Keloid Scars After Surgery: Understanding Them Correctly to Treat Them Effectively

You have just come through a successful operation, but a few months later, an incision you thought had healed begins to rise, turn red, itch, and spread beyond the original incision line. The worry of "will this scar look bad forever?" causes many people to lose confidence, especially when the scar is in a visible area such as the neck, chest, shoulder, or face. Keloid scars after surgery are not only a cosmetic concern; they can also cause pain, tightness, and affect quality of life. Understanding their true nature is the first step toward managing them effectively.

The Scientific Basis: Why Do Keloid Scars Form After Surgery?

After the skin is injured, the body activates the healing process by producing collagen to rebuild tissue. In most people, this process is self-regulating and stops once the wound has closed. However, in certain individuals with a particular predisposition, the fibroblasts become overactive and continue to synthesize collagen even when it is no longer needed, causing scar tissue to grow beyond the boundaries of the original wound.

This is precisely what distinguishes a keloid from a hypertrophic scar. A hypertrophic scar is raised but stays within the limits of the incision and tends to stabilize on its own over time. A keloid scar after surgery, by contrast, spreads outward like a crab's claw, rarely regresses on its own, and tends to recur. This mechanism is closely linked to genetic factors, skin pigmentation, and anatomical location.

Factors That Increase the Risk

• Genetic predisposition: People with a family history of keloid scarring, or with darker skin, have a markedly higher risk.
• Location of the incision: The chest in front of the breastbone, the shoulders, earlobes, neck, and back are areas under high skin tension, which can readily stimulate excess collagen production.
• Age: Younger people often have a stronger scarring response due to higher skin metabolic activity.
• Wound condition: Infection, excessive tension, or improper postoperative care prolongs inflammation and promotes keloid formation.

Identifying a person's predisposition early through examination allows the doctor to take preventive measures right from the moment the incision is closed, rather than only addressing the scar after it has already formed.

Treatment Options for Keloid Scars After Surgery

Today, medicine offers several methods to control and improve keloid scars after surgery. There is no single solution suitable for everyone; doctors usually combine several methods based on the size, location, time of onset, and individual predisposition of each person.

Common Treatment Approaches

• Intralesional corticosteroid injections: A foundational method that helps soften, flatten, and reduce itching, usually given in several sessions a few weeks apart.
• Pressure therapy and silicone sheets: Creating a moist environment and steady pressure on the scar tissue helps regulate collagen, and is especially useful when applied early.
• Laser: Certain types of laser help reduce redness and improve the color and surface texture of the scar.
• Surgical excision combined with recurrence prevention: Removing the scar tissue together with medication injections or other supportive measures, since excision alone carries a high recurrence rate.

The key point is that the earlier treatment begins, the more favorable it tends to be. When the scar tissue is still new and in an active phase, it usually responds better to intervention than an old scar that has become firmly fibrotic. Results vary from person to person and require a direct examination by a specialist to develop an individualized treatment plan.

The Benefits of Treatment in the Right Specialty Setting

Treating keloid scars after surgery at a specialized medical facility offers value that goes beyond aesthetics. First, the patient receives a comprehensive assessment of their scarring predisposition, which makes it possible to choose an appropriate method rather than relying on unfounded word-of-mouth remedies. Managing the scar properly helps reduce uncomfortable symptoms such as itching, pain, and tightness.

In addition, a well-structured treatment plan helps reduce the risk of recurrence while restoring confidence in daily life and social interaction. Most importantly, when closely monitored by a doctor, the patient can have their treatment adjusted promptly if the scar responds slowly or shows abnormal signs, limiting the "lose money and still suffer" situation often seen with self-treatment.

Clearing Up Common Misconceptions

Around the topic of keloid scars after surgery, there are many misconceptions that cause patients to hesitate or take the wrong approach.

• "Just cutting out the keloid will get rid of it": False. Excision alone often causes the scar to recur, sometimes even larger, if not combined with preventive measures.
• "Keloids will flatten on their own over time": Unlike hypertrophic scars, true keloids rarely regress on their own and tend to stay the same or grow larger.
• "Applying turmeric or folk remedies will dissolve a keloid": There is no reliable scientific evidence for this; in many cases it can even cause irritation and skin darkening.
• "Everyone who has surgery gets a keloid": Not true. Keloids depend largely on individual predisposition; not everyone who undergoes surgery develops one.

Important Medical Notes

Every method of treating keloid scars after surgery must be carefully considered on an individual basis. Some cases call for caution or are relatively contraindicated for certain interventions, including: women who are pregnant or breastfeeding, people with an active infection in the treatment area, people with uncontrolled chronic conditions (diabetes, bleeding disorders), and people with a history of allergy to the medications intended for use.

Possible side effects vary by method; for example, corticosteroid injections can cause tissue atrophy, small blood vessel dilation, or local changes in pigmentation; laser can cause temporary redness, darkening, or peeling; surgery carries the risk of recurrence and of leaving a new scar. For these reasons, patients need to be examined by a specialist, have a full medical history taken, and be closely monitored throughout the process. Never buy injectable medications on your own or undergo invasive procedures at a facility that lacks proper medical standards.

Conclusion

Keloid scars after surgery are the result of an abnormal healing process in someone with a particular predisposition, not the fault of the operation itself. The good news is that this condition can be fully managed if it is recognized early and treated with the right method at a specialized facility. Each person has a different predisposition, so treatment results vary by individual and a direct examination is essential to establish an appropriate plan.

If you are worried about your risk or are dealing with a troublesome scar, come for a free predisposition screening with a specialist to be assessed and advised on a safe course of action. Dr. Vo Thanh Sang — Specialist Level I in Plastic and Aesthetic Surgery, with more than 15 years of experience and over 12,000 patients, Head of the Plastic and Aesthetic Surgery Unit at World Wide Hospital — personally performs examinations, consultations, and surgery. The facility meets hospital standards (it is not a spa), located at 244A Cong Quynh, District 1, Ho Chi Minh City.

Book a screening via Hotline 079 7479 222 to have a leading specialist accompany you.