Hypertrophic scars and keloids are very common concerns among dermatologic patients, whether from a medical or cosmetic standpoint. The treatment of these lesions is challenging and associated with variable response or recurrence. The authors of this study review the most current literature on the treatment of hypertrophic scars and keloids ranging from intralesional therapies to laser and surgical modalities. The authors describe a treatment algorithm employing combination therapies while aiming to limit the use of surgical intervention. Representative case reports are presented to illustrate the use of solo or combination therapy.