline.

Treatment: intralesional steroid injection as first line, given as a course; silicone alongside; surgical excision always combined with post-operative steroid or radiotherapy, since excision alone has a high recurrence rate; pressure earrings for earlobe keloids; cryotherapy or laser as adjuncts.

Never excise a keloid without a plan for what follows. Cutting one out and closing the wound frequently produces a larger keloid than the original.

For piercing keloids specifically, see how do I get rid of a keloid on my nose piercing?

Depressed Scars: The Three Atrophic Subtypes

The three atrophic scar subtypes — ice pick, boxcar and rolling — shown in cross-section, Centre for Surgery London — Each subtype responds to a different treatment.

Atrophic scars sit below the surrounding skin. Acne is the commonest cause; chickenpox and deeper injuries account for most of the rest.

Most sources stop at “atrophic scarring”. That is not enough to plan treatment, because the three subtypes respond to quite different things.

Ice pick — narrow, deep, V-shaped, usually under 2mm at the surface. Too deep for resurfacing to reach the base. Responds to TCA CROSS or punch excision. Laser and microneedling alone will not close them.

Boxcar — broader U-shaped depressions with sharp vertical walls, typically 1.5–4mm. Responds to fractional laser, radiofrequency microneedling, and punch techniques for deeper examples.

Rolling — wide, shallow, sloping-edged depressions giving an undulating surface. Caused by fibrous bands tethering skin to deeper tissue. Responds best to subcision, which releases those bands, often combined with resurfacing.

Most people with acne scarring have all three subtypes at once, which is why single-modality treatment disappoints and combined protocols work better.

See how to get rid of acne scars, TCA CROSS, Morpheus8 for acne scars, and laser acne scar removal.

Fine-Line Scars

What most surgical incisions become. Initially pink and slightly raised, fading over 12 to 18 months to a pale flat line.

The final appearance is largely determined before the scar forms — by where the incision was placed relative to natural skin tension lines, how the tissue was handled, and how the wound was closed in layers.

Well-placed surgical scars usually become difficult to see without looking for them. They do not vanish. See scar management after cosmetic surgery.

Contracture Scars

Most often follow burns. As the wound heals it contracts, pulling surrounding tissue inward and producing a tight, often shiny scar that can restrict movement.

Contractures crossing a joint are a functional problem, not a cosmetic one. They are the one scar type where treatment may be medically necessary rather than elective.

Surgical management uses Z-plasty or W-plasty to lengthen and reorient the scar, tissue expansion, skin grafting, or local flap reconstruction. Milder contractures respond to laser resurfacing, pressure garments, and sustained stretching and massage.

Hypopigmented (White) Scars

Where the melanocytes that produce pigment have been destroyed, the healed scar ends up paler than surrounding skin. Common after burns, deep excisions and some inflammatory conditions.

These are among the hardest scars to improve, because pigment cells do not repopulate the area on their own.

Standard resurfacing — fractional laser, radiofrequency microneedling, controlled peels — can improve texture and blend the edges, but it cannot put pigment back. For that, the pigment cells themselves have to be replaced.

Melanocyte grafting

Also called melanocyte–keratinocyte transplantation, this transfers your own pigment cells from normal skin into the depigmented area. It is one of the few treatments that addresses the actual cause of a white scar rather than disguising it.

How the procedure works:

Donor harvest. A very thin shave biopsy is taken from normally pigmented skin, usually the thigh or buttock. The donor site is small — roughly 1cm² of donor skin can treat 5 to 10cm² of recipient area.
Cell separation. The sample is incubated in enzyme solution, which separates the epidermis from the dermis. The epidermal layer is then broken down into a suspension of individual melanocytes and keratinocytes.
Recipient preparation. The surface layer of the white scar is removed by dermabrasion or ablative laser, creating a receptive bed.
Application. The cell suspension is applied to the prepared area and covered with a dressing, left undisturbed for around a week while the cells take.
Repigmentation. Colour develops gradually over two to six months as the transferred melanocytes settle and begin producing pigment.

Who it suits: stable, fully mature hypopigmented scars — typically at least 12 months old with no ongoing change. It is also used for stable vitiligo, which is where the technique originated and where the evidence base is strongest.

Who it does not suit: scars that are still maturing, active inflammatory skin disease, a personal history of keloid formation, or unstable vitiligo with lesions that are still spreading.

Realistic outcomes. Results are better in vitiligo than in scars, because scar tissue is a less favourable recipient bed — the dermis is abnormal and blood supply reduced, so melanocyte survival is less predictable. Repigmentation is often substantial but rarely a perfect colour match; the treated area may settle slightly lighter or darker than surrounding skin. We would rather set that expectation before treatment than after.

Medical micropigmentation

Where grafting is unsuitable or has been declined, pigment can be tattooed into the scar and colour-matched to surrounding skin. It does not restore living pigment cells, so it fades over several years and needs maintenance, and it will not tan with the rest of the skin. For small, stable, well-defined white scars it can be an effective and considerably simpler option.

See can white scars be removed completely?

Stretch Marks (Striae)

Frequently left out of scar guides, but stretch marks are genuinely a form of dermal scarring — the collagen network tears when skin stretches faster than the dermis can adapt.

Red or purple initially (striae rubrae), fading to silvery-white (striae albae) over months to years. Common after pregnancy, rapid weight change, adolescent growth, and steroid use.

The window matters more here than almost anywhere. Red striae still have active blood vessels and respond considerably better to laser and topical retinoids than white ones. Once they turn white, options narrow substantially.

Realistic outcome is improvement in colour and texture, not elimination.

What the Evidence Actually Supports

Scar treatment attracts more marketing than most areas of aesthetics. Ranked honestly:

Strong evidence: silicone gel and sheeting — the best-supported topical treatment, reducing redness, thickness and itch when used daily for three months or more. Intralesional steroid for raised scars. Sun protection during the first year.

Good evidence: fractional and pulsed-dye laser. Radiofrequency microneedling for atrophic scarring. Subcision for rolling scars. TCA CROSS for ice pick scars.

Reasonable but limited: pressure therapy. Scar massage — probably helpful, modest effect. Dermal filler for individual depressions, temporary by nature.

Weak or absent evidence: vitamin E oil, onion extract preparations, and the great majority of “scar removal” creams sold online.

See do silicone strips help scars heal better?

The Timing Strategy Most People Get Wrong

Scar treatment divides into two phases, and the first is worth considerably more than the second.

Phase one — active scar management, weeks 2 to 12 months. Begins once the wound has closed. Silicone, sun protection, massage, and steroid injection for scars showing early signs of thickening. Cheap, non-invasive, and this is where the final appearance is largely decided.

Phase two — mature scar revision, 12 months onward. Surgical excision, laser, or microneedling on a settled scar. More expensive, more invasive, and generally less able to transform a poor scar than phase one was to prevent it.

The mistake is skipping phase one, waiting to see how the scar turns out, and then seeking revision. By then the most effective window has closed. If you have had surgery or an injury within the last year, the highest-value thing you can do is start silicone and sun protection now.

What Affects How Your Scar Heals

Within your control: smoking — the single largest modifiable factor, worsening healing measurably; sun exposure during the first 12 months, which can darken a scar permanently; diligence with silicone and massage; following post-operative instructions.

Not within your control: genetics and family history of keloid or hypertrophic scarring; Fitzpatrick skin type; age — younger skin heals more vigorously and scars more readily; anatomical site — face and neck heal well, chest and shoulders poorly; whether infection occurs.

Within your surgeon’s control: incision placement along tension lines, gentle tissue handling, layered tension-free closure, and recognising a high-risk patient before operating rather than after.

What We Don’t Recommend

Vitamin E oil. Widely recommended, weak evidence, and a meaningful rate of contact dermatitis. Silicone is the better-supported choice.

Hydrogen peroxide or alcohol to “dry out” a wound. Outdated. Moist healing produces better scars.

Picking scabs or crusts. Reopens the wound and prolongs inflammation, both of which worsen the final scar.

Sun exposure on a fresh scar. SPF 50 daily for at least a year.

Excising a keloid without adjuvant treatment. High recurrence, often worse than the original.

Demanding revision within six months. Most scars improve substantially on their own during that period.

Steroid injections from non-medical providers. Misplaced injection causes skin atrophy and depigmentation.

Online “scar removal” creams. Very few have any evidence base.

Costs

Non-surgical treatments start from around £350 per session, with most protocols needing three to six sessions.

Surgical scar revision is priced individually at consultation, depending on size, site and complexity.

Steroid injection courses are among the least expensive interventions and often the most effective for raised scars.

Finance is available through Chrysalis Finance, subject to status. See laser scar removal cost for detail.

NHS funding is restricted to functional problems — restricted movement, recurrent breakdown or ulceration. Cosmetic improvement is not usually funded.

When to Seek Assessment

Most scars settle without help. Seek earlier review if:

The scar is becoming progressively raised, firm, red or itchy beyond 6–8 weeks
It is extending beyond the original wound boundary — this suggests keloid formation and earlier treatment works better
It restricts movement at a joint
There are persistent open areas, discharge, or signs of infection
You have a personal or family history of keloid scarring and have recently had surgery
It is causing significant distress, regardless of how it looks to others

For raised scars in particular, early treatment substantially outperforms late treatment.

Frequently Asked Questions: Types of Scars

What are the main types of scars?

Eight are commonly recognised: fine-line, hypertrophic, keloid, atrophic (with ice pick, boxcar and rolling subtypes), contracture, hypopigmented, and stretch marks. The atrophic subtypes matter because each responds to different treatment.

What is the difference between a hypertrophic scar and a keloid?

A hypertrophic scar stays within the boundary of the original wound. A keloid grows beyond it into healthy skin. Hypertrophic scars often improve on their own over 12 to 24 months; keloids rarely do without treatment.

Can a scar be removed completely?

No. Scars are permanent changes to the skin’s structure. Treatment reduces visibility, sometimes dramatically, but never restores original skin. Anyone promising complete removal is overselling.

How long does a scar take to heal?

The wound closes within one to two weeks, but the scar matures for 12 to 18 months. Appearance at three months is not the final appearance.

Which scar type is hardest to treat?

Hypopigmented white scars, because pigment cells do not repopulate the area naturally. Keloids are the most likely to recur after treatment.

What is the best treatment for raised scars?

Silicone gel or sheeting daily as a baseline, with intralesional steroid injection for scars that are thickening. Surgery is reserved for mature scars that have not responded.

What is the best treatment for acne scars?

It depends on the subtype. Ice pick scars need TCA CROSS or punch excision; rolling scars need subcision; boxcar scars respond to resurfacing. Most people need a combination.

Does silicone actually work on scars?

Yes — it has the strongest evidence base of any topical scar treatment. It needs daily use for at least three months to be effective.

Does vitamin E help scars?

The evidence is weak, and a meaningful proportion of people develop contact dermatitis from it, which can worsen the scar. Silicone is better supported.

Are some people more prone to bad scarring?

Yes. Fitzpatrick skin types IV–VI and those with a family history of keloid formation have a higher rate of hypertrophic and keloid scarring. Tell your surgeon before any procedure.

When should scar revision surgery be done?

Usually at least 12 months after the original injury, once the scar has fully matured. Earlier intervention risks operating on a scar that would have improved anyway.

Can old scars be improved?

Often, though less dramatically than treatment started during the maturation window. Laser, radiofrequency microneedling and surgical revision can all improve mature scars.

Are stretch marks scars?

Yes — they are dermal scars caused by tearing of the collagen network. Red stretch marks respond considerably better to treatment than white ones.

Will my scar go away on its own?

It will fade and flatten considerably over 12 to 18 months, but it will not disappear. Hypertrophic scars often settle substantially. Keloids do not.

Scar Assessment at Centre for Surgery

Assessment begins with establishing the scar type, since that determines everything that follows. Your surgeon will examine the scar, take a history including any family history of keloid formation, and set out what is realistically achievable.

Scar assessment and revision at Centre for Surgery is led by Mr Shehab Jabir, Consultant Plastic and Reconstructive Surgeon (GMC: 7083880), who undertakes a substantial volume of scar work — from surgical revision and contracture release through to pigment restoration for hypopigmented scars.

We will also say when no treatment is the right answer — which is common for scars under a year old that are still maturing.

All surgery is performed by GMC-registered surgeons at our own day-surgery facility at 95–97 Baker Street, Marylebone, under TIVA. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery is booked. No GP referral is required.

Phone: 020 7993 4849
Email: contact@centreforsurgery.com
Address: 95–97 Baker Street, Marylebone, London W1U 6RN
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