Can Keloid Scars Be Surgically Removed?

Surgical removal of a keloid is generally not the first treatment choice. When not combined with other treatments, it typically offers at best only a temporary solution, with a 50-100% reoccurrence rate. Even more alarming is that when keloids do recur after surgery they can often be worse than the original keloid.² The reason is that surgery triggers and can aggravate the same conditions that caused the keloid to form in the first place, leading to even more collagen synthesis and scar tissue formation.⁵ An exception to the generally poor outcome of surgery seems to be the excision of keloids resulting from inflamed and/or infected hair follicles on the nape of the neck (AKN), which often do not reoccur.²

According to some experts, using intramarginal excision as a surgical technique to remove the keloids reduces the risk of recurrence. The theory is that by using a surgical incision which does not extend beyond the border of the keloid, the bulk of the keloid can be removed while limiting the stimulation for excess collagen synthesis in previously unaffected areas.⁵ However, even with this technique surgical excision is generally not recommended at all for sessile (flat) keloids.²

Surgeons may also choose to use tissue-engineered skin to help close surgical wounds after keloid removal. These bi-layered skin substitutes may be a good choice in large and difficult surgical sites and could limit the tension and the associated increased keloid risk.⁸

To help prevent the keloid from growing back, surgical treatment is usually combined with other treatments and moisturizing topical ointments should be used post-surgery to aid healing.² For earlobe keloids, pressure earrings may be all that’s needed—preventing recurrence in one study for 8-48 months during follow-up observation.³ Most other keloids (except for AKN) benefit from more extensive treatment but produce much better results than surgery alone. For example, adding corticosteroid injections (which inhibit collagen synthesis and inflammation) can improve reoccurrence rates after surgery to 20% or less.² Research indicates that a combination of surgery, corticosteroid injections, and silicone sheeting show the best outcomes in most body areas, with less than 13% reoccurrence over a year after surgery.¹⁷

Speaking of which, follow-up to surgery is critical in order to initiate additional treatment as quickly as possible if the keloid appears to be reoccurring. A typical post-surgery treatment plan might include weekly injections with doses ranging between 10 and 40 mg/ml for the first month or so, and then monthly up to six months.^2,17

Other therapies that are reported to work well before or following surgery are:^3,17

• Chemotherapy drugs (e.g., 5-fluorouracil combined with corticosteroid injections with pulsed dye laser therapy)
• Compression therapy
• 
  Corticosteroid injections
• Immunotherapy drugs (e.g., interferon alpha-2b, imiquimod, and tacrolimus)
• Radiation
• Verapamil injections
• Wound dressings (e.g., silicone sheeting)