If you’re staring at your scar at the six or eight week mark and wondering why it’s still this red, raised, or itchy, you’re in the right place. Most surgical scars look worse before they look better, and what you’re seeing is usually just normal healing rather than a sign something’s gone wrong. This article explains what a normal scar looks like at each stage, how to spot a hypertrophic or keloid scar, when to contact the clinic, and what A/Prof Bish Soliman and his dermal therapy team do about scars that are not behaving as expected.

Is it normal for a surgical scar to be red and raised?

In most cases, yes. A scar that’s pink, slightly raised, tight, itchy, or tender between weeks 2 and 12 is just moving through the normal proliferation phase of healing. This is when your body is busy laying down new collagen across the wound, and the scar tends to look its angriest right before it starts to fade. You only need to worry when those features get worse, or hang around well past the expected window.

The single most useful question to ask yourself is not “is my scar raised?” but “is my scar getting better or worse over time?” A scar that is slowly fading, flattening, and softening from one month to the next is healing normally, even if it does not look the way you hoped at six weeks.

What a normal surgical scar looks like at each stage

Here’s a quick checklist of what to look for:

Weeks 1 to 2. You’ll see a thin red or pink line, with sutures or surgical tape still in place. A bit of swelling and bruising around the edges is fine. Normal.
Weeks 2 to 6. Pink to red, slightly raised, may feel firm or rope-like. Itching and tightness are common. Normal.
Months 2 to 6. Colour begins to fade. The scar softens and feels less prominent under the fingertips. Normal.
Months 6 to 12. Pale, flat, mostly soft, with diminishing sensation. Normal.
Month 12 and beyond. White or skin-toned, flat, with little to no sensation. This is the mature scar.

Some scars take longer than others. Scars across high-tension areas (the chest, shoulders, lower abdomen, and over joints) often stay pink and firm for longer than scars in low-tension areas like the upper face. That is not abnormal; it just means the scar needs a little more time and a little more support.

What is a hypertrophic scar?

Think of a hypertrophic scar as a thickened, raised, red or pink mark that doesn’t stray outside the original incision line. It happens because your body has laid down too much collagen at the healing site. You’ll see them most often on the chest, shoulders, abdomen, and over joints, basically anywhere movement and tension tug on the wound as it tries to heal.

Signs that point to a hypertrophic scar:

Firm, rope-like, and clearly raised above the surrounding skin
Pink to red, sometimes darker in deeper skin tones
Often itchy, sometimes tender
Stays inside the original wound line and does not spread outward

Hypertrophic scars typically appear between four weeks and six months post-op. The factors that raise the risk include tension across the wound, infection during healing, smoking, darker skin types, and a personal or family history of difficult scarring.

What is a keloid scar?

A keloid is an aggressive, raised scar that pushes past the borders of the original wound. That’s the main thing that sets a keloid apart from a hypertrophic scar, it doesn’t stay inside the incision line. It spreads into the surrounding healthy tissue and can keep growing for months, or even years, if you leave it alone.

Signs that point to a keloid scar:

Raised, shiny, often dark, pink, or purple
Extends beyond the edges of the original wound
Can be itchy, tender, or sometimes painful
Tends to grow slowly and continuously, rather than fading

Keloids are most common on the earlobes, chest, shoulders, upper back, and jawline. The risk is higher in patients with darker skin types, a family history of keloids, and younger patients (under 30). Catching a keloid early matters because keloids are much harder to treat the larger they grow.

Hypertrophic vs keloid: a side-by-side comparison

Feature	Hypertrophic scar	Keloid scar
Shape	Raised but contained within wound line	Raised and extending beyond the original wound
Growth pattern	Plateaus, then often improves on its own	Continues to grow, sometimes for years
Timing	4 weeks to 6 months post-op	4 weeks to several years post-op
Colour	Pink to red, sometimes darker in deeper skin tones	Pink, red, purple, or darker than surrounding skin
Symptoms	Firm, itchy, sometimes tender	Itchy, tender, sometimes painful; cosmetically prominent
Treatment response	Often responds well to silicone, steroid injection, and laser	Less predictable; high recurrence after surgical excision alone
Recurrence risk	Moderate; reduces with treatment	High, especially after surgery without adjunctive therapy

If you are not sure which category your scar falls into, the most reliable indicator is whether the raised tissue stays inside or extends beyond the original incision line. Take a clear photo and bring it to your next review.

When to see your surgeon about a scar

Book a review with A/Prof Bish Soliman if any of the following are happening to your scar:

It is becoming larger, redder, or more raised over time (rather than fading)
The raised tissue is growing beyond the original incision line
It is causing pain, restricted movement, or persistent significant itch beyond 6 weeks
It has been pink, raised, or symptomatic for more than 12 months

Infection is a different beast from a scarring problem, and it needs faster action. If you notice sudden pain, heat, redness creeping out from the scar, any discharge, or a fever, ring the clinic within 24 hours.

The earlier an abnormal scar is reviewed, the more treatment options are usually available, and the more responsive the scar tends to be.

How abnormal scars are treated

Treatment runs the gamut, from non-invasive products you use at home to in-clinic procedures. We manage most patients with a combination, and only step things up if the scar isn’t responding.

First-line scar management

For most hypertrophic scars, and as part of the care plan for anyone at risk of keloids, we start conservative and stay consistent:

Silicone scar tape. Medical-grade silicone such as Nokori Scar Tape, worn daily for a minimum of 12 weeks. For at-risk scars, the dermal therapist often runs an extended protocol of up to 12 months.
Scar balm and massage. Twice-daily scar massage with a conditioning balm such as the Nokori Scar Balm to break down internal collagen build-up.
Pressure therapy. Compression garments after body and breast procedures help reduce hypertrophic risk on long incisions.
Strict sun protection. SPF 50+ over the scar (or under clothing) for the entire first year.

For a detailed walk-through of the daily routine, see How to Care for Surgical Scars: A Step-by-Step Recovery Timeline.

In-clinic treatments

If a scar isn’t settling with conservative care on its own, in-clinic options come next:

Intralesional steroid injections. A corticosteroid injected directly into the raised scar to flatten and soften it. Usually repeated over a series of sessions.
Vascular laser. Targets the redness in the scar by treating the small blood vessels feeding it.
Fractional laser. Improves the texture and surface quality of the scar.
Surgical scar revision. Considered in selected cases, and rarely used as a first-line treatment for keloids because of the high risk of recurrence. When revision is performed on a keloid-prone patient, it is usually combined with adjunctive therapy such as steroid injection or radiotherapy.

A/Prof Bish Soliman’s dermal therapist often runs an extended Nokori protocol for patients with a hypertrophic or keloid history, and refers patients into in-clinic treatments when the scar is not responding to conservative care.

How to lower your risk of abnormal scarring before surgery

Scar outcomes are influenced before the operation as much as after. The steps that make the biggest difference in the weeks leading up to surgery include:

Stop smoking at least 6 weeks before surgery. Nicotine restricts the blood supply that the wound needs to heal cleanly.
Optimise nutrition. A protein-adequate diet and reasonable vitamin D status support wound healing.
Tell your surgeon about any personal or family history of keloids. This changes the operative plan and may trigger pre-treatment with steroids or extended scar therapy from day one.
Have realistic expectations about scar placement. Some scars can be hidden in natural skin folds or beneath underwear lines; others cannot.

A/Prof Soliman discusses scar placement and likely scar quality at consultation as standard, and the post-operative scar care plan is tailored to your skin type and family history.

A note for skin cancer surgery patients

Scars from skin cancer excision on the face, scalp, and chest are particularly susceptible to hypertrophic change because of tissue tension and ongoing sun exposure. Early scar care and strict UV protection are essential for this patient group. The dermal therapist will often start at-risk patients on silicone tape earlier than usual and review them more frequently through the first six months.

Why choose A/Prof Bish Soliman for plastic and reconstructive surgery in Sydney

A/Prof Bish Soliman is a Sydney-based, award-winning Specialist Plastic and Reconstructive Surgeon. Scar management is a routine part of every recovery plan at his Woollahra, St Leonards, and West Pennant Hills clinics. The dermal therapy team uses the Nokori Scar Tape and Scar Balm protocol from the day surgical dressings come off, and refers patients into in-clinic treatments (steroid injection, vascular and fractional laser, or surgical revision) when scars are not behaving as expected. The result is a structured, individualised pathway, not a one-size-fits-all approach.

Credentials

FRACS (Plastic Surgery). Fellow of the Royal Australasian College of Surgeons.
MS (Plastic Surgery). Master of Surgery, University of Sydney.
MBBS (Hons 1). Bachelor of Medicine and Bachelor of Surgery, First Class Honours, University of Notre Dame Australia.
BCom. Bachelor of Commerce, University of Sydney.
Morgan Travelling Fellowship. Royal Australasian College of Surgeons.
AHPRA Specialist Registration in Plastic Surgery. MED 0001679053.
Two consultant microsurgery positions at major Sydney tertiary referral hospitals.
Awards: Bower and Sherrard Medal (Notre Dame), JMO of the Year (Westmead Hospital), NSW Doctor of the Year Finalist.

Professional memberships

Australian Society of Plastic Surgeons (ASPS) profile
Australian Society of Aesthetic Plastic Surgeons (ASAPS) profile
Australian and New Zealand Board of Certified Plastic Surgeons (ANZBCPS) profile
Australian Medical Association (AMA) member
American Society of Plastic Surgeons (ASPS USA) member

Clinic locations

The Woollahra Clinic. Level 1, 156 Edgecliff Road, Woollahra NSW 2025
West Pennant Hills. 31 Castle Hill Road, West Pennant Hills NSW 2125
North Shore Health Hub. Tower A, Level 3, Suite 5/7 Westbourne Street, St Leonards NSW 2065

If you are concerned about a scar that is not settling, or you have a personal or family history of keloids and want to plan ahead before surgery, book a consultation with A/Prof Bish Soliman at any of our three Sydney locations. The clinic accepts GP referrals. Phone 1300 372 474.

FAQs

How can I tell if my surgical scar is hypertrophic or keloid?

A hypertrophic scar sits raised, red, and firm, but it never crosses the line of your original incision. A keloid pushes past the wound line, taking over healthy skin and keeping on growing for months. If your scar is spreading out rather than fading away, book in for a review.

Is it normal for a scar to be itchy and raised after 6 weeks?

Yes, it can be. Between weeks 2 and 12, most surgical scars get a bit itchy and slightly raised while the scar is still busy laying down new collagen. Things usually calm down between the three and six month mark. If you’re still getting itch, redness, or thickening past 12 weeks, that’s worth a closer look.

What can flatten a raised surgical scar?

For most raised scars, daily silicone scar tape, scar massage with a balm, sun protection, and time will do the job. Stubborn hypertrophic scars tend to respond well to steroid injections into the scar, vascular laser, or fractional laser. A/Prof Bish Soliman will recommend a plan based on scar type and location.

Are keloid scars preventable?

Not completely, but you can lower the risk a fair bit. If you or someone in your family has had keloids before, mention it to your surgeon before you book. Once you’re cleared, start silicone tape early, keep tension off the wound, and shield the scar from the sun for that whole first year. Some at-risk patients are pre-treated with steroids.

Does Nokori scar tape work on hypertrophic scars?

Yes. Medical-grade silicone dressings like Nokori Scar Tape are recognised as first-line therapy for hypertrophic scars. They hydrate the scar, apply gentle compression, and help regulate collagen formation. Consistent daily wear for 12 weeks or more produces the best results.

When should I worry about an infected scar versus a thickened scar?

Infection presents with sudden pain, heat, redness spreading outward, discharge, or fever, and needs urgent contact with the clinic. A thickened or hypertrophic scar develops slowly over weeks, is not painful in the same way, and can be reviewed at your next scheduled appointment.

Medical references

All surgery carries risks. Individual results vary. Always consult a qualified specialist plastic surgeon for personalised advice. This article is general information only and does not constitute medical advice or a doctor-patient relationship.

Hypertrophic, Keloid or Normal? How to Tell If Your Surgical Scar Is Healing Well