I have keloid scarring on my beard area. I was seeing a dermatologist who injected steroid on the keloid scars, and gave me antibiotics because she thought it was folliculitis. When I leave the house, I use concealer makeup because it looks terrible. I would like to get this treated properly. What are my options for keloid removal, and how do I go about choosing who or where I can get these treatments? Are estimated costs for keloid removal treatments available? Thanks!
Options for Facial Keloid Removal?
Doctor Answers (6)
Abnormal scarring can be divided into two general categories.
The first is hypertrophic scarring. This is characterized by thick, raised or wide scars that stay within the boundaries of the original incision or wound. They can be caused by stretch on the incision as its healing, chronic infection or separation of an incision during the healing process.
The second is keloiding, which is characterized by scar growth outside of the original scar boundaries.
Treatment for hypertrophic scarring can include steroid injections, silicone sheeting and re-excision with meticulous closure of the wound. Treatments like laser can be used but tend to require several treatments with subtle results.
Treatment for keloids can include steroid treatment but frequently requires excision. Resistant keloids may even require excision + radiation.
Be sure to discuss your concerns with a board certified plastic surgeon or dermatologist.
I hope this helps.
Keloids are benign tumor growths of scar tissue. Common areas include the earlobes, beard area, and groin. Treatment options for keloids center on the cause of keloids -> unregulated inflammatory response to trauma. This is why steroids, radiation, pressure, and inflammatory modulation (interferon, 5-FU) therapies are advocated. Surgery alone has a recurrence rate of around 85%, and is not recommended in isolation without adjuvant therapies.
The beard area is a very difficult place to treat. Although steroid injections may help with a developing keloid, they usually only soften an established keloid. Interferon and 5-FU treatment has very mixed results, but most data points to a less than effective treatment. For this area, I usually recommend a trial therapy of surgical excision of a small area of the keloid combined with immediate steroid injection and a pressure garment (similar to a chin strap) with or without adjuvant radiation. If you have resolution in the treated area, I would proceed with the same therapy for the remainder of the keloid. If you have a recurrence of the keloid, you may need more aggressive treatment.
Recently, some surgeons have been reporting good results using different types of dermal matrix replacements (such as Alloderm or Integra) followed by very thin split thickness skin grafting. Having been used for years in burn scar reconstruction, there is some belief that by providing a scaffold for wound repair, one can alleviate the abnormal scar response in a keloid. These reports are currently anecdotal, however may be an option for you. I would recommend a thorough discussion with a plastic surgeon in regards to your keloids.
True Keloid....hopefully not.
Hopefully your scar is more of the hypertrophic type as true keloids are very difficult to treat and recur quite often. You need a good evaluation by an experienced surgeon to get your options laid out for you.
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Facial Keloid Options
If you are already steroid injections several times with no results then you may want to consider surgical revision. If you have not had several injections yet, go back for more treatments before giving up on that route as it is the safest way to treat keloids.
If you decide to consider the surgical route, understand that the keloid can return and there is a chanced that it can return larger than before. To decrease the possibility of this happening your surgeon will most likely begin steroid injections shortly after the scar revision surgery.
Keloid Scars vs. Hypertrophic Scars on the Face: Raffy Karamanoukian, MD
Keloid scars and hypertrophic scars can occur on the face and body. Begin by speaking to a board certified plastic surgeon so that your surgical and nonsurgical options can be explored. In the majority of cases, treatment should be conservative, with an analysis of the scar and initial treatment consisting of silicone patches and TAC injection. The next stage of treatment includes surgical revision and primary closure.
Injection, excision or more for keloids
An important diagnosis that your physician can make is to differentiate between a keloid and a hypertrophic scar.
In general a keloid will extend beyond the confines of your original scar (incision).
Keloid treatment is a challenging problem every treatment available offer a percentage of recurrence and this is important to know.
- Injection only with kenolog works well for hypertrophic scars. Keloids are much harder to treat with injection. It is a safe way to start any way. The caveat is to inject inside the lesion and not beyond it.
- Excision of the keloid carries more then 50% recurrence rate.
- Excision in addition to injection with Kenolog decreases that incidence.
- The ultimate treatment is keloid excision in addition to kenolog and radiation! This is a special protocol that is only used for the extreme cases. It carries a morbidity risk due to the long term effect of radiation in the head and neck area.
I hope that helps.