Keloid removal can work well for patients with keloids, a special type of skin lesion in which normal skin healing is disrupted and the scar continues to grow abnormally. 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. Keloids can be removed surgically, and then generally a steroid injection is performed to minimize the chance of recurrence.
Good candidates for this procedure:
Patients with abnormal scars that thicken and continuously grow in size
Patients with noticeable keloid scarring
What to expect: Consultation
All cosmetic consultations are complimentary and serve as a great opportunity to gain further insight by voicing your concerns and having questions answered. During the initial consultation, Dr. Hsu will ask some questions to get to know you and determine if you are a good candidate for keloid removal.
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 your medical history, including existing medical conditions, past surgeries, tobacco usage, daily medications, supplements, and allergies. If he determines that you are a good candidate and the keloid has a good chance of being improved, Dr. Hsu will explain the next steps in going forth with the procedure. In order to reach your aesthetic goal, both you and Dr. Hsu will work together to decide all the necessary details that will ultimately give you the best results.
On the day of surgery, Dr. Hsu will meet you before surgery to make markings on the areas planned for surgery and answer any last minute questions you may have.
Keloid removal is generally a straightforward hour-long procedure that is performed under local anesthesia in our 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 aesthetically. 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 forces 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 & Post-operative Instructions:
Dr. Hsu will place dressings on the surgical area that should remain dry until Dr. Hsu says it is permissible to shower. Usually, you can wet the area after a couple of days. In the meantime, to clean the rest of your body you can bathe or use wipes. Swelling & bruising will peak about 48 hours after surgery but will gradually decrease in about one to two 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. The biggest limitation for post-operative patients is driving, which should be avoided when on pain medications. You will usually stop taking pain medication after a couple of days, so plan your work schedule accordingly.
Dr. Hsu will be available 24 hours following the surgery to address any immediate concerns. He will continue to follow patient progress for an extended period of time to ensure the patient is healing well. Dr. Hsu will want to closely monitor your post-operative results to catch any signs of keloid recurrence. Follow up appointments are scheduled immediately after surgery and for up to one year afterward.
Dr. Hsu's view on Keloid Removals.
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, 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 I have had some very good results from utilizing this protocol.