Hypertrophic scarring: causes, treatment and financial protection

What is hypertrophic scarring?

• Hypertrophic scarring refers to a raised, thickened scar caused by excessive collagen formation
• Synonyms: hypertrophic scar, raised scar, excessive scarring
• It remains confined to the original area of the wound – unlike a keloid
• Typical time frame for onset: a few weeks to months after the wound has healed

Every wound heals through the formation of scar tissue. During this process, the body produces collagen to bind the edges of the wound together. Normally, this process is balanced: collagen production and breakdown are in equilibrium, resulting in a flat, pale scar.

In the case of a Hypertrophic scarring this balance is disrupted. The body produces more collagen than it breaks down. The result is a raised, firm and often reddened scar that protrudes above the surface of the skin. A characteristic feature is that the hypertrophic scar does not extend beyond the borders of the original wound.

Hypertrophic scars are among the most common wound-healing disorders following surgical and cosmetic procedures. Areas of the body subject to high skin tension or movement are particularly affected – such as the sternum, the shoulders and the back, as well as areas following breast augmentation, a tummy tuck or a breast lift.

The difference between hypertrophic scarring and keloids

Hypertrophic scars and keloids are often confused because both are raised and bulging. The key difference lies in their extent and course – and therefore also in their treatment.

Characteristic	Hypertrophic scar	Keloid
Extent	Remains in the original wound area	Grows beyond the edges of the wound
History	It often resolves itself to some extent	Continues to grow; rarely regresses
Origins	Weeks after the injury	Even months later, sometimes without any obvious trigger
propensity to relapse	Low to moderate	High, even after treatment

This distinction is important because a keloid is significantly more stubborn and requires different treatment strategies. A specialist in dermatology or plastic surgery will make the definitive diagnosis.

Causes and risk factors for hypertrophic scarring

Hypertrophic scarring rarely results from a single cause. In most cases, a combination of factors disrupts wound healing or increases the mechanical stress on the scar.

Local factors in hypertrophic scarring

• High wound tension: Scars over joints, on the sternum or on the shoulder are under constant tension
• Wound infection: Delayed, inflammatory healing promotes excessive tissue growth
• Impaired wound healing: for example, following wound dehiscence or delayed wound healing
• Foreign body irritation: Sutures or debris in the wound
• Mechanical irritation: early strain or repeated movement of the scar

Patient-related factors

• Genetic predisposition: a family history of excessive scarring
• Skin type: People with darker skin tones are more prone to hypertrophic scars and keloids
• Age: Younger skin is more likely to develop hypertrophic scars
• Hormonal factors: such as during pregnancy or puberty
• Smoking and malnutrition: impair wound healing overall

Symptoms and progression of hypertrophic scarring

• A raised scar that protrudes above the surface of the skin
• Reddish to livid discolouration, particularly during the active phase
• Firm, sometimes hard texture
• Itching, a feeling of tightness or pressure
• Restricted movement if the scar is located over a joint

Hypertrophic scarring usually develops in the first few weeks to months following wound healing. During the active phase, the scar is red, raised and may itch or feel tight. Itching is a typical early sign and an indication of active tissue remodelling.

Some hypertrophic scars gradually fade on their own over a period of months. However, a scar never disappears completely – the aim of treatment is to make it flatter, paler and smoother, and to relieve symptoms such as itching.

Treatment options for hypertrophic scarring

Treatment depends on the age, size and activity of the scar. The earlier treatment begins, the better the outcome. Many procedures are carried out in combination.

Conservative methods for scar treatment

The mainstay of treatment is silicone patches or silicone gel. These keep the scar moist, regulate collagen formation and relieve itching. Pressure or compression therapy – for example, using special compression bandages or custom-made garments – applies sustained pressure to the scar, helping to flatten it. In addition, regular scar massage helps to keep the tissue supple.

Injection and instrumental procedures

In the case of firm, stubborn scars, the doctor injects cortisone (corticosteroids) directly into the scar tissue to soften and flatten it. Cryotherapy (freezing) and modern laser therapies can further reduce redness and raised areas. These procedures usually require several sessions and medical supervision.

Surgical scar correction

Surgical correction is only considered if conservative treatments have been exhausted or if the scar is causing functional problems. As any further surgery may itself lead to the formation of a hypertrophic scar, it is usually combined with subsequent silicone therapy, compression therapy or radiotherapy to prevent a recurrence.

1. Early start As soon as the wound has healed, start using silicone and scar care products.
2. Main treatment Use silicone, compression and massage consistently over several months.
3. Medical check-up If you have an active, itchy or enlarging scar, seek advice from a specialist.
4. Escalation A cortisone injection, laser treatment or cryotherapy, depending on the findings.
5. Correction Surgical revision should only be carried out in cases of prominent or functionally disruptive scars.

Prevention: Scar care right from the start

Part of the risk is determined by the surgical technique – for example, making incisions with minimal tension and ensuring careful wound closure. These factors are in the hands of an experienced surgeon. However, consistent scar care in the weeks and months following the procedure is just as important.

UV protection plays a key role: fresh scars are sensitive to the sun and may remain permanently darker. You can find out more about the healing process in our guide to aftercare following cosmetic surgery.

Costs and financial protection in cases of hypertrophic scarring

• Silicone gel and silicone plasters: depending on the duration, the price ranges from two to three figures
• Cortisone injections: usually a low three-figure sum per session; several are often required
• Laser or cryotherapy: several sessions, often costing in the mid three-figure range per session
• Surgical scar correction: depending on the extent of the procedure, from several hundred to over a thousand euros

Whether the costs are covered depends on the reason. If the scar is purely a cosmetic concern, patients usually have to pay for the treatment themselves – statutory health insurance typically refuses to cover the costs, particularly following cosmetic surgery. The situation may be different if the hypertrophic scar constitutes a medically relevant complication, such as one causing functional impairment or associated with a wound-healing disorder requiring treatment.

This is where a Consequential Costs Insurance: It covers medically necessary follow-up treatment following complications arising from a cosmetic procedure that are not covered by health insurance – with a free choice of doctor in the event of a claim. Whether a specific scar treatment is considered medically necessary follow-up treatment depends on the individual case and the terms and conditions of the policy.

You can find further information on covered procedures on the overview page for treatments and procedures, as well as in the frequently asked questions.

Frequently asked questions about hypertrophic scarring

Sources

• German Dermatological Society (DDG) / AWMF: Guidelines on the treatment of pathological scars (hypertrophic scars and keloids)
• German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC): Information on scar formation and scar correction
• Institute for Quality and Efficiency in Health Care (IQWiG): Patient information on wound healing and scarring