Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 15 April 2026
Hypertrophic and keloid scarring are recognised medical scar types. Severe, painful, or rapidly enlarging scars benefit from dermatological assessment. This page is general information, not a diagnosis. Dr Garara will assess each scar at consultation and discuss the appropriate pathway.
Scars develop when the skin’s healing response produces collagen that is different in organisation and quality from undamaged dermis. Depending on which way the healing response over- or under-shoots, scars take different forms — and the right treatment differs accordingly.
Dr Bhavin Garara’s approach is to map the scar topography at consultation, identify which combinations are present, and build a realistic, staged plan.
Subtypes: Ice-pick — narrow, deep, sharp-edged pits. Boxcar — wider, U-shaped depressions with sharp edges. Rolling — wave-like undulations from fibrous bands tethering the skin to underlying tissue.
Raised but stay within the original wound border. Usually red and may itch.
Raised and extend beyond the original wound border. More common in skin of colour and at certain anatomical sites; often itch.
Red (PIE) or brown (PIH) marks left after acne or skin injury; not strictly scars but often treated together.
Severe inflammatory acne, surgical procedures, trauma, burns, and chronic skin conditions can all leave scars.
Hypertrophic and keloid tendency runs in families and is more common in some ethnic backgrounds.
Skin over bone (sternum, jawline, shoulders) is more prone to hypertrophic and keloid scarring.
Tension on a healing wound, infection, delayed healing, and certain medications can affect scar outcome.
Higher Fitzpatrick types are more prone to keloid formation and post-inflammatory hyperpigmentation.
At the clinics in London, Dr Garara assesses scar topography in detail (depth, type, tethering, colour, age), Fitzpatrick skin type, healing history, and any indication for dermatological referral.
The plan combines treatments appropriate to each scar type — subcision for tethered rolling scars, fractional laser for boxcar and ice-pick scars, intralesional steroid for raised scars, regenerative skin treatments for tissue support, and structural rebuilding (biostimulator or Seffiller in selected cases) where volume restoration is needed.
Features
Subcision, fractional laser, RF microneedling, intralesional steroid, regenerative, and Seffiller — combined by scar type.
Scar revision is typically layered — multiple modalities chosen by scar type, over several months. The aim is meaningful long-term improvement, not complete erasure.
For tethered rolling scars where fibrous bands hold the skin down to underlying tissue, subcision — using a needle or cannula to mechanically release the fibrous tethers — frees the skin so it can rise to a more even plane. Often combined immediately with collagen biostimulator placement into the subcised space to discourage re-tethering.
UltraClear (a 2910nm fibre laser marketed as a “cold ablative” fractional system) is designed to refine the sharp edges of boxcar and ice-pick scars and to stimulate collagen renewal across treated zones. MultiFrax (a 1550/1927nm non-ablative dual-wavelength laser) is a gentler option for diffuse textural irregularity. Multiple sessions are typically needed.
Sylfirm X delivers radiofrequency through fine needles into the dermis, useful for breaking up dermal scar tissue and supporting collagen remodelling. Particularly effective in combination with other modalities.
For raised hypertrophic and keloid scars, intralesional steroid injection softens and flattens the raised scar by reducing the overactive healing response. A brand example some patients may have heard of is Kenalog®. This 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.
Intralesional steroid is a prescription-only medicine (POM) and must be prescribed and administered by a qualified medical prescriber following a face-to-face consultation. The effect is to flatten and soften a raised scar; more than one treatment is usually needed, and the result is not described as permanent.
For depressed and tethered scars, poly-L-lactic acid (PLLA) or calcium hydroxyapatite (CaHA) preparations placed into the void created by subcision build collagen over weeks and months, discouraging the scar from re-tethering and supporting elevation.
Polynucleotides (Rejuran®), PDRN, multi-ingredient skinboosters, autologous PRP, and platelet-derived exosomes support tissue quality, encourage organised collagen healing, and reduce post-inflammatory pigment risk.
For severe atrophic scarring with significant volume loss, Seffiller (the clinic’s autologous fat-grafting treatment) can rebuild the dermal foundation using the patient’s own tissue. A proportion of the transferred fat integrates and provides long-lasting volume; results vary between individuals.
Treatment for higher Fitzpatrick skin types (IV–VI) requires careful device selection and conservative settings to reduce the risk of post-inflammatory hyperpigmentation or, in some cases, keloid formation. Dr Garara has particular experience in aesthetic medicine for skin of colour.
For tethered rolling scars where fibrous bands hold the skin down to underlying tissue, subcision — using a needle or cannula to mechanically release the fibrous tethers — frees the skin so it can rise to a more even plane. Often combined immediately with collagen biostimulator placement into the subcised space to discourage re-tethering.
Book a consultation with Dr Bhavin Garara.
Book a Consultation| Treatment | Best suited for | Typical downtime | How long results last | What it does |
|---|---|---|---|---|
| Subcision + biostimulator | Tethered rolling scars | 2–5 days of swelling and bruising | Long-lasting; collagen remodelling continues for months | Releases tethers and rebuilds collagen |
| Fractional laser (UltraClear / MultiFrax) | Boxcar, ice-pick, and diffuse textural scarring | 3–7 days of redness and peeling | Long-lasting; results develop over months | Refines surface and remodels collagen |
| Radiofrequency microneedling | Mixed scar patterns; dermal remodelling | 2–4 days of mild redness | Long-lasting; collagen remodelling continues for months | Breaks up dermal scar and remodels |
| Intralesional steroid (POM) | Raised hypertrophic and keloid scars | None — brief soreness | Softens / flattens over weeks; usually repeated | Reduces overactive healing response |
| Regenerative skin treatments | All scar types; supports healing | 1–3 days of mild redness | Around 6–12 months with a course | Supports tissue quality |
| Seffiller (autologous) | Severe atrophic scarring; selective | 5–10 days of swelling | Variable — a proportion integrates and lasts | Rebuilds dermal foundation with patient’s own tissue |
Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.
Scar revision is widely performed but carries treatment-specific risks. Energy-based treatments can cause post-inflammatory pigment change, particularly in skin of colour — managed by conservative settings and patient-specific protocols. Intralesional steroid carries risks of skin atrophy at the injection site if over-used and rare pigment changes; this is managed by careful dosing and spaced injections. Subcision can cause bruising and rare nerve irritation.
We share this because patients deserve full information. Dr Garara is happy to discuss specific risks at consultation. Suspicious or rapidly changing scars warrant dermatological review.
Common questions about facial scar treatment.
Facial scarring connects to other concerns. You may also want to read about:
For an overview of all the facial concerns we treat, visit our Face 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.
