A raised scar forms when your body produces too much collagen during wound healing. Instead of laying down collagen fibers in a flat, organized pattern, the repair process goes into overdrive and builds up excess tissue that sits above the level of your surrounding skin. This overproduction results in one of two types of raised scars: hypertrophic scars or keloids, each with different behavior and outlook.
What Happens Inside a Raised Scar
Normal wound healing follows a predictable sequence. After the initial inflammation clears, your body sends collagen-producing cells to the wound site to rebuild the skin’s structure. In a flat scar, these cells do their job and then slow down, leaving behind a thin, organized layer of collagen that blends relatively well with the skin around it.
In a raised scar, that process doesn’t shut off properly. The collagen-producing cells keep working long after the wound has closed, stacking dense, disorganized collagen fibers on top of each other. The result is a firm, thickened mound of scar tissue. The collagen in raised scars tends to be arranged in tight, tangled bundles rather than the neat parallel lines found in normal skin, which is why raised scars often feel stiff or rubbery to the touch.
Hypertrophic Scars vs. Keloids
Not all raised scars behave the same way, and the distinction matters because it affects how likely the scar is to improve on its own.
A hypertrophic scar stays within the boundaries of the original wound. It typically appears one to two months after the injury, looks red or pink, and feels firm. The good news is that hypertrophic scars often flatten and soften over time without treatment, sometimes over the course of one to two years.
A keloid, on the other hand, grows beyond the edges of the original wound and can continue expanding into healthy skin nearby. Keloids can take months or even years to develop after an injury, and they tend to persist without spontaneous resolution. They’re also more resistant to treatment than hypertrophic scars. Keloids most commonly appear on the earlobes, shoulders, cheeks, and middle of the chest.
A simple way to tell the difference: if your raised scar is wider than the original cut, burn, or piercing site, it’s likely a keloid. If it’s thick but still confined to the wound area, it’s probably hypertrophic.
Why Some People Get Raised Scars
Several factors influence whether a wound heals flat or raised. Genetics plays a major role. People with darker skin tones are significantly more likely to develop keloids, and a family history of keloid scarring increases your risk substantially. Age matters too: raised scars are more common in people between 10 and 30, when collagen production is at its most active.
Where the wound is on your body also matters. Areas with high skin tension, like the shoulders, chest, and jawline, are more prone to raised scarring because the constant pulling on the wound edges stimulates extra collagen production. Earlobes are a common site for keloids after piercings, despite being low-tension, likely because of a unique inflammatory response in that tissue.
The type and severity of the wound plays a role as well. Burns, surgical incisions that heal under tension, acne, and piercings are all more likely to produce raised scars than small, clean cuts. Infections during healing or wounds that take a long time to close also increase the odds.
Itching, Pain, and Other Symptoms
Raised scars aren’t just a cosmetic concern. Many people notice persistent itching, tenderness, or even pain in the thickened tissue. This happens because the dense collagen presses on nerve endings in the surrounding skin, and because the scar tissue itself has a limited blood supply that can trigger low-grade inflammation. Itching tends to be worse during the active growth phase and in dry or hot conditions. Keeping the scar moisturized with a fragrance-free lotion or silicone-based gel can reduce irritation.
How Raised Scars Are Treated
Treatment options depend on the type, size, and age of the scar. For hypertrophic scars, the simplest starting point is silicone sheeting or gel, which works by hydrating the scar tissue and creating gentle pressure that helps flatten it over weeks to months. Pressure garments work on a similar principle and are commonly used for burn-related scars.
Steroid injections are one of the most widely used treatments for both hypertrophic scars and keloids. A corticosteroid is injected directly into the scar tissue, which breaks down excess collagen and reduces inflammation. Most people need two or three injections spaced about a month apart, though treatment can continue for six months or longer for stubborn scars. The injections can be uncomfortable, but they’re effective at reducing both the height and the firmness of raised tissue.
For scars that don’t respond to injections alone, laser therapy is another option. Fractional laser treatments work by creating tiny columns of controlled damage in the scar tissue, prompting the body to remodel the collagen as it heals. Patients in clinical studies reported noticeable improvements in scar thickness, pliability, color, and symptoms like itching and pain after a series of sessions. The treatments are typically done in a dermatologist’s office and require minimal downtime.
Surgical removal is sometimes considered for large keloids, but it comes with an important caveat: cutting out a keloid can trigger an even larger one to form in the same spot. For this reason, surgery is almost always combined with steroid injections or radiation therapy afterward to prevent recurrence.
Reducing Your Risk With New Wounds
If you know you’re prone to raised scarring, there are practical steps you can take after any new injury or surgery. Keep the wound clean and moist during healing, as wounds that dry out or scab heavily are more likely to scar prominently. Avoid unnecessary tension on the wound: if you’ve had surgery, follow activity restrictions carefully, since stretching the incision site promotes excess collagen production.
Starting silicone gel or sheeting early, once the wound has fully closed, can help prevent a scar from becoming raised in the first place. Sun protection is also important. UV exposure can darken scar tissue and may worsen inflammation during the remodeling phase, so covering new scars or applying sunscreen consistently for the first year makes a meaningful difference.
If you’ve had keloids before, let any surgeon, dermatologist, or piercer know ahead of time. Preventive steroid injections at the wound site, started shortly after the procedure, can significantly reduce the chance of a new keloid forming.