Keloids & Keloid Surgery: Treatments, Aftercare, and Recurrence Prevention
Keloids are overgrowths of scar tissue that extend beyond the original wound. The right plan usually combines procedures (and discipline) rather than relying on surgery alone.
By Dr. Tim Neavin • Updated
What is a keloid (vs hypertrophic scar)?
Keloids grow beyond the boundary of the original injury and can itch or feel tender. Hypertrophic scars are raised but stay within the original wound edges and often flatten with time. The distinction matters because keloids recur more without a layered plan.
Who tends to get them & common sites
- Family history or prior keloids increases risk.
- Typical areas: earlobes (piercings), chest/sternum, shoulders, upper back, jawline.
- They often appear after acne, piercings, lacerations, or surgery.
Non-surgical treatments
- Silicone gel/sheets & taping: Daily use improves hydration and helps flatten/soften scar tissue. See our scar treatment guide.
- Intralesional injections: Steroids (e.g., triamcinolone) often combined with 5-FU in a series to reduce thickness, itch, and color.
- Cryotherapy (select cases): Freezing small lesions, often paired with injections.
- Laser adjuncts: Vascular lasers can reduce redness/itch; fractional devices may improve texture as part of a broader plan.
- Pressure therapy: Especially useful for ear keloids (custom pressure earrings) after treatment.
When surgery makes sense
Excision alone has high recurrence. We consider surgery when it’s paired with adjuvants:
- Excision + adjuvant radiation: A brief course of superficial/electron-beam therapy started soon after removal can significantly reduce recurrence (coordinated with radiation oncology).
- Excision + series of injections: Post-op steroid/5-FU injections at set intervals for several months.
- Ear keloid algorithm: Shave or excise, pressure earrings, taping/silicone, and scheduled injections ± radiation depending on size/history.
Aftercare & recurrence prevention
- Follow the schedule: Keep every injection/laser/radiation visit; spacing matters.
- Silicone + sun protection: Daily silicone and strict SPF on exposed areas for 6–12 months.
- Pressure (ear): Wear pressure devices as prescribed; compliance drives results.
- Avoid re-injury: Delay new piercings and avoid friction/tension on the area.
Risks & long-term considerations
- Recurrence: Even with optimal care, some keloids return. Layered plans lower the odds.
- Skin changes: Pigment shifts, thinning, or small depressions can occur; plans are adjusted to minimize these.
- Radiation considerations: Not for pregnancy; we keep dose/field limited and coordinate closely with radiation oncology.
FAQ
Do keloids ever go away on their own?
They can soften, but true keloids rarely disappear without treatment. Hypertrophic scars are more likely to flatten with time.
Can I pierce again after an ear keloid?
Often not recommended; if you do, choose a different site and discuss timing and preventive strategies first.
Is keloid treatment covered by insurance?
Sometimes—especially when painful, itchy, or functionally limiting. Coverage varies by plan and documentation.
Next step: If you’re dealing with a stubborn keloid, we’ll map a layered plan and set the follow-up cadence that keeps it under control.
Board-certified plastic surgeon with extensive experience in breast, face, and body procedures.
