What a keloid is
A keloid is a scar that spreads beyond the edges of the wound, cut, piercing or acne spot that caused it, and can keep growing for months or years if left untreated. A hypertrophic scar is raised too, but it stays within the original wound's edges and flattens over months without treatment. The distinction matters: a hypertrophic scar settles by itself; a keloid does not (NHS; BAD).
Why cutting a keloid out alone does not remove it
A keloid is the skin's own response to injury, not a growth that ends once it is cut away. Excision 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 keloids return in "nearly 100%" of cases when excision is used alone (AAD). That is why surgery by itself is reserved for specific cases, and why the area is watched closely afterwards.
How keloids are treated
Published reviews describe several approaches, frequently combined:
- Steroid injections. A course of injections directly into the scar tissue, repeated over multiple visits, is the most established treatment. The British Association of Dermatologists notes that regrowth is still recorded in "up to 50%" of keloids treated this way (BAD).
- Surgical excision with adjuvant treatment. Because excision alone regrows in nearly all cases, reviews describe combining it with injections, pressure or another adjuvant therapy afterward to lower that risk.
- Pressure. Compression garments, clips or earrings, worn for months, are described as a way to reduce regrowth, mainly on the earlobe after piercing-related keloids.
- Silicone gel or sheets. Used on flatter or smaller raised scars, mainly on the body.
- Approaches used at some centres. Cryotherapy, laser treatment and radiotherapy after surgery appear in the published literature. Radiotherapy is not part of treatment at this practice.
Common sites, and who is more prone
Keloids form on the earlobe, chest, shoulders, upper back and jawline more than on other sites — places where the skin is under more tension or where piercings and acne are common. They are more common in people of African, Asian and Hispanic descent, and appear between the ages of 10 and 30. A family history is present in some Europeans with keloids (BAD). Someone who has formed one keloid is more likely to form another, which is relevant when planning any operation, including one unrelated to the scar itself.
What to expect across a course of treatment
Treatment is judged visit by visit rather than after one session. Steroid injections are given at intervals, with the scar reassessed each time before deciding whether to continue, stop, or move to a different approach. Excision, when used, is followed by monitoring in the months after the operation, because that is when a keloid is most likely to return.
Treatment in Lebanon: at this practice
Dr. Vincent ElKhoury, a board-certified plastic and reconstructive surgeon, examines each scar at his clinic on Mkalles Main Street, Mansourieh, Metn, before any treatment starts. Small raised scars are thermally shaved and, on the body, followed with silicone gel. Most keloids are treated with a series of intralesional steroid injections. Large or uncomfortable keloids are surgically excised, at Hayek Hospital or Bellevue Medical Center, with the area watched closely afterwards. More detail is on the keloid scar management page.
Questions
FAQ
Why do keloids come back after they are cut out?
Excision creates a new wound in skin that has already formed a keloid once, and the same process can start again. The American Academy of Dermatology reports regrowth in nearly all cases when excision is used alone, which is why it is combined with other treatment, or reserved for larger, uncomfortable scars, rather than used as a first step for every keloid.
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 time. A keloid spreads beyond those edges and does not stop without treatment.
Who is more likely to get keloids?
People of African, Asian and Hispanic descent, most people between the ages of 10 and 30, and anyone who has formed one keloid before — which makes them more likely to form another.
How is keloid treatment done at this practice in Lebanon?
The scar is examined at the clinic in Mansourieh, Metn, before any treatment begins. Small raised scars are shaved and treated with silicone; most keloids receive a series of steroid injections; large or uncomfortable keloids are surgically excised at Hayek Hospital or Bellevue Medical Center.