Why Are Some Scars Indented While Others Are Raised?

Scars tell the story of how our bodies heal, but not all scars look the same. Some are flat and blend with the surrounding skin, while others may be indented (atrophic) or raised (hypertrophic and keloid). At the International Keloid & Scar Treatment Center in Orlando, FL, we specialize in understanding the science behind scarring—and providing advanced treatments to improve both appearance and comfort.

The Science of Scar Formation

When your skin experiences an injury—whether from surgery, acne, burns, or trauma—your body immediately begins the repair process. This involves producing collagen, the protein responsible for providing structure and strength to skin tissue.

The way your body produces and organizes collagen during healing determines whether your scar will be:

• Flat – Collagen production is balanced and organized.
• Indented (atrophic) – Collagen loss or breakdown leads to a sunken appearance.
• Raised (hypertrophic or keloid) – Collagen production is excessive, resulting in thick, elevated tissue.

Indented Scars: When Tissue Is Lost

Atrophic scars form when there isn’t enough collagen to fully repair the damaged skin, leaving behind a depression or sunken area.

Common causes include:

• Acne scars (particularly ice pick, boxcar, and rolling types)
• Chickenpox scars
• Surgical scars where tissue loss occurred

This collagen deficiency can result from deeper skin damage or prolonged inflammation. The skin’s structure is weakened, and without enough support, the scar heals below the surface level.

Raised Scars: When Collagen Goes into Overdrive

Raised scars happen when your body produces too much collagen during the healing process. These can be:

• Hypertrophic scars – Stay within the boundaries of the original injury, but are thick and firm.
• Keloid scars – Extend beyond the original wound area, sometimes growing much larger than the initial injury.

These scars are more common in people with darker skin tones and may have a genetic component. In Florida’s sunny climate, raised scars can become more visible due to pigment changes if exposed to UV rays without protection.

Why People Scar Differently

Several factors influence how your scars form, including:

• Genetics – Some people naturally produce more or less collagen during healing.
• Skin type and tone – Darker skin tones have a higher risk of keloid formation.
• Location of the injury – Areas under tension (like the chest, shoulders, or joints) are more prone to raised scars.
• Depth and severity of the wound – Deeper wounds are more likely to result in atrophic or raised scars.

Treatment Options for Indented and Raised Scars

At the International Keloid & Scar Treatment Center, we offer tailored treatments based on the type of scar:

For indented scars:

• Collagen-stimulating therapies (microneedling, laser resurfacing)
• Dermal fillers to temporarily restore volume
• Platelet-rich plasma (PRP) therapy to encourage natural repair

For raised scars:

• Corticosteroid injections to flatten and soften
• Laser therapy to reduce redness and thickness
• Surgical removal (with preventive treatments to reduce recurrence in keloids)
• Pressure therapy and silicone gel sheeting

Expert Scar Care in Orlando

Our Orlando-based center is recognized for advanced, evidence-based care for both hypertrophic and keloid scars, as well as atrophic scars. With years of experience and a patient-focused approach, we offer comprehensive evaluations to determine the most suitable treatment plan for your individual needs.

Whether your scar is indented or raised, you don’t have to live with discomfort or self-consciousness. With modern techniques and our specialized expertise, we can help restore smoother, healthier-looking skin.

Schedule a consultation today at the International Keloid & Scar Treatment Center in Orlando to explore safe, effective treatments for your scars—so you can feel more confident in your skin.