How likely is to recur after surgery? My Keloids were caused by acne.
Best Surgical Procedure for Keloids
Doctor Answers 4
Keloids have a 50% recurrence rate
Statistically speaking, keloids will recur 50% of the time when excised; this is certainly true in my experience. A true keloid is histologically different from normal scar tissue and indeed from what many people refer to as keloids (hypertrophic scars: aka ugly scars). It would be very unusual for acne scars on the face to be true keloids, because true keloids tend to form on the sternum, deltoid, and earlobe regions and rarely elsewhere.
There are numerous different options which include intralesional injection with steroid several weeks prior to excision, followed by excision and concomitant injection, followed by post-excisional injection. One method I have employed anecdotaly (on a multiply recurrent earlobe keloid which failed radiation treatment) was excision, followed by immediate application of mitomycin.
If a patient has a keloid and is willing to understand that the odds of recurrence are 50%, and understands that radiation is an acceptable alternative, it is reasonable to excise the keloid along with steroid injections and/or use of mitomycin.
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Unfortunately the best surgical therapy for keloids is really no surgery. True keloids will recur the vast majority of times following incision or excision. This remains a true dilemma and no one hs figured ourt the cure for this condition.
Best surgical procedure for keloids
Let's discuss the K WORD
Although the public (and a lot of misinformed MD's) frequently refer to every raised, ugly scar as KELOID. In fact, such scars can be more accurately regarded as HYPERTROPHIC SCARS, of which keloids are a small minority.
Hypertrophic scars are raised scars that look like speed bumps. The healing process was too vigorous and the scar is raised and a little wide BUT it does NOT spill out of its boundaries. Most of such scars, can be cut out and depending on the location, original mechanism of closure etc the scars can be REVISED to give a much nicer result.
KELOIDS on the other hand are an explosive scar response that ALWAYS overflows the original cut or injury. For example, the hanging ear lobule cherries seen in response to a tiny ear piercing in some black women. From a microscopic point of view, a keloid looks like a cancer with the sole exception that the cells are not cancerous but they demonstrate a wild architecture and act without regard to local normal tissues. UNFORTUNATELY, there is NO ONE WAY keloids, if indeed that is what you have, can be treated. The mere removal is often associated with their re-appearance, sometimes in worse shape. Combination surgical removal followed by radiation works better but is also associated with issues. Removal followed by the use of other medication also is not a 100% solution.
I would guess your acne caused a scar hypertrophy not a keloid. I would suggest you see either a Plastic surgeon or a good dermatological surgeon and see what he/she says.
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Surgery for keloids
Unfortunately, nobody knows what is the "best" surgical procedure for keloids. Total removal, intra-lesional removal, steroid injections at the time of removal, compression therapy after removal have all been tried. I believe the best treatment is removal with immediate radiation therapy. However, I have even seen a recurrence in this setting.
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