Every piercing leaves some scar tissue around the channel as it heals. This is normal and usually invisible. The piercing channel is essentially a small permanent scar through the tissue. Problems arise when the scar tissue becomes visible, raised or persistent in ways that affect appearance or function. This page covers the types, the causes and the treatments.

The Normal Scar Tissue Around Every Piercing

When tissue is wounded and heals, the body lays down collagen to close the wound. This collagen forms a scar that fills the wound. For a piercing, the channel itself is essentially a permanent scar lined with epithelial cells. The scar is what holds the channel open and keeps it patent.

This scar tissue is invisible to the casual observer. The piercing area looks like normal skin with jewellery passing through it. The underlying structure is scar tissue that has been reorganised into a functional channel.

Problems start when the scar tissue forms in ways that produce visible bumps, raised areas or marks. These are not normal scar tissue, they are excessive scar formation in response to ongoing irritation or other factors.

Hypertrophic Scars

What They Look Like

Firm raised scars right at the piercing entry or exit. Pink, red or slightly darker than surrounding skin. Often shiny. Stay within the boundary of the original piercing wound. Can be itchy.

What Causes Them

The body’s healing response has been more aggressive than necessary, laying down excess collagen at the wound. Triggered by repeated minor trauma or persistent irritation rather than a one-off injury. Common factors include cheap jewellery, sleep pressure, repeated touching and harsh products.

The Trajectory

Hypertrophic scars typically appear during healing rather than after it. They can persist for months and slowly soften and fade over time once the irritation source is removed. Some flatten completely over years; some leave a small permanent raised area.

How to Prevent

• Quality jewellery from day one
• Protected sleep position
• Hands off the piercing
• Gentle saline aftercare only
• Address any irritation source promptly before scarring develops

How to Treat

• Address any ongoing irritation first
• Silicone gel sheets or silicone gel applied to the scar daily for several weeks
• Gentle massage with mild moisturiser once the piercing is fully healed
• Specific scar treatments from a GP or dermatologist for persistent cases (steroid injections, laser, cryotherapy)
• Time: most hypertrophic scars improve significantly over 12 to 24 months

Keloid Scars

What They Look Like

Raised firm scars that extend beyond the boundary of the original wound. Pink, red or darker than surrounding skin. Can grow over months or years. Continue to enlarge even when no further irritation is present.

What Causes Them

A genetic predisposition that causes the body’s scar-forming response to overshoot dramatically. Keloids have a strong family history component. More common in people of African, Asian and Hispanic descent. Once you have one keloid, you are more likely to form another.

Where They Form Most

Helix and other cartilage piercings are higher risk than soft tissue piercings. Areas of skin tension (chest, shoulder, back) are higher risk than areas of low tension. Nostril piercings can keloid, but the front of the face produces them less than other areas.

How to Prevent

• If you have a family or personal history of keloids, discuss with the piercer before booking
• Choose piercings with lower keloid risk (lobes lower than helix)
• Use the highest quality jewellery
• Follow aftercare meticulously
• Consider silicone gel sheets prophylactically once the piercing is healed

How to Treat

• See a GP for referral to a dermatologist
• Silicone gel sheets applied long-term
• Steroid injections (most common medical treatment, repeated over months)
• Cryotherapy (freezing)
• Laser treatment
• Surgical removal (controversial because keloids often return)

The Hard Truth About Keloids

True keloids are difficult to treat and tend to recur. Prevention is much more effective than treatment. If you are keloid-prone, weigh the keloid risk seriously when deciding on piercings.

Atrophic Marks

What They Look Like

Small sunken pits or depressions where a piercing used to be. Lighter or darker than surrounding skin. Most visible on cartilage piercings after the jewellery has been removed and the piercing has closed.

What Causes Them

The body has not regenerated tissue completely after the piercing closed, leaving a slight depression. More common with piercings that were stretched, infected or otherwise stressed during their lifetime.

How to Prevent

• Quality jewellery throughout the piercing’s life
• Avoid infections and excessive irritation
• Avoid unnecessary stretching
• Remove jewellery if you are no longer planning to wear it, rather than letting the area become bumpy first

How to Treat

• Microneedling or laser treatment from a dermatologist for cosmetic concerns
• Filler injections in some cases
• Time: marks often soften over years
• For most people, atrophic marks are subtle enough not to need treatment

Pigmentation Changes

Worth a separate note. Some piercings leave changes in skin pigmentation rather than raised or sunken scars. Hyperpigmentation (darker patches) and hypopigmentation (lighter patches) can both occur.

What Causes Them

Inflammation during healing can affect melanocytes (pigment-producing cells), particularly in darker skin tones. Sun exposure during healing also contributes. Excessive irritation during healing increases the risk.

How to Prevent

• Minimise irritation during healing
• Avoid extended sun exposure on the piercing area for the first months
• Quality jewellery to prevent prolonged inflammatory reactions

How to Treat

• Time: pigmentation often normalises over 6 to 18 months
• Sunscreen to prevent further darkening
• Topical treatments (azelaic acid, vitamin C) for hyperpigmentation in healed piercings
• Dermatologist consultation for persistent cases

Silicone Gel Sheets and Silicone Gel

The most evidence-based treatment for hypertrophic scars and prevention strategy for keloid-prone clients.

How They Work

Silicone gel sheets create an occlusive barrier over the scar that traps moisture, normalises the wound environment and reduces the signals that cause excess collagen deposition. The mechanism is well-studied for scar reduction.

Brands

ScarAway, Dermatix, Mederma, Hansaplast scar gel and own-brand pharmacy versions all work similarly. £15 to £25 for a pack that lasts several weeks.

How to Use

Apply the silicone sheet or gel directly to the scar for 12 to 24 hours a day for at least 8 to 12 weeks. The treatment is slow and requires consistency. Most improvement appears over 2 to 3 months of daily use.

When to Start

Once the piercing is fully healed (and only then). Applying silicone gel to an unhealed piercing is not appropriate. Start when you have a visible hypertrophic scar that has persisted for some time after the underlying irritation has been addressed.

When the Scar Is Actually a Different Problem

Active Bump vs Settled Scar

An active irritation bump fades when the cause is removed. A settled scar persists. If a “scar” on a piercing is still tender, growing or fluctuating in size, it is probably an active bump rather than mature scar tissue.

Granuloma

A small fleshy growth that can sometimes form near piercings. Looks like a smooth skin tag. Different from scar tissue. Often resolves with jewellery changes and basic aftercare.

Cyst

A fluid-filled sac that can form near piercings in some clients. Different structure from scar tissue. May need GP attention.

Atypical Skin Conditions

Some clients have underlying skin conditions (lichen planus, sarcoidosis, others) that can produce skin changes around piercings. Persistent unexplained changes warrant a dermatologist review.

Removing the Jewellery for Scar Treatment

Sometimes the question arises: should the piercing be retired to allow the scar to heal?

For Mild Hypertrophic Scars

Usually not. Address the underlying cause (jewellery, sleep, irritation) and the scar typically improves while the piercing remains in place. Keep the piercing.

For Persistent Hypertrophic Scars With Irritation

Sometimes. If the piercing continues to be irritated despite best efforts, removing the jewellery and allowing the area to fully settle may be the right move. The scar still takes months to fade after removal.

For True Keloids

Often. Keloids that are actively growing may benefit from removing the jewellery and letting the area settle while treatment proceeds. The keloid may still need medical treatment.

What Happens to the Channel

Piercings can close after jewellery removal. Lobes within days, cartilage within weeks. A closed channel can sometimes be re-pierced through the same path later if the scar is resolved.

Scar tissue is the body’s record-keeping system. Heavy disturbance during healing produces visible scars. Gentle healing leaves invisible ones. The same factors that produce clean healing produce clean scars.
Shallows piercing team

The Prevention Framework

The same factors that produce clean healing produce minimal scar tissue. The reverse is also true.

Top Five Prevention Factors

1. Quality jewellery from day one (implant grade titanium or solid gold)
2. Minimal interference (no twisting, no touching, no harsh products)
3. Protected sleep position
4. Address any irritation source promptly (before scarring develops)
5. Patient timeline (do not stress the channel before it is ready)

For Keloid-Prone Clients

1. Discuss with the piercer before booking
2. Choose lower-risk piercings (lobes over cartilage where possible)
3. Use the highest quality jewellery
4. Consider silicone gel sheets prophylactically once healed
5. Address any scarring early before it establishes

Long-Term Outlook

For Hypertrophic Scars

Most improve significantly over 12 to 24 months with appropriate treatment. Some leave a small permanent raised area. Most clients can manage the appearance with patient treatment.

For Keloids

Variable. With treatment, many keloids can be reduced significantly. Recurrence rates after surgical removal alone are high. Combined treatments produce better outcomes.

For Atrophic Marks

Often subtle enough to live with. Cosmetic treatments are available for those wanting to address the appearance.

For Pigmentation Changes

Often normalise over time, particularly with sun protection. Topical treatments can speed the process.

The Honest Summary

Some scar tissue forms around every piercing. Most of it is invisible. The visible kinds (hypertrophic scars, keloids, atrophic marks) have specific causes and specific treatments. Prevention matters more than treatment because the same factors that prevent excess scarring also produce better overall healing.

Quality jewellery, minimal interference, patient timeline. The simple aftercare principles cover most of what scar prevention requires. For specific scarring concerns, address the cause first and consider silicone gel sheets once the piercing is fully healed.

Scar tissue and piercings are linked but the visible problems are largely preventable. The same care that produces clean healing produces minimal scarring. When scars do appear, the type matters because the treatment varies. Address the cause first, apply evidence-based treatments where appropriate, and accept that some piercings leave permanent traces.