Keloid Scars

Whenever an area of the skin is subjected to damage through injury, surgery or inflammation, the resultant healing process will normally produce a scar. During this scar-forming process, new tissue is laid down during the ‘proliferative’ phase, including the production of collagen (a type of tough connective tissue). Sometimes when scars are formed, too much of this collagen is produced within the scar and this results in what is known as a ‘hypertrophic’ scar.

These scars appear raised, red or dark in colour and can become painful or itchy. In the extreme spectrum of hypertrophic scars are a group of scars known as keloids. These are formed through excessive collagen deposits within the scar tissue to the extent that it produces an ‘overgrowth’ which extends beyond the original boundary of the injured area. Keloid scars typically appear raised above the skin, and have a shiny and rubbery appearance and texture. They are typically red or appear darker than the original skin tone.

Those with keloid scarring may suffer from pain, itching or low self-esteem due to the appearance of these scars. Whilst difficult to treat, there are a number of treatment options available through experienced specialists that can help to improve these symptoms.

Mr Ioannis Goutos is a leading plastic surgeon with a distinct interest in the care of scars, in particular the management and treatment of keloid scarring. He places particular emphasis on exploring the psychodynamic aspects of scar treatments and the effects that the scarring has on each individual and their quality of life. He has extensive experience in diagnosing and treating keloid scars and is well placed to provide excellent care and cosmetic outcomes for those wishing to have treatment.

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About this condition

Keloid scars can be diagnosed by an experienced clinician through listening carefully to a patient’s history and performing a detailed examination. A hallmark feature of keloid scars is that they are unpredictable in their formation and growth and can arise any time after an injury (not just in the first few months). Keloids can also become painful, itchy or produce a burning sensation in the skin. In addition, once formed, they may continue to grow at a later time. Occasionally, a specialist may also suggest a biopsy of the scar to rule out a very rare form of skin tumour.

There are number of risk factors and precipitating triggers associated with keloid scarring. Provoking injuries may include:

Cuts or lacerations to the skin (including accidental injury, surgery or self-harm)
Piercings and tattoos
Vaccinations
Acne or folliculitis (inflammation around the hair follicles)
Chicken pox or other skin infections
Burns

Factors associated with an increased risk of keloid scar formation include:

Having a family history or genetic predisposition to forming bulky or keloid scars
Having a darker tone of skin
Injury to an area of skin that is under high tension, such as the chest, shoulders, back and lower abdomen (although keloid scars can arise anywhere on the body)

In addition to the above, there is also an association between hormonal changes within the body and the propensity to develop keloid scarring, for example during pregnancy, puberty or endocrine disorders (such as hypothyroidism). Uncontrolled hypertension (high blood pressure) has also been associated with an increased risk of keloid scar formation.

If you are known to suffer from keloid scarring, there are a number of steps that can be taken to avoid the formation of keloid scars. Firstly, it is important to identify any precipitating factors towards scar development, such as acne or folliculitis. These should be treated early by a skin specialist to minimize the risk of damage to the skin and resultant keloid formation. Further measures that can avoid bulky scar formation include avoiding any preventable skin injuries such as tattoos and piercings. If you have an accident or are planning to have surgery, you should inform your doctor that you are at a higher risk of developing keloid scars. This will allow your doctor to take appropriate measures to reduce the keloidal risk, such as advising additional wound healing treatments or modifying aspects of your surgery.

Treating keloid scars is a very specialist area and should be undertaken by an experienced plastic surgeon and multi-disciplinary team. There are 2 main groups of procedures that can be offered to keloid patients that manage different objectives. The first group of interventions will aim to replace the keloid scar with a fine, symptom-free scar. This is best achieved using extra-lesional (i.e complete) excision of the scar followed by post-operative radiotherapy. The second group of interventions aim to reduce the bulk of the scar and to minimize any pain or itching symptoms. There are a wide range of agents that can be used to achieve this including:

Steroid injections
Injection of 5-fluorouracil (a type of chemotherapy medication)
Application of steroid tapes
Cryosurgery
Lasers alone or in combination with steroids

The best treatment for your keloid scar will depend on the location, size and symptoms associated with the scar. Following a detailed assessment of the scar and discussion of your treatment and cosmetic goals, the most appropriate treatment plan can be considered by your specialist team.

Testimonials

Mr Goutos is delighted to share some of his patient and peer feedback on their experiences of his services.

Louise Steel

2023-08-16

Mr Goutos performed keloidectomy surgery on both my earlobes, and I am so grateful to have been referred to him. From the first consultation, through surgery, and now my 3-month follow-up, I have nothing but good words to say.

Luke Ward

2023-07-10

This man is an extremely intelligent, professional gentleman. He will set realistic expectations from the beginning and will not ‘beat around the bush’ so-to speak. From the initial consultation to post-surgery, it has been a rollercoaster ride. However the high level of expertise & professionalism Mr Goutos maintained has been impeccable. All I can say to any other individual considering treatment with Mr Goutos, is that you are in incredibly safe hands. And on top of this, he has a great sense of humour. I wish nothing but the best for this man, and the best results for his future patients.

Mauricio Lucas

2023-07-06

Outstanding Doctor - Exceptional Expertise I recently had the pleasure of consulting and also going through surgery. Dr. Goutos removed a large class of keloids from my back and chest, and without a doubt, I can confidently say that he is the best doctor I have ever had the privilege of seeing. From the moment I entered his practice, I was immediately struck by his professionalism, knowledge, and exceptional bedside manner. Dr. Goutos possesses an extraordinary level of expertise in his field, and his technical skills are truly remarkable. His ability to diagnose and treat medical conditions is unparalleled, and I have personally witnessed his remarkable success in improving the health and well-being of countless patients. What sets Dr. Goutos apart is his genuine care and concern for his patients. He takes the time to listen attentively, ensuring that he understands every aspect of the medical issue at hand. He communicates clearly and effectively, explaining complex medical concepts in a way that is easy to comprehend, which greatly helps in alleviating any concerns or fears. One aspect that impressed me greatly was Dr. Goutos' commitment to staying updated with the latest advancements in his field. He incorporates cutting-edge techniques and treatments into his practice, ensuring that his patients receive the highest standard of care available. This dedication to continuous learning and improvement is a testament to his unwavering dedication to his profession. Additionally, the support staff at Dr.Goutos' practice deserves recognition for their exceptional service. They are friendly, compassionate, and highly efficient, ensuring that appointments run smoothly and patients feel comfortable throughout the entire process. Overall, I cannot emphasize enough how fortunate I feel to have found Dr.Goutos' exceptional skills, genuine care, and unwavering commitment to his patients make him a truly outstanding specialist. I wholeheartedly recommend him to anyone seeking top-notch medical care.

Kashmala Khan

2023-01-26

Mr. Goutos and his team did an amazing job reversing a scar I had on my forehead. This was a very old scar and had bothered for many years. The laser treatment and fat transfer procedure has changed my life and given me so much confidence. I would definitely recommend him, he is a fantastic and very skilled surgeon. Thank you so much!

Javier

2023-01-14

Mr Goutos and his team removed some lipomas from my arms. The initial consultation right through to the aftercare was professional, sensitive and genuine. Mr Goutos put me at ease right from the start, discussing my history and background and then discussing the various options for the incisions and sutures. The incisions were quick, efficient and professional. I felt completely at ease knowing I was in expert hands. The incisions were extremely neat and have closed and scared really well. I had a number of questions after the operation and one of the sutures became infected. Mr Goutos was quick to make an appointment for me, see me and deal with the infection and offered for me to see him again if the infection didn’t calm down. He was genuinely empathetic to my needs and took time to check each scare, explain things and assure me along the way. He didn’t at any point, make me feel I was asking silly questions or too many. I highly recommend Mr Goutos for his exceptional incisions and suturing as well as his professional conduct, caring approach and after care. The whole experience was smooth and easy and I am very grateful for what he has done for me.

Ieva Lihovida-Yarlett

2022-12-07

We came to see Dr Goutos a few month ago to remove invasive spider nevus on my 9 year old sons nose . After a lovely consultation with Dr Goutos , he suggested to do several laser treatment sessions. After a few sessions we already noticed a massive improvement. On the final laser treatment session the spider nevus was completely gone. Thank you to the Dr Goutos for tackling the problem so rapidly and with great results!

Amy Munson

2022-10-27

We took our 4yr old daughter to Mr Goutos following an accident which resulted in a small burn scar on her cheek. Mr Goutos gave us various options and we went for laser treatment. After 4 appointments the scar has gone! The care that Mr Goutos gave us was exceptional and so good with children. He made us feel very comfortable and confident in his ability. I would recommend him to anyone if they were looking for a doctor in that particular field. Can't thank him enough.