The Scar That Won't Settle. We Have a Programme for That.
Multimodal by Design. — No single treatment adequately manages keloids or hypertrophic scars — and the programmes at Ministry of Skin are multimodal by design. Intralesional therapy for the overactive fibroblast. Laser for the vascularity sustaining it. Silicone for the interval between sessions. Each modality acting on a different dimension of the scar biology — together producing the improvement that any single approach cannot.
Overview
A scar is, in essence, the body's repair mechanism working harder than necessary — laying down collagen in response to injury faster and more extensively than the wound required. In most people, this process self-regulates: the acute collagen synthesis that closes the wound gradually reduces as healing completes, leaving a flat, pale scar that fades over months. In some patients, this regulation fails. The fibroblasts continue to synthesise collagen beyond the boundary of the wound. The scar thickens, rises above the surrounding skin surface, and in some cases extends beyond the original wound margin entirely — becoming a lesion that is structurally, visually, and often symptomatically distinct from the wound that produced it.
Hypertrophic scars remain within the original wound boundaries and may partially improve spontaneously over 12–24 months — though often incompletely, leaving residual raised, firm, discoloured tissue that does not fully normalise without intervention. Keloids are characterised by their extension beyond the wound margins and their failure to regress spontaneously — and by a recurrence rate following treatment that makes them among the most clinically challenging conditions in dermatology. They do not resolve. They require management. And the management, to be effective, must be sustained.
At Ministry of Skin, we discuss both of these realities clearly with every patient who presents with keloidal or hypertrophic scarring — the genuine improvement that the right programme produces, and the genuine commitment in time and consistency that achieving it requires. The outcome of scar management done well is not a scar that has disappeared. It is a scar that is flatter, softer, less symptomatic, and less visible — that has been brought as far as the biology of the lesion will allow, and maintained there.
What Keloid & Scar Management Actually Does
The biological mechanism of keloid and hypertrophic scar formation is an overactive fibroblast response — fibroblasts in the scar tissue continuing to produce collagen at rates that exceed the remodelling capacity of the surrounding matrix, producing the bulk and firmness that characterise these lesions. Effective treatment must interrupt this overactivity directly, at the cellular level where the excess collagen synthesis is occurring, while simultaneously addressing the surface and structural characteristics of the scar that produce its visible and symptomatic impact.
This is why no single treatment adequately manages keloids and hypertrophic scars — and why the programmes at Ministry of Skin are multimodal by design. Intralesional therapy addresses the fibroblast overactivity. Laser treatment addresses the surface and the vascularity that sustains the scar's activity. Silicone therapy addresses the ongoing mechanical and hydration conditions that affect scar behaviour between sessions. Surgical revision, where appropriate, addresses the structural characteristics that cannot be resolved by non-surgical means. Each modality acts on a different dimension of the scar biology — and the combination of all relevant modalities, applied consistently over the timeline required, produces the improvement that any single approach alone cannot.
The Ministry of Skin Approach
Treatment Modalities
Intralesional Corticosteroid Injection is the cornerstone of both hypertrophic and keloidal scar management — and the treatment with the most extensive clinical evidence for efficacy in these lesion types. Triamcinolone acetonide is injected directly into the scar tissue at 4–6 week intervals, inhibiting fibroblast proliferation, reducing the rate of new collagen synthesis, and promoting gradual resorption of the excess collagen that constitutes the scar's bulk. The effect is progressive — visible softening and flattening beginning within 4–6 weeks of the first injection and accumulating over a course of sessions as the scar tissue gradually responds to the anti-fibrotic stimulus. For keloids resistant to corticosteroid monotherapy, 5-fluorouracil is incorporated into the intralesional cocktail — providing an additional anti-proliferative mechanism that acts synergistically with the corticosteroid to improve the treatment response in resistant lesions.
Vascular Laser targets the prominent vascularity of active, erythematous scars — reducing the blood vessel network that sustains the inflammatory activity driving ongoing scar growth, improving the colour of the scar from the deep red or purple of an active lesion toward a more normalised tone, and reducing the pruritis and heat that many patients find among the most distressing symptoms of active keloidal scarring. At Ministry of Skin, vascular laser is applied alongside intralesional therapy rather than independently — because the most effective scar management addresses both the fibroblast activity and the vascular support sustaining it simultaneously.
Fractional Laser is used for hypertrophic and keloidal scars that have responded to intralesional therapy and require surface texture and colour improvement — the laser remodelling the scar surface, stimulating more organised collagen architecture in the treated area, and progressively improving the visual appearance of the lesion alongside the bulk reduction achieved by intralesional treatment. At Ministry of Skin, fractional laser for keloids is always applied in combination with intralesional steroid at the same session — because the controlled wound created by ablative laser would otherwise stimulate the fibroblast overactivity that intralesional therapy is working to suppress.
Silicone Therapy — medical-grade silicone sheets or gel applied to the scar continuously between clinic sessions — provides the hydration and mechanical environment that supports scar remodelling between appointments. Silicone normalises the transepidermal water balance of the scar tissue, reduces the mechanical tension on the scar surface, and modulates fibroblast activity through a mechanism involving improved tissue hydration and the effect of a static electrical field generated by the silicone material. Its efficacy in both hypertrophic scar improvement and keloidal scar management as a maintenance and prevention strategy is supported by clinical evidence, and it forms a standard component of the home management programme for all scar patients at Ministry of Skin.
Results, Realistic Expectations, and the Honest Discussion We Have at the Start
Meaningful improvement in keloidal and hypertrophic scars — flattening, softening, reduction in symptoms, improvement in colour — is achievable for most patients through a sustained programme at Ministry of Skin. The degree of improvement and the timeline to achieve it depend on the scar type, its age, its location, its vascularity, and the individual's biological propensity for scar overactivity. Most patients notice initial softening and symptom improvement within the first 2–3 intralesional sessions; visible flattening and colour improvement accumulates over a programme of 6–12 months of active treatment.
What we tell every patient at the outset is that keloid management is a long-term commitment, not a finite course. The biology that produces keloids does not change with treatment — the tendency for fibroblast overactivity in susceptible individuals persists — which means that the improvement achieved requires maintenance to sustain. A keloid that has been successfully flattened and kept controlled over two years is a successful outcome. A keloid treated for six months and then abandoned is one that will very likely return. At Ministry of Skin, we design programmes with this in mind — and we maintain the honest, ongoing conversation about progress, adjustment, and realistic goals that a condition of this nature deserves.
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Frequently Asked Questions
Can keloids be permanently cured?
Keloids can be significantly improved and, with consistent maintenance, kept well-controlled over the long term — but the underlying biological tendency that produces them does not resolve with treatment. The goal of keloid management at Ministry of Skin is to achieve the maximum possible flattening and symptom reduction, and to maintain that improvement through ongoing management. Permanent elimination of a keloid without recurrence is possible for some lesions but cannot be guaranteed for all — and this is communicated honestly at every initial consultation.
How long does scar treatment take?
A standard active treatment programme involves 6–12 months of intralesional injections at 4–6 week intervals, combined with laser treatment, silicone therapy, and other modalities as indicated. Initial improvement is visible within the first 2–3 sessions; the most significant cumulative improvement develops over the full 6–12 month active programme. Maintenance treatment at longer intervals follows the active phase and is continued indefinitely for keloid-prone patients.
Is intralesional steroid injection painful?
Injecting into firm scar tissue requires more pressure than injecting into normal soft tissue, producing a sensation of pressure and brief sharp discomfort during the injection. At Ministry of Skin, topical anaesthetic is applied before intralesional injection for keloidal scars, and local anaesthetic ring blocks are used for very tender or large lesions. Most patients find the procedure manageable, particularly as the scar begins to soften over the first few sessions and the injection becomes progressively easier to administer.
Can the same scar have both laser and intralesional treatment?
Yes — and at Ministry of Skin this combination is standard for scars requiring both bulk reduction and surface improvement. When fractional laser is applied to a keloidal scar, it is always performed in the same session as intralesional steroid injection — the steroid suppressing the fibroblast response that ablative laser would otherwise stimulate, producing surface improvement without the recurrence risk that laser applied without concomitant anti-fibrotic therapy carries.
What can I do to prevent keloids from forming after surgery or injury?
For patients with a known keloid tendency, prevention begins at wound closure — fine sutures with minimal tissue tension, early application of medical-grade silicone gel from the day of suture removal, pressure therapy where the wound location allows, and early intralesional intervention if the healing scar begins to thicken. At Ministry of Skin, we offer pre-surgical consultation for patients with known keloid tendency to plan preventative measures around any planned procedure — because managing the risk of keloid formation from the time of wound closure is significantly more effective than treating an established keloid after it has formed.
