Keloid or hypertrophic scar?
The first step is to tell the two apart. A keloid spreads past the borders of the original injury. A hypertrophic scar stays inside those borders. Hypertrophic scars often flatten and soften by themselves over months to about two years. Keloids usually do not settle without treatment.
This difference is made on examination, and it shapes everything that follows. Treatment aims to make the keloid flatter and softer, with fewer symptoms. Recurrence is common, and a sensible plan allows for it. Results vary.
Why keloids form
A keloid is a healing response that does not switch off. Type I and type III collagen keep being laid down after normal remodelling should have ended, so the lesion goes on expanding. Genes play a major part, and keloids often run in families. Please mention any family history at consultation, even if you have never had a keloid yourself.
Who is affected, and where
Keloids are substantially more common in people of Chinese, Malay, Indian and African descent than in people with white European skin. They are a routine presentation in Singapore.
Earlobes after piercing, the upper chest, shoulders, upper back and jawline. These are areas under skin tension.
Surgical scars, burns and acne lesions. Vaccination sites can sometimes be affected.
Symptoms that bring people in
Appearance is only part of it. Many keloids itch. Some are tender, or burn or sting. Where a keloid crosses a joint or the neck, it can feel tight and limit movement. For many patients, these symptoms are the main reason for seeking help.
Keloid treatment in Singapore: the methods used
Medicine placed into the lesion is the first-line step, sometimes combined with others. Before a course starts you are assessed, and the monitoring and possible side effects are explained.
Used as add-on measures, depending on the site.
Another add-on, chosen by site, lesion age and past response.
An add-on directed at the blood vessel and texture parts of the lesion.
Only where appropriate at all, and paired with add-on treatment. It is not offered as a stand-alone answer.
Why cutting it out alone is a problem
Cutting a keloid out alone carries a high chance of it coming back. When it returns, it is often bigger than before. Please weigh this carefully before you agree to removal. So any surgery is combined with other treatment.
How a plan is built
What treatment cannot do
Treatment cannot promise that a keloid will disappear or never return. The realistic goals are a flatter, softer lesion with fewer symptoms. How far a keloid responds varies with its size, site and age, your skin type, genetic factors and earlier treatment. Timing is agreed with you after examination, because each plan is staged differently.
Who needs extra care
If you or a close relative has had keloids, this matters whenever the skin will be cut or pierced. That includes piercings and elective procedures. You may still have options, but the choice and the planning can differ. For this reason, your history is asked about before treatment here, including before acne or scar work. Other scars are a different matter. Acne scars are assessed separately, and tethered scarring is covered by 4D Scar Reconstruction.
Risks and fees
The main risk is recurrence, and removal by surgery alone can leave a larger keloid. Side effects of injected treatment are explained before you start. Fees are not published. They depend on the number and size of lesions, the site, the methods needed, and how the plan is staged. A figure is not given before assessment. Costs are explained at consultation, before anything is agreed.