Assess your personal risk of keloid or hypertrophic scar formation before a tattoo or piercing. 6 weighted risk factors including skin type, placement, and personal history.
"In 25 years of piercing, the single most underestimated pre-procedure conversation is scar risk. Clients with darker Fitzpatrick types, a family history, or placements on the chest and upper back are in a genuinely different risk category — and they deserve to know that before they commit. This assessment puts the clinical picture on the table honestly."
Founder & Piercing Expert
Clinical History Verified
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</iframe>Both are forms of excessive scar tissue, but they behave differently. A hypertrophic scar is raised and firm but stays within the boundaries of the original wound — it often improves over 12–18 months. A keloid extends beyond the original wound margins and can grow progressively over months or years. Keloids have a strong genetic component and are significantly more common in people with Fitzpatrick skin types IV–VI. Both can follow tattoos, piercings, or any procedure that breaks the skin barrier.
Ear cartilage — particularly the helix and tragus — has one of the highest documented rates of keloid formation of any common piercing placement. The upper chest, sternum, and upper back are also high-risk anatomical zones due to the nature of the underlying connective tissue. Earlobes can keloid but typically form the smaller, more treatable type. For high-risk clients, BioFlex® polymer is strongly preferred over metal jewelry at these placements because its flexibility reduces the chronic mechanical stress that triggers excessive scar tissue formation.
Yes, though less commonly than piercings. Tattooing creates thousands of micro-punctures across the skin surface; in susceptible individuals, the cumulative inflammatory response can trigger hypertrophic or keloid scarring, particularly in high-risk placements. Overworking the skin, using excessive needle trauma, or tattooing over a site that has already shown hypertrophic scarring significantly increases the risk. Artists should document client scar history and discuss risk openly before proceeding.
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