Raised Scar and Keloid Treatments Compared

Start with the kind of raised scar you have

If you are reading this, you probably have a firm, raised scar that itches, feels tight or simply bothers you when you look at it. Before comparing treatments, it helps to know which kind it is. A hypertrophic scar stays within the wound and often flattens slowly on its own. A keloid spreads past the wound and rarely fades without treatment. The guide keloid vs. hypertrophic scar walks through how to tell them apart.

It also helps to know what you want. The American Academy of Dermatology (AAD) suggests asking yourself whether easing itch or pain matters most, whether a flatter or softer scar would make you feel better, or, for an earlobe keloid, whether your main goal is to wear earrings again. MedlinePlus adds that keloids often do not need treatment at all if they do not bother you.

Timing matters too. A scar that is only a few weeks or months old may still be changing, and some raised scars settle with time and simple care. The guide is your scar ready for treatment covers when starting early makes sense and when waiting is wiser.

Options you wear: silicone and pressure

Silicone gel sheets are thin, self-adhesive sheets of medical-grade silicone. The AAD says silicone has been used since 1982 and can reduce a raised scar's size, hardness, redness, itch and stiffness, and can help prevent a raised scar after surgery. Studies suggest the sheets work better than silicone ointment. The catch is time: you wear a sheet every day, often for months. Never put one on a scab or open wound, and tell your provider if your skin breaks down or you get a rash under it.

Pressure therapy uses an elastic bandage, garment, stocking or a special pressure earring to press on the scar. The AAD says pressure can reduce scarring while a burn heals and help keep a keloid from coming back after surgery. It is demanding: the AAD describes wearing a keloid pressure garment 12 to 20 hours a day for several months, and some people wear pressure dressings for as long as a year. Pressure earrings tend to be the easiest to wear, and pressure therapy is not an option for wounds on the face.

Treatments in the office: injections, laser and freezing

These are the treatments a medical provider performs. Each has a different job, and each has trade-offs worth asking about.

• Injections into the scar. Corticosteroids, or medicines such as 5-FU or bleomycin, are injected directly into a raised scar or keloid to shrink it and ease itch and pain. The AAD says most people need more than one injection and that between 50% and 80% of keloids shrink after injection, but many of those regrow within five years. Possible side effects include thinning skin and lighter or darker spots, and the AAD notes light spots are a particular concern in darker skin.
• Laser. The AAD says laser treatment can reduce the height and fade the color of a keloid and is often combined with injections or pressure. For hypertrophic scars, a 2021 review found good evidence that pulsed-dye laser reduces redness and itch. The same review warns that fully ablative lasers, which remove the surface of the skin, are not recommended for these scars because of high recurrence.
• Freezing (cryotherapy). A very cold substance freezes the scar from the inside. The AAD says one treatment can reduce a scar's size by 50% or more and that freezing is most useful for small keloids. It may not be recommended for brown or black skin because it can leave a permanent light spot.

Surgery and radiation for stubborn keloids

Surgery cuts the scar out. For a hypertrophic scar, a 2021 review in Plastic and Reconstructive Surgery says surgery is rarely needed unless the scar tightens across a joint and limits movement. Keloids are another story. The AAD warns that nearly all keloids return after surgery alone, and the same review cites recurrence rates of 45 to 100 percent when surgery is not combined with anything else. MedlinePlus notes that treatment, especially surgery, sometimes makes a keloid larger.

That is why keloid surgery is usually followed by another treatment, such as injections, pressure, silicone sheets or freezing. Radiation is one of these follow-up options. The AAD says it has been used for more than 100 years to help keep keloids from growing back, but it can cause peeling, itching and permanent color changes, and there have been reports of cancer years later. The AAD says a type called superficial radiation therapy can be appropriate after surgery when safety measures are in place.

Why plans combine treatments, and what recurrence means

For keloids, the AAD says using two or more treatments often improves results, and it is honest about the limits: no treatment consistently gets rid of a keloid, what works for one person may do nothing for another, and nothing always prevents a return. Over-the-counter scar products with onion extract or vitamin E have limited research behind them, according to the AAD.

A realistic plan usually sets goals such as softer, flatter and less itchy, rather than gone. The AAD says the same of laser treatment in general: it can make a scar less noticeable, but it cannot get rid of a scar. Plan for follow-up visits and ask how a return would be handled. The long-form laser scar removal guide explains how raised scars fit into the wider picture of scar treatment.

What Laser Eraser offers for raised scars

Laser Eraser treats keloids with a series of injections into the scar, not with the laser, as described on the keloid scar treatment page. Raised scars that stay within the wound are treated with the PicoWay laser, as described on the hypertrophic scar treatment page. The other options in this guide are general treatments described by the AAD and medical reviews, not services listed on the practice's site.

A scar from a recent surgery should be cleared with your surgeon first, and a scar that is growing fast, bleeding or not healing needs a dermatologist. When you are ready to compare plans, the guide questions to ask before scar treatment gives you a checklist for the visit.