Dr Bhavin Garara
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Scars

Scars

Skin scars from surgical excisions, mole removal, piercings, ingrown hairs, and minor trauma can heal unpredictably. Some patients develop raised, thick, sometimes itchy scars — hypertrophic if they stay within the original wound border, keloid if they extend beyond it. Effective management combines intralesional steroid (a prescription-only medicine) to flatten the raised component, followed by laser or radiofrequency to refine residual texture, and regenerative skin support throughout.

Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 13 February 2026

On this page

Hypertrophic and keloid scars are recognised medical scar types. This page is general information, not a diagnosis. Severe, painful, or rapidly growing scars benefit from dermatological assessment.

What it is

What Are Hypertrophic and Keloid Scars?

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When skin is injured, the healing response lays down new collagen to repair the breach. If the response over-shoots — producing more collagen than is needed, often in a disorganised pattern — the resulting scar is raised. Hypertrophic scars stay within the original wound margins; keloid scars grow beyond them.

Dr Bhavin Garara’s approach combines pharmacological management of the inflammatory component (intralesional steroid) with energy-based and regenerative treatments to refine the result over a course.

What causes it

What Causes Them?

  1. 1

    Genetic predisposition

    Family history of keloid formation is the strongest risk factor.

  2. 2

    Skin type

    Keloid is more common in higher Fitzpatrick types.

  3. 3

    Anatomical site

    The sternum, shoulders, earlobes, and jawline are particularly keloid-prone.

  4. 4

    Wound tension and healing factors

    Tension on a healing wound, infection, and delayed healing all increase risk.

  5. 5

    Type of injury

    Surgical excision, deep acne, piercing, burns, vaccination sites, and ingrown hairs can all trigger keloid formation in predisposed individuals.

Dr Bhavin Garara
Dr Bhavin Garara, MBBS, BMedSci, PGDip
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Dr Garara's approach

How Dr Garara Treats Them

At the clinics in London, Dr Garara assesses the scar’s age, size, symptoms, anatomical site, and your history of healing. The plan usually starts with intralesional steroid to flatten the raised component, then layers in laser or radiofrequency for residual texture and regenerative support for tissue quality.
  • Anatomy-led assessmentTreatment plans built around your unique facial structure and movement.
  • Personalised planCombinations chosen for your skin, goals, and lifestyle — not a one-size-fits-all protocol.
  • Natural resultsA refreshed, well-rested version of you — never a frozen or over-treated look.

Features

Treatment Options

Intralesional steroid (Kenalog®), fractional laser, radiofrequency microneedling, regenerative skin treatments, and an explicit no-surgical-excision-alone policy.

Intralesional steroid (prescription-only medicine)

Intralesional steroid (prescription-only medicine)

The first-line treatment for raised hypertrophic and keloid scars. Targeted micro-injections soften and flatten the scar by reducing the overactive fibroblast response. A widely-used brand example is Kenalog®.

Fractional laser resurfacing

Fractional laser resurfacing

Once flattened, residual textural irregularity can be refined with UltraClear (a 2910nm “cold ablative” fractional system) for thicker, irregular surfaces.

Radiofrequency microneedling (Sylfirm X)

Radiofrequency microneedling (Sylfirm X)

Sylfirm X delivers radiofrequency through fine needles into deeper dermal scar tissue, helping reorganise disorganised collagen.

See Sylfirm X →
Regenerative skin treatments

Regenerative skin treatments

Polynucleotides (Rejuran®), PDRN, autologous PRP and platelet-derived exosomes support tissue quality and organised collagen healing.

What we do not do

What we do not do

The clinic does not perform surgical excision of keloid scars without a comprehensive medical management plan, because excision alone often produces a larger keloid.

Treatment is layered — intralesional steroid first to flatten, then laser or radiofrequency to refine residual texture, with regenerative skin support throughout.

Intralesional steroid (prescription-only medicine)

  • Best for: Raised hypertrophic and keloid scars
  • Downtime: None — brief soreness
  • Lasts: Softens / flattens over weeks; usually repeated

The first-line treatment for raised hypertrophic and keloid scars. Targeted micro-injections of intralesional steroid soften and flatten the scar by reducing the overactive fibroblast response. A brand example some patients may have heard of is Kenalog®.

Intralesional steroid is a prescription-only medicine in the UK, which means it can only be prescribed and administered by a qualified medical prescriber following a face-to-face consultation. Whether it is suitable for you is something Dr Garara will discuss with you at consultation. It is not suitable for everyone.

Treatment is usually repeated every 4–6 weeks; the effect is to flatten and soften the raised scar over weeks to months. The result is not described as permanent — maintenance is usually needed.

Fractional laser resurfacing

  • Best for: Residual surface texture once flattened
  • Downtime: 3–7 days of redness or peeling
  • Lasts: Long-lasting; results develop over months

Once flattened, residual textural irregularity can be refined with UltraClear (a 2910nm fibre laser marketed as a “cold ablative” fractional system) for thicker, irregular surfaces.

Radiofrequency microneedling (Sylfirm X)

  • Best for: Deep dermal scar reorganisation
  • Downtime: 2–4 days of mild redness
  • Lasts: Long-lasting; collagen remodelling continues for months

Sylfirm X delivers radiofrequency through fine needles into deeper dermal scar tissue, helping reorganise disorganised collagen.

Regenerative skin treatments

  • Best for: All scar types; supports tissue quality
  • Downtime: 1–3 days of mild redness
  • Lasts: Around 6–12 months with a course

Polynucleotides (Rejuran®), PDRN, autologous PRP and platelet-derived exosomes support tissue quality and organised collagen healing.

What we do not do

The clinic does not perform surgical excision of keloid scars without a comprehensive medical management plan, because excision alone often produces a larger keloid. Where surgical management is appropriate, this is via a plastic surgery or dermatology specialist with adjunctive treatment planned.

Treatment for higher Fitzpatrick skin types (IV–VI) requires careful device selection and conservative settings to reduce the risk of post-inflammatory hyperpigmentation or further keloid formation. Dr Garara has particular experience in aesthetic medicine for skin of colour.

Considering treatment for a hypertrophic or keloid scar?

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Compare at a glance

Treatments at a Glance

Intralesional steroid (POM)

Best suited for
Raised hypertrophic and keloid scars
Typical downtime
None — brief soreness
How long results last
Softens / flattens over weeks; usually repeated
What it does
Reduces overactive healing response

Fractional laser

Best suited for
Residual surface texture once flattened
Typical downtime
3–7 days of redness or peeling
How long results last
Long-lasting; results develop over months
What it does
Refines surface

Radiofrequency microneedling

Best suited for
Deep dermal scar reorganisation
Typical downtime
2–4 days of mild redness
How long results last
Long-lasting; collagen remodelling continues for months
What it does
Reorganises dermal collagen

Regenerative skin treatments

Best suited for
All scar types; supports tissue quality
Typical downtime
1–3 days of mild redness
How long results last
Around 6–12 months with a course
What it does
Supports tissue quality

Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.

Safety & risk

Is Treatment Safe?

Intralesional steroid is widely used for raised scars and is generally well tolerated. Risks include local skin atrophy at the injection site (more common with over-frequent dosing), hypopigmentation (more common in skin of colour), and rare systemic effects with very high cumulative doses. These are managed by careful spaced dosing and conservative volumes. Energy-based treatments carry the usual risks of post-inflammatory pigment change.

We share this because patients deserve full information. Dr Garara is happy to discuss specific risks at consultation.
  • Qualified medical practitionerTreatment carried out by an experienced doctor with detailed anatomical training.
  • Reversal agents on handHyaluronidase and other complication-management tools are immediately available.
  • Full informed consentRisks, alternatives, and expected outcomes discussed in detail before any treatment.
Dr Bhavin Garara
Reviewed byDr Bhavin Garara

Frequently Asked Questions

Common questions about treating hypertrophic and keloid scars.

Read next

Related Concerns

Skin scars connect to other concerns. You may also want to read about:

Facial scarringPigmentation (body)Acne and breakouts
← All skin concerns

For an overview of all the facial concerns we treat, visit our Skin treatments hub.

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This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.