Dermatological surgery of keloid scars

Following a lesion or wound, the healing stage allows the production of new skin . What you need to know is that the scar tissue created is likely to differ from healthy skin , hence a possible uneven appearance. Hair as well as sweat and sebaceous glands are absent from the scar tissue. Moreover, this new skin is also devoid of melanocytes, resulting in a lighter appearance than the surrounding skin.

A keloid scar results from an anomaly occurring during this healing process (fibro-proliferative disorder). An overproduction of collagen will increase the thickness of the scar, which will be fibrous and puffy, resulting in an unsightly growth that is quite difficult to hide on a daily basis.

A normal scar stops evolving after the first year following the initial lesion. It is not itchy and does not cause pain. Its texture is usually flat and its color white. A keloid scar, on the other hand, takes on a raised appearance , thickened and darker in color than the surrounding skin. It is shiny , firm to the touch.

It can be the cause of itching, skin irritation but also pain, which motivates the consultation in dermatology . If keloid scars can affect any part of the body, they especially tend to be more frequent on the midline of the thorax (at the level of the sternum ), the shoulders, the lower part of the face as well as on the ears due to of piercings .

The keloid scar appears following a wound, injury or surgery. Some factors favor the formation of this type of scars:

• Black skins are more prone to keloid scars
• Deep wounds are more likely to develop into keloids after healing
• A genetic predisposition as well as a history of keloid scar are predisposing factors.

Unlike a normal scar, a keloid scar continues to grow and may expand beyond the boundaries of the original wound. It never regresses spontaneously. But still, this type of scar can appear months or even years after the injury.

Do not confuse hypertrophic scar and keloid scar: the hypertrophic scar also takes on a raised and thick appearance, but it stops evolving after a year. This is also the main differential diagnosis of a keloid scar.

Before the start of the therapeutic course, it is essential to differentiate between keloid and hypertrophic scars. Different types of treatments can be considered to treat keloid scars .

It is essential to note that keloid scars have a high potential for recurrence after treatment. Surgical treatment is usually indicated immediately when the scar is voluminous and/or extensive. It is recommended to opt for a combined treatment in order to limit the risks of recurrence: surgical excision can be associated with postoperative radiotherapy.

Dermatologists perform injections of Kenacort in the keloids, a steroidal anti-inflammatory drug belonging to the family of synthetic corticosteroids . Generally, 3 sessions spaced a few weeks apart are effective in significantly reducing the size of the scar.

Co2 fractional laser is also one of the treatment methods for keloids . Depending on the particularities of each scar, the number of sessions required varies. At Skin Marceau , we use the Deka Smartxide Punto CO2 laser . The laser beam generates heat that will initiate intense cell renewal.

For keloids located at the level of the earlobes for example, the treatment is based first on the fractional CO2 laser, then it is possible to complete with injections of kenacort.

The surgical revision of keloid scars is part of the dermatological surgery performed by our team of dermatologists at Skin Marceau.

Surgical excision is accompanied in about half of the cases by a recurrence, hence the indication of a combined treatment.

Prices for keloid scar surgery at Skin Marceau are available in the table below: