Hypertrophic scars can compromise both the aesthetic outcome and the functional recovery following facial or body cosmetic procedures, so prevention should begin before incision. Preoperative evaluation needs to include a detailed history of previous scarring, keloid tendency, skin type, and systemic factors such as nutrition, smoking status, and metabolic conditions. Surgeons and patients should discuss incision placement, tension-minimizing techniques, and realistic expectations for healing. Preoperative skin optimization with good hydration, sun protection, and treatment of active inflammation reduces risk. Planning also involves outlining postoperative care, scar surveillance, and early interventions, because proactive strategies yield better long-term results than waiting for an established raised scar to form.
Surgical technique plays a central role in minimizing hypertrophic scar formation; meticulous tissue handling, precise hemostasis, and layered closure should be prioritized. Reducing wound tension by using deep sutures to distribute forces away from the dermis helps prevent abnormal collagen deposition. Selection of suture material and appropriate timing for removal are factors that influence scarring, with absorbable deep sutures and fine nonreactive epidermal closure often preferred. Surgeons should avoid excessive cautery and aggressive undermining that can disrupt vascular supply. When feasible, placing incisions along natural skin lines or creases and ensuring symmetry decreases mechanical stress and makes subsequent scar maturation less conspicuous.
When conservative methods fail, medical therapies provide additional control.
In the immediate weeks after surgery, diligent wound care reduces inflammation and promotes orderly healing, which lowers the chance of hypertrophic scarring. Patients should follow cleansing and dressing instructions to keep the incision clean and hydrated while avoiding irritating topical agents. Controlling edema and preventing infection are critical, so elevation, compression when indicated, and timely antibiotics for contamination can be helpful. Sun avoidance and sunscreen application protect newly forming tissue from pigmentary changes and ultraviolet-driven inflammation. Gentle massage initiated when wounds are fully epithelialized may improve pliability, but timing and technique should be guided by the surgical team to avoid disrupting fragile repairs.
Silicone-based therapies are among the most well-documented noninvasive measures to prevent and manage hypertrophic scars, with evidence supporting both sheets and gels for flattening and softening raised scars. These products create an occlusive environment that maintains moisture and may modulate growth factors involved in scar formation. Consistent, long-term use—often several months—is typically necessary to see meaningful change, and adherence influences outcome. Silicone is generally safe, cosmetic, and suitable for many anatomical sites, but it must be applied to intact skin and cleaned regularly to prevent irritation. For patients unable to tolerate sheets, silicone gel formulations provide a thinner alternative that still offers therapeutic benefit.
Procedural interventions can refine or correct persistent raised scars.
Intralesional steroid injections remain a cornerstone treatment for established hypertrophic scars and early keloid tendencies, acting to suppress fibroblast activity and reduce collagen production. Triamcinolone is commonly used and delivered into the scar body at scheduled intervals, with dosage and frequency tailored to size, location, and response. Side effects can include localized skin atrophy, pigment changes, and telangiectasia, so clinicians must balance effectiveness with cosmetic risks. For resistant lesions, steroid injections are often combined with silicone therapy, pressure therapy, or needling techniques to enhance remodeling. Close follow-up is necessary to monitor improvement and to adjust therapy for both efficacy and safety.
Emerging injectable options such as 5-fluorouracil, verapamil, and combination regimens expand therapeutic choices for hypertrophic scars, particularly when steroids alone do not suffice. 5-fluorouracil inhibits fibroblast proliferation and can be used alone or with steroids to improve results while potentially reducing steroid dose. Verapamil, a calcium channel blocker, may influence collagen synthesis and has shown mixed efficacy but remains an option in refractory cases. These agents require experienced practitioners for injection technique and to manage adverse effects. Decisions about pharmacologic injections should account for scar maturity, anatomical considerations, and patient-specific contraindications to ensure safety and maximize benefit.
Individual risk factors guide customized prevention and treatment plans.
For scars that do not respond adequately to medical therapy, procedural treatments offer another pathway to improvement and include methods such as laser therapy, microneedling, and surgical revision. Fractional lasers and pulsed dye lasers target vascularity and collagen remodeling to reduce height and redness, often requiring multiple sessions spaced weeks apart. Microneedling stimulates controlled dermal injury and can be combined with topical agents to enhance penetration and remodeling. Surgical scar revision may be appropriate when scar contracture or distortion compromises form or function, but revision should be timed after adequate maturation and often paired with adjuvant measures like steroid injections or silicone to reduce recurrence.
Pressure therapy and silicone combined with occlusion may benefit scars on areas amenable to compression, such as the torso and extremities, by reducing perfusion and mechanical stimulation that perpetuates hypertrophy. Custom garments or silicone-lined dressings provide sustained, uniform pressure and are usually worn for many hours each day over months to achieve maximal benefit. Though pressure devices are less practical for some facial locations, creative approaches or shorter high-tension windows can sometimes be effective. Patient education and regular follow-up are necessary to maintain compliance, monitor for skin breakdown, and assess the need to modify the regimen as the scar evolves.
Communication and follow-up ensure consistent, effective scar management.
Skin type, genetic predisposition, and the location of the surgical site inform both the likelihood of hypertrophic scarring and the optimal management pathway. Darker phototypes and individuals with prior abnormal scarring require heightened vigilance and early intervention. Certain anatomical zones, such as the chest, shoulders, and jawline, experience greater tension and are more prone to hypertrophic changes, which should influence incision planning and postoperative strategies. A personalized approach integrates patient preferences, tolerance for interventions, and lifestyle factors like sun exposure and smoking that can influence outcomes. Shared decision-making helps calibrate expectations and encourages adherence to prescribed regimens.
Timing is critical when addressing hypertrophic scars; preventive measures ideally begin perioperatively, and interventions for rising scars should commence promptly while balancing tissue stability. Early recognition of abnormal scar behavior enables prompt initiation of therapies such as silicone, pressure, or intralesional steroid, which often produce better results than treatments started after scars are fully matured. Conversely, aggressive procedures performed too early may disrupt healing. Clinicians should establish a monitoring schedule to evaluate changes in scar height, color, and symptoms and to intervene at appropriate milestones, adjusting intensity and modality according to response and tolerance.
Clear preoperative counseling about scar risk, the expected timeline of maturation, and the array of preventive and therapeutic options prepares patients for active participation in their recovery. Regular postoperative visits allow clinicians to evaluate healing, reinforce wound care, and initiate early interventions if hypertrophic changes emerge. Documentation of scar progression and treatment responses helps refine individualized plans and informs decisions about escalation to medical or procedural therapies. Educating patients on realistic goals, potential side effects, and the necessity of persistence with long-term regimens fosters adherence and enhances satisfaction with aesthetic outcomes.
Collaboration between surgeon, dermatologist, and patient produces the best outcomes for hypertrophic scar prevention and treatment after cosmetic operations. Multidisciplinary input can optimize perioperative planning, select evidence-based combinations of therapies, and sequence interventions to balance efficacy with safety. Patients benefit when providers coordinate use of topical, injectable, pressure, laser, and surgical options to target specific scar characteristics and anatomical demands. Continuous reassessment of progress, willingness to adapt strategies, and emphasis on preventative habits such as sun avoidance and smoking cessation further improve long-term appearance and function. A proactive, tailored approach maximizes the chance of achieving smooth, inconspicuous scars.
