Keloid Treatment: Hollowing out and Radiation

Hi, I have large keloids on my shoulders. My plastic surgeon suggested hollowing it out, maybe taking 90% of it out in the middle, then he can use the rest of the top skin to close it without tension. I will still have a scar but at least it will be flat, then radiation treatment right after and three more every other day. I'm concerned that cutting it out even with radiation will give me a bad scar or another keloid because of the tension. Does this treatment sound like a good solution?

Doctor Answers 3

Recurrence and treatment options for keloids

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Keloids are quite difficult to treat, but very gratifying when the lesions are eliminated or improved.

The first stage of treatment remains compression and intralesional injection at regular intervals. Surgery, although an option, should be reserved for debilitating or deformational lesions. Radiation, is also reserved for these few cases where the deformity risks far outweigh the long-term destructive risks of radiation.

I would advise a conservative approach to most keloidic lesions. Although surgery is a viable option, all other options should be exhausted before attempting surgery.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Consider Surgery with Botox

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Hello Mark,

I agree with your Surgeon's recommendation of "hollowing out" the keloid and keeping most of the overlying skin intact. This will allow for the keloid to be flattened out and decrease the tension on the scar as it heals, reducing the chances of the keloid reforming. Yes, the top part will reattach to the bottom part so as to give the area a flattened appearance.

I also use Botox during keloid removals to further decease any tension on the wound as it heals.

Kenalog is also helpful and can be used before, during and after surgical removal.

Keep in mind that even in the best of scenarios keloids can return - the goal is to minimize the bulk of the keloid and have a tension free healing process so as to minimize that potential risk.

I think you are on the right track - keep asking questions and good luck to you,

Dr. Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon

Combination treatment for keloids

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I think what you call "hollowing" is just removing a portion of the keloid and leaving a small peripheral portion. If you decide to proceed with this procedure, it is indeed the right way to do it, since removing the whole keloid can make it return with a vengeance, and even bigger. Unfortunately, with keloids, there is always a risk of recurrence. We usually inject Kenalog (steroids) at the time of the excision as well, and sometimes for several months afterwards. Another promising and relatively new therapy that you may want to consider is the combination treatment with Kenalog and Botox injections and IPL (Intense Pulse Light) therapy. You might want to discuss this with your surgeon to see whether he has any experience with it. It is a good option to try before excision, as you don't burn any bridges, and you can always resort to excision later.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

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