A keloid is scar tissue that didn’t stop growing. Normal healing lays down collagen, then switches off. In a keloid the process overshoots, so the scar keeps expanding beyond the boundaries of the original wound — thick, raised, firm, often darker than surrounding skin, and frequently itchy or tender.
They can follow anything that breaks the skin: surgery, an ear piercing, acne, a burn, chickenpox, a vaccination, sometimes an injury too small to remember.
Keloid or hypertrophic scar?
| Keloid | Hypertrophic scar | |
|---|---|---|
| Shape | Grows beyond the original wound | Stays within the original wound |
| Timing | Can appear months after injury | Usually appears within weeks |
| Natural course | Rarely improves on its own, may keep growing | Often improves over 1–2 years |
| Recurrence after removal | Common | Less common |
Who develops them
- People with a personal or family history of keloids
- Darker skin types, including many Asian and African skin types
- People aged roughly 10–30
- Areas such as the earlobes, chest, shoulders, upper back and jawline
- After piercings, acne, burns, surgery or minor injuries
If you’re prone to keloids, tell your surgeon before any surgery, including gender-affirming or breast surgery, so preventive steps can be planned.
Let's be straight about "removal"
Treatment flattens, softens, and shrinks keloid tissue. That’s a real and often dramatic improvement — but keloids are managed rather than cured, and recurrence is common enough that any honest plan accounts for it. Most cases need a combination of treatments and a period of follow-up, not one procedure.
Anyone promising a keloid will be gone permanently after a single session is telling you what you want to hear.
Treatment options
1. Intralesional steroid injection
Corticosteroid injected directly into the scar suppresses the overactive collagen production, softens the tissue, and reduces itching and tenderness — often quickly. Injections are usually repeated monthly over several months. This is the workhorse of keloid treatment and often the first step.
2. Vascular and pigment laser
Laser targets the blood vessels feeding the scar and the excess pigment within it, reducing redness and darkness and helping flatten the raised tissue. Sessions take around 15 minutes under numbing cream and are spaced two to four weeks apart, adjusted to how your skin recovers. Plan for at least six sessions for a full result, with visible improvement after each.
3. Surgical excision — and why it is never done alone
Cutting a keloid out seems like the obvious answer, and on its own it’s the most likely route to a worse outcome. Excision alone recurs in more than half of cases, and the returning keloid is sometimes larger than the one removed — because the surgery is itself a fresh wound in skin that has already proven it over-heals.
Excision is effective when it’s combined with adjuvant treatment: steroid injection into the wound margins, pressure therapy, silicone, or radiotherapy in selected cases. That combined plan is a surgical decision, made by a surgeon, with follow-up scheduled from the start.
Which route suits you depends on the keloid’s size, age, site, and how it behaves. Most plans combine two of the three.
A good candidate
Crusting and scabbing are normal and typically persist for one to two weeks. Cold packs may help minimize discomfort after treatment. There will be a mild, ticklish sensation during the treatment, but this should not affect you or the procedure itself. Results will improve after each subsequent session, with the number of courses depending on the severity of the keloid.
Post-treatment Care
Light crusting over a laser-treated area is normal for one to two weeks; let it shed rather than picking it. A cool pack helps in the first few hours if the area feels warm.
Keep the site protected from sun for several weeks — UV exposure on healing scar tissue is what produces lasting pigment change. Use SPF 30 or above and cover the area where you can. Continue moisturising as advised, and if you’ve been given silicone sheeting or a pressure garment, consistency with it does more for the outcome than any single appointment.
Results build across sessions. How many you need depends on how thick and how established the keloid is.
Risks and Complications
Uncommon, but worth knowing:
- Bleeding or bruising at the treatment site
- Skin lightening (hypopigmentation) or darkening (hyperpigmentation)
- Thinning of the skin or a dip at the injection site, from repeated steroid injections
- Recurrence — the main one, and the reason follow-up is part of the plan
Preventing keloids after planned surgery
If you’re keloid-prone and considering an elective procedure, raise it before you book. Patients having top surgery, breast augmentation, a breast lift, or gender reassignment surgery frequently ask about scarring risk, and there is a lot that can be done in advance: incision placement, closure technique, and starting silicone or pressure therapy at the right point in healing. Telling your surgeon you keloid is one of the more useful things you can do at consultation.
Why patients choose Kamol Hospital for keloid treatment
Keloids are genuinely difficult to treat well — the difference between a flattened, faded scar and one that returns larger than before usually comes down to whether treatment was combined and sequenced properly, not just which single method was used. At Kamol, your doctor plans that combination around your specific keloid rather than defaulting to one approach.
Because keloid risk is relevant to any future surgery you might have — including procedures we perform here — flagging it during a keloid consultation means it’s on record for your doctor to account for if you’re ever planning surgery with us later, rather than something you have to remember to mention each time separately.
Frequently asked questions
Can a keloid be removed permanently?
Reduced and controlled, reliably. Removed permanently, not guaranteed for anyone. Keloids recur, especially after surgery alone, which is why treatment plans combine methods and include follow-up. Substantial flattening and softening is a realistic goal; a promise of permanent removal isn’t.
Is treatment painful?
Laser sessions are done under numbing cream and most patients feel a mild tickling or tapping. Steroid injections into firm scar tissue sting for a few seconds. Surgical excision is performed under local or general anaesthetic depending on size and site.
Why can't I just have it cut off?
Because the surgery is a new wound in skin that has already demonstrated it over-heals. Excision on its own recurs in over half of cases, sometimes producing a larger keloid. It works well when combined with steroid injection, pressure or silicone therapy afterwards — which is why this is a surgical plan rather than a single procedure.
Do keloids ever go away by themselves?
No. Hypertrophic scars often flatten on their own over a year or two; keloids don’t. If yours has been shrinking without treatment, it may be hypertrophic rather than keloid, which is good news and worth confirming.
How many sessions will I need?
For laser, at least six, spaced two to four weeks apart. Steroid injections typically run monthly for several months. A combined surgical plan involves the procedure plus a defined follow-up schedule. Thickness, age and site all affect the number.
Is Thailand a good place to have keloid treatment?
Bangkok hospitals see keloids at high volume, largely because the skin types most prone to them are the local majority — so the clinical experience base is deep, and so is experience treating pigmented skin without triggering new pigment problems. Kamol Hospital works under Thai Ministry of Public Health hospital licensing with Thai Medical Council registered surgeons.
Is it worth travelling to Bangkok, Thailand for keloid treatment?
It depends on your plan. A course of injections or laser needs weeks between sessions, so patients often start during a longer stay in Thailand and continue on a return visit. Surgical excision with adjuvant treatment is a stronger case for travelling, since the procedure and its early follow-up can be completed in one trip and the cost is well below Western equivalents. If you’re already coming for other surgery, keloid treatment slots in easily.
Will treatment leave the area a different colour?
Possibly, temporarily. Both lightening and darkening can occur, and both are more likely with sun exposure during healing — which is why strict sun protection for several weeks isn’t optional advice.
