Surgical Dermatology

Keloid Scar Surgery Singapore

Dr. Liew Hui Min

accredited consultant dermatologist

Keloid scar surgery involves the removal or reduction of keloid scars, which are raised, thickened areas of skin that extend beyond the boundaries of the original wound. This procedure aims to improve the appearance of the affected area and reduce associated symptoms such as pain, itching, and restricted movement. Keloid surgery may be performed using various techniques to minimise the risk of recurrence, as keloids have a tendency to return after surgical intervention.

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Keloid Scar Surgery

Keloid scar surgery performed by a dermatologist might be an option for individuals experiencing the following conditions and symptoms.

Cosmetic Concerns: Keloids can cause significant aesthetic distress, particularly when located in visible areas such as the face or ears. Surgery may be considered when the appearance of keloids causes substantial concern to the individual.
Physical Discomfort: Many keloids cause persistent itching, tenderness, or pain that interferes with daily activities. These symptoms may respond to surgical intervention when other treatments have not provided relief.
Functional Limitations: Large keloids, especially those crossing joints or in areas of frequent movement, can restrict normal motion and function. Surgery may help restore range of motion and normal functionality.
Treatment-Resistant Keloids: Surgery may be recommended for keloids that have not responded adequately to conservative treatments such as silicone sheets, compression therapy, or steroid injections. However, it is not recommended to undergo any surgery on the torso, as the risk of recurrence is very high.

Benefits of Keloid Scar Surgery

Keloid scar surgery offers several potential advantages for patients dealing with problematic keloid formations.

Symptom Relief

Surgery can reduce or eliminate physical symptoms associated with keloids, including pain, itching, burning sensations, and tenderness.
Aesthetic Improvement

Removal or reduction of keloid tissue can improve the appearance of affected areas. The extent of improvement varies based on the size and location of the original keloid and the surgical technique employed.
Functional Recovery

For keloids that limit movement or function, surgical intervention can restore mobility and reduce physical restrictions. This is particularly relevant for keloids located near joints or in areas subject to regular movement.

Surgical Techniques

Surgical Excision

This technique involves surgically removing the keloid tissue and closing the wound with sutures. The procedure can be performed using various methods, including shave excision (removing the raised portion), core excision (removing the central part while leaving peripheral edges), or complete excision (removing the entire keloid with margins).

Intralesional Excision

In this approach, the bulk of the keloid is removed while leaving the peripheral rim intact. The technique aims to reduce the size of the keloid while potentially lowering recurrence rates compared to complete excision.

Cryosurgery

This technique uses extreme cold to destroy keloid tissue. Liquid nitrogen is applied to freeze the keloid, causing tissue destruction through the formation of ice crystals within cells. Multiple sessions are often required, spaced several weeks apart. Cryosurgery may be less effective for large or deep keloids but has shown good results for smaller lesions.

Laser Surgery

Lasers target the blood vessels within the keloid or ablate the tissue directly. Laser treatment can flatten keloids and reduce redness, often requiring multiple sessions for optimal results. This technique may be used alone or in combination with other surgical approaches.

Preparing for the Procedure

Medical Evaluation: A comprehensive assessment is conducted to determine the most appropriate approach for keloid treatment. This includes examination of the keloid’s size, location, and characteristics, as well as review of previous treatments and their outcomes. Medical history, including tendency to form keloids, healing patterns, and any underlying conditions that may affect healing, is also evaluated.

Medication Review: Certain medications that may increase bleeding risk, such as aspirin, non-steroidal anti-inflammatory drugs, and blood thinners, may need adjustment before surgery. Supplements with anticoagulant properties, including vitamin E, garlic, and ginkgo biloba, may also require temporary discontinuation.

Lifestyle Adjustments: Smoking cessation is advised at least two weeks before surgery, as smoking can impair healing and increase complication risks. Alcohol consumption should be limited or avoided in the days leading up to surgery. Maintaining good nutrition and hydration helps optimise the body’s healing capacity after the procedure.

Step-by-Step Procedure

Anaesthesia Administration

The procedure begins with the administration of appropriate anaesthesia. Local anaesthesia is most commonly used, injected around the keloid to numb the area. For larger keloids or anxious patients, sedation may be added to enhance comfort.

Surgical Site Preparation

The keloid and surrounding skin are cleansed with antiseptic solution to reduce infection risk. Sterile drapes are placed to create a clean field for the procedure. The surgical area may be marked to guide precise excision, particularly for complex or irregularly shaped keloids.

Keloid Excision

Using a scalpel or surgical scissors, the keloid tissue is carefully removed according to the planned technique. For complete excision, the entire keloid is removed along with a small margin of normal-appearing skin. Care is taken to maintain appropriate depth and preserve underlying structures while removing abnormal tissue.

Wound Management

After keloid removal, the wound is closed using fine sutures to minimise tension, which is a key factor in keloid recurrence. Tension-free closure techniques, such as layered closure or advancement flaps, may be employed for larger defects. In some cases, the wound may be left partially open to heal by secondary intention to reduce tension.

Post-Surgical Care and Recovery

Immediate Wound Care

The surgical site should be kept clean and dry for the first 24-48 hours following the procedure. A dressing is typically applied and should be changed according to specific instructions. Gentle cleaning with mild soap and water may be permitted after the initial period, avoiding scrubbing or irritating the wound.
Activity Restrictions

For the first few weeks, activities that stretch or place tension on the surgical site should be avoided. The specific restrictions depend on the location of the keloid and the extent of surgery. Gradual return to normal activities is typically permitted as healing progresses, with full activity usually resumed within 4-6 weeks for most procedures.
Follow-up Treatments

A series of post-operative treatments is often scheduled to minimise recurrence risk. These may include scheduled corticosteroid injections at 3-4 week intervals for several months or regular assessment for early signs of recurrence. Adherence to the recommended follow-up schedule significantly improves long-term outcomes.

Potential Risks and Complications

Keloid surgery carries several risks that patients should consider when weighing treatment options. Potential complications include infection at the surgical site, wound dehiscence (opening of the wound), bleeding, and abnormal scarring at the new incision site. Some patients experience prolonged pain, numbness, or altered sensation in the treated area. Hyperpigmentation or hypopigmentation may develop, causing colour changes that can be particularly noticeable in patients with darker skin tones. Given the risk of recurrence, it is essential to follow activity restrictions and adhere to regular follow-ups to minimise this risk.

Frequently Asked Questions

How visible will scarring be after keloid surgery?

Some degree of scarring is inevitable after any surgical procedure. The goal of keloid surgery is to replace the prominent keloid with a flatter, less noticeable scar. The final appearance depends on many factors, including the location of the scar, surgical technique, wound healing, post-operative care, and individual skin characteristics.

How long does the entire keloid treatment process take?

The complete treatment process, including surgery and follow-up treatments, typically spans several months to a year. Initial healing after surgery takes approximately 2-3 weeks, but the full maturation of the surgical scar takes 12-18 months. Follow-up treatments are often scheduled at regular intervals throughout the first year after surgery.

How many surgical procedures might I need?

Many patients require more than one surgical intervention to achieve satisfactory results. The number of procedures depends on the keloid’s response to initial treatment, its size and location, and whether recurrence occurs.

Dr Liew Hui Min

Dually Accredited Dermatologist In Singapore and the UK

Dr. Liew Hui Min is an accredited consultant dermatologist from the Ministry of Health and the General Medical Council UK.

Her clinical interest includes:

Paediatric Dermatology,
Women’s Dermatology,
General Adult Dermatology.

Having trained in major London Hospitals, Dr Liew returned to Singapore in 2014 as a Consultant at KK Women’s and Children’s Hospital (KKH) where she specialised in paediatric, women, obstetric and vulva dermatology. Currently, Dr Liew practices at HM Liew Skin & Laser Clinic located at Gleneagles Hospital.

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