Permanent Keloid Removal: Best Practices

Keloids are more than just scars; they are a complex and often frustrating skin condition. A keloid is an overgrowth of scar tissue that develops after a skin injury, such as a cut, burn, piercing, or even acne. Unlike a typical scar, a keloid grows beyond the original wound boundaries and can become large and raised, causing cosmetic concern and sometimes discomfort or itching.

The primary challenge with keloids is their tendency to return after removal, often larger than before. This high recurrence rate makes permanent removal difficult, requiring a sophisticated and multidisciplinary approach. Simply cutting out a keloid is rarely enough. A successful outcome depends on combining different treatment methods tailored to the individual.

Understanding Keloids

To treat keloids effectively, it is essential to understand how they form and what makes them different from other scars.

Pathophysiology of Keloid Formation

Keloid formation is a result of a dysregulated wound healing process. Normally, when skin is injured, the body produces collagen to repair the damage. In people prone to keloids, this process goes into overdrive. The body produces an excessive amount of collagen, leading to a thick, fibrous growth that extends beyond the original injury site. This process can continue for months or even years.

Differences Between Keloids and Hypertrophic Scars

Keloids are often confused with hypertrophic scars, but they are not the same.

• Hypertrophic Scars: These are raised and thickened but remain within the boundaries of the original wound. They may improve and flatten over time on their own.
• Keloids: These scars invade the surrounding healthy skin, growing beyond the initial injury. They do not regress without treatment and can continue to expand.

Risk Factors and Genetic Predisposition

Certain factors increase the likelihood of developing keloids. Genetics play a significant role; if your parents have keloids, you are more likely to develop them. Individuals with darker skin tones (of African, Hispanic, or Asian descent) have a higher genetic predisposition. Age is also a factor, with keloids being more common in people under 30.

Surgical Removal of Keloids

Surgical excision is often the first step in treating large or bothersome keloids, but it must be performed with great care and combined with other therapies.

Surgical Excision Techniques

The goal of surgical removal is to excise the keloid tissue completely. The surgeon makes an incision to remove the overgrown scar tissue. However, this creates a new wound, which is at high risk of forming another keloid.

Importance of Minimal Tension Wound Closure

How the new wound is closed is critical. Surgeons use techniques to ensure minimal tension on the skin, as tension is a key trigger for keloid formation. This involves aligning the closure with relaxed skin tension lines—the natural creases and folds of the skin.

Advanced Surgical Methods

Modern techniques can improve the outcomes of surgical excision. These include laser-assisted excision, which can help reduce blood loss, and the use of radiofrequency devices. For larger keloids, local flaps of skin may be used to cover the area with less tension.

Risks of Surgery Alone

Performing surgery without any follow-up treatment is highly likely to fail. The recurrence rate for keloids removed by surgery alone can be as high as 45-100%. This is why adjuvant (add-on) therapies are a mandatory part of modern keloid management.

Adjuvant Treatments to Prevent Recurrence

To prevent a keloid from growing back after surgery, one or more of the following treatments are used.

Corticosteroid Injections

Injecting corticosteroids directly into the scar tissue is a cornerstone of keloid treatment. These anti-inflammatory agents can be used before surgery to soften the keloid and are essential post-operatively to suppress the abnormal healing response. Injections are typically given every 4-6 weeks.

Radiation Therapy Post-Surgery

Superficial radiation therapy (SRT) delivered shortly after surgery is one of the most effective ways to prevent recurrence. It works by inhibiting the overactive cells that produce excess collagen. The treatment is precisely targeted to the scar area, with timing and dosage carefully planned to maximise effectiveness and safety.

Pressure Therapy

Applying continuous pressure to the healing wound can help prevent a keloid from forming. This can be achieved with pressure garments for larger areas or specialised pressure earrings for keloids on the earlobes.

Silicone Gel Sheets and Dressings

Silicone sheets or gels are a simple, non-invasive option. When applied to a healing scar, they hydrate the skin and reduce collagen production, helping to flatten the scar and prevent it from becoming a keloid.

Cryotherapy and Cryosurgery

Cryotherapy involves freezing the keloid tissue with liquid nitrogen. This can be used on its own for smaller keloids or in combination with other treatments like steroid injections. It works by damaging the cells and blood vessels within the scar.

Other Non-Surgical Treatments

For smaller keloids or for patients who do not want surgery, several non-surgical options are available.

Laser Therapy

Pulsed-Dye Laser (PDL) is particularly effective for reducing the redness in keloids and can help flatten them. It targets the blood vessels within the scar tissue, reducing blood flow and inhibiting growth.

Topical Treatments and Creams

Various creams and topical treatments are available, but their effectiveness is limited for true keloids. Some, like imiquimod cream, have shown modest results when used after surgery, but they are not a standalone solution.

Emerging Treatments

Research into keloid management is ongoing. Newer treatments being explored include injections of medications like 5-fluorouracil (5-FU) and bleomycin, which can be combined with steroids to improve results.

Combined Treatment Protocols

The modern gold standard for permanent keloid removal is multimodal therapy. No single treatment is consistently effective on its own. The highest success rates are achieved when multiple approaches are combined into a personalised plan.

Importance of Multimodal Therapy

Combining treatments targets the keloid from different angles. For example, surgery removes the bulk of the scar, radiation prevents the cells from overproducing collagen, and steroid injections manage inflammation. This synergistic approach dramatically reduces the risk of recurrence.

An effective protocol might involve surgical excision followed immediately by a course of radiation therapy, combined with steroid injections starting a few weeks later, and the use of silicone sheeting for several months. At Dr DC Plastic Surgery Clinic Pune, we design such comprehensive plans to offer the best possible outcomes.

Post-treatment Follow-up

Long-term success requires diligent follow-up care. Patients must be monitored for at least one year after treatment to watch for any signs of recurrence, as early intervention is key to managing it.

Frequently Asked Questions (FAQs)

Can keloids be permanently removed?

Yes. Permanent keloid removal is possible, but it requires a combined approach. Surgery alone has high recurrence rates. The most effective results come from multimodal treatment—surgery followed by radiation, corticosteroid injections, silicone therapy, or cryotherapy.

Why do keloids come back after surgery?

Keloids recur because the body’s healing response becomes overactive, producing excess collagen. Surgery creates a new wound, which can trigger new keloid formation. That is why adjuvant treatments like radiation and steroid injections are essential after excision.

What is the best treatment for large keloids?

Large keloids respond best to surgical removal combined with radiation therapy and corticosteroid injections. This combination reduces collagen overproduction, lowers inflammation, and significantly decreases recurrence.

Are non-surgical treatments effective for keloids?

Non-surgical treatments like laser therapy, silicone sheets, cryotherapy, and steroid injections can help reduce size and symptoms. However, for permanent results in larger keloids, these treatments work best when part of a combined protocol.

Conclusion

Permanently removing a keloid is a complex challenge, but it is achievable with the right strategy. The best practices involve a deep understanding of the patient’s risk factors and a commitment to a multimodal treatment plan that goes far beyond simple excision. The emphasis must be on preventing recurrence through a combination of surgery, adjuvant therapies, and long-term follow-up.

Because every keloid and every patient is unique, an individualised treatment plan is essential. For those seeking Keloids Treatment in Pune, consulting with a specialist clinic is the first step. Future research will continue to refine our approaches, but today’s combined therapies, delivered by an expert team like the one at Dr. DC Plastic Surgery Clinic, offer the most promising path to clear, healthy skin.

♦ Disclaimer: The information provided in th is article is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Please consult your doctor or a qualified healthcare provider with any questions about your health condition.