Body piercing scars can develop around existing or retired piercings in anyone, but if you have a problem within the first few weeks after getting pierced, you're likely dealing with an irritation rather than a scar. How can you tell the difference? If you have developed a scar, what type is it and how can you minimize it? Let's take a look at the differences between piercing scars and irritations, as well as how to treat each issue.
Piercing Scars vs. Irritations
Scars are most likely to develop within 4-8 weeks of getting or retiring a piercing. If a bump or other irritation forms sooner than that, then you're likely dealing with a temporary irritation. Although metal allergies or infection could be at the root of your piercing problem, typically only hypergranulation is mistaken for a scar. Hypergranulation manifests as the notorious red piercing bump (illustrated below) that plagues some people with new piercings.
Treating Hypergranulation
Hypergranulation most frequently occurs around a piercing due to a combination of pressure, moisture and irritation. That means the first step in identifying the type of bump that's formed around your piercing is to change your body jewelry and eliminate any unnecessary pressure on the fistula (piercing hole). 
Ask your piercer to replace your jewelry with a longer barbell or labret post or a captive ring that's large enough to give your piercing some breathing room. You may also want to switch to PTFE or titanium jewelry to eliminate material-related irritations from the list of possible piercing problems you could be experiencing.
Once your new jewelry is in place, ramp up your aftercare regime to keep your piercing flushed and the skin in and around it as clean and healthy as possible. You can use a saline wash like Recovery Piercing Aftercare Spray to rinse your piercing several times a day. You should also do full sea salt solution soaks twice a day for at least the first 1-2 weeks after changing your jewelry. Just soak a cotton ball with saline rinse or homemade sea salt solution (1 cup sterile water with 1/4 tsp. sea salt stirred in), press it gently against your piercing, and repeat with a series of clean cotton balls until you've applied the solution for a total of 5 minutes per session. It's even better if you can fully submerge your piercing in saline wash. For instance, with a belly or nipple piercing, you can fill a small glass with sea salt solution, lean forward, press the container against the skin around your piercing, hold it in place as you sit upright again, and keep it there for 5 minutes. Add a couple drops of tea tree oil to your sea salt solution or a drop to each cotton ball before applying them to external piercings to take advantage of this oil's natural antiseptic and moisturizing properties.
It's also important to wear
loose clothing and let your piercing breathe as much as possible while trying to recover from a hypergranulation issue. Pressure and moisture aren't always the result of tight jewelry, so you have to do your best to eliminate other things that could cause these problems, like wearing tight clothes. This is particularly true with belly button piercings, since they're located right where your body bends in half and where the waistband of your pants is likely constantly rubbing against your piercing. Dermals may also be at higher risk, if they're placed in frequently-covered areas like your chest or hips.
If your piercing issue doesn't respond to a change in jewelry and improved piercing aftercare, you may be dealing with an infection or a scar. Signs of infection include red streaks radiating from a piercing, skin that's hot to the touch, and/or discharge of thick, yellowish pus instead of just the normal clear lymph that dries to white "crusties" around healing piercings. If you believe you may have an infection, see your family physician right away; you may need an antibiotic to clear it up.
Identifying & Treating Scars
There are three types of scars that may develop around current and retired piercings: keloids, hypertrophic scars, and atrophic scars. Here's an example of what each type of scar tends to look like:
Atrophic scars are most likely to appear where retired piercings once were. They're characterized by their sunken/indented appearance, roughly-textured surfaces, and more normal skin tone. Like atrophic scars, hypertrophic scars tend to be closer to flesh tone, although they may be a little redder when they first develop. They're raised scars that form immediately around a piercing.
Hypertrophic scars and atrophic scars are much more common than keloid scars, which is ironic since so many people dealing with hypergranulation issues jump to the conclusion that they have keloids. It isn't surprising that people make that mistake, though, since the red, puffy skin caused by hypergranulation can look similar to a keloid scar, as is the case with the more severe belly piercing hypergranulation issue shown to the left. 
Keloids are usually a darker, more reddish-brown color than surrounding tissue, they're bulbous, and they tend to be fairly smooth surfaced. Unlike a hypergranulation issue, which is an irritation of the area immediately around a piercing, keloids will continue growing well beyond a piercing site, and no amount of proper piercing aftercare or jewelry changes will minimize them. Development of keloids tends to be a hereditary issue, and they usually require professional medical attention to treat.
If you know you're prone to keloids or that they run in your family, be very cautious about getting any piercings. Those who don't have a history of developing keloids personally or within their family are highly unlikely to develop them in future. If you do develop a keloid around a piercing site, a dermatologist can help you address it with one or more treatment options. Keloids can be frozen to kill overactive skin cells, they can be treated with corticosteroid injections that reduce inflammation, the scar tissue can sometimes be lasered off or surgically removed, or they can be shrunk down with radiation therapy.
Atrophic and hypertrophic scars are typically much easier to treat than keloids. You can either purchase a silicone scar therapy gel or jojoba oil, and massage a small amount into your scar twice a day for as many weeks or months as it takes to diminish the scar. Over time, these treatment options slowly break down the communication barrier that scars put up between healthy and abnormal tissue cells. Once communication between cells is reestablished, the tissue below a scar can get instructions from healthy surrounding cells about how to regenerate normally, reducing the scar layer by layer as damaged skin cells are sloughed off and replaced by normal new ones. Left untreated, new cells below a hypertrophic or atrophic scar will continue regenerating in the same screwy way indefinitely, so the scar isn't likely to change much in appearance over time without intervention.
It's important to note that neither silicone gel nor jojoba oil scar therapy treatments should be used before a new piercing is fully healed. They may clog the healing fistula, trapping in bacteria and leading to infection. Every piercing takes a different amount of time to heal, and healing times vary from person to person. To be safe, you should wait the maximum amount of time the type of piercing you've gotten takes to heal before beginning to treat a piercing scar.
Preventing Piercing Scars
Piercers tend to send their clients home with a saline wash like H2Ocean or Recovery Piercing Aftercare Spray to help new piercings heal fully and without scarring. It's important to use it 3-6 times per day and follow all other piercing aftercare instructions your piercer gave you to encourage new layers of protective epithelial tissue to grow as quickly as possible. If epithelial tissue reforms within 2 weeks after getting a piercing, you're less likely to scar or develop other piercing issues. That's why it's important to keep your new piercing clean, let it breathe, eat nutritiously, get good rest, and generally take care of yourself while your piercing heals. Doing so will also help minimize the chances that you'll develop an atrophic scar later, if you retire your piercing.
More Piercing Problem, Scar & Aftercare Info
To learn more about piercing scars, hypergranulation, and how to prevent these piercing issues, check out our full-length Body Piercing Scars article. If you'd like to read more about proper piercing aftercare, check out our Body Piercing Aftercare article. We also offer a wealth of information about specific types of piercings in our Piercing Information library, like our Lip Piercing FAQs and Everything You Need to Know About Dermal Piercings articles.
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