Know this first
Ear keloid surgery is a treatment to reduce enlarged scar tissue. Since it can grow back after surgery, we plan excision and suturing that takes the shape of the ear into consideration, as well as additional management to reduce the risk of recurrence. Not all ear keloids require surgery. Diagnosis/Treatment Guide 8
This is general medical information for those preparing for ear keloid consultation at the Seoul N Dermatology Clinic in Yongam-dong and Southeast District, Cheongju. The actual treatment and method will be decided after a medical consultation.
01. Is the lump at the piercing site all a keloid?
Keloid is a condition in which scar tissue grows excessively during the wound healing process and can grow beyond the original wound area. It can occur in the earlobe or ear cartilage area and may be itchy or painful. However, earring allergies or other skin lesions may look similar and should be diagnosed first. If the appearance is not typical, a biopsy may be necessary. Diagnosis/Treatment Guide 8
Even if the ear keloid is the same, the parts to check are different.
Location and condition · What we assess
lump in earlobe
The size and extent of connection of the lesion and the shape of the earlobe remaining after removal.
hard cartilage area of the ear
Thin skin, the shape of the ear rim, and the extent to which the skin can be preserved.
Lesions extending from front to back of the ear
Scar tissue that is not only visible on the outside but also connected on the inside.
Lesions that have grown back after previous treatment
Past surgery/injection history, timing of recurrence, response to additional treatment
In surgical planning, the extent of the lesion and the shape of the ear are evaluated. study 2, Study 3, Literature Analysis 6
02. When should I consider ear keloid surgery?
If the lump is large and uncomfortable or affects the shape of the ear, or if the lesion remains or grows repeatedly after existing treatment, treatment including surgery may be consulted. It is a good idea to also discuss the level of pain/itching and your desired improvement goals. Diagnosis/Treatment Guide 8
For lesions that are small or have mild symptoms, non-surgical treatments such as injections may be considered first. Conversely, even if you choose surgery to reduce the lump, you must also decide on a management plan such as subsequent injections and compression. It is especially important to determine what treatment was previously received for relapsed lesions. Literature Analysis 6
03. What are the different ear keloid surgery methods?
A. How to excise the lesion and suture it directly
After the scar tissue is excised, the remaining skin is sewn together. Consider the extent of removal and remaining tissue to determine whether direct suturing is possible. The pulling of the suture area and changes in the shape of the earlobe and ear border must be considered together. Agreement 1
B. Core excision using superficial skin
This is an approach that utilizes part of the skin covering the lesion while removing the inner scar tissue and reshaping it. If you need to consider the thin skin and contour of your ears, you may want to consider this as an option. We determine what skin to preserve, what scar tissue to remove, and the blood supply to the skin. study 2, Study 3
‘Leaving the skin’ does not necessarily mean leaving behind the problematic tissue. Some studies have reported an association between remaining lesions and recurrence, so the extent of resection must be fully evaluated. This method does not guarantee better results in all ear keloids. Study 3
C. Reconstruction that covers the defect with skin after excision
If the lesion is large and difficult to suture right away, move the surrounding skin. local flapcovered with skin or other areas skin transplantYou can review . Differences in skin color and contour and recovery burden are taken into consideration, and new scars or keloids may form in the area where the skin was harvested. Agreement 1
Surgery methods at a glance
| access | Main things to check | Limitations to consider together |
|---|---|---|
| Direct suturing after resection | Can it be closed without difficulty with the remaining skin? | Suture pulling and ear shape changes |
| Central excision and skin utilization | Is it possible to remove the necessary scar tissue while saving the skin? | Remaining lesions and skin blood flow |
| Reconstruction such as flaps and skin grafts | How to cover a large defect | Additional scarring and recovery process |
The above division is an explanation for understanding the surgery. Actual techniques can be combined or adjusted with each other, and a specific method is not selected based on its name alone. Agreement 1, study 2
04. Why you need post-surgical care
Keloids may thicken again even after surgery. Studies have used injections, compression devices, silicone, and, in some patients, radiation therapy along with excision. However, because the lesions and observation periods are different, it is difficult to determine one combination as the correct answer for all patients. Literature Analysis 6
Rosacea Treatment — Controls scars that thicken again
Triamcinolone, a steroid, can be injected into the scar to control tissue thickening. The timing and frequency are determined depending on the condition. The injection site may become thinner or its color may change. study 4
Compression devices — adjust position and pressure
Medical compression earrings and clips are an option for post-operative care. It must be adjusted to suit the shape of the ear and skin condition. Excessive pressure may cause pain or skin damage. Avoid self-care using regular earrings or forceps and follow your healthcare provider’s instructions for use. Literature Analysis 5
Silicone Gel/Sheet — Assists in managing scars
It can be used after the wound has closed and as permitted by the medical staff. Its role is different from surgery to cut out large keloid tissue, and it is used while checking for skin irritation. Decide individually whether to combine it with compression or other treatments. Literature Analysis 5, Self-Care Guide 9
Radiation therapy — not performed at our hospital
Seoul N Dermatology Clinic does not perform radiation therapy. The information below is a general introduction to the treatment methods reported in the literature, and is not a treatment guide provided by our hospital.
There are cases where it is considered as adjuvant treatment after surgery. A specialist will determine whether and when to apply it, and skin reactions, pigment changes, and potential long-term risks should also be explained. In growing children, radiation therapy is generally avoided and other adjuvant treatments are considered first. This treatment is not necessary for all patients. Agreement 1, study 7
The above is a description of treatment options reported in the literature. Items that are actually performed at our hospital and items that require treatment from other institutions can be confirmed during consultation.
05. Even after the wound has healed, we check its progress.
- diagnosis
- Excision/suture plan
- Post-operative care
- Check progress
wound recovery period
Please receive guidance on the schedule for dressing, washing, showering, and stitch removal according to the scope of surgery and condition of the wound. Avoid scratching the wound or forcefully removing the scab, and try to reduce friction that irritates the ear. Self-Care Guide 9
scar management device
After the wound closes, check for changes in thickness, hardness, and itchiness. We evaluate the need for injections and compression devices, and adjust the management method if there is discomfort from thinning or pressing the skin. study 4
Check long-term progress
It is difficult to determine whether there will be recurrence just by looking flat immediately after surgery. Changes over several months are also important, and studies also evaluate long-term outcomes. If it hardens or rises again, do not wait long until your next appointment and consult a doctor. Literature Analysis 6
06. Things to know about expected changes
Surgery can help reduce the size and discomfort of raised lesions, but new surgical scars may remain and may regrow. Problems such as bleeding, infection, open wounds, pain, changes in skin color, and changes in ear shape may occur. Treatment response and recovery period vary from person to person.
Additional treatments such as injections, compression, and radiation each have their own side effects, so the necessary treatment and manageable range of treatment must be discussed together. study 4, Literature Analysis 5, Diagnosis/Treatment Guide 8
In this case, contact your medical staff.
- If pain, swelling, or redness continues to worsen or is accompanied by pus, heat, or fever.
- If bleeding continues or the suture site opens.
- If the skin under the compression device becomes severely sore, peels, becomes pale, or turns dark.
- When the scar hardens again and grows, or when itching and pain repeat.
Before surgery, please tell us about your previous keloid treatment, any medications you are taking, any allergies, or any medical conditions that may affect wound healing. Do not stop taking the medicine arbitrarily; consult your medical team.
07. Ear Keloid Surgery, Frequently Asked Questions
no. Depending on the size, symptoms, and response to existing treatment, non-surgical treatments such as injections may be considered first. Your doctor will determine if surgery is necessary. Diagnosis/Treatment Guide 8
It can grow back. Even if auxiliary treatment is used after surgery, the possibility of recurrence remains, and the progress must be checked to see if any changes occur. Literature Analysis 6
The anesthesia method is determined depending on the scope of surgery and the patient's condition. There may be pain and discomfort during the anesthesia process or after surgery, so it is a good idea to have your pain control plan explained to you.
It depends on the suturing method and the state of wound recovery. Rather than applying a certain date to everyone, receive guidance on stitch removal and scope of activity at your post-operative check-up appointment.
Pressure and wearing time should follow the medical staff's instructions. Do not press hard enough to cause skin damage, and consult if pain, peeling, or color change occurs. Literature Analysis 5
Because piercings create new scars, you need to consider the risk of keloids coming back. People who have developed keloids are advised to consult with their medical team to avoid re-piercing. Self-Care Guide 9
after a medical consultation, check the scope of the surgery and any additional treatment required, and receive guidance on the estimated cost of surgery, treatment, and follow-up care by item. Insurance coverage must also be checked based on individual treatment details, so it is not determined uniformly on this page.
08. What is the basis for this guide?
We referred to ear keloid surgery studies, expert consensus statements, literature analysis on postoperative adjuvant treatment, and the American Academy of Dermatology's patient guide. Each study differs in the location and size of the lesion, whether it is a first-time lesion or a recurrent lesion, and additional treatment and observation period.
The core ablation study includes data on concurrent use of radiation therapy, and the injection/compression combined study also includes small-scale studies. Therefore, the results of the paper should not be interpreted as the effect of a specific surgical method alone or as the expected treatment outcome at our hospital. study 2, study 4, Literature Analysis 6
References
- 1.Ogawa R, Akita S, Akaishi S, et al. Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018. Burns Trauma. 2019;7:39.
- 2.Ogawa R, Akaishi S, Dohi T, et al. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plast Reconstr Surg. 2015;135(3):868–875.
- 3.Chong Y, Kim CW, Kim YS, Chang CH, Park TH. Complete excision of proliferating core in auricular keloids significantly reduces local recurrence: A prospective study. J Dermatol. 2018;45(2):139–144.
- 4.Datema FR, Saridin J, Timmer FCA, Rothuizen LT, van Zijl FVWJ. Triple Therapy Protocol for Primary and Secondary Auricular Keloids: A Prospective Outcome Evaluation. Dermatol Surg. 2023;49(9):838–843.
- 5.Tahir SM, Ihebom D, Simman R. Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2024;12(6):e5864.
- 6.Zawadiuk LRR, Van Slyke AC, Bone J, et al. What Do We Know About Treating Recalcitrant Auricular Keloids? A Systematic Review and Meta-Analysis. Plast Surg (Oakv). 2022;30(1):49–58.
- 7.Sclafani AP, Gordon L, Chadha M, Romo T 3rd. Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature. Dermatol Surg. 1996;22(6):569–574.
- 8.American Academy of Dermatology. Keloid scars: Diagnosis and treatment.
- 9.American Academy of Dermatology. Keloid scars: Self-care.
Consult with us on the right treatment direction for your ear condition.
It will be helpful for consultation if you report when it appeared, how big it grew, and what treatment you received. Talk about the shape of your ears, your current discomfort, and even your schedule for future care.
※ This page contains general medical information to help you understand the surgery and management of ear keloids. Actual treatment, surgical method, and additional management plan will be decided after a medical consultation.
※ Treatment effects and recovery periods vary from person to person. After surgery, it may recur or cause scarring, pain, bleeding, infection, open wounds, changes in skin color, or changes in ear shape. Combination treatment also has side effects for each treatment, so it is carried out after consultation.