Types of Scars in Malaysia
Types of scars include atrophic scars (sunken scars such as acne scars), hypertrophic scars (raised but limited to the wound area), keloid scars (overgrown scar tissue extending beyond the wound), and contracture scars (tightened skin often from burns). Each type forms differently and may require specific treatments to improve appearance and skin texture.
What Are Scars?
Scars are permanent marks on the skin that form after an injury, surgery, or inflammation heals. When the dermis (deep skin layer) is damaged, the body produces collagen to repair the wound, creating a scar that differs in texture and appearance from surrounding skin.
Overview of Scars
What causes scars
Scars form whenever the deeper layer of your skin (the dermis) is injured. Your body responds by producing collagen fibers to close and repair the wound. The amount and organization of this collagen determine the final appearance of your scar.
Common causes of scarring include:
Acne and skin inflammation
Cuts, wounds, and surgical incisions
Burns and thermal injuries
Skin infections like chickenpox
Trauma or accidents
How scars form on skin
When your skin is wounded, it goes through three healing phases: inflammation, tissue formation, and remodeling. During remodeling, your body produces collagen to fill the injury. If collagen production is excessive, you get raised scars. If collagen is insufficient, depressed (sunken) scars form.
The final appearance of a scar depends on:
The depth and size of the original wound
Your skin type and genetics
How well the wound healed
Whether infection occurred during healing
Your age and overall health
Main Types of Scars
Normal (fine line) scars
These are the most common type of scar. After a wound heals, it typically forms a flat, pale line that may fade over time. Normal scars stay within the boundaries of the original injury and do not cause symptoms like itching or pain.
Hypertrophic scars
Hypertrophic scars are raised, red, and thickened. They remain within the borders of the original wound or incision. These scars are caused by excessive collagen production during healing.
Hypertrophic scars may be itchy or tender. They often improve on their own over 6 to 12 months. Treatment options include silicone gel sheets, steroid injections, and laser therapy.
Keloid scars (common in Malaysia & darker skin types)
Keloid scars are raised, thick scars that extend beyond the original wound boundaries. Unlike hypertrophic scars, keloids continue to grow and can become much larger than the original injury site.
Why keloids are common in Malaysia:
Darker skin types (Fitzpatrick III–V, common among Malaysians) have a higher tendency for keloid formation
Genetics play a strong role – keloids often run in families
Common locations include the chest, shoulders, earlobes, and jawline
Keloids can be painful, especially when pressure is applied (such as from shirt collars). They may continue growing for months or years. In severe cases, a keloid can reach over 10cm in length.
Treatment options include steroid injections, silicone therapy, laser treatment, and surgical removal (often combined with post-surgery injections to prevent recurrence).
Atrophic (sunken) scars
Atrophic scars are depressed or sunken areas of skin caused by loss of collagen during healing. These are the most common type of acne scars.
Atrophic scars have three main subtypes:
| Scar Type | Appearance | Common Location |
|---|---|---|
| Ice pick | Narrow (<2mm), deep, sharply defined pits | Cheeks, temples |
| Boxcar | Wider (1.5–4mm), defined edges, flat base | Cheeks, temples |
| Rolling | Wave-like, uneven texture from fibrous bands | Cheeks, jawline |
Contracture scars (burn-related)
Contracture scars occur after burns, especially deep or extensive burns. As the scar tissue tightens, it can restrict movement in joints and muscles. These scars may also affect underlying nerves and tendons, requiring specialized treatment from a plastic surgeon.
Causes of Different Scars
Acne and skin inflammation
Acne scars form when inflammatory acne damages the dermis. The body attempts to heal by producing collagen, but the result is either too much (raised scars) or too little (depressed scars).
The risk of scarring increases with:
Severe, cystic acne
Picking or squeezing pimples
Delayed treatment of acne inflammation
Cuts, wounds, and surgery
Any incision or laceration that reaches the dermis will leave a scar. Surgical scars vary based on:
The type of procedure performed
The surgeon’s technique
How well the incision heals
Your body’s individual healing response
Post-operation scars may appear as raised, thick scars or as thin, flat lines. Treatment options include silicone sheets, corticosteroid injections, and surgical revision.
Burns and trauma
Burn scars vary depending on the burn’s severity:
Superficial burns typically heal without significant scarring
Deep burns often cause hypertrophic or keloid scars
Extensive burns can lead to contracture scars that restrict movement
Burn scars can be red, raised, and itchy, or appear as sunken, white patches on the skin.
Skin conditions (e.g., chickenpox, infections)
Infections like chickenpox can leave scars, particularly when blisters are scratched or become infected. These scars often resemble ice pick or boxcar scars.
Risk Factors in Malaysia
Skin type and genetics
Malaysia’s diverse population includes many individuals with Fitzpatrick skin types III to V. These darker skin types have a higher tendency for:
Keloid formation after injury
Post-inflammatory hyperpigmentation (dark spots after healing)
Persistent pigmentation following scar treatment
If keloids run in your family, you are at higher risk of developing them after surgery or injury.
Wound healing habits
How you treat a wound during healing directly affects the final scar:
Picking or scratching scabs increases scarring risk
Exposing healing wounds to sunlight causes darkening
Poor wound hygiene may lead to infection and worse scarring
Heat, humidity, and infection risk
Malaysia’s tropical climate presents specific challenges for wound healing:
High humidity can delay wound drying and healing
Warm temperatures promote bacterial growth
Sweating can irritate healing wounds
Proper wound cleaning and dressing are especially important in Malaysia’s climate.
Delayed treatment or poor wound care
Many Malaysians delay seeking treatment for wounds or acne, allowing inflammation to worsen and increase scarring. Early professional assessment and treatment can significantly reduce scar severity.
Treatment Options
Topical treatments (silicone gel, creams)
Silicone gel and silicone sheets are first-line treatments for hypertrophic and keloid scars. They work by hydrating and flattening scar tissue over time. The Ministry of Health Malaysia includes silicone therapy as a standard scar management approach.
Other topical options include:
Retinoids to improve skin texture
Hydroquinone for pigmentation (use under medical supervision)
Moisturisers with SPF to prevent darkening
Steroid injections for keloids and thick scars
Corticosteroid injections are highly effective for raised scars. They reduce inflammation, flatten scar tissue, and relieve itching and pain.
Treatment Protocol:
Injections every 4 to 6 weeks
Multiple sessions typically required
Often combined with other treatments for best results
The Ministry of Health’s scar clinic uses triamcinolone injections as a primary treatment for hypertrophic scars and keloids.
Laser therapy for texture and pigmentation
| Laser Type | Best For |
|---|---|
| Pico Laser | Pigmentation and fine scar texture |
| Fractional CO2 Laser | Deep resurfacing and texture improvement |
| Yellow Laser | Red scars and skin clarity |
Laser treatment is customised to individual skin type and performed in a safe clinical environment.
Microneedling and chemical peels
Microneedling creates tiny punctures in the skin to stimulate collagen production. It is effective for atrophic (sunken) scars. Newer technologies like Exion™ RF Microneedling combine radiofrequency with microneedling for deeper skin remodeling.
Chemical peels remove the outer skin layer, helping with superficial scars and pigmentation. Superficial peels have low downtime.
For moderate-to-severe atrophic scars: A 2025 Malaysian study involving 62 patients found that a combination of polynucleotides and hyaluronic acid produced observable improvement in atrophic facial acne scars with an excellent safety profile. After 6 months, 46.8% of patients showed at least a one-grade reduction in scar severity.
Surgical scar revision
For severe scars, especially large keloids or contracture scars, surgical removal may be appropriate. However, surgery alone has a high recurrence rate for keloids. Most surgeons combine excision with post-operative steroid injections or radiation therapy.
GLOJAS Specialist Clinic Insight
In our clinical experience, the most common misunderstanding patients bring to consultation is expecting a single treatment to “erase” their scar completely. Realistic expectations are essential. Scars can be improved — made flatter, softer, lighter, or less noticeable — but no treatment can make a scar disappear entirely. We also see many patients who have delayed treatment for years, believing nothing can be done. The truth is that modern combination therapy (using lasers, injectables, and topical treatments together) often produces significantly better results than any single approach alone. The earlier you seek treatment, the better your outcome tends to be.
Prevention of Scars
Proper wound cleaning and care
The best way to minimise scarring is to prevent it during healing:
Clean wounds gently with mild soap and water
Apply an appropriate dressing to keep the wound moist
Change dressings regularly to prevent infection
Seek medical attention for deep or infected wounds
Avoiding picking or scratching wounds
Picking at scabs or scratching healing wounds disrupts collagen organisation and leads to worse scarring. Let scabs fall off naturally.
Sun protection to prevent darkening
UV exposure darkens healing scars, making them more visible. This is especially important for Malaysian skin types prone to pigmentation.
Apply SPF 30+ sunscreen daily on healing scars
Cover scars with clothing when possible
Continue sun protection for at least 6 months after healing
Early treatment of acne and injuries
Treating acne early prevents the deep inflammation that causes scarring. If you have cystic or painful acne, see a doctor promptly rather than waiting for it to resolve on its own.
For surgical wounds, follow your surgeon’s aftercare instructions carefully to optimise healing.
When to See a Doctor
Scars that grow or become painful
If your scar continues to grow beyond the original wound boundaries, or if it becomes increasingly painful or itchy, seek medical assessment. These are signs of active keloid formation that may benefit from treatment.
Keloids affecting movement or appearance
Keloids on the chest, shoulders, or other visible areas can cause both physical and emotional distress. If your keloid:
Restricts movement (especially after burns)
Makes wearing certain clothing uncomfortable
Causes significant self-consciousness
Consult a dermatologist or plastic surgeon for treatment options.
Signs of infection in healing wounds
Seek immediate medical attention if your healing wound shows:
Increasing redness or warmth
Pus or unusual discharge
Fever
Worsening pain
Emotional distress due to visible scars
Scars on visible areas like the face, neck, or hands can cause significant psychological distress. If your scar affects your confidence, social interactions, or quality of life, do not hesitate to seek professional help. Effective treatments are available to improve scar appearance.
Frequently Asked Questions
1. Can scars be completely removed?
No. Scars can be significantly improved — made flatter, softer, lighter, or less noticeable — but cannot be completely erased. Modern combination therapies can achieve excellent results, but some evidence of the original scar will likely remain.
2. How soon after injury can I start scar treatment?
For surgical scars, start silicone therapy or massage once the wound has fully closed (usually 2–3 weeks after surgery). For acne scars, treatment typically begins after active acne is controlled. The Ministry of Health’s scar clinic reviews stable scars every 3–4 months.
3. What is the difference between a keloid and hypertrophic scar?
Hypertrophic scars remain within the original wound boundaries and may improve over time. Keloid scars extend beyond the original injury, continue growing, and are more common in darker skin types. Keloids are also more likely to recur after surgical removal.
4. Do scar treatments work on old scars?
Yes, but older scars are more difficult to treat than newer ones. While fresh scars respond best to early intervention (silicone, steroid injections), many treatments like laser resurfacing, microneedling, and subcision can improve even long-standing scars.
5. Are scar treatments covered by insurance in Malaysia?
Generally, treatments for symptomatic keloids (painful, itchy, or restricting movement) may be covered. However, cosmetic scar treatment for acne scars or non-symptomatic scars is typically not covered. Check directly with your insurance provider.
Conclusion
Scars are a natural part of the healing process, but not all scars are the same. Understanding your scar type — whether normal, hypertrophic, keloid, atrophic, or contracture — is the first step toward effective treatment.
In Malaysia, certain factors make scar management unique. Darker skin types have a higher tendency for keloid formation and post-inflammatory pigmentation. The tropical climate requires extra attention to wound hygiene and sun protection.