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RO A keloid is not simply a thick scar. The distinction is where it stops. A hypertrophic scar stays inside the boundary of the original wound and tends to flatten over months. A keloid grows beyond that boundary into skin that was never injured, and it does not regress on its own. Only the second one is a keloid, and the two are routinely confused.
| Hypertrophic scar | Keloid | |
|---|---|---|
| Extent | Within the original wound | Spreads into uninjured skin |
| Course | Often softens and flattens with time | Persists or continues to enlarge |
| Recurrence | Lower after treatment | High, including after excision |
The scalp is an unusual site for it. Keloids form most readily on the chest, shoulders, upper back and earlobes, where skin tension is high. Scalp keloids do occur, but they are far less common than the concern suggests, and the nape at the lower edge of the donor area is the part most often involved.
Risk is identified from history, not from appearance. A personal or family history of keloids is the single most useful predictor, and susceptibility is higher in darker skin phototypes. That is a consultation question, asked before surgery is planned — because a keloid tendency changes where and how the donor is harvested, and in some cases whether surgery is advisable at all.
Related terms
- Hair transplant scarring
- Hair transplant for scars
- Cysts after hair transplant
- Donor area anatomy
- Scarring alopecia
For how hair type and skin affect surgical planning, see afro-type hair transplant. For how the donor area is assessed beforehand, see the donor area guide.
