Keloids

Keloids are personal for so many of my clients — a piercing that went wrong, an acne scar that took over more skin than the original breakout ever occupied. The one thing I always say, and I want to say it to you now before we go any further: earlier is genuinely better here. If a scar is starting to grow past its original edges, don’t wait years to have it looked at.

This isn’t just a scar getting bigger. It’s a distinct healing response worth treating early.

A keloid is a raised, thickened scar that grows beyond the boundary of the original wound — sometimes significantly larger than whatever injury caused it. They can form after any skin trauma: cuts, acne, piercings, insect bites. Firm, sometimes itchy or tender, and typically darker than the skin around them.

Why This Happens

A keloid happens when your skin’s healing process doesn’t know when to stop. Normal healing closes a wound and then gradually settles the scar down to flat, smooth tissue. With a keloid, the skin keeps laying down scar tissue well past the point the wound is actually closed, so it keeps growing rather than settling — often spreading beyond the edges of the original injury.

Why some people’s skin behaves this way and others’ doesn’t isn’t fully understood, but genetics play a strong role, and melanin-rich skin is significantly more prone to keloid formation than lighter skin. Keloids often run in families, and once you’ve had one, you’re at meaningfully higher risk of developing others from future skin trauma — which is exactly why I ask every client with a keloid history about it before any procedure, not just the one they came in for.

It’s also worth knowing the difference between a keloid and a hypertrophic scar, because they’re commonly confused. A hypertrophic scar is also raised and thickened, but it stays within the boundary of the original wound and often flattens somewhat on its own over time. A keloid spreads beyond the wound’s original edges and typically does not resolve without treatment — that distinction actually changes what treatment approach makes sense.

How Treatment Helps

A combination approach tends to work best, and each piece plays a different role. Corticosteroid injections flatten and soften existing keloids by calming the ongoing overgrowth. Laser treatment reduces redness and visible size by targeting the excess blood vessels that feed the keloid. Silicone-based products help through steady pressure and hydration on the scar surface, and tend to help most with newer or smaller keloids rather than long-established ones.

If you’re keloid-prone, choosing providers who actually use keloid-aware technique for any future procedure — piercing, surgery, anything that breaks the skin — meaningfully reduces your risk of forming new ones.

I want to be clear about exactly where my own role fits into that combination, because these treatments come from different practitioners. Corticosteroid injections are a dermatologic procedure — I don’t administer them, and if that’s the right next step for you, I’ll say so directly and point you to a dermatologist rather than working around it. What I do myself is laser treatment to calm redness and vascularity, and guidance on silicone-based products and keloid-aware aftercare for anything I treat. For many of my keloid-prone clients, the real plan is both: a dermatologist for injections when they’re warranted, and me for the laser and prevention side, working together rather than one instead of the other.

My Advice for Anyone Keloid-Prone After Surgery or an Injury

This is my own clinical opinion, not something I administer myself, but it’s the single piece of advice I’d want every keloid-prone person to walk away from this page with: don’t wait to see whether a keloid actually forms before treating it. If you already know you’re keloid-prone and you’ve just had surgery, or any injury that broke the skin, ask a dermatologist as soon as possible about early preventive treatment for that fresh scar or wound. Starting early, before a keloid has had the chance to form, is a meaningfully easier fight to win than trying to treat one after it’s already grown.

If you have surgery scheduled, this is a conversation to have with your surgeon or dermatologist beforehand, not after you notice a scar starting to raise. If it’s an unplanned injury instead, the same logic still applies — get to a dermatologist and ask about early preventive treatment for the wound as soon as you can. I don’t administer these treatments myself, but I’d rather every keloid-prone person already know to ask that question than find out about this option only after a new keloid has already started.

What Makes It Worse

Surgical removal alone, without follow-up treatment, has a high recurrence rate and often results in a keloid larger than the original, since the excision itself is a new wound for keloid-prone skin to react to the same way. Picking at or irritating an existing keloid stimulates further inflammation and further growth. And assuming a bump will simply resolve on its own, if you’re keloid-prone, tends to delay the early treatment that actually gets the best results, since smaller, newer keloids respond to treatment more completely than large, long-established ones.

What Getting Better Actually Looks Like

Treatment is about flattening, softening, and reducing size and symptoms — not always complete disappearance, especially for older or larger keloids. Earlier treatment consistently gets better results than waiting years, and multiple sessions over time is the typical path, not a single fix.

Frequently Asked Questions

Is RF microneedling safe if I’m keloid-prone? No — I don’t use it on keloids or keloid-prone skin, and I don’t recommend it there either. The needles involved are longer than most people expect, and the added heat is real trauma layered on top of the mechanical injury — exactly the kind of new-wound signal that can provoke keloid-prone skin into producing more excess scar tissue, not less. It’s also genuinely painful on skin that’s already scarred or inflamed. I’ve written the full reasoning on the RF Microneedling page.

Will a keloid come back after treatment? It can, particularly without maintenance — keloid management is often an ongoing process rather than a single resolved event, which is why I set that expectation early rather than after the fact.

Can makeup or skincare shrink a keloid? No — topical skincare doesn’t reach the depth where the overactive collagen production is actually happening. Silicone sheets and gels are the exception, working through sustained pressure and hydration rather than an active ingredient.

When to Get It Looked At

Any new, unusually raised or growing scar — especially one spreading beyond its original wound — is worth an evaluation before it gets larger. And if you’re planning a piercing, procedure, or surgery and have a personal or family history of keloids, mention it beforehand so extra precautions can actually be taken.

Related Conditions and Treatments

Keloids often develop from Hormonal Acne and, in melanin-rich skin, can be connected to the same inflammatory tendency behind HS.

Most of my keloid-prone clients have been told at some point to just leave it alone, that nothing can really be done. That was never true, and earlier attention consistently gets better results than years of waiting. I’d like the chance to look at yours and tell you honestly what I think would help.