Surgical removal of keloids is an area of great controversy. The major risk associated with keloid removal surgery is the risk of recurrence after surgery. Also, 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. Imagine an ear keloid that was triggered by piercing. The injury from piercing is a lot smaller than the injury to remove an ear keloid. This new and larger wound will obviously result in formation of a much larger keloid. Being cognizant of the high risk of recurrence after surgery, most surgeons almost always recommend some form of treatment after surgery, either in form of steroid injections, or pressure devices, or even radiation therapy. The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%.
In addition, performing surgery to remove ear keloids can result in loss of normal ear tissue. Cases shown below are few examples of loss of ear/earlobe tissue following surgery.
Radiation therapy is often utilized to reduce the risk of keloid recurrence after surgery. Although radiation can reduce the risk of recurrence, it does not eliminate that risk. Besides, radiation carries a definite risk of causing cancer and therefore should not be used to treat a benign condition such as keloid in young patients