Keloid vs Hypertrophic Scar · Los Angeles
Understanding What Makes a Keloid Different
Many patients arrive at Kare Plastic Surgery unsure whether their raised scar is a keloid or a hypertrophic scar. The distinction matters because the two conditions require different treatment approaches.
Keloid Scars
Grow beyond the original wound boundary into surrounding normal tissue. Continue to enlarge over time without treatment. Do not regress on their own. Have a very high recurrence rate after surgery alone. Require combination therapy for durable control. More common in patients of African, Asian, Hispanic, and Mediterranean descent and often run in families. Can develop from minor injuries including pimples, insect bites, piercings, and vaccinations.
Hypertrophic Scars
Remain within the original wound boundary. May improve on their own over 12 to 18 months. Respond well to steroid injections and laser treatment alone. Have a much lower recurrence rate after surgical revision than keloids. Are more likely to develop in areas of high skin tension such as the shoulder, chest, and joints. Learn more on our hypertrophic scar page. Call (310) 998-5533.
Contracture Scars
Form when scar tissue tightens across a joint or skin surface, restricting movement and causing pain. Common after burns and traumatic injuries. Contracture scars may require reconstructive surgery including skin grafts, local flaps, or Z-plasty to release the scar and restore normal function. Dr. Karamanoukian evaluates contracture scars at Kare Plastic Surgery and discusses all appropriate treatment options. Call (310) 998-5533.
Keloid Body Areas Treated at Kare Plastic Surgery Los Angeles
Chest
Shoulders
Upper Back
Earlobes
Face
Scalp
Neck
Arms
Abdomen
Bikini Area
Surgical Scars
Piercing Sites
Kare Plastic Surgery · Santa Monica, Los Angeles
Schedule Your Keloid Removal Consultation with Dr. Karamanoukian
Keloid Surgery: Excision vs Incision Technique
The two primary surgical approaches to keloid removal are excision and intralesional incision. Dr. Karamanoukian selects the technique based on the size of the keloid, its location on the body, the quality of the surrounding skin, and the likely response to adjuvant treatment after surgery.
Keloid Excision
Keloid excision removes the entire keloid including its outer margins using a fusiform or elliptical incision that surrounds the keloid with a small border of normal tissue. The wound is then closed with layered, tension-free sutures designed to minimize the mechanical stress on the healing scar. Excision is the preferred approach for well-defined keloids with clear boundaries, keloids on the earlobe or face where precision matters for the cosmetic outcome, and smaller keloids where the surrounding skin can be brought together without tension. The tension of the wound closure after excision must be carefully managed, since high tension on the skin edges is a primary driver of keloid recurrence.
Intralesional Incision
Intralesional incision, also called core excision, removes the central bulk of the keloid while intentionally leaving a thin rim of keloid tissue at the wound edges. This technique avoids cutting through normal skin adjacent to the keloid, which reduces the total surgical insult to the tissue and limits the zone of fresh wound healing that could trigger new keloid formation. It is particularly useful for large keloids on the chest, back, or shoulders, where excision with primary closure would place significant tension on the wound, and for keloids that have recurred after prior excision. The residual rim of keloid tissue at the wound edges is then treated aggressively with postoperative steroid injections to suppress further growth.
Intraoperative Steroid Injection
At the time of keloid surgery, Dr. Karamanoukian injects triamcinolone acetonide directly into the wound bed before closure. This intraoperative injection begins suppressing fibroblast activity and collagen production in the immediate healing period when the wound is most vulnerable to keloid re-formation. Postoperative steroid injections continue at four to six week intervals for several months after surgery. Studies show that combining steroid injection at the time of excision with postoperative injections substantially reduces the recurrence rate compared to surgery alone.
Postoperative Radiation
For high-risk keloids, particularly those that have recurred after prior surgery, radiation therapy delivered within the first 24 to 48 hours after excision is one of the most effective tools available to prevent regrowth. The radiation disrupts the rapid cell division that characterizes keloid fibroblast activity in the early healing period. Dr. Karamanoukian coordinates with radiation oncology colleagues to deliver this adjuvant therapy when indicated. Patients with large, previously recurrent, or deeply pigmented keloids typically benefit most from postoperative radiation as part of their treatment plan.
Laser Therapy
Pulsed dye laser reduces the redness and vascularity of keloid scars by targeting the blood vessels that give them their pink or red color and that supply the nutrients for continued growth. Fractional laser treatments improve the surface texture and thickness of keloid tissue. Laser therapy is often used alongside steroid injections in the postoperative period as part of a multi-modal approach to keeping the healing wound flat. It is also used as a standalone treatment for earlier stage or smaller keloids that may not require surgery. Learn more on our keloid treatment page.
Silicone and Pressure Therapy
Medical grade silicone sheets or gel applied daily to the healing wound after keloid surgery help maintain moisture at the scar surface and reduce the inflammatory activity that drives collagen overproduction. Pressure therapy, applied through compression garments, elastic dressings, or custom ear pressure devices for earlobe keloids, adds a mechanical signal that suppresses keloidal fibroblast activity. Both are noninvasive and well tolerated, making them ideal components of the home care routine that Dr. Karamanoukian recommends between in-office treatments at Kare Plastic Surgery.
Any new skin incision can trigger a keloid in a predisposed patient. For this reason, Dr. Karamanoukian keeps incisions as small as possible during keloid surgery and uses meticulous no-tension closure technique throughout. Patients with a personal or family history of keloid formation who are planning any future surgical procedure should inform their surgeon in advance so that preventive measures can be planned from the outset. Call (310) 998-5533 to discuss your history at a consultation with Dr. Karamanoukian.
"Keloid surgery is not simply about cutting out the scar. It is also about understanding the biology of why that scar formed."
Dr. Raffy Karamanoukian · Nationally Recognized Keloid Specialist · Kare Plastic Surgery
Who Is a Candidate for Keloid Removal Surgery in Los Angeles?
Patients who may benefit from keloid removal surgery at Kare Plastic Surgery include those who have a keloid that is growing larger over time, causing itching, pain, or restriction of movement, or that is significantly affecting their self-confidence or choice of clothing. Surgical candidates should be in good general health, free of active skin infection in the keloid area, and have realistic expectations about the combination treatment process, which typically involves multiple postoperative visits for steroid injections or laser treatment.
Patients whose keloids have returned after prior surgical removal are also good candidates, since Dr. Karamanoukian's combination approach offers a better chance of durable improvement than repeat surgery without adjuvant therapy. Patients who have previously received steroid injections without adequate improvement are also frequently candidates for surgical removal combined with more aggressive postoperative management. Call (310) 998-5533 to discuss your specific situation.
Frequently Asked Questions
What is a keloid scar?
A keloid is a type of raised scar that grows beyond the boundary of the original wound and continues to enlarge over time. It forms when the body produces far more collagen than needed during wound healing, resulting in a firm, rubbery growth that can be pink, red, or darker than the surrounding skin. Keloids do not resolve without treatment. Dr. Raffy Karamanoukian at Kare Plastic Surgery in Los Angeles evaluates and treats keloids of all sizes and locations. Call (310) 998-5533.
Does keloid surgery cause keloids to come back?
Surgery alone for keloids carries a recurrence rate of up to 90 percent. This is why Dr. Karamanoukian combines surgical excision with postoperative steroid injections, radiation therapy, laser treatment, and silicone therapy to suppress the collagen overproduction that would otherwise cause the keloid to return, often larger than the original. This combination approach significantly lowers the recurrence rate. Call (310) 998-5533.
What is the difference between keloid excision and incision?
Keloid excision removes the entire keloid tissue including its margins. Keloid incision, also called intralesional excision, cuts within the keloid and removes the central portion while leaving a thin rim of keloid tissue at the wound edges to reduce the amount of surgical trauma to surrounding skin. Dr. Karamanoukian selects the technique based on the size, location, and history of the keloid. Both approaches are combined with adjuvant therapies to minimize recurrence. Call (310) 998-5533.
Which body areas can be treated for keloid removal?
Dr. Karamanoukian treats keloids on the chest, shoulders, back, arms, abdomen, earlobes, face, scalp, neck, and bikini area. Multiple keloids can often be treated in a single visit at Kare Plastic Surgery in Los Angeles. Visit our scalp keloid page for specific information on hairline and scalp keloids. Call (310) 998-5533 for a same-week consultation.
How many postoperative treatment sessions are needed after keloid surgery?
Most patients receive steroid injections every four to six weeks for three to six months after keloid surgery, for a total of four to eight injection sessions. Laser treatments may be added as needed. Radiation therapy, when used, is given in a short course immediately after surgery. The number and spacing of postoperative sessions depends on how the scar is healing and whether any early signs of recurrence are present. Dr. Karamanoukian monitors each patient closely after surgery at Kare Plastic Surgery. Call (310) 998-5533.
Schedule Your Keloid Scar Removal Consultation