The short answer
Scars fall into a few broad types: flat or pale scars, indented (atrophic) scars, raised (hypertrophic) scars, keloid scars that grow beyond the original wound, and tight contracture scars. Each behaves differently, so the type decides whether restorative needling, camouflage pigment, medical care or no treatment at all is the right first step. Keloid scars need particular caution and a doctor’s input.
“Scar” covers a surprising range of skin changes, and they do not all behave the same way. Knowing which type you have is the first step in understanding what, if anything, will help. It is also the first thing we assess at consultation.
The main types of scars
Flat and pale (mature) scars
These are the scars most people picture: flat, often paler than the surrounding skin, sometimes slightly shiny. They are common after surgery, injuries and healed wounds. Because the main issue is often colour, they are frequently candidates for camouflage pigment, and sometimes needling to improve texture. We cover this in camouflaging white scars and hypopigmented skin.
Atrophic (indented) scars
Atrophic scars sit below the surrounding skin because tissue was lost during healing. Acne scarring is a classic example, and many stretch marks have a similar indented quality. Needling is commonly considered for these, aiming to encourage collagen remodelling and soften the contour, although results vary.
Hypertrophic (raised) scars
Hypertrophic scars are raised, firm and often pink or red. They stay within the boundary of the original wound and, unlike keloids, often settle with time. They are usually best assessed by a doctor first, and treatment is typically timed to when the scar has had a chance to mature.
Keloid scars
Keloids are firm, raised scars that grow beyond the original wound. They can appear weeks to years after an injury, tend to persist, and are more common in people with darker skin. Because any injury to the skin can trigger more keloid growth, they need particular caution. Anyone with a tendency to keloid scarring should speak with a dermatologist before considering needling or tattooing.
Contracture scars
These scars pull the skin tight and can limit movement, often following burns. They are a medical matter first. A paramedical approach may be considered afterwards for appearance, but only with your treating team’s input.
Why type decides the plan
| Scar type | What it looks like | Typical first consideration |
|---|---|---|
| Flat / pale | Level with skin, lighter or different in colour | Colour match with camouflage pigment, sometimes needling |
| Atrophic | Indented or sunken | Needling to prompt collagen remodelling |
| Hypertrophic | Raised, firm, within the wound edge | Medical assessment; wait for maturity |
| Keloid | Raised, growing beyond the wound edge | Dermatologist first; needling and tattooing need caution |
| Contracture | Tight, restricts movement | Medical care first |
Other things we look at
Scar type is only part of the picture. We also consider the scar’s age, how mature it is, where it sits, your skin type and tone, and how your skin has healed before. Timing is covered in when to start scar treatment after surgery, and what treatment can realistically change in can scars really be revised?
Not sure what you have?
Scar types can overlap and are hard to judge by eye alone. A free consultation, in clinic or by video, is a straightforward way to have your scar looked at. If it needs medical input first, we will tell you.
Frequently asked questions
What is the difference between a hypertrophic scar and a keloid?
A hypertrophic scar is raised but stays within the boundary of the original wound and may improve over time. A keloid grows beyond the original wound, tends to persist, and is more resistant to treatment.
Can keloid scars be treated with needling or tattooing?
Keloid scars need extra caution because further injury to the skin can make them worse. Anyone with a tendency to keloid scarring should speak with a dermatologist before considering needling or tattooing.
What is an atrophic scar?
An atrophic scar is an indented or sunken scar, where the skin has lost tissue during healing. Acne scars and some stretch marks are commonly atrophic.
How do I know what type of scar I have?
A professional assessment is the reliable way to tell. Look at whether the scar is raised, flat or indented, whether it extends beyond the original wound, how it feels, and how old it is.
Further reading
This article is general information only and is not medical advice. Results and timelines vary between individuals, and suitability is assessed at consultation. If you have a medical condition or are unsure about a change in your skin, speak with your doctor.