Not all keloid scars behave the same, and where they appear on the body can make a real difference in how they heal and how they respond to treatment. Areas such as the chest, shoulders, and jawline are under constant movement and natural skin tension, which can place extra stress on healing tissue. For many patients, this is why scars in these locations often feel more stubborn and more likely to return after treatment.
It can be especially frustrating when you have already invested time and effort into care, only to see a raised scar slowly reappear in the same spot. Understanding why these areas are considered “high-risk” helps set realistic expectations and highlights the importance of a tailored treatment plan rather than a one-size-fits-all approach.
In this article, we will explore what makes high-tension areas different, how they affect keloid behaviour, and the clinical strategies specialists use to improve long-term outcomes in these challenging locations.
What “High-Tension Areas” Mean in Scar Healing
When the skin heals, it is not just closing a wound—it is rebuilding strength and flexibility at the same time. In areas that move or stretch frequently, the healing tissue is placed under constant pull. This ongoing tension sends signals to the body to keep producing collagen, which is the building block of scar tissue.
In high-tension areas like the chest, shoulders, and jawline, everyday actions such as breathing deeply, lifting your arms, talking, or chewing can subtly stretch the skin again and again. Over time, this repeated movement can make a scar thicker, firmer, and more likely to rise above the surface of the skin.
This is one of the main reasons keloids tend to behave more aggressively in these locations. The skin is never truly “at rest,” so the natural stop signal for scar growth can be delayed. For patients, this means healing often takes longer and treatment plans usually focus on gradual control rather than rapid changes.
Why the Chest, Shoulders, and Jawline Are High-Risk Zones
Certain parts of the body are more likely to develop stubborn keloid scars because of how the skin naturally moves and stretches in daily life. The chest, shoulders, and jawline are three of the most common examples, and each area presents its own challenges during healing and treatment.
On the chest, the skin expands and contracts with every breath, stretch, or change in posture. This constant motion can keep the healing tissue under low-level tension for long periods, encouraging the scar to remain raised and sometimes to grow wider over time.
The shoulders are involved in almost every upper-body movement, from reaching and lifting to simple activities like getting dressed. This frequent motion can place repeated stress on a healing scar, making it harder for the tissue to settle and flatten naturally.
Along the jawline, the skin is affected by facial expressions, speaking, and chewing. Because this area is also highly visible, even small changes in scar texture or thickness can feel more noticeable to patients. The combination of movement and cosmetic concern often makes keloids here particularly challenging to manage.
Comparison Table: How These Areas Affect Keloid Treatment
| Area | Level of Skin Tension | Common Challenges | Risk of Recurrence | Typical Treatment Approach |
| Chest | High | Constant movement from breathing and posture can keep the scar under ongoing stretch, making it harder to settle and flatten. | High | Structured injection plans, combination therapy, and long-term monitoring to control growth gradually. |
| Shoulders | High | Frequent arm and upper-body movement can reopen micro-stress in healing tissue, slowing improvement. | High to Moderate | Repeated treatment sessions with careful spacing, often combined with aftercare support to reduce tension on the area. |
| Jawline | Moderate to High | Daily facial movement and high visibility make even small changes in scar texture more noticeable. | Moderate to High | Targeted injections, close follow-up, and personalised treatment timing based on patient lifestyle and movement patterns. |
What Patients Should Expect During Treatment
Treatment for keloids in high-tension areas is usually planned as a process rather than a single visit. Most patients start with a consultation where the specialist looks at the scar’s size, location, and how long it has been present, as well as any previous treatments they may have tried. This helps shape a plan that fits both the skin and the patient’s daily routine.
During treatment sessions, injections are commonly used to help soften the scar and reduce ongoing inflammation. The procedure itself is usually quick, and while some patients feel mild discomfort or pressure, this often settles shortly after the session is over.
Between visits, patients may be given simple aftercare advice, such as avoiding unnecessary stretching of the area or watching for early signs of regrowth. This shared approach combining in-clinic treatment with everyday care plays a key role in improving long-term outcomes, especially in areas where the skin is constantly moving.
Conclusion
Keloids in high-tension areas such as the chest, shoulders, and jawline can be particularly challenging, not because treatment is impossible, but because the skin in these locations is constantly in motion. This ongoing tension can slow healing and increase the risk of a scar becoming raised again, which is why a personalised and carefully timed treatment plan is so important.
Working with a specialist allows patients to move beyond trial-and-error and toward a structured approach that focuses on long-term control rather than quick fixes. With the right combination of clinical care, follow-up, and everyday awareness, many patients are able to see steady improvements in both comfort and appearance over time.
Ready to explore your treatment options?
Book a free bespoke consultation with a keloid specialist doctor at the London Keloid Scar Clinic and receive a personalised plan tailored to your scar location and lifestyle.
Frequently Asked Questions
Q: Why do keloids in high-tension areas come back more often?
A: These areas move and stretch every day, which can keep the skin under constant stress and encourage the scar tissue to continue growing even after treatment.
Q: Is treatment more painful in areas like the chest or jawline?
A: Most patients describe the discomfort as mild and brief. Specialists often use techniques to minimise pain and make each session as comfortable as possible.
Q: How many sessions are usually needed to see results?
A: Improvement often happens gradually over several visits. The exact number depends on the size, location, and how the scar responds to treatment.
Q: Can keloids in these areas be completely removed?
A: The goal is usually to flatten, soften, and control the scar rather than promise complete removal, especially in high-risk locations.
Q: Will daily activities affect my results?
A: Yes. Movements like lifting, stretching, or frequent jaw motion can influence healing, which is why aftercare and follow-up guidance are important.
Q: When should I consider seeing a specialist?
A: If a raised scar continues to grow, feels uncomfortable, or has returned after previous treatment, a specialist assessment can help guide a more targeted plan.
