Keloids are large sometimes dumbell shaped scars that grow out of the confines of the original wound. Most facial keloids are caused by acne that creates inflamed scars. They are most common in Afro Americans but occasionally are found in Hispanics and Asians. Keloids do not respond to silicone sheeting. Virtually all keloids that are cut out will return within 2 to 3 months if steroids and pressure are not applied after surgery. In some cases radiation is used to prevent recurrence especially if the patient cannot return for weekly office visits or the body area involved is not amenable to the application of pressure by a garment, for example keloids on the neck. Although the exact skin condition prior to keloid formation cannot be reached vast improvement is possible.
If the keloid is causing a functional problem such as blocking a body opening or affecting range or motion or has a history of recurrent infections its removal is covered by health insurance. In California state laws mandate coverage of the removal of all visibly large keloids.
This patient had a face keloid scar that formed in an acne scar. It interfered with her ability to sleep on her left side. The treatment was excision, steroid injection and application of a pressure garment. This is the type of keloid clearly covered by health insurance in California.
This patient had a keloid on each cheek after trauma to the skin. The keloids were surgically removed by surgeons twice in the past and recurred within 2 months. After keloid removal by Dr. Stone recurrence was prevented by scar injections, cordran tape and application of a pressure mask. The photos here were taken 1 1/2 years after excision. The after photos are taken without and with camouflage makeup.
A patient with this type of facial keloid has the option of a pressure mask or radiation. If the mask is chosen it has to be worn at all times for 6 to 12 months.
Read Dr. Stone’s blog about Scars, Keloids and Hypertrophic ScarsScars, Keloids and Hypertrophic Scars
Keloid surgery can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.
The alternatives include laser or cryotherapy ablation vs. surgical removal. There is no major advantage of one over the others because the main goal is the prevention of recurrence. It matters more what you do to keep it from coming back than what you do to remove the keloid.
The options to prevent recurrence are compression garments, scar injections, medicated tape and weekly office visits vs. radiation and medicated tape. Some areas like the neck are just not amenable to pressure garments and some patients live too far away to come in for weekly office visits. Those patients have to go the radiation route.
As with any type of surgery there is the risk of infection or bleeding. If radiation is used there is a risk of burns or future skin cancer. With appropriate care the risk of these is extremely low. You have to pick your radiation doctor carefully and it may be safer to go with a non-participating provider than a doctor who participates with your health insurance.
If the keloid is large enough and/or the surrounding skin tight enough you will not be able to have the keloid completely removed. In that case it is shelled out and some of the overlying skin removed. The highest risk then is incomplete survival of the shell skin. This usually does not affect the end result but does prolong the recovery period.
The benefits are not having a raised, hard scar that may itch, periodically get infected or interfere with movement.
If the radiation route is chosen radiation treatments begin within 24 hours for a total of 3 treatments. Sutures are removed at 10 to 12 days and then medicated tape is applied for 3 to 6 months
If the pressure garment route is chosen the pressure device is fitted before and shortly after surgery. Scar injections are performed at and 1 week after surgery. Sutures are removed at 10 to 12 days and the pressure device is then applied at all times except when bathing for 3 to 6 months. The device may be a custom fit garment or acrylic mask. Initial office visits are weekly and then are gradually extended to every 2 to 3 weeks.
Dr. Aaron Stone
Call today for a consultation!120 South Spalding Dr, Suite 330
Beverly Hills, Los Angeles,CA 90212