What should I do for a stubborn facelift keloid scar?

Keloid scarring after a facelift is very rare and it sounds like you have tried all the conventional treatments. One must be very cautious with further treatment, as there is a risk of making things worse. If you are having a second attempt at excision, usually we will inject steroids into the wound at the time and then every month for the next 4-6 months to try and prevent recurrence.

Keloid treatment should initially be conservative but should focus
on definitive treatments and a goal of recurrence reduction. 
In these patients, I have focused on a multidisciplinary course of
treatment including topical treatments, silicone sheeting, aggressive
TAC injections, and surgery. This protocol should only be performed with
physicians or surgeons who are experienced in aggressive keloid
management for resistant scars. I also reserve such treatment for
keloids in the proliferative phase of growth.
A consultation is always a great first step; followed by application of Plato's Scar Serum before laser and injection. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

A picture would be very helpful.  The reason would be that one could possible distinguish the scar as a keloid or hypertrophic scar.  A keloid is a raised scar that typically does not spread (not wide) vs a hypertrophic scar that is wider than the original incision.  Hypertrophic scars are a result of increased tension on the skin at closure of a facelift.  This may be treated by removal of the area  and closure of the skin without tension.  Sometimes hair may be loss in these areas and hair transplants could help camoflauge the scar.  If this truly a keloid then they are very difficult to treat with a high recurrence rate.  Traditional methods include steroid injection, removal, and silicone sheeting.  Send pictures and/or seek consultations from a couple of BC PS.

Dr. ES

i would have to say this is rare

certainly unfortunate

and challenging

hypertrophic scars are more common

please give us follow up when you finish your treatment and let useknow what your doc thought it was (keloid v hypertrophic scars) and what he suggested

Thank you for your question.  True keloids are rare in the face in caucasians but I have seen one in a type 1 skin (she was fair, red hair, with freckles, East European).  More other facial keloids were in darker skin patients (Fitzpatrick Skin types 4, 5 and 6). You have done all things that can be done with true keloids: silicone pressure, intralesional steroids, radiation, etc.  My most difficult ones did respond to re-excision and immediate radiation treatment (type 6 skin, skin lesion excision, cheek).  Radiation treatment requires a discussion with the radiation doctor to evaluate the pros and cons of radiation.  The other possibility is undue tension at the closure and perhaps some excessive inflammatory response to some stitches.  Those normally leads to scars called hypertrophic scar, and the treatment would be no-tension closure, wide undermining and perhaps trying a different types of internal stitching and to keep those to a minimum.  Best of luck!  Dr. Marc DuPere, Board-Certified Toronto Plastic Surgeon

You didn't mention where your keloid scars are, but they mainly occur in the posterior hairline, behind your ear, especially if a lot of tension was placed on your wounds at the time of closure. Scars in the temple and in front of your ear heal well in nearly everyone.

Sounds like you had all of the possible treatments for keloid / hypertrophic scars. You should ask your surgeon if scar excision with wide undermining (to reduce tension on your wounds) might be helpful.

All the best to you.

Dr. Joseph

Although six scars occasionally result from skin injuries it is decidedly rare to see this after facelift. The sequence of treatment reported is proper. Persistence with your plastic surgeon will probably yield ultimately a satisfactory result. It's regrettable that you have to go through this as it is most uncommon.

    Unquestionably, surgical excision combined with radiation yields the best cure rate for keloid scars.  Surgical excision with steroid injections, pressure, etc. yields 50 to 80% cure rates.  I would be curious as to the radiation protocol and timing after excision.  Find a plastic surgeon with ELITE credentials who is a scar expert and has published chapters on the subject.  Kenneth Hughes, MD Los Angeles, CA

As other surgeons have noted, pictures would be helpful. If the skin was closed under too much tension, a hypertrophic scar can results. A hypertrophic scar is different from a keloid. A hypertrophic scar is thickened scar that stays within the boundaries of the incision line. A keloid actually spreads outside the boundaries of the incision line and often has a mushroom like appearance. I have never had a keloid from a facelift surgery but I have treated keloids in the ear lobe, and traumatic keloids in the neck and face. I excise the keloid and apply a medication known as Mitomycin-C during the surgery. I close the skin under no tension and then perform a series of three Kenalog (steroid) injections following surgery about 2-3 weeks apart. 

Keloids can be very frustrating and you are wise to follow up with a plastic surgeon to evaluate all of your options.

A keloid can be tough to deal with. If you already had scar revision and local radiation there may not be a lot of other options.