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. This new and larger wound will obviously result in formation of 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 radiation therapy.

The risk of recurrence after surgery for certain keloids such as chest wall, shoulder keloids is near 100%. 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 formation of a much larger keloid.

It is well understood that keloid is a genetic and an inherited disorder of wound-healing mechanisms of the skin. Surgery cannot change the genetic makeup of a patient. Surgery only triggers the abnormal wound healing response, which is the core problem in keloid formation.

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.

Radiation can damage the organs that are in the vicinity of the treated keloid. Radiating the neck are can 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 to remove all bulky keloids,

2) Intra-lesional steroids

3) Intra-lesional chemotherapy.

The goal of treatment for any keloid lesion, and in particular ear keloids, should not only be pivoted on the removal of the keloid tissue, but most importantly on two very crucial principles:

1. Prevention of damage to the ear
2. Prevention of recurrence of the keloid

Performing surgery to remove 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 keloid also results in loss of normal ear tissue.  Absent future keloid recurrence, the loss of ear tissue will result in an unacceptable aesthetic outcome.  Unfortunately, this very important outcome is never reported in the medical literature.

Cases shown below are few examples of loss of ear/earlobe tissue following surgery.

Below are some examples of what surgery has done to several patients.