What Exactly is a Keloid?

My skin keloids.

I hear this all the time from patients, warning me that they tend to scar badly.  But what, exactly, is a keloid?  

photo credit: emedicine.com

Keloid (photo credit: emedicine.com)

 

photo credit: emedicine.com

Hypertrophic scar  (photo credit: emedicine.com)

 

The image to the left is a keloid resulting from an ear piercing.

 

 

 

 

 

The image to the right is a hypertrophic scar.  Granted, it’s a pretty bad scar, but it’s intrinsically different from a keloid.

 

 

 

 

So what is the difference between a keloid and hypertrophic scar?

  • Hypertrophic scars are scars that thicken and raise up as they heal.   They may be red and itchy, and often they get better with time.
  • Keloids will continue to grow past the boundaries of the original scar (as in the photo above), and keloids do not get better with time.
  • Hypertrophic scars can form on anyone.
  • Keloids are more common in darker skinned individuals.

Why does this difference matter?

  • Hypertrophic scars are very common over the chest, shoulders, arms and legs, even in individuals who heal well elsewhere. This last point is important: just because you have a bad scar over your chest or shoulders does not mean that you form bad scars in general.
  • If you have a tendency to keloid, you can form keloids anywhere, and from anything.  Even something as simple as a bad acne breakout can start a keloid forming.
  • Treating hypertrophic scars may involve steroid injections, laser therapy, or silicone sheeting.
  • Keloids are much harder to treat because they tend to come back: up to 80% of keloids will recur after removal.  Treatment may even require radiation therapy to help prevent recurrence.

So you can see that keloids and hypertrophic scars actually behave very differently.  Just because you have formed hypertrophic scar in the past, does not mean you will scar badly in the future.  A history of keloids, however, does make you more prone to keloids in the future.  Finally, keloids are much more difficult to treat than hypertrophic scars.

If you think you have a tendency to keloid, I recommend seeing a Plastic Surgeon for an accurate diagnosis.  He or she will also be able to recommend treatment for the scars you already have, and ways to help prevent them in the future.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Floppy Earlobes?

You may have looked at your grandmother’s or mother’s ears (or heck, even your own) and noticed that they appear larger, especially around the earlobe.  Did you ever wonder what causes this?

  • Noses and ears actually do continue growing during our lifetime, albeit very slowly.  The underlying cartilage framework increases in size, and the overlying skin is subject to the effects of gravity just like the rest of the body.  This can result in larger ears, and even floppy earlobes.
  • Wearing heavy earrings can cause earlobes to stretch out as well.  Not only will the skin stretch, but the piercing hole will become elongated, so that your earrings always appear to be on the verge of falling out.

The good news is that large earlobes are easily treated.  Trimming the earlobes down is a simple procedure that involves numbing the area with local anesthetic, removing excess skin, and reshaping the earlobe with sutures.   If the piercing hole is stretched, this can be repaired at the same time.

original photo from shutterstock.com

original photo from shutterstock.com

If you look at the photo above, the area marked in blue is the skin that is removed. The resulting incision is in the shape of a T.  Reducing large earlobes does leave scars, but the earlobe usually heals very well, and the scars are generally not be noticeable after several months to a year.  Be aware, however, that earlobe reduction can remove an ear piercing, or change its position significantly, so you may need to have your ears re-pierced after they have fully healed.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Liposuction at the Same Time as Abdominoplasty

When I see patients who are unhappy with the appearance of their stomach, I may recommend abdominoplasty (tummy tuck), liposuction, or even a combination of the two.  Doing liposuction at the same time as an abdominoplasty seems logical: the goal of liposuction is to remove excess fat and the goal of abdominoplasty (tummy tuck) is to remove excess skin, so they are complimentary procedures.  But many people don’t realize that doing the two procedures at the same time can actually lead to problems.

During an abdominoplasty, the skin over the abdomen is elevated off the underlying muscles all the way up to the level of the rib cage.  This allows the excess skin to be pulled down and removed. On the figure below (demonstrated an an incredibly fit model, who admittedly needs neither lipo or a tummy tuck), the blue outlines the area of skin which is elevated off the underlying muscles.

original image from shutterstock.com

original image from shutterstock.com

Lifting the skin up cuts many of the blood vessels which supply the skin with nutrients, so the blood supply to this skin flap is decreased.  Subsequently performing liposuction in an area with decreased blood supply can cause problems including skin necrosis, where the skin actually dies, leaving an open wound.  Thus liposuction over the central and upper abdomen (the areas marked in red) should be done cautiously and conservatively after an abdominoplasty.  The hips, thighs, and flanks, however, are not at all affected by having an abdominoplasty; performing liposuction on these areas at the same time is safe (areas marked in green).  If you are considering having liposuction and an abdominoplasty at the same time, here are some questions you may want to ask your surgeon:

  1. Do you do liposuction and an abdominoplasty at the same time?
  2. If so, how often do you perform this procedure?
  3. Have you ever had any complications?

To summarize, having an abdominoplasty and liposuction at the same time is possible.  Depending on the areas where liposuction is performed, the combination can lead to a higher complication rate.  If this is something you are considering, be sure that you feel comfortable with your surgeon’s experience level and his or her explanation of how the procedure will be performed, as well as the risks and benefits.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.