Surgical removal of keloids is an area of great controversy. The biggest risk associated with keloid removal is the risk of recurrence after surgery. Keloids that re-occur after surgery are often bigger in size and much harder to treat.
The onset of a keloid is triggered by wounding of the skin. In surgically removing a keloid, a much bigger wound is induced by the surgeon. This new and larger wound will obviously result in formation a much larger keloid. Knowing this risk, surgeons almost always recommend some form of treatment after surgery, either in form of steroid injections, or pressure devices, or even harmful radiation therapy.
Predicting the risk of recurrence of a keloid after surgical removal is impossible. What is greatly needed is a methodology to make a risk determination as to which keloids will recur and which will not. This is an area that has never been researched. The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%. Local injection of steroids after surgery may reduce the risk of recurrence of certain keloids. The degree of benefit from this intervention is unclear.
The diagram below shows the vicious cycle of surgery that many keloid patients fall into.
Flat, small and minor keloids should never be treated with surgery. We see over and over is that a surgeon has removed a small keloid from the skin, and the result has been worse than the original keloid. It is well understood that keloid is a genetic and an inherited disorder wound-healing mechanisms of the skin. Surgery cannot change the genetic makeup of the person. Surgery only triggers the abnormal wound healing response, which is the core problem in keloid formation
Radiation therapy is also utilized to reduce the risk of keloid recurrence after surgery. Although it can reduce the risk of recurrence to some extent, radiation carries a definite risk of causing cancer and therefore should not be used to treat a benign condition such as keloid. Radiation can damage the organs that are in the vicinity of the treated. Radiating neck will result in total loss of thyroid function, making the person hypothyroid, requiring lifelong thyroid supplement medications. Radiation to the chest area can damage the heart and lungs. Radiating abdomen can damage the liver. Radiating pelvis can damage the bone marrow, ovaries in women, and testicles in men, potentially causing infertility.
Best treatment options to remove keloids are:
1) Cryotherapy which can successfully remove all bulky keloids,
2) Intra-lesional steroids
3) Intra-lesional chemotherapy.
Aftermath of Keloid Surgery:
The goal of treatment for any keloid, in particular ear keloids, should not only be pivoted on removal of the keloid tissue, but most importantly on two very crucial principles:
- Prevention of damage to the ear
- Prevention of recurrence of keloid
Performing surgery to remove primary ear keloids is inherently contrary to these two very basic principles. Surgery by its nature induces a totally new injury to the skin. Quite often, surgical removal of a primary keloid also results in loss of surrounding normal ear tissue. Loss of normal ear tissue, even in absence of future keloid recurrence will result in an unacceptable aesthetic outcome.
There are several reports of very high success rates in treating ear keloids with surgery and radiation therapy. But a common thread among all these publications is total absence of reporting of the aesthetic outcomes after ear keloid surgery. Cases shown below are few examples of the so called "Successful Ear Keloid Removal". Partial to total loss of earlobe following earlobe keloid surgery is never reported, and at times not even discussed with the patients prior to surgery.
Cryotherapy Instead of Surgery:
Cryotherapy on the other hand, can very successfully remove all ear keloids, without causing any hard to the ear tissue, and with excellent therapeutic outcome Cases shown below are few examples of clinical outcome of ear and earlobe keloids using Cryotherapy, which results in a far more superior aesthetic outcome than any form of ear keloid surgery.
Cryotherapy has been the main component of treating all above ear keloids.
Below are some examples of what surgery has done to several patients.