Understanding Keloid and Hypertrophic Scar Risk
Two distinct abnormal scar types are relevant for patients considering plastic surgery in Korea.
A hypertrophic scar is a raised, thickened scar that remains within the original wound boundary. It typically develops within weeks of healing and can fade or flatten over months to years with treatment. A keloid (케로이드, keroidu — a scar that invades tissue beyond the original wound edge) is more aggressive: it extends into surrounding normal skin, rarely regresses without treatment, and can recur after removal.
Both conditions are more prevalent in people of East Asian, Southeast Asian, and African ancestry than in people of European ancestry. This difference is genetically mediated — specific variants affecting collagen synthesis and wound-healing signalling pathways appear at higher frequency in these populations. It is a statistical population-level finding, not a deterministic outcome for any individual patient.
The practical consequence for aesthetic medicine is significant. Many of the most common Korean plastic surgery procedures — rhinoplasty, double eyelid surgery (쌍꺼풀 수술, ssangkkeopul susul — the surgical creation of an upper eyelid crease), jaw reduction, and breast augmentation — involve deliberate incisions. In a patient with elevated keloid susceptibility, those incisions carry a higher probability of producing visible or problematic scarring.
Importantly, surgical quality does not eliminate biological risk. A technically precise incision closed under minimal tension by a board-certified surgeon¹ can still produce a hypertrophic or keloid scar in a genetically susceptible patient. Understanding this separates realistic informed consent from unrealistic expectations.
How Korean Surgeons Account for Asian Skin
Korea’s plastic surgery sector performs a high volume of incision-based procedures on patients of East Asian ancestry. Board-certified surgeons registered with the 대한성형외과학회 (Daehan Seonghyeong Oegwa Haghoe — the Korean Society of Plastic and Reconstructive Surgeons, or KSPRS), who complete a mandatory four-year plastic surgery residency after six years of medical school,¹ ² train on an almost exclusively Asian patient base. This shapes technique in several measurable ways.
Incision placement in natural skin folds. Double eyelid incisions are placed precisely in the natural supratarsal crease; rhinoplasty open-approach incisions are placed at the columella base where skin tension is low. These sites are selected in part because tension-free closure in a natural fold produces less conspicuous scarring in Asian skin.
Fine suture gauge and layered closure. Experienced Korean surgeons typically use fine absorbable sutures in deep layers to eliminate tension on the skin surface, with fine non-absorbable sutures for the skin itself — closed and removed early (commonly at five to seven days) to minimise suture-track scarring.
Avoidance of unnecessary dermis violation. In procedures where the same result can be achieved with a shorter or repositioned incision, Korean surgical training emphasises minimising incision length — reducing the total scar burden.
Often a good candidate
- No personal history of keloid or hypertrophic scarring on any prior wound
- No first-degree relatives with keloid history
- Planning incisions in natural, low-tension skin folds (eyelid crease, columella base, behind-the-ear)
- Committed to post-operative silicone and SPF protocol for the full six months
Should reconsider or wait
- Personal history of hypertrophic (but not keloid) scarring on prior wounds
- Planning procedures involving chest or shoulder incisions
- Unable to attend Korean clinic follow-up visits at 4–6 weeks for steroid injection assessment
- Rib cartilage rhinoplasty planned — chest harvest site is a variable scar location
Not a suitable candidate
- Strong personal history of keloid formation, particularly on the chest, shoulders, or ears
- Multiple first-degree relatives with keloid history combined with any personal abnormal scar
- Refusing post-operative scar management protocol — risk of poor outcome is meaningfully elevated without it
What to Disclose Before Surgery
Before consenting to any incision-based procedure in Korea, provide your surgeon with a complete scar history. Omitting this information reduces your surgeon’s ability to counsel you accurately on risk.
Disclose all of the following:
- Any prior keloid or hypertrophic scar, on any part of the body — including ear piercings, chickenpox scars, childhood injury scars, acne scars, or prior surgical scars
- Whether any prior scar required treatment (steroid injection, excision, silicone therapy, laser)
- First-degree relatives (parents, siblings) with known keloid history
- Any history of inflammatory skin conditions — acne, eczema, or psoriasis — particularly in areas near planned incisions
- Prior aesthetic procedures involving incisions, and how those healed
Your Korean surgeon can verify board certification status through the KSPRS public registry,³ which confirms that a surgeon has completed the required training and is legally authorised to perform plastic surgery.⁴ A verified board-certified surgeon should conduct a pre-operative consultation that explicitly addresses your scar history.
If your surgeon does not ask about scar history during consultation, raise it yourself. Ask specifically: what post-operative scar management protocol does this clinic provide, and what is the plan if a hypertrophic response develops? If you are travelling from abroad, confirm whether the clinic offers steroid injection at the 4–6 week follow-up, or whether you will need to arrange this through a dermatologist in your home country.
Post-Operative Scar Management Protocol
Scar management after Korean plastic surgery is not optional for patients with Asian skin types — it is a clinical requirement that meaningfully affects outcome.
Sutures removed at the clinic. Incision sites kept clean and dry. No topical treatment applied yet while epithelialisation completes.
Silicone gel or sheeting applied daily to all closed incision sites. Silicone creates an occlusive barrier that regulates hydration and reduces collagen overproduction. Applied for a minimum of 12 hours per day.
SPF 50+ applied daily to all external healing scars. Fresh scars hyperpigment readily in Asian skin under UV exposure — sun protection is required for the full six months, including incidental daily sun.
Clinic review. If the scar appears raised, red, or indurated (firm), the surgeon or dermatologist administers triamcinolone acetonide (a corticosteroid) by intralesional injection directly into the scar. This is the first-line treatment for early hypertrophic response and is most effective when applied early.
Repeat steroid injection if hypertrophic response persists. Silicone therapy continued. Scar maturation assessed — most scars reach final appearance at 12–18 months.
Patients returning home before the 4–6 week follow-up should request a written scar protocol from their Korean clinic and identify a local dermatologist in their home country who can administer triamcinolone if needed. Silicone gel products (Kelo-cote, Dermatix, or equivalent) are available in most countries without prescription.
Am I at higher risk of keloids because I'm Asian?
Statistically, yes — people of East Asian, Southeast Asian, and African ancestry have higher rates of keloid formation than people of European ancestry. This is a population-level statistical difference, not a certainty for any individual patient. Many Asian patients heal with minimal scarring; some develop hypertrophic or keloid scars. The best individual predictor is personal history: if you have healed cleanly from previous wounds (including piercings, childhood injuries, or prior surgery), your individual risk may be lower than the population average. If you have developed abnormal scars previously, discuss this explicitly with your surgeon.
Which procedures have the highest scar risk in Korea?
Higher-tension incision areas carry more scar risk: chest and shoulder incisions (relevant for breast augmentation approach), jaw area incisions (oral incisions for jaw surgery have lower external risk but intraoral healing varies), and any incision in high-movement areas. Lower-risk incisions for Asian patients: subnasal (lip lift), behind-the-ear (facelift), and double eyelid incisions in the natural crease. Rib cartilage harvest incisions in the chest, used in some rhinoplasty cases, are a more variable scar location — discuss this specifically if rib cartilage is planned.
What is the scar management protocol after Korean plastic surgery?
Standard Korean clinic post-operative scar protocol typically includes: silicone gel or sheeting from week 2 (after suture removal), applied daily; SPF 50+ sunscreen on all healing incisions for 6 months; avoiding any sun exposure on fresh scars; and early steroid injection (triamcinolone) at the first sign of hypertrophic response — usually offered at the 4–6 week post-op visit if the scar appears raised or red. Patients returning home early should ask for a written scar protocol and source silicone products in their home country.
Sources
¹ [ksprs-registry-org-identity] Korean Society of Plastic and Reconstructive Surgeons, About page. https://www.plasticsurgery.or.kr/
² [ksprs-registry-training-requirements] KSPRS Board Certification Requirements. https://www.plasticsurgery.or.kr/
³ [ksprs-registry-public-verification] KSPRS Public Registry. https://www.plasticsurgery.or.kr/
⁴ [ksprs-registry-legal-requirement] KSPRS Legal Requirements and Medical Practices Act reference. https://www.plasticsurgery.or.kr/