🧬 How to Prevent Hypertrophic Scars and Keloids: A Complete Guide By Dr. Marco Aurelio Rendón – Board-Certified Plastic Surgeon in Guadalajara, Jalisco

🧬 How to Prevent Hypertrophic Scars and Keloids: A Complete Guide
By Dr. Marco Aurelio Rendón – Board-Certified Plastic Surgeon in Guadalajara, Jalisco

Scars are a natural part of the healing process, but in some cases, the skin produces an excessive amount of collagen, leading to hypertrophic scars or keloids. These scars may appear raised, thick, itchy, or even uncomfortable. The good news is that with proper care and the right surgical techniques, they can be prevented.

This guide explains what they are, why they form, and how to avoid them, especially after cosmetic or reconstructive surgery.

 
🔍 Hypertrophic Scar vs. Keloid: What’s the Difference?

• Hypertrophic scars
  Formed from excess collagen production.
  Stay within the original wound borders.
  Often improve slowly over time.
• Keloids
  Extend beyond the boundaries of the original incision.
  Grow progressively over months or years.
  More common in genetically predisposed patients.
  Correct differentiation is key because the prevention strategy changes depending on the type.

 
🧠 Why Do They Form?
The main factors include:

• Genetic predisposition
• Excess tension on the wound
• Infection or delayed healing
• Location (chest, shoulders, jawline, and ears are high-risk zones)
• Early sun exposure
• This is why personalized scar management is essential.

 
🛡️ Evidence-Based Strategies to Prevent Abnormal Scarring
✅ 1. Proper surgical technique

A good scar begins in the operating room. In my practice I use:

• Incisions aligned with natural skin tension lines
• Deep sutures to reduce surface tension
• Layered closure with meticulous precision
• These steps significantly reduce the risk of thick or elevated scars.

 
✅ 2. Avoid sun exposure for at least 3 months
Sun exposure can darken, harden, and inflame healing tissue.

Recommendations:

Use SPF 50+ sunscreen once the incision is fully closed
Avoid direct sunlight on the scar
 
✅ 3. Silicone sheets or silicone gel
Silicone therapy is the worldwide gold standard for scar prevention.

Benefits:

• Maintains hydration
• Reduces inflammation
• Prevents excessive collagen buildup
• Typically started 2–3 weeks post-op, depending on healing.

 
✅ 4. Specialized topical treatments (Pirfenidone and others)
Pirfenidone is widely used to improve scar quality.

Instructions:

• Apply twice daily
• Continue for at least 2–3 months
• It helps reduce fibrosis and promote soft, flexible healing.

 
✅ 5. Scar massage
Starting around weeks 3–4 (only under medical approval):

• Use circular motions with gentle pressure
• Perform 2–3 times daily
• Helps soften the tissue and improve elasticity
   
  ✅ 6. Avoid tension and early exercise
  Too much movement or stretching can thicken the scar.

Extra caution is needed for:

• Abdomen
• Chest
• Arms
• Return to exercise must be gradual and always supervised.

 
✅ 7. Additional prevention for high-risk patients
If you have a history of keloids or very thick scars, early intervention is key.

Options include:

• Steroid injections, every 3–6 weeks
• Fractional CO₂ laser therapy
• Controlled microneedling
• PRP (Platelet-Rich Plasma) in selected cases
• In my practice, I use a combined protocol to keep recurrence as low as possible.

 
🧴 When to Seek Medical Attention
Contact your plastic surgeon if you notice:

• Persistent redness
• Intense itching
• Thickening after week 6
• Growth beyond the incision line
• Early management always produces better results.

 
⭐ Conclusion
Hypertrophic scars and keloids can be prevented with proper surgical planning, personalized postoperative care, and evidence-based therapies. In Guadalajara, I offer comprehensive scar management protocols including silicone therapy, laser treatments, and close follow-up to ensure the best possible healing.