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Surgery and Keloid Scarring?

I was in a car accident and fractured my radius and ulna; I have keloid scars from the surgery on both my wrist and elbow. Does this mean I will also keloid from plastic surgery?

Doctor Answers (8)

Keloid after Mommy Makeover?

+1

   It is important to distinguish among a poor scar, a hypertrophic scar, and keloid scar.  If you are a true keloid former you will have a greater propensity to form keloids with a mommy makeover.


Los Angeles Plastic Surgeon
5.0 out of 5 stars 203 reviews

Scars-Good, Bad, and Keloid

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Whenever the skin is cut, the wound heals with scar formation.  A good scar will be smooth, flat, thin, and blend in with surrounding skin color.   A bad scar can be thick (hypertrophic), wide, dark red or violet/pinnk, and tender.  A true keloid scar grows up and over the natural boundaries of the wound, and represents an overabundant growth of collagen.  An individual person may have a tendency to form keloid scars in a particular area of the body only or throughout their body.  However, even in someone who normally would not form a keloid scar, a keloid might develop after an injury or surgery to repair an injury.  In these cases, their is usually trauma to the surrounding skin, which predisposes to keloid formation.  Both true keloids and thickened scars can be improved by various types of treatments, non-surgical and surgical.  Usually, elective or cosmetic surgery carries a minimal risk of keloid formation because the skin wound is created under ideal circumstances and in locations that usually heal well.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 7 reviews

Surgery and Keloid Scarring

+1

Keloids are more common with traumatic injuries than with surgical incisions which are planned in the most favorable direction for healing. If you have large bumps at the site of ear piercings, you may be at higher risk for future keloids. 

However, if these are the only abnormal scars you have you may not be at any significantly increased risk. 

When the time comes, have a discussion with your plastic surgeon.

Thanks and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

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Do Previous Keloids Predict Risks of Future Scarring?

+1

Thank you for the question. The fact that you had developed keloids from a traumatic event in no way is predictive of your chances of developing a keloid after an operation, which is essence controlled trauma. In both cases a wound is being created however in the accident the surrounding tissue that is not cut open is still injured. In a surgical procedure the injury is isolated to the tissue you manipulate with your knife/dissection.

It would be nice to have a picture of the scars you are calling a keloid as most people will mistaken hypertrophic scars for keloids. Hypertrophic scars are usually amenable to revision while keloids are very resistant to revision and have a high rate of recurrence after treatment.

I hope this helps. Best wishes.

Pedro M. Soler, Jr., MD
Tampa Plastic Surgeon
5.0 out of 5 stars 7 reviews

Mommy makeover - keloid

+1

In my experience, traumatic scars are not good indicators for keloids after cosmetic surgery such as a mommy makeover.  A more realistic indicator is other surgical scars or scar from childhood that were from an extensive injury.  Patients who have extensive keloid history from any injury or cut I steer away from cosmetic surgery.  In my practice we have managed some of these patients successfully silicone sheeting or scar creams with silicone along with either Kenalog or 5 FU injections during the healing phase.  Best wishes!!

Stefan Mark Szczerba, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 18 reviews

Keloids - fact or fiction?

+1

The vast majority of patients who feel they have, or have been told they have keloids actually have hypertrophic scars. These are very common following traumatic injuries and in areas of high tension (upper arms, shoulders, chest). The difference is in the biology - a keloid is a true benign tumor from unregulated scar deposition. You may have seen folks with very large (sometimes the size of a grapefruit) scars hanging from their earlobes. Or men with large scars in their beard area due to minor shaving nicks. These are true keloids. A keloid is very difficult to treat, often requiring excision, steroid injections, constant pressure application, and sometimes radiation.

A hypertrophic scar however is much more common and is a normal response of the body to increases in tension. This affects plastic surgery patients because much of what we do involves pulling things tight and closing under tension. Still, there are some people whose body is more apt to generate a hypertrophic scar under similar circumstances where others do not. This propensity is important because there are many scar manipulations we can do to help improve the appearance of scars once they form. Thankfully, even in hypertrophic scars from plastic surgery, a scar revision often fixes the problem as the new scar is usually under much less tension than the original.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Keloid scarring

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That is not necessarily the case. What you think is a keloid may not actually be a keloid. Many patients come into my office thinking they have a keloid but on examination different types of scars are present. I actually have a patient who fractured the forearm in a fall. Only 2 areas on the forearm developed keloids where orthopedic fixation devices were introduced. None of the other injuries developed keloids although they did scar. I have another patient with an excellent quality abdominal scar from abdominal surgery but a large difficult keloid of the chest where a central catheter previously became infected. The development of a keloid is dependent on genetic predisposition and conditions that affect the scar during the healing process such as local infection.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Risk of keloid scar

+1

A history of developing a keloid scar definitely means you are at increased risk of poor scarring after any type of surgery including cosmetic surgery.  There is a genetic component to healing and unfortunately, it sounds as if you have a tendency towards keloid scarring.  Now, that does not mean there is a guarantee that you will develop another one with any further surgery.  The skill of the closure and tension on the wound during the healing phases do play a big role in how the incision will heal.  Make sure you consult with a board-certified plastic surgeon for any cosmetic surgery.  Good luck!

Naveen Setty, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.