The American Society of Plastic Surgeons groups them four ways, and each gets a different plan. Discoloration and surface irregularities (a red, brown or slightly uneven scar) respond to lasers, peels, dermabrasion and bleaching agents. Hypertrophic scars (thick, raised, red, sometimes itchy, confined to the wound) respond to steroid injections, silicone and laser, with excision for the stubborn ones. Keloids (raised scars that grow beyond the original wound and can be painful) need combination therapy and recur if only cut out. Contractures (scars that pull and restrict movement, often after burns) need surgical release with Z-plasty, flaps or grafts. Wide, stretched or stepped surgical scars, the most common cosmetic complaint, are excised and re-closed in layers.