Keloid removal works well for patients with keloids, which are a type of skin lesion caused by abnormal healing. These lesions can often be seen after ear piercing, after C-section or other surgery, or after skin injuries to various parts of the body. Certain parts of the bodies are more common to develop keloids, such as the earlobes, chest, and outer shoulders. Often times, patients with more pigment in their skin (African-Americans, Latinos, and Asians) are more prone to suffer from keloids. Cases are seen less commonly in Caucasian populations with less skin pigment. Beverly Hills plastic surgeon, Dr. Charles Hsu performs surgical keloid removal for his patients and he usually adds a steroid injection to minimize the chance of recurrence.
Best Candidates for Keloid Removal
Physically healthy men and women with noticeable keloid scarring.
Patients with abnormal scars that thicken and continuously grow in size.
During the consultation, Dr. Hsu will first ask about the history of the keloid, including details such as how it happened, how long it has been there, and whether any alternative therapies have been previously attempted. He will examine the keloid to determine whether there is a good chance to improve the keloid with surgery. He will also ask about the patient’s medical history, including existing medical conditions, past surgeries, tobacco usage, daily medications, supplements, and allergies. If he determines the keloid has a good chance of being improved with surgery, Dr. Hsu will explain the next steps in going forth with the procedure.
Keloid removal is generally a straightforward 1 hour procedure that is performed under local anesthesia in Dr. Hsu’s office. After numbing the entire area, Dr. Hsu will excise the abnormal scar, free up the skin on each side, and sew the sides together. Dr. Hsu will use a special technique that involves multiple layers of sutures to relieve the skin tension. By freeing up the skin on both sides and using the multiple layer technique, Dr. Hsu ensures that the new incision's tension force on the skin will be minimized, which means less chance that the keloid will return. There is a chance that these keloids can return after surgery, so these steps are important in order to minimize that chance.
Recovery and Post-Op
Dr. Hsu will place dressings on the surgical area that should remain dry until Dr. Hsu says it is permissible to shower. Swelling and bruising will peak about 48 hours after surgery but will gradually decrease in about 1 – 2 weeks. At about two weeks after surgery, Dr. Hsu will begin to perform steroid injections on the operated area to try preventing the skin from reforming the keloid. These injections may be repeated at future visits depending on Dr. Hsu’s assessment of how things are healing. Because keloid removal is not an extremely invasive procedure, most patients can return to work immediately. Follow up appointments are scheduled immediately after surgery and for up to one year afterward.
From Dr. Hsu
“I have worked on many patients with keloids over the years, in both my time as clinical faculty at Stanford as well as my time down here in Beverly Hills. I’ve seen and worked on keloids from C-section scars, as well as many facial keloids.
I try to be selective about the keloids that I will operate on, and that is because there are a number of cases in which keloid surgery can work very well, and a number of cases in which keloid surgery is not as successful. In my experience, there are certain parts of the body where it is difficult to make much improvement with surgery. Also, the age of the patient factors in as well. In particular, the chest and outer shoulders tend to be difficult areas to obtain much improvement. It can be attempted, but only if the patient understands that the chance of success (removal of the keloid and minimal to no recurrence of the keloid) is less than on other areas. Areas where I have had some really great success include C-section scars and ears, as well as under the breast in patients who have had prior breast augmentation (another reason why I don’t like to put in large implants -- smaller implants tend to have less chance of forming keloids after breast augmentation).
I think that the success of keloid surgery depends very much on surgical technique, since proper evaluation of the area to assess the tension forces, and therefore how to relieve them, is crucial to minimize the chance of recurrence of the keloid. In nearly all patients, I will also include steroid injection into the area as well, and I will repeat this in follow up visits depending on my assessment of how things look during the healing phase.
Finally, in nearly all keloid patients, I will select a scar gel for them that is also helpful. By utilizing all of these methods together, the success of keloid surgery can be maximized, and my patients have had some very good results from utilizing this protocol.”
Frequently Asked Questions
What is a Keloid?
Keloids are often round, oval, or oblong smooth-topped scars on the skin over sites of injury. However, they can be irregularly shaped with claw-like extensions into normal skin.
There is minimal discomfort after keloid removal. Patients can often return to work immediately following the procedure. Sutures are typically removed in 5 – 7 days. After the procedure, Dr. Hsu may schedule injections of a steroid to decrease the chance of recurrence. Other techniques to minimize recurrence may be used, such as silicone sheeting and compression therapy.
Cortisone injections (intralesional steroids) are usually given once per month until the maximum benefit is obtained. Injections are safe (very little steroid gets into the bloodstream) and usually help flatten keloids. However, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.