Keloids are a type of scarring that results in an overgrowth of abnormal scar tissue outside the boundaries of the original incision or injury. These are particularly common in certain areas of the body, such as the ears, earlobes, neck, back, and shoulders. Also, keloids are more common in patients with darker skin, particularly Asians and African Americans. These lesions can be quite disfiguring and cause patients both physical and emotional discomfort.
Many different treatments have been tried for keloids, including partial or complete surgical excision, laser removal, and even radiation therapy or chemotherapy. Experts now agree that the best, and least risky, method is to perform a near-total (>95%) surgical resection of the keloid, followed by serial injection of a mild steroid (typically triamcinolone, also known as Kenalog). This treatment, plus topical wound care in some cases, results in dramatic improvement in almost all cases. For some patients, and in some anatomic locations, a silicone-based gel or sheeting (wound dressing) can be used to promote faster healing and decrease the likelihood of recurrence.
Keloid treatment can be performed with local anesthesia only in the great majority of cases. An exception is for pediatric cases, where sedation or general anesthesia may be required to make sure that the child is comfortable and not scared. For very large keloids, and in certain difficult areas, repeated excisions may be necessary and skin grafts may be required. For keloids or hypertrophic scars after an injury or surgical procedure, secondary restorative surgery, as well as scar removal and revision, is initiated several weeks to months after injury. Dr. Ransom would be happy to discuss in detail the treatment of your keloids or scars; please schedule a consultation today!
Anyone with a keloid or hypertrophic scar can undergo treatment or revision of the affected area. A detailed medical and surgical history, plus a physical examination of the lesions, are needed to determine the best plan for you. In some cases where multiple treatments or attempts at repair have failed, Dr. Ransom may recommend a multiple-modality approach or serial treatments. For a small group of patients, unfortunately, keloids will recur in some form regardless of the techniques or medications used. In these patients, the goal is to improve cosmetic appearance and resolve any functional issues. Dr. Ransom is a facial plastic and reconstructive surgeon and does not typically treat keloids outside of the face and neck regions.
Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.
Depending on the size and location of the keloid or hypertrophic scar, surgical treatment will vary. The overall course of treatment generally involves a single minor surgical procedure, followed by routine office visits. These visits are frequent immediately following the procedure, and then become less frequent over time. Dr. Ransom closely monitors the healing process over a period of months and uses topical and injection medications to reduce the likelihood of recurrence and give you the best appearance possible.