24 June 2025
FACE SURGERY
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Keloids are not just raised scars; they can be painful, emotionally damaging and the treatment of keloid can become a frustrating experience, both for the patient and the surgeon. The property of recurrence of keloid is responsible for these. The ear lobule is one of the most common areas where keloid happens, apart from chest and shoulder. Keloids over the ear lobule are most commonly caused by improperly repaired cleft of lobule, after infection of an ear-piercing site or even after seemingly normal repair of cleft of ear lobule. In some individuals, keloid can be spontaneous in origin without any external stimuli. Recently, we treated a young woman at Cutis Hospital who had very large keloids on both of her ear lobules. This treatment of keloid not only relieved her of the symptoms like pain and itching, it helped her feel much better and she regained her lost confidence.
This case of very large bilateral ear lobule keloid not only shows the difficulty and complexity of treatment of keloid, it also shows how important it is, to get treated by an experienced and expert plastic surgeon for such a complex problem. It also emphasizes the importance of long-term follow-up to get good results.
Keloid and cancer, both are 6 letter words. Though both are completely different from each other, I see some interesting similarity between them. Cancer is very difficult to cure (especially in advanced stages), same applies to keloid which has grown large over a period of time.
Cancer disfigures the person especially over the visible areas of the body, same applies to keloid when it happens on the chest or ear of a person. Repeated recurrences of cancer physically kill the patient, while repeated recurrences of keloid become frustrating and emotionally devastating experience for the patient akin to mental killing. But, the confined area of involvement of keloid without risk of death, unlike the cancer which spreads to other normal body parts and can lead to death draws the differentiation line between the two.
Having learnt this about the keloid, let us understand what it actually is. Before going directly to keloid, we need to understand normal wound healing and scar formation process.
We know that whenever there is any injury to our body, healing happens, and ultimately, the wound heals itself completely with the visible end result called scar. To us, healing after the injury and formation of a scar is apparently 7 to 10 days phenomena. But, below the apparently healed surface of a scar, biological processes of synthesis of newer collagen protein and degradation of old collagen protein continuously take place. Though both collagen synthesis and collagen degradation processes happen simultaneously, the whole cascade of events is so finely regulated by the nature, that we cannot perceive either of them.
At the end, after few weeks to few months of these finely regulated natural biological processes of collagen synthesis and collagen degradation comes to a halt and upon cessation of them, what we see on the surface is a soft, supple and acceptable scar as the end result.
In persons with tendency for keloid development, the fine balance between the collagen synthesis and collagen degradation is lost and the abnormal collagen bundles are produced by the body which are deposited one over the other in a haphazard manner.
Ultimately, what is seen on the surface of the skin is an ugly, undesirable, non-functional protuberance or many of them in clusters deposited over skin and projecting as scars what we call as keloid, instead of soft and supple normal scar which is level and harmonious with skin.
Real Patient Story: Bilateral Ear Keloid Removal Success
Recently, a lady of 26 years presented to us with large, unsightly keloid over both her ear lobules with constant pain and severe itching. She had undergone repair of both her ear lobule clefts by an unqualified person and with some non-documented technique of chemical cauterization in house hold setting before few months.
The size of both keloids and symptoms they caused were significant enough to warrant surgical intervention. Any surgical intervention for removal of keloid always poses unavoidable risk of recurrence.
We discussed our keloids treatment plan, follow up visits and possibility of recurrence of keloid after surgery with patient and her husband and decided to proceed with surgical removal of both ear lobule keloids under local anesthesia. Though keloid looks like just another swelling, removal (excision) of keloid is bit different from excision of other normal swellings like lipoma, sebaceous cyst or dermoid.
As we already discussed, keloid is literally made up of haphazardly arranged bundles of abnormal collagen. While removing large keloid from a very small area like ear lobule, it is imperative to preserve the shape of the lobule and at the same time, complete removal of keloid is also equally important.
We had to work meticulously to achieve both these goals for our patient. After complete removal of both lobule keloids, apparent wound healing and suture removal were complete within 8 days. However, we had strong doubt about the recurrence of keloid; so close and watchful follow up visits were scheduled. Our suspicion about recurrence was proved by appearance of induration (hardness) within the ear lobule scars of surgery after 4 weeks, which is a sign of early recurrence. We immediately treated both the scars with injection Triamcinolone acetonide (type of locally injectable steroid) under local anesthesia.
We were prepared to repeat the treatment session with injection Triamcinolone acetonide after 3 weeks, but to our surprise and good luck of the patient, both scars remained soft and supple and they remained so, since last 6 months. We hopefully believe, she will not develop keloid again. But, our close watch over recurrence of keloid is still on and we will not stop observing her till next 1 years, at least.
Conclusion
Though keloid is not a life-threatening condition, it causes constant irritation to the patient in the form of severe itching and pain. The psychological effect of ear lobule keloid on a person's appearance and self-esteem cannot be underestimated. Timely detection, proper treatment by an experienced and qualified plastic surgeon and close follow-up after the surgery are the prerequisites to successful outcome.
If you or someone close to you is afflicted with recurring or persistent keloids, Cutis Hospital has specialized treatment with a patient-focused philosophy. Our expert Plastic surgeons and skilled staff are here to help you through each phase of your treatment process.
