Treating raised scars and keloids with injections, lasers, silicone or surgery combined with injections
Raised scars and keloids form when too much collagen is produced as a wound heals. They can be made flatter, softer and paler with intralesional injections, lasers and silicone sheets. Surgery is reserved for cases that need it and is always combined with injections.
How raised scars and keloids differ
A hypertrophic scar is raised and red but stays within the original wound edge, usually appearing 1–2 months after the wound heals and gradually flattening on its own over 1–2 years. A keloid spreads beyond the original wound edge, can keep growing for years, is often itchy and painful and does not regress on its own. Keloids are common on the earlobes, chest, shoulders, upper back and jawline, and can arise even from acne or ear piercing. Telling the two apart matters, because a keloid treated with surgery alone grows back larger in 50–80% of cases. Dr. Kate, a dermatologist, assesses the type, age and location of the scar and plans treatment that usually combines several methods.
Treatments at the clinic
| Method | How it is done | Expected results |
|---|---|---|
| Intralesional steroid injection | Triamcinolone is injected into the scar tissue every 4–6 weeks for 3–6 sessions, sometimes mixed with 5-FU for resistant keloids | The scar softens, flattens and stops itching. Side effects are thinning or lightening of the surrounding skin |
| Lasers | A vascular laser reduces redness, or a fractional laser smooths the surface and opens channels for medication, every 4–8 weeks | Less redness and a smoother surface; used alongside injections |
| Silicone sheets or gel | Applied for 12–24 hours a day for 2–6 months, starting as soon as the wound has closed | Reduces height and redness in new scars and prevents them in people prone to scarring |
| Surgery combined with injections | A large or pendulous keloid is excised, with a steroid injection immediately and every 3–4 weeks for a further 3–6 months, plus silicone sheets | Reduces recurrence to around 10–30%. Never done as surgery alone |
| Scar revision | A wide or tethered scar is excised and re-sutured along the skin's natural lines, or redirected with a Z-plasty | A fine-line scar that blends with the skin. The original scar must be 6–12 months old |
Who should come for a consultation
A red, raised surgical or caesarean scar
Starting treatment within the first 3 months works better than waiting
A lump on the earlobe after piercing
The most common keloid, usually needing surgery combined with injections
Raised acne scars on the chest, shoulders or jawline
Injections and vascular laser, while keeping new acne under control
Planning surgery with a history of keloids
Prevention planned before the operation greatly reduces the risk
The typical treatment process
A scar cannot be made to disappear as if it had never been there. The goal is a scar that is flat, soft, not itchy and close to normal skin colour. Steroid injections may thin or lighten the surrounding skin, which mostly improves once treatment stops. Tell the doctor if you are pregnant, have an infected wound or have uncontrolled diabetes. People who have had keloids should not have piercings, tattoos or cosmetic surgery without consulting a doctor.
Preventing raised scars after surgery or injury
- Keep the wound suitably moist so it does not dry out, scab and crack
- Start silicone sheets or gel as soon as the wound has closed and continue for 2–3 months
- Avoid tension on the wound, such as heavy lifting, for 4–6 weeks
- Apply sunscreen to the healed scar for 6–12 months
- If the scar starts to become raised, red or itchy after healing, see the doctor within 1–2 months
Frequently Asked Questions
Do keloid injections hurt? How many are needed?
There is a tight, stinging sensation during the injection because the scar tissue is dense; numbing cream or local anaesthetic helps. Most people need 3–6 injections 4–6 weeks apart. Small, recent scars respond faster.
Can a keloid simply be cut out?
Only when combined with steroid injections and silicone sheets for several months after surgery. With surgery alone, the chance of it growing back larger is as high as 50–80%, so the clinic does not excise keloids without a follow-on injection plan.
Will a raised scar go away on its own?
Most hypertrophic scars flatten on their own within 1–2 years, and treatment speeds this up and relieves itching. Keloids do not regress on their own and usually grow, so they should be treated.
When is the right time to treat a raised caesarean scar?
Silicone sheets can start once the wound has healed well, at around 3–4 weeks, and injections can begin as soon as the scar starts to rise, usually in months 1–3. Tell the doctor if you are breastfeeding; the dose injected directly into the scar is small and is usually acceptable.
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