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Heavy scar is either a keloid or a hypertrophic scar, The distinction is important because there is no good treatment for keloid scars but hypertrophic scars are often be improved with scar revision.

The best ways to determine the difference are by examination and the response to treatment.

Keloid scars usually extend beyond the edges of the original scar and can become progressively larger. Hypertrophic scars do not.

Keloid scars are more common in people with dark complexions and hypertrophic scars in those with fair complexions.

Keloid scars rarely respond to treatment. Hypertrophic scars often improve with treatment. This means that patients who have keloid scars may undergo scar revision therapy with only a small chance of success.

Tests are not effective in distinguishing the two types of scar. The amount of collagen and fibroblast activity is the same in both and examination of the scar under the microscope is usually of minimal value.

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