Keloid scar treatment is not the same for every keloid. Some patients are advised to start with steroid injections, others are offered laser treatment, and in some cases, surgery may be considered as part of a broader plan. This guide explains how these options differ and why keloids can be difficult to treat.
What Is a Keloid Scar?
A keloid is a raised scar that grows beyond the edges of the original wound. It forms when the healing process continues for longer than expected and more scar tissue builds up. Keloids can develop after acne, piercings, surgery, burns, cuts, or even minor skin injury.
Keloids are often firm to the touch and may be pink, red, brown, or darker than the surrounding skin. Some may also feel itchy, tender, or uncomfortable. In other cases, the main concern may be the way the scar looks.
Keloids are different from hypertrophic scars. A hypertrophic scar stays within the edges of the original injury, while a keloid grows beyond them. This difference is important when treatment options are being considered.
Why Is Keloid Treatment Challenging?
Keloid treatment can be challenging because keloids do not all behave in the same way. Their size, age, location, thickness, symptoms, and treatment history can all affect how they respond. This means one treatment plan may not suit every keloid.
Another reason is that keloids can come back after treatment. Even when a scar becomes flatter or less active, recurrence can still happen over time. This is one of the main reasons treatment often needs careful follow-up.
Because of this, more than one treatment may sometimes be considered. The aim is often to reduce the scar’s thickness, symptoms, and activity rather than expect one treatment to fully resolve it on its own. This is also why treatment planning needs to be based on the individual scar.
Option 1 — Corticosteroid Injections
Corticosteroid injections are one of the most established treatments for keloids. They are placed into the scar to help reduce inflammation and scar activity, and they may help flatten or soften the keloid over time. These injections are often given as a course of treatment rather than a single session.
A steroid called triamcinolone is often used in keloid treatment. It may help make the scar flatter and reduce symptoms such as itch or tenderness, although more than one treatment is often needed. Side effects can include thinning of the skin, colour change, or small visible blood vessels in the treated area.
Steroid injections are often considered when the keloid is raised and active, especially if itch, tenderness, or ongoing growth are part of the problem. They may also be used before or after another treatment, such as surgery. This is one reason they remain a common part of keloid treatment plans.
Option 2 — Laser Therapy for Keloids
Laser treatment may be used for some keloids, depending on the scar being assessed and what is being addressed. It may be considered for features such as redness, blood vessels, or surface texture. The type of laser used depends on the scar itself.
Nd:YAG (1064nm) or KTP (532nm) laser wavelength-based laser devices (Cutera Excel V +) are one option that may be used when redness and scar activity are part of the concern. Ablative lasers such as CO2 or Er:YAG (Erbium Laser) may also be considered in selected cases. More than one session may be needed, depending on how the scar responds.
Laser treatment is not always the first option for every keloid. In some cases, it may be used together with other treatments as part of the overall plan. The decision depends on the scar and how it is behaving.
Option 3 — Surgical Keloid Removal
Surgery may be considered when the keloid is large, bulky, or not responding well enough to non-surgical treatment. It involves cutting out the keloid scar tissue. Even so, surgery on its own is approached with caution because keloids can recur after removal.
Surgery alone can increase the risk of a keloid returning. For this reason, surgery is often combined with another treatment, such as steroid injections or other scar management measures. This is one reason surgery is usually considered as part of a broader treatment plan rather than on its own. This is the method Dr Ed utilizes for large ear keloids.
Surgery may still have an important role in the right patient. It can be considered when reducing scar bulk is a key goal, when the scar is causing functional issues, or when other treatments alone have not been sufficient. The main point is that the scar’s behaviour after surgery matters just as much as the surgery itself.
Sometimes radiation therapy ( in a hospital environment ) post surgical removal can be effective in reducing recurrence of the keloid scar. But it can increase one’s chances of cancer in the localised areas of treatment.
Combination Therapy — Why One Treatment Often Isn’t Enough
Combination therapy is common in keloid treatment because each method works in a different way. A steroid injection may be used to reduce scar activity, laser treatment may be used for redness or selected scar features, and surgery may be considered when reducing scar bulk is part of the plan. This is why more than one treatment may sometimes be used for the same scar.
Using more than one treatment does not mean every patient will need a complex treatment plan. In some cases, one treatment may be enough to start with, while in other cases, a staged approach may be more appropriate. The decision depends on the scar itself and how it responds over time.
This also helps explain why keloid treatment is often planned over time rather than as a single step. A scar may change after the first treatment and need a different next step. Combination therapy is one way of responding to that change in a more tailored way.
What Does The DOC Offer for Keloid Treatment in Melbourne?
At The DOC, keloid scar treatment is planned around the scar itself. Factors such as the size, location, and behaviour of the scar are taken into account before treatment is recommended. Dr Ed Omarjee has more than 20 years of experience as a cosmetic doctor and has treated over 1000 keloid scars.
Treatment may involve anti-inflammatory medication placed into the scar, surgical removal in selected cases, or a plan that uses both. The treatment approach depends on the scar and on what is being addressed. This is why the plan can vary from one patient to another.
Keloid treatment at The DOC often takes place over a series of appointments rather than as a single visit. During consultation, the scar is examined, and the treatment plan is discussed based on the scar itself and your treatment history. Aftercare, possible risks, and costs are also explained as part of the consultation.
How to Choose the Right Treatment for Your Keloid
The most suitable treatment depends on the scar itself. Factors such as the keloid’s size, thickness, location, symptoms, and duration can all affect the plan. A smaller and newer keloid may be approached differently from one that is larger, thicker, or has been present for longer.
It also depends on what you are hoping to address. For some patients, the main concern is thickness, while for others it may be itch, tenderness, colour, or recurrence after earlier treatment. These differences can affect which option, or combination of options, may be considered.
This is why consultation is an important step in keloid treatment. It allows the scar to be assessed properly and the available options to be explained clearly. The treatment plan can then be based on the scar itself and your treatment history.
Frequently Asked Questions
What is the most effective treatment for keloid scars?
There is no single treatment that works best for every keloid. The most effective option depends on the scar itself, including its size, thickness, location, and treatment history. In some cases, more than one treatment may be used.
Can keloid scars be permanently removed?
Keloids can be treated, but they can come back after treatment. This is why recurrence is an important part of treatment planning. Follow-up may also be needed over time. But Keloids can become extinct in activity.
Do steroid injections flatten keloid scars?
Steroid injections may help flatten or soften some keloids. A course of treatment is often needed rather than one session alone. The response can vary from one scar to another.
How many laser sessions does it take to remove a keloid?
There is no fixed number for every keloid. Some scars may need several laser sessions over time. The number depends on the scar, the type of laser used, and how the scar responds.
Are there discomforts associated with keloid treatment?
There can be, depending on the treatment being used. Injections, laser treatment, and surgery can each involve different treatment sensations and healing times. What to expect is usually explained before treatment begins.
Can keloid scars come back after treatment?
Yes, they can come back after treatment. This is one reason keloid treatment often involves more than one method. It is also why follow-up can be an important part of care.
Book a Consultation
Book a consultation with Dr Ed Omarjee, FRACGP, CPCA, and ACAM Fellow, at The DOC Melbourne to discuss which keloid scar treatment may be suitable for your scar, your treatment history, and your goals.
