What it involves
The approach is chosen by the scar in front of us, not applied the same way to every case.
Small, raised scars — the kind that read almost like a thickened skin tag — are shaved down with a thermal device under a monopolar current. On scars on the body, silicone gel is then applied while the skin settles.
Most true keloids are treated with a series of intralesional steroid injections (triamcinolone, sold as Kenacort). The steroid is injected directly into the firm tissue of the scar itself, and the keloid decreases in size gradually, session by session, rather than flattening immediately.
A keloid that is large, or uncomfortable enough that the patient wants it gone rather than reduced, is surgically excised.
What it will not do
An injection does not erase a keloid in one visit — the response builds gradually over a course of sessions, and how many depends on how the individual scar responds.
Cutting a keloid out on its own is not a reliable cure: keloids have a real tendency to return after excision alone, sometimes larger than before. That risk is why surgery is kept for the keloids that genuinely need it, and why it is not treated as a shortcut past the injections.
Follow-up
How the course is judged
Each injection is checked at a return visit before the next one is given, so the plan can change with what the scar is actually doing rather than following a fixed script.
First visit
ExaminationThe scar is examined and a plan chosen — shaving and silicone, a course of injections, or excision.
Each session
Injection or shaveBrief, done in clinic. No general anaesthetic for the injections.
Between sessions
Response is watchedThe keloid is reassessed at the next visit before deciding whether to continue, stop, or change approach.
After excision
Watched for returnThe area is followed afterwards, since this is when a keloid is most likely to come back.
Honesty
Risks, and what can go wrong
Every treatment here has them. They are listed so a patient who has read them and still wants to proceed is a patient who will be content afterwards.
- 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 injection or shaving.
- Recurrence, which is the main risk after excision and the reason it is not used as a first step for every keloid.
Questions
What patients ask
Is one injection enough?
Rarely. A keloid usually decreases in size gradually over a series of sessions rather than flattening after one. How many depends on how it responds.
Does surgery get rid of it for good?
Excision alone carries a real risk that the scar comes back, often larger. That is why it is reserved for keloids that are large or uncomfortable, and why the area is watched afterwards.
What is a keloid, versus an ordinary scar?
An ordinary scar stays within the edges of the original wound. A keloid grows beyond them, stays raised, and can keep growing for months or years if untreated.
Does the injection hurt?
It is an injection directly into firm scar tissue, so there is a sting at the time. It is brief and does not need general anaesthesia.
What about small raised scars — do they need injections too?
Not usually. Small ones are often treated by shaving them down with a thermal device, then silicone gel on scars on the body while the skin settles.