Keloid and hypertrophic scars are 2 types of excessive scarring observed clinically that require different therapeutic approaches. The clinical course and physical appearance define keloids and hypertrophic scars as separate entities; however, they are often confused because of an apparent lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scars and keloids have long been recognized by plastic surgeons and dermatologists. Yet, translating these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. The present report is an attempt to clarify the longstanding controversy regarding these 2 similar yet separate and nonidentical entities by highlighting the reported points of differentiation as well as the similarities.