In an outpatient setting, our surgeons can remove excess scar tissue, reconstruct the surrounding skin and other soft tissues, and minimize scarring after the procedure. Compression — This involves using a bandage or tape to apply continuous pressure 24 hours a day for a period of six to 12 months. Such compression can cause a keloid to become smaller. For keloids that form at the site of an ear piercing, a clip known as a “Zimmer splint” usually reduces keloid size by at least 50% after one year of compression.
Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound. However, there’s a risk that laser treatment can make your keloids worse by causing increased scarring and redness. While these side effects are sometimes better than the original scar, you may still expect there to be some form of scarring.
In an effort to reduce wound tension, both full- and split-thickness skin grafts have been used, but these have been only partially successful. Make all attempts to remove any source of postoperative inflammation, such as trapped hair follicles, foreign material, hematomas, or infectious areas. Studies have demonstrated that with button compression devices on the earlobe, no recurrence was noted from 8 months to 4 years. The increased numbers of fibroblasts, recruited to the site of tissue damage, synthesize an overabundance of fibronectin, and receptor expression is increased in keloids.
This treatment resurfaces the keloid and surrounding skin with high beams of light in an effort to create a smoother, more toned appearance. Having a few cryotherapy treatments before receiving injections of corticosteroids may reduce the size of a keloid. Sometimes, silicone is used alone to flatten a keloid.
Mast cell population within keloid scars is also increased, and, subsequently, histamine production increases. Keloids are found only in humans and occur in 5-15% of wounds.
They tend to affect both sexes equally, although a higher incidence exists of women presenting with keloids, possibly secondary to the cosmetic implications associated with the disfigurement. The frequency of keloid occurrence in persons with highly pigmented skin is 15 times higher than in persons with less pigmented skin. Persons at the extremes of age rarely develop keloids.
In one study, 34% of the raised scars had some flattening after patients used the silicone gel daily for six months. Receiving radiation treatments after surgical removal may also prevent a keloid from returning. To give their patients the best results, dermatologists may recommend more than one type of treatment for a keloid.
These scars can be difficult to get rid of, and some return after treatment. Using two or more types of treatment often improves results. For scars that cover large areas of skin—for example, a burn scar—a surgeon may use a reconstructive technique, such as skin expansion, to allow for replacement of the burn scar with normal skin. In skin expansion, surgeons first implant a small balloon beneath healthy skin next to the scar. In the weeks before surgery to remove the scar, the balloon is slowly filled with saline water during office visits to expand the healthy skin.
Then, when performing surgery to remove the scar, the surgeons use this expanded skin to replace the damaged or burned skin. Plastic surgeons at NYU Langone who specialize in treating scars use advanced aesthetic and reconstructive techniques to improve the appearance of a scar or reduce its size.
Laser treatment is used for other types of skin scarring, all with similar benefits and risks. For certain types of scars , your doctor may recommend laser treatment.