SKINSURGICAL
Keloid Removal in Murrieta
Keloid removal is the surgical excision of a keloid scar. The raised fibrous tissue is cut out and the wound is closed under minimal tension, most often as an office procedure under local anesthesia. Because a keloid is itself the product of disordered wound healing, the incision that removes one can seed another, so excision is planned as one half of a combined protocol and paired with an adjuvant such as postoperative radiation therapy or intralesional corticosteroid injection. This is a distinct treatment from keloid injections, which shrink a keloid without removing it.
At a Glance
- Keloid excision performed alone has a reported recurrence rate of 45% to 100%, so it is paired with an adjuvant therapy such as postoperative radiation or intralesional corticosteroid injection[1]
- Surgical excision followed by radiation therapy is reported to recur in approximately 20% of cases, compared with about 37% for radiation therapy alone[2]
- Radiation is most effective when initiated on the same day as the excision, with total doses in the range of 12 to 20 Gy[2]
- Keloids extend beyond the boundary of the original injury, which distinguishes them from hypertrophic scars that stay within the wound margins[1]
- Reported keloid incidence reaches 4.5% to 16% among people with darker skin of African, Asian, and Hispanic descent[1]
Overview
A keloid is a scar that grows beyond the boundary of the original injury. Its fibroblasts proliferate more, survive longer, and undergo apoptosis at lower rates than those involved in normal healing. Collagen synthesis within the lesion runs about 20 times that of healthy skin, driven largely by dysregulated transforming growth factor-beta signaling. A hypertrophic scar behaves differently: it remains within the wound margins and typically does not rise more than about 4 millimeters above the skin.
Surgical excision removes the lesion entirely. That makes it an option for large, bulky, pedunculated, symptomatic, or functionally obstructing keloids, as well as lesions that have not responded to injection. It also creates a new incision in skin that has already demonstrated keloidal healing. Excision alone has a reported recurrence rate of 45% to 100%, and patient guidance from the American Academy of Dermatology states that nearly all keloids return when surgery is used on its own.
For that reason, excision is always combined with an adjuvant. Excision followed by radiation therapy has a reported recurrence rate of roughly 20%, compared with about 37% for radiation alone. Radiation is most effective when started on the day of excision. Total doses range from 12 to 20 Gy, and recent data support biologically effective doses above 30 Gy. Examples include 13 Gy in one fraction, 16 Gy in two fractions, or 18 Gy in three fractions delivered over five to seven days. When radiation is unavailable or inappropriate, intralesional corticosteroid injection is the common adjuvant. Pressure therapy, silicone gel sheeting, and cryosurgery may be used alongside it.
Susceptibility is not evenly distributed. Reported incidence reaches 4.5% to 16% among people with darker skin of African, Asian, and Hispanic descent, and incidence rises during puberty and pregnancy. Family history increases susceptibility, although no single causative gene has been identified. Keloids most often involve the deltoid, presternal chest, upper back, and ears. The chest and trunk have the highest reported recurrence after treatment, at about 34%.
What to expect
- Clinical evaluation of the keloid, including size, site, symptoms, prior treatments, and any personal or family history of keloid formation
- Photography for documentation and comparison at follow-up
- Discussion and selection of the adjuvant protocol before surgery is scheduled, since radiation requires coordinated scheduling
- In some protocols, a series of corticosteroid injections every two to three weeks for about four sessions before the operation
- Preparation and infiltration of local anesthesia at the excision site
- Excision of the keloid, with the margin plan chosen for the site and lesion shape
- Undermining of the wound edges and layered closure designed to eliminate tension
- Same-day initiation of radiation therapy when that adjuvant has been selected, or injection of corticosteroid into the wound margins
- Application of a dressing, with pressure earrings or a compression garment fitted where the site allows
- Suture removal at the interval appropriate to the site, followed by silicone gel sheeting
- Cryosurgery about two weeks after suture removal in protocols that include it
- Scheduled surveillance visits over the following one to two years to catch early regrowth
How a keloid removal works
- Excision removes the keloidal collagen and the population of overactive fibroblasts within the lesion. For a large scar, that is something topical and injectable treatments cannot fully accomplish.
- The wound is closed with as little tension as possible. Mechanical tension at the wound edge is a recognized driver of keloid formation, so the closure may use undermining, deep layered sutures, and orientation along relaxed skin tension lines to reduce the force pulling on the healing scar.
- The difficulty is that removing the lesion creates a fresh surgical wound in skin that has already shown a keloidal response. This is why excision alone has such a high recurrence rate and why the adjuvant is part of the plan from the start.
- Postoperative radiation suppresses fibroblast proliferation during the healing period when keloid tissue would otherwise begin to form. Same-day initiation performs better than delayed treatment.
- Intralesional corticosteroid may be used before or after excision to suppress fibroblast activity and collagen synthesis in the wound bed. Over the following months, pressure therapy reduces local blood flow, while silicone sheeting maintains hydration of the stratum corneum as the scar matures.
- Site changes the plan more than size does. An earlobe lesion is discrete, its margins are accessible, and the wound can be closed without tension. Tension is the variable most within a surgeon's control and the one that decides whether a fresh keloid forms in the scar. A lesion spanning the jaw or neck has none of those advantages because the skin is under load each time the head turns. Dr. Banthia examines the lesion and the surrounding skin before deciding whether excision is the right first treatment.
- Because excision alone recurs at a high rate, the adjuvant is settled before a surgical date is set, not after the wound has healed. The lesion's site and size, the patient's history of keloid formation, the selected adjuvant, and who will deliver it are addressed at the consultation. Dr. Banthia will also say when the better opening move is to treat the lesion without cutting it, as is often the case for a small keloid.
When it's recommended
- Large, bulky, or pedunculated keloids that are impractical to treat by injection alone
- Keloids that have not responded to a full course of intralesional corticosteroid injection
- Keloids causing pain, persistent itching, or restricted movement
- Earlobe keloids from piercings, where the lesion is discrete and the margins are accessible
- Keloids that obstruct function, such as a lesion narrowing the ear canal. The same problem at a joint is treated the same way and by a surgeon who operates there; this practice's keloid work is on the face, head, and neck
- Keloids causing significant cosmetic concern where the patient accepts an adjuvant protocol
- Ulcerated, infected, or repeatedly traumatized keloids requiring definitive removal
Is a keloid removal right for you?
Reach out to learn more from Dr. Vishal Banthia.
Recovery & aftercare
- Sutures are typically removed within one to two weeks, with the exact interval depending on the site
- The surgical wound is protected from tension, stretching, and trauma during early healing
- Adjuvant therapy continues on its own schedule after the excision, whether that is radiation, injection, or both
- Pressure earrings or compression garments are worn for extended daily periods over several months where the site allows, and adherence is the main practical challenge
- Silicone gel sheeting is applied to the maturing scar for months after closure
- The scar remains flat and quiet in a successful result, and early thickening, itching, or extension past the incision line is the sign that prompts re-evaluation
- Surveillance continues for one to two years, since recurrence commonly appears within that window
Alternatives
- Intralesional corticosteroid injection alone, the first-line nonsurgical treatment, which softens and flattens a keloid without removing it
- Cryotherapy, used alone for small lesions or combined with injection
- Silicone gel sheeting or silicone-based scar products
- Pressure therapy with compression garments or pressure earrings
- Laser treatment to flatten the lesion and reduce redness, often combined with injection
- Radiation therapy alone, which carries a reported recurrence rate of about 37%
- Observation, with prevention of further elective trauma to keloid-prone skin
Related treatments
Frequently Asked Questions
- Keloid removal is the surgical excision of a keloid scar. The raised fibrous tissue is cut out, and the wound is closed with as little tension as possible, usually under local anesthesia in an office setting. Because surgery alone has a high rate of regrowth, excision is always combined with an adjuvant treatment.
- Keloid injections place corticosteroid into the lesion over a series of sessions, softening and flattening it while leaving the scar tissue in place. Keloid removal cuts out the lesion. Injection is the first-line nonsurgical treatment and may be used before, after, or instead of surgery. Excision is reserved for large, symptomatic, obstructing, or injection-resistant keloids and is always combined with an adjuvant such as radiation or injection.
- Recurrence is the central risk. Excision alone has a reported recurrence rate of 45% to 100%, and published patient guidance describes nearly all keloids as returning when surgery is used on its own. Pairing excision with radiation lowers reported recurrence to roughly 20%. Intralesional corticosteroid, pressure therapy, or cryosurgery is the common alternative when radiation is unsuitable. Dr. Banthia settles the adjuvant plan before a surgical date is set, so the recurrence figures are part of the decision rather than information given after treatment.
- The incision used to remove a keloid is a new wound in skin that has already shown a keloidal healing response. Adjuvant therapy addresses that healing period. Radiation suppresses fibroblast proliferation and is most effective when started on the day of surgery. Corticosteroid injection, pressure, and silicone sheeting act on the maturing scar over the following months.
- Sutures typically come out within one to two weeks, depending on the site. The wound is protected from tension and trauma while it heals, and adjuvant treatment continues on its own schedule. Pressure earrings or compression garments may be worn for extended periods each day over several months. Follow-up continues for one to two years because regrowth usually appears within that window.
- Excision is generally deferred when there is an active infection, when the wound cannot be closed without tension, when a bleeding disorder or anticoagulation is unmanaged, or when the patient cannot complete the required adjuvant course. Pregnancy is a reason to avoid a protocol that uses radiation. Small keloids that have not yet been treated with injection are usually managed nonsurgically first.
- The difference is where the scar stops. A hypertrophic scar stays within the boundary of the original wound and usually settles over one to two years. A keloid grows beyond that boundary and does not settle on its own. Dr. Banthia makes that distinction during the examination because an ordinary raised scar is treated with scar revision, a different operation with a different recurrence profile.
- Yes. The earlobe is the most common keloid site seen by a facial surgeon, usually after a piercing. Its discrete, accessible margins make it one of the more approachable lesions to excise cleanly. Dr. Banthia removes earlobe keloids with the adjuvant plan settled in advance and will discuss whether re-piercing is advisable afterward. For keloid-prone skin, it frequently is not.
- Keloid Removal may not be appropriate for individuals with active infection at or around the lesion or unwillingness or inability to complete the adjuvant therapy that follows excision. Possible side effects include recurrence of the keloid, which is the principal risk and is reported in 45% to 100% of cases after excision alone, recurrence at a larger size than the original lesion, wound dehiscence, particularly where closure was under tension. Dr. Banthia will review your health history to ensure Keloid Removal is safe for you.
- Consultations for keloid removal are available at Dr. Banthia's Murrieta office (39755 Date St, Suite 105, Murrieta, CA 92563); Dr. Banthia's Carlsbad office (2390 Faraday Ave, Carlsbad, CA 92008). Contact the office to schedule an appointment at the location most convenient for you.
Keloid Removal risks & candidacy
Who should avoid this
- Active infection at or around the lesion
- Unwillingness or inability to complete the adjuvant therapy that follows excision
- Bleeding disorders or anticoagulant therapy without medical clearance
- A wound that could not be closed without tension, since tension drives recurrence
- Active tobacco or nicotine use, which impairs wound healing at the closure
- Uncontrolled diabetes or another condition that impairs wound healing
- Pregnancy, when the planned adjuvant is radiation therapy
Possible risks
- Recurrence of the keloid, which is the principal risk and is reported in 45% to 100% of cases after excision alone
- Recurrence at a larger size than the original lesion
- Wound dehiscence, particularly where closure was under tension
- Infection at the surgical site
- Bleeding or hematoma
- Hypopigmentation or hyperpigmentation of the treated skin
- Skin atrophy and telangiectasia from corticosteroid used as an adjuvant
- Erythema and pigmentary change from adjuvant radiation, reported in roughly 30% of irradiated patients
- Rare serious complications of adjuvant radiation, reported in under 1% of patients
- Contour irregularity or deformity at the site, particularly on the earlobe
- Pain or altered sensation at the scar
Your practitioner
Dr. Vishal Banthia, MD, FACS
Dr. Vishal Banthia is a double board-certified facial plastic surgeon practicing in Murrieta and Carlsbad, California. He is certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery, and is a Fellow of the American College of Surgeons. His practice is surgical and face-only: facelift, neck lift, eyelid surgery, and rhinoplasty. He lectures internationally, has published peer-reviewed research indexed in the National Library of Medicine, and received the American Academy of Otolaryngology's Humanitarian Travel Award for cleft lip and palate surgery in Honduras.
Sources & references
This article draws on 4 sources, including peer-reviewed research, leading medical institutions.
Government & research
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Educational & general
Medically reviewed by Dr. Vishal Banthia, MD, FACS · Last reviewed: 2026-09-22