Keloid treatment and surgery in Calgary

Keloid Surgeryat Rejuvenation Dermatology Calgary South.

A keloid is a scar that keeps growing beyond the wound that made it. Cutting one out and doing nothing else brings it back larger in most patients, so keloids are treated with a plan: steroid injection to flatten and soften, excision for keloids that will not respond, and injection, silicone and pressure afterward to stop the recurrence. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, sets the plan for each keloid and performs every step himself. Medical keloid treatment is covered by Alberta Health Care with a referral.

Book a consultation Call (403) 286-6888

14Years of training FRCPCRoyal College certified VPAlberta Society of Dermatologists

What it is

Injection first, surgery second, prevention always.

Keloid treatment is a course rather than a procedure. Every part of it is chosen to reduce the chance of the scar returning.

Steroid injectionTriamcinolone injected directly into the keloid every four to six weeks softens, flattens and shrinks it, and settles the itch and pain. Most keloids respond enough that surgery is never needed.

Excision with injectionA keloid that is too large, too firm or unresponsive is excised under local anaesthetic and closed without tension. Steroid is injected at the time of surgery and at intervals afterward, because excision without it recurs in the majority.

PreventionSilicone gel or sheeting, pressure where the site allows, and sun protection for a year. Follow-up injections at the first sign of thickening. The plan is written before the first injection.

The treatment ladder

Injection, cryotherapy, laser, excision, radiation.

Keloids are stubborn, and the treatments are combined rather than chosen singly. The ladder is climbed only as far as each keloid needs.

First

Intralesional steroid

The foundation of every plan. Repeated injections over months flatten most keloids and relieve symptoms.

With injection

Cryotherapy and fluorouracil

Freezing before injection softens firm keloids so the steroid penetrates. Fluorouracil is added for keloids that resist steroid alone.

For redness and texture

Laser

VBeam reduces the redness and itch of an active keloid; fractional laser softens a flattened one and helps deliver steroid.

VBeam

Highest recurrence risk

Excision with radiation

For large, recurrent keloids, low-dose radiation within days of excision gives the lowest recurrence rate. Arranged with radiation oncology when warranted.

Why a dermatologist

Surgery alone makes keloids worse.

The commonest keloid mistake is a clean excision with good intentions and no plan for what follows. The result is a bigger keloid.

DiagnosisKeloids are distinguished from hypertrophic scars, which stay within the wound and improve with time, and from rare tumours that mimic them. The distinction changes the treatment.

Injection techniqueSteroid placed in the right plane, at the right concentration, at the right interval flattens a keloid; placed wrongly it thins the surrounding skin and does nothing to the scar.

Knowing when to cutExcision is reserved for keloids that injection cannot manage, and is always combined with injection, silicone and pressure. Dr. Kuzel decides the threshold and performs the surgery.

A year of follow-upRecurrence begins quietly in the first months. Regular review catches thickening while a single injection can stop it.

What is treated

Earlobe, chest, shoulder, jaw and surgical keloids.

Keloids favour a few sites, and each has its own approach.

Piercing

Earlobe keloids

The commonest surgical keloid. Excised with injection and a pressure earring for months afterward. Good results.

Acne and tension

Chest and shoulder keloids

High-tension sites with the highest recurrence. Injection is the mainstay; surgery is rare and combined with the most protection.

Acne and acne scarring

Beard area

Jaw and neck keloids

Often from shaving and folliculitis. Injection, laser for the redness, and management of the folliculitis that started them.

After surgery

Surgical and caesarean keloids

Injection, silicone and laser flatten and soften. Re-excision only with a full prevention plan.

Scar revision

Prone patients

Before planned surgery

Patients with a keloid history who need surgery elsewhere are seen beforehand so injection and silicone begin at the time of the wound.

Not a keloid

Hypertrophic scars

Raised scars that stay within the wound and settle over time. Treated with silicone, injection and laser; surgery rarely.

Keloids

Your visit

Assessment, a plan, and a course.

Injection usually begins at the first visit. Surgery, where needed, is booked once the plan is set.

ConsultationHow the keloid started, how it has grown, what has been tried, and any family history of keloids.

Examination and planDr. Kuzel confirms it is a keloid, grades it, and sets the plan: injection alone, injection with cryotherapy or laser, or excision with a prevention protocol.

InjectionsEvery four to six weeks, a few minutes each, with topical or cold anaesthesia. Response is assessed at each visit.

Surgery, if neededLocal anaesthetic. Excision, tension-free closure, steroid injected at the time. Twenty to forty minutes. Pressure dressing.

Prevention and follow-upSilicone from two weeks, pressure where possible, injection at intervals, and review through the first year.

Aftercare

The months after matter more than the day of.

A keloid excision heals like any other wound. What stops it returning is what you do for the next year.

After treatment

After injection: mild soreness for a day; small pale or dimpled spots occasionally appear at the injection site and usually resolve
After excision: dressing on for forty-eight hours, then daily washing and ointment until sutures are out at seven to fourteen days
No tension on the wound: avoid stretching, heavy lifting and, for earlobes, heavy earrings
Silicone gel or sheeting for twelve hours a day from two weeks, for at least six months
Pressure earrings or garments where the site allows, worn as directed
SPF 50 on the scar for a year; a tanned scar thickens and darkens
Return early for any itch, firmness or thickening; one injection at that stage prevents a recurrence

Booking and fees

Assessment and injection of symptomatic keloids, and excision where medically indicated, are covered by Alberta Health Care with a referral. Laser treatment for the appearance of a keloid is cosmetic and priced at consultation.

Referrals by fax to (403) 225-2914. Call (403) 286-6888 with questions.

What to expect

Flatter, softer, smaller, and watched.

Injection flattens and softens most keloids over three to six sessions and relieves itch and pain within weeks. The keloid does not disappear; it becomes a flat, pale, quiet scar. Some keloids need maintenance injections once or twice a year.

Excision with injection and prevention keeps most keloids from returning. Earlobe keloids do best; chest and shoulder keloids are the hardest, which is why surgery there is reserved for cases where injection has failed. Where recurrence begins, early injection stops it in most patients.

No treatment guarantees a keloid will not recur, and Dr. Kuzel says so at consultation. What can be promised is a plan that gives the best chance, and follow-up that catches recurrence early.

3 to 6Injections for most keloids 4 to 6Weeks between injections 12Months of follow-up after surgery

Questions

Questions about keloid treatment, answered.

Is keloid treatment covered in Alberta?

Assessment, injection and medically indicated excision are covered by Alberta Health Care with a referral from your family physician. Laser for appearance is not.

Can a keloid just be cut out?

It can, but without injection and prevention it returns larger in most patients. Excision is always combined with steroid injection, silicone and pressure, and reserved for keloids that injection cannot manage.

How many injections will I need?

Three to six, four to six weeks apart, for most keloids. Some need maintenance once or twice a year.

Do the injections hurt?

Injecting a firm keloid is uncomfortable for a few seconds. Cold spray or topical anaesthetic is used, and the keloid softens with each session so later injections are easier.

Will the keloid come back?

It can. Injection alone rarely causes recurrence because nothing is cut. After excision, the prevention plan keeps most keloids away, and early injection stops the ones that begin to return.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound and improves over a year or two. A keloid grows beyond the wound and does not settle on its own. Both are treated with injection and silicone; keloids need more.

Can I get my ears pierced again?

Not recommended after an earlobe keloid. Piercing elsewhere carries the same risk.

I am prone to keloids and need surgery. What should I do?

Be seen beforehand. Injection, silicone and tension-free closure from the day of the wound reduce the chance of a keloid forming.

Does laser remove keloids?

No. VBeam reduces the redness and itch, and fractional laser softens a flattened keloid, but laser does not remove one. It is used alongside injection.

Who performs the treatment?

Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South, assesses every keloid and performs every injection and excision personally. He sees patients in English and Czech.

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