Keloid or hypertrophic scar: the first question
Keloid treatment in Lebanon, as elsewhere, starts by telling a keloid apart from an ordinary raised scar, because the two are treated differently. A hypertrophic scar stays within the edges of the wound that caused it and flattens by itself over months. A keloid does not. The British Association of Dermatologists describes a keloid as a scar that, unlike a hypertrophic scar, can develop after very minor skin damage such as an acne spot, spreads beyond the original area of skin damage, and does not resolve without treatment (BAD). The NHS lists steroid injections, silicone gel or sheets, cryotherapy and laser therapy among the treatments used for keloid scars, and states that surgery to remove a keloid is likely to make it grow back bigger when used on its own (NHS).
Steroid injections
A course of steroid injections directly into the scar tissue, repeated over several visits, is the standard first treatment. The American Academy of Dermatology reports that between 50% and 80% of keloids shrink after steroid injection, though many of these keloids regrow by five years (AAD). The British Association of Dermatologists gives a similar picture from the other direction: "up to 50%" of keloids treated this way grow back (BAD). Neither figure is a guarantee, in either direction — it is why the scar is reassessed at each visit rather than judged after one injection.
Surgical removal, and why it is not used on its own
Cutting a keloid out creates a new wound in skin that has already shown it heals this way, and the same process can start again along the new scar line. The American Academy of Dermatology states that nearly 100% of keloids return when excision is used alone (AAD); the British Association of Dermatologists describes surgical removal on its own as rarely a success, since it can leave a larger wound in which the keloid is likely to regrow (BAD). That recurrence, and what changes when excision is combined with another treatment afterward, is covered in full in why keloid scars come back.
Pressure and silicone
Pressure devices — bandages, clips or splints worn for 12 to 20 hours a day over several months — are described as reducing keloid size, particularly on the earlobe (AAD; BAD). An ear-lobe keloid after piercing is one of the more common cases seen, and a pressure earring or clip, worn consistently, is one of the options discussed for it. Silicone gel or sheets, used for several months, can reduce a keloid's thickness and make it paler, and are sold without prescription (BAD).
A course set at consultation, not a single visit
Combining more than one treatment — injections with pressure, or excision followed by injections — is described in the literature as improving results over any single approach used alone, because keloids respond differently to each (AAD). What that means in practice is a course: several visits, spaced out, with the scar checked at each one before deciding whether to continue, stop, or change approach. That plan, and which treatments apply to a given scar, is set at consultation rather than fixed in advance.
Risks, in plain words
- Thinning or lightening of the skin at an injection site, which can happen with repeated steroid injections.
- Small visible blood vessels near an injected area.
- Discomfort at the time of an injection or a thermal shave.
- Recurrence — the reason surgery is not used as a first step for every keloid, and why the area is watched afterwards.
At this practice
Dr. Vincent ElKhoury, a board-certified plastic and reconstructive surgeon, examines every keloid himself, at his clinic in Mansourieh, Metn, before any treatment starts. What is offered here — thermal shaving and silicone for small raised scars, a series of steroid injections for keloids that do not need excision, and surgical excision at Hayek Hospital or Bellevue Medical Center for those that are large or uncomfortable — and how the choice is made, is on the keloid treatment in Lebanon page.
Questions
FAQ
What is the difference between a keloid and a hypertrophic scar?
A hypertrophic scar stays within the edges of the original wound and flattens by itself over months. A keloid can start from very minor damage such as an acne spot, spreads beyond the original area, and does not resolve without treatment.
Is one steroid injection enough to treat a keloid?
Rarely. Published figures show 50% to 80% of keloids shrink after steroid injection, but many regrow by five years, and "up to 50%" grow back after this treatment. A course over several visits, with the scar reassessed each time, is how it is judged — not a single session.
Why is a keloid not simply cut out?
Excision creates a new wound in skin that has already formed a keloid once, and the same process can start again. Surgery used alone shows recurrence in nearly all cases, which is why it is combined with another treatment afterward or reserved for keloids that are large or uncomfortable.
How is an ear-lobe keloid after piercing treated?
It is one of the more common cases. Pressure — a clip or splint worn consistently for months — is one option described for earlobe keloids, alongside steroid injections or, where appropriate, excision. Which combination applies is decided at consultation.
Sources
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