I have a keloid on the back of my neck slight above the hair line. I ahve had it removed surgically but it always comes back. The steroid injections do not seem to be helping. What do you think the next step would be to have it removed permanetly

I have three keloids on the back of my neck the size of a nickel I have state insurance Aetna better health wondering if you take it

Hi, what is pulsed dye laser treatment? Is it effective for larger keloids on the body? And is it covered by insurance? Thanks

Whats the difference between cryoshape and cryotherapy?
why is one better than the other?
Is it safer? Is it more effective? Does it cost less? Is one more dangerous than the other?
what is the recurrence for the behind the ear keloid in both options
Thank you in advance for your reply and time

I have a keloid on my chest I’ve had it for abput 8 years now it’s gettinh bigger amd bigger it really hurts and from time to time it bleeds i need it removed hpw much would it cost

Hello Dr. Ringpfeil. I hypertrophic/keloid scars on my jawline from cystic acne. They have flattened out a lot but I have about 6 small raised bumps on both sides of my face that are still red in color. I have tried kenalog injections up to 40mg in the past with good results, but after I stop getting them they become raised again. I have tried 1540 fractional laser with little or no improvement. I saw that your office provides 5-fu and intralesional injections combined with pulsed dye laser. This sounds promising and I would like to try this method. Please give me feedback Dr. I was thinking of making a consultation very soon.

Thank you Doctor Ringpfeil for the feedback from my previous question in regards to Acne keloidalis nuchae. I just have a couple more questions in regards to Acne keloidalis nuchae. How much would the CO2 laser procedure cost? After the CO2 laser procedure, would I need to get a hair transplant? And do you often encounter this condition with your patients? Thank you again Ringpfeil for shedding some light on my condition.

Hi Doctor Ringpfeil, I have been having acne keloidalis nuchae (AKN) for about five years. My head is always itching, bleeding, and it hurts when I sleep. I have been on several pill, creams, kenalog shots, and ointments. But nothing has work and I have been really frustrated living with this condition on my head. Doctor, have you done any type of procedures with acne keloidalis nuchae, if so what are the measures that you take?

hi
i have done topical cryo rx to my ear, cheek and chest. i had moderate improvement to my ear but little to no response to the other areas. i have also tried steroids and chemo. the most troubling site is on my cheek. it is slighlty raised and tentacle like. would you recommend intralesional cryo given topical seemed not to work

Hi, I have a keloid on the back of my earlobe from an infected piercing from years ago. It is fairly small bur I do not think my insurance would cover any treatment and have not had any prior treatment for the keloid. Which procedure do you think would be recommended for this kind of keloid and about how much would that be? Just curious before I take the step of getting a consultation. Thank you.

What is the out of pocket cost for a pulse dye laser treatment in the chest region? Also do you offer this treatment in your philadelphia office? I am asking because I assume I will need multiple treatments to see effective results.

Good afternoon,
I think I’d be fit the bill for the CryoShape procedure, however I need to know how much it costs before committing to a consultation.
Thanks!

I have a keloid on my chin how much does it cost look at it and determine the best possible procedure

Does insurance generally cover Pulse Dye Laser treatments for keloids? Thank you!

I have keloid skin, when I was younger got my ears pierced and a lump appear, then a few years ago had surgery and currently still have small little lumps from the scars. Want to get a tattoo will that be a good idea or will lumps occur?

Hello Dr are you familiar with Electrosurgical Excision of Acne Keloidalis Nuchae with Secondary Intention Healing? I researched this procedure because i need a keloid in my scalp removed with minumum hair loss as much as possible.Do you practice this type of procedure?

I really wanna see Dr Ringpfeil but when I made appointment online, her name didn’t appear on the choices of doctors. 😔
Is there a chance to see Dr Ringpfeil instead? I wonder if there’s numbing cream applied to keloids before injection? What should I expect if I’m getting kenalog injections? Is it too painful?

Good evening Doctor i have a scar on my face right side on my jaw line its been there since 2006 i did two chemical treatments along with 3 injections a while ago. Please let me know if you can help me Im brown skin it looked like a keloid, but then I was informed it could also be a hypertrophic scar as well. The scar is no longer raised above the skin it just looks like a black burn. I can send a picture if possible thanks.

I’ve had these keloids since I was 17. I’m 39 now and have like more than thirty keloids on my body. The pain is like hell and now that I have two kids, it just so difficult dealing with these monsters. I need help but I can not afford to shoulder the expenses because I am not working. My husband has insurance. I am hoping and praying our insurance can cover this. This keloids are killing me.😭 Please tell me cryoshape is insurance approved.

Hi, I have a keloid on the cartlidge of my right ear. I got two excisions done as well as radiation and it grew back both times. I no longer trust getting excisions anymore. Do you think Cyroshape would be my next best option?

I was wondering if the office on locust stress does cryoshape? I really want the keloid on the back of my ear gone but I don’t want to go too far for the procedure. how are the payment plans?

what is the cost for a consultation and to have my ear evaluated. i have a keloid. is the consultation free?

I have a keloid on my right shoulder that is about 1 cm in diameter and 0.5 cm in height. Would Cryoshape be effective in getting rid of this keloid? I haven’t tried any other type of treatment, and I don’t have any intentions of doing that either because from what I read, these other treatments are not always 100% effective. I also wanted to know how experienced you are at Cryoshape, how often do you perform it? Thank you

I have two big acne keloidalis on my face please what’s the best option for me to remove them ?

My daughter, age 17, has keloids on both earlobes, for about 3 years, now. They occurred after wearing heavy earrings that ripped her earlobes(not all the way through). The one on the right is about 1/2″ in diameter and is on the front and back of the earlobe. The left one is about 1/4″. Insurance will not cover this surgery. We have been told that she would need radiation after surgery in order to prevent them from recurring. What is the cost for something like this, and do you offer some kind of payment plan or financing?

I have an abnormally shaped keloid on my abdomen that I would like to have treated. Would the cryoshape work for an abnormal shape and larger scar?

Hi, I’m interested in Cryosurgery and cryoshape treatments for my keloid. I have a keloid about the size of a half dollar coin on my shoulder blade. It’s about 3 years old. I’m wondering which treatment between the two is more effective and also the associated costs? Are they covered by insurance? TY.

i have keloids on my back and on my chest i wanted to know is there any possible wat to flatten them or remove them. and how much would it be?

After six years with a successful kidney transplant I decided to have my dialysis fistula closed because of hand numbness. The scar to create the fistula healed flat but wide. However, the scar to close off the fistula has healed as a keloid (red and itchy at times). I’ve had one round steroid injections and weeks use of a steroid tape. This only seemed to irritate the scar more. Any suggestions to calm and smooth this scar down?

My son has acne keloids across his chest. He says they appear to be growing and are itchy at times. He has has steroid injections in some of them but feels this has not really been successful. What other options are available? Can you use a laser to make the pink color disapppear?
Thank you.

I have a keloid on the back of my earlobe the size of 3 or 4 stacked dimes. I would like to have the Cryoshape procedure done and was wondering how much it would cost without insurance?

I have a keloid on my right earlobe for about 5-6 years now and I really want to get it removed but I’m afraid it’ll come back and get a lot bigger than what it is. Will cryotherapy help remove it completely?

Had keloid removal surgery/steroid injections/laser 8 years ago for keloid on my chin (approx. 5 in long 1-2in wide ), it keeps getting infected, and is actively growing. Would this keloid be a candidate for cryotherapy? Does you office do cryotherapy? I am told because of the location of my keloid removal and radiation is not a preferable option, because of the potential cancer risks.

I have acne keloidalis across the nap of my neck. I have been treated in the past with steroid injections with some varying results (some flattening over a long period of time). What other treatment is available to reduce it further.

There’s no pictures regarding Hypertrophic scarring. Do you have experience in such? I see that’s it’s talked about. However, I don’t see any cases in your gallery?

I have a dime size keloid on the cartilidge part of my ear and steroid injections have been unsuccessful. Will cryotherapy work for this? Please help!

I have a large keloid across my chest, one end of my keloid is still growing and apart of my keloid is the same shade as my skin while the end that’s still growing is about ten shades darker than my complection. What do you think is my best option for stopping it from growing

On both sides of my lower jaw I have acne scars that turned into keloids. They are small little keloids and I want to know the best treatment and how much it would cost.

hi ,i am 48 years old male had a mini lift done and after 8 month decided to review my surgon after realising that the scares are getting
worst, after my visit he told me that they became keloid and asked me to go to a pharmacy and by the kortione
he prescribed to me , came right back with the small bottle , gave me injections (the most painful experience i had in my like )now 3 weeks later its getting redder and worst … is this normal nd part of the healing process?
i wonder if me swiming in the ocean for my triathalon training a month after the surgery caused this ?
thank you

i have a treated keloid on my chest which has gone well with me, though the scar remains, its totally flattened now with no pains.well my problem is that i just got my earlobe pierced some days back and i

i have keloids on my chest for almost 7 to 8 years ago.by the time it becomes huge and huge.
now i have treated them through injected removal.
if it regrowth again.what should i do?
i am very confused.please reply

I have 4 keloids that i would like to have either laser or injected removal. Three on the back of my ear lobes they are the size of a gum drop candy and the fourth one is on top of my ear lobe that is the size of an pencil eraser. I am not too familier with the removal process and I am not sure which one is needed for me to take. I would also like to know the cost of the procedure for them. Thank you.

I have some subcutaneous scarring on my abdomen next to my belly button. I had a very small area of fat removed. I have been getting kenalog injections on and off for the past 2 yrs. The kenalog works, but for only 2-3 months at a time, then the scarring returns. I’ve been reading that 5-FU injections may work better. Is that something you do or recommend?

I have for years had a history of keloids, starting with a hernia when I was a toddler, a hysterectomy and bypass surgery about 4 years ago. Since the heart surgery I now have 3 scars under the breast from the drainage tubes a scar on my chest and one on my neck the size of a dime. I am quite concerned about the one on my neck, I have had kenalog injections in the past and they only resulted in smaller keloids growning around the outside of the flattened one. I would like more information on cryosurgery in hopes that this would be a possible solution to my scars.

I have four very large keloids on my back . One is the size of my hand. I’m now going to NYC for treatment because I can not fine a Dr. in Philadelphia who will treat me. I will have had cryotherapy an 5fu is this the best treatment .

I had 4 keloid bumps on my chest, each about the size of the eraser tip on a pencil. I saw a plastic surgeon in Delaware and a dermatologist in Bryn Mawr. I received a series of keloid injections, which flattened the keloids slightly – however, the keloids initially became depressions in my chest before growing within a few months into slightly flatter bumps (still equally as red as before). Last fall, several more keloid bumps grew around the same area. Most are lighter, smaller, and flatter, but there are two are especially raised and very red and tender (about half the size of a eraser tip). Both the plastic surgeon and dermatologist recommended laser removal. I have not received any keloid treatment for the newer keloids, but I would rather go straight to a laser removal procedure, and not risk developing pitted scars from injections. I am feel strongly against surgery because of the likelihood of the keloids just growing back. Would you also recommend laser treatment? How much would one laser treatment cost for these 5 keloid bumps on my chest? (3 are the size of eraser tip on a pencil, and 2 are half that size.) How many treatments would I need? Is there any way I can get laser treatments covered by insurance? I have Aetna. My keloid injections were always covered…Would the initial consultation be covered by insurance? Thank you so much! I really appreciate your answers.

I have Keloids that have formed under my chin from ear to ear. My Dr says they don’t seem to be very aggressive for the amount of time they have been forming which is about 10 yrs. I have had endless injections. They are extremely painful. I have also had Fraxil laser which seem to help but it was very expensive. Unfortunately the Dr went out of business.
I can’t take the injections anymore. They are so painful. My Dr wants to excise them. It will cost me $11,000. Afterwards, I will need 3 days of radiation which will be an additional cost. Please let me know if this is the correct thing to try or should I just “Let it be.
Do you have a better treatment? have you seen success with keloid patients. Please help

I have keloids on both sides of my face on my jawline. I’ve seen over 10 dermatologist and have had about 15 steroid shots but no improvement at all. My question is, in conjunction with the shots, is there anything else that could be used to help shrink the keloids? This is killing my confidence.

I have a keloid in my left ear that isnt painful its just really gross looking
Its from a piercing i got a few years back, im just curious about the process
I would have to take to get it removed supposedly the injections only flatten but
I would like it removed around what price range would it be to get that done?!

I have a keloid on my ear right where the cartledge is from a piercing, I wanted to know if that can be removed and about how much would it cost, my insurance will not cover it being as though its considered cosmetic! Can you guys help me please?!

I had a small keloid on the center of my chest and this doctor who was an expert in removing them told me “Oh yeah removing it would be your best option & lets follow that up with 3 treatments of radiation to ensure that that won’t return”. She LIED to me because what she didn’t tell me was that there was an even greater chance of it coming back and even larger than my original keloid. Now I have this nasty looking thing on my chest that is SO PAINFUL and consumes my everyday living. It burns me up how some doctors tell you what ever they want just to make a Buck!! Even with the steriod injections I have been getting for the past three months I still have no relief. My belief is that if you have a keliod , just get use to the fact that it will be with you until the day you die. there is no escaping the pain, the scar, the uncomfortable feeling you get when you look at yourself in the mirrior. No doctor will ever be able to fix that!!!!!

I currently have a keloid on my right ear the size of a quarter, that i would likes removed. I previously had surgery and and this is the end result. I was wondering if you offer Cryosurgery and if so what the cost would be without insurance. I also received steroid injections also.

I have what you might call a medical emergency. A cluster of keloids(5) have grown to the size of 50cent peices on my face in my beard area. The skin is being expanded to the point breaks have occurred as well bleeding and a pus like substance drains out of the cracks. What procedure would best help my situation? I have insurance, but what would the cost of beneficial surgical correction be?

I have had a keloid on my chest for about 4 years. Every year its increasingly painful and it seems to get bigger. I know treating keloids is very difficult. And I was wondering if there is something that can be done. When it first appeared I had three steroid injections that did nothing. I had another keloid and it was treated by steroid injection and it went away. Any feedback would be beneficial.

I have a friend in China who suffers from keloid and wants to come to the USA to get treatment. I am wondering if treatment of keloid is your specialty. If not, could you please recommend a specialist on keloid? Thanks for your help. Sincerely, Z. Gu

i was wondering how much it would cost to get two keloids on my ear removed..they are about the size of a nickel. also you dont accept my insurance but i was wondering how much it would be as far as a consultation. anyway i am really lookin to get them removed so any information would be great

I once had a genital piercing that has left me with what I believe is either a keloid or a hypertonic scar, which I would like removed. What are my options and how much are the costs? Any information would be greatly appreciated!

Keloid disease does not yet have a cure and the phrase ‘permanent removal’ is therefore unfitting. In any area where a keloid had once been, a new keloid could form with significant trauma at any time.
Surgical removal of keloid results in recurrence about 85% of the time and sightly less if immediately followed by 4 days of radiation or weekly steroid injections x 4. Only keloids on the ear have a lesser recurrence rate because there is no movement beneath the healing skin in the post operative period of 3 months. Of the recurrent keloids, 14% will be bigger than the previous one.
Your next best step might be Cryoshape or external cryotherapy. Cryoshape works best for keloids that are about the size of a Lima bean. This technique that shrinks about 80% of the keloid from within after one treatment. We have not seen worsening keloids after Cryoshape and they have not been reported. There is a 5% chance that the keloid does not respond to treatment. Keloids that a larger than a Lima bean may require several treatments 4 months apart.
External cryotherapy can shrink keloids that are smaller than a Lima bean. When combined with injections, the results after 4-6 monthly treatments are equal to Cryoshape. It can fail to shrink the keloid about 10% of the time. It is not associated with worsening keloids.
The residual scar after Cryoshape or external cryotherapy is not as smooth as an ideal surgical wound.

We do not participate with Aetna Better Health but you have the option to pay out of pocket.

Pulsed dye laser treatment is used to treat keloids up to one inch in diameter. It is often used in conjunction with other treatments. This treatment is recognized by insurance and submitted per insurance guidelines.

Cryoshape is freezing a keloid from within whereas cryotherapy refers to freezing from outside. It takes many monthly treatments to flatten a keloid with cryotherapy and pigment overlying the keloid will be lost after the procedure. Cryoshape flattens a keloid usually in one treatment and pigment on the surface often recurs within a year. The recurrence rate behind the ear is low with either method. Both are safe and the infection rate is low. Cryoshape is FDA approved but is not accepted by insurance. It is more expensive than cryotherapy per treatment due to the consumable cost of the Cryoshape probe. Cryotherapy is FDA approved and accepted by most insurances.

Painful keloids respond favorably to steroid or fluorouracil injections, pulsed dye laser treatment, internal or external cold (Cryoshape/cryosurgery). We do not perform excisions on the chest because the chance for the keloid to grow bigger than before is greater than 95%. Web-shaped keloids that cross the midline of the chest, can be revised with Z-plasty and CO2 laser when they are no longer painful.

Indeed, pulsed dye laser and injections with triamcinolone or combintaion of traimcinolone and fluorouracil (5FU) are a great solution for keloids along the jawline. Fractionated lasers, whether ablative or non-ablative, do not seem to be very helpful for keloids and on occasion they can even trigger a keloid to fare up again.

The CO2 procedure is similar to cutting with a knife, Instead of a knife, the CO2 laser energy is used to cut out the keloidal tissue. The wound can than either be closed with stitches, or, if small enough, left open for healing with a scar. It is not yet possible to use hair transplantation to cover a scarred area, because the scar does not provide the environment for hair follicles to survive. The risk for another keloid to form is slightly less than with a traditional scalpel but still exists. A proper evaluation is needed to assess your options for keloid treatment/removal and proper price quote. And, yes, we treat many people with acne keloidalis nuchae.

I wish there was a great treatment for acne keloidalis nuchae.
It can be prevented to some extent when hair is not clipped too short. When the condition has occurred, treatment of the keloiding area is the only know approach.
If the keloids are green pea sized, injection of steroid pr steroid/fluorouracil into each one of them is reasonable. If they are up to 1.5 inches long and at least a quarter inch wide, Cryoshape is an option. Larger keloids are sometimes excised by CO2 laser locally or as an entire section across the lower scalp and then the skin pulled together if possible.The biggest worry with excision is the possible recurrence of keloids.
Oral anti-inflammatory antibiotics (doxycycline or combination of clindamycin and rifampin), topical steroids and topical retinoids are used to minimize the inflammation when it has already occurred, hence reducing the chance that new keloids form.

Keloids on the earlobes are not as difficult to treat as elsewhere on the body. Depending on the size and position, they can be treated by injection, internal or external cryosurgery, or excised and injected afterwards to avoid recurrence. The initial consultation as well as treatments apart from internal cryosurgery (Cryoshape) can be submitted to insurance unless the diagnosis keloid is excluded from your benefit. If the keloid is very small, cost for treatment ranges in the hundreds without insurance coverage. If Cryoshape is desired, cost of treatment is $1000.

Cryoshape will work as long as the keloid is raised at least 0.4 cm above the surface of your skin. The thinner the keloid, the greater the chance to loose pigment in the treated area. Most of the time, pigment returns after 6-24 months, and matched cover up (Dermablend or Covermark) can be used during that time if desired. Please make an appointment for consultation with any of our dermatologists or use online consultation https://www.ringpfeildermatology.com/tools/onlinederm.php. The Cryoshape procedure is performed by me and can be scheduled after consultation.

Keloids require multiple pulsed dye laser treatments. The laser treatments for keloids are usually submitted to insurance and each insurance has its own rates of pay. If you do not have medical insurance, we charge up to $250 per treatment depending on the size of the keloid. Please schedule an appointment for evaluation.

Cryoshape is $1000 per treatment. If you have more than one keloid that is treated on the same day, there is a charge of $100 per additional keloid.

The fee for in-office consultation is $115, online consultation is $80 (follow the directions on the homepage). If you have insurance, the in-office charge for consultation and treatment charges are submitted to your insurance. The only keloid treatment that cannot yet be submitted is that for Cryoshape.

Insurance usually accepts pulsed dye laser treatment for keloids as proper treatment except when exclusion criteria apply to your plan. Our office submits pulsed dye laser treatment or destruction of keloid depending on the insurance type. Insurance will accept but not pay for treatment if you have a deductible or coinsurance.

It is indeed not a good idea for you to undergo any elective procedure including tattoo placement because a keloid can form with any type of trauma.

While I am familiar with electrosurgical amd with CO2 laser assisted excision of acne keloidalis nuchae, i do not perform this treatment. I wonder if it might still be offered at the departments of either Thomas Jefferson University or University of Pennsylviania.

Steroid or combination injections to reduce itch or pain in keloids and to shrink keloids exert quite a bit of pressure whether by injection or needle free application through dermojet. Pain can be associated with this pressure and when this is the case, we use numbing medicine around the keloid before steroid injection. Topical numbing medicine dose not really reach the nerve endings within a keloid, no matter how long before steroid injection/application it is applied. Please be assured that all associates in the office render the same care to our patients and treatment for keloids. In the interest of maintaining quality of care, I am personally unable to take care of new patients at this time.

Sending a picture as part of an online consultation might work but in my opinion, a scar is best evaluated in person. If dark discoloration is the biggest issue, the picosure laser might be able to reduce the pigment and is safe on your skin as it does not generate heat. Please schedule a scar consultation with me.

Treatment of painful keloids with injections is insurance covered. I would strongly recommend this in your situation. Treatment with cryoshape to reduce/remove a keloid is FDA approved but not yet insurance covered.

Cryoshape or external cryosurgery are probably the only options at this time. A single Cryoshape treatment is needed when the keloid is the size of a Lima bean. Larger keloids may need more than one treatment session several months apart.

At this time, Cryoshape is offered only at the Haverford location. The Haverfordd office is easily accessible by public transport (regional rail, bus) as well as by car. On site parking is free.

In-office consultation for a keloid is usually an insurance covered benefit. If you do not want to use your insurance, we charge $115 for in-office consultation fee and $80 for on-line consultation.The consultation fee is not applied to the treatment.

The dimension of your keloid could be just a bit too flat for management by Cryoshape. Considering that your keloids has never been treated and is likely very firm, It may lend itself to treatment. Evaluation is certainly recommended. We perform several Cryoshape treatments per months and have several years under our belt.

Depending on location and size of these 2 growths on your face, you might be a candidate for treatment by injection or Cryoshape. I recommend evaluation.

Treatment options for these small keloids on the earlobes are excision followed by injection, by topical immune-modulatory medication or by radiation. I am surprised to hear that insurance does not cover excision and follow up treatment of keloids on the earlobe. While we frequently perform the first two modalities, we do not offer radiation and work closely with the universities in town. In office evaluation will allow us to accurately assess her options and determine a price quote.

The shape is not important when considering Cryoshape as the probe can be inserted in multiple angles if needed. A keloid in the shape of a Lima bean or slightly larger responds to one treatment whereas keloids the size of an egg will need multiple treatments to reduce sufficiently. Please make an appointment for evaluation to see if you are a candidate for Cryoshape.

If your keloid is raised enough that the cryoshape probe can be inserted, Cryoshape would provide the better treatment in this location. If your keloid is as flat as a half dollar coin, external cryosurgery is the only cryosurgical option. External cryosurgery is submittable to insurance whereas Cryoshape is not yet insurance approved. we currently charge $1000 for treatment of a single keloid; each additional lesion is between $100-200.

If the keloid is recent, a silicone strip (e.g. ScarAway) can be applied for the next three months. It can be removed to shower. Strips of various sizes are available online. One strip will last you about 1-2 weeks.

Flattening of keloids is possible, removal is difficult. The cost depends on the technology that is needed to treat your keloids. Treatment must be tailored to the size and shape of your keloids. Please make an appointment for consultation so that we can examine your keloids, formulate a treatment plan and provide a cost estimate. Treatment options include intralesional cryosurgery, external cryosurgery, injection, laser, radiation (only for very large keloids – not performed in our office))

A pink color in keloids responds well to pulsed dye laser treatments in individuals with light complected skin (Fitzpatrick I-III) yet may permanently reduce pigment in darkly pigmented individuals (Fitzpatrick IV-VI). Other lasers are not known to achieve significant results in keloids. Injections with steroid and fluorouracil may be worth considering as well as intralesional cryosurgery if the keloid is elevated enough.

The current Cryoshape charge is $1000 for one keloid, each additional treated the same day is $100. On the earlobe, surgery followed by a series of injections of steroid every 2 weeks is another worthwhile option. Unlike everywhere else on the body, the earlobe has only a minimal risk of forming another keloid after surgery+injections, and the total cost of treatment is about about half of that of Cryoshape. The initial consultation in the office with one of our physicians is the same for both, and cna range from $57.50 to $115.

Cryotherapy (including Cryoshape) shrinks keloids and often removes them completely but the technique is not as precise as surgery. This means that there may be a bit of a contour irregularity at the base of the former keloid. Most people will find the outcome very acceptable, however.

Cryosurgery and perhaps even cryoshape are options for you in this location. Please make an appointment for evaluation and so that the procedure details, benefits, downtime and side effects that may pertain to you can be discussed.

The treatment with the longest lasting remission is localized steroid injections of larger keloidal papules and topical treatment of the area with a retinoid and steroid combination. If the affected area is predominantly on the scalp and if it is a suitable size, excision can be performed. Unfortunately, there are no better solutions yet.

It may be a very worthwhile option to consider.

Hypertrophic scars are very common and respond often quickly to treatment. We are so accustomed to treating them that we have simply overlooked to collect pictures. Thank you for pointing this out. We will be mindful and have pictures up soon.

Only steroids are known to reliably stop active growth in a keloid. Steroids are also used to flatten keloids. They are injected directly into the growing keloid and therefore do not cause effects on the rest of our body.

The best treatment for small keloids on the jawline is injection with a steroid. It can take several injections 4-6 weeks apart to flatten keloids. Keloid treatment is considered medical and would be billed to insurance if you have one. If you do not have insurance, the treatment may range between $50 and $100 per visit. At the first visit, you will need a medical consultation. The fee for this initial consultation is $115 if you do not have insurance.

It is unlikely that swimming in the ocean one months after surgery caused keloid formation. Keloids form spontaneously and are more common with a genetic predisposition. When you do not have any keloids on the skin, it is difficult to predict this genetic trait. Keloids often need several treatments. When they are red, pulsed dye laser is used in conjunction with injections to flatten keloids. I recommend you seek care by a plastic surgeon or dermatologist who performs both.

Statistically speaking, you have a high chance of forming a keloid on the pierced earlobe. Prevention of keloid formation can be attempted using a steroid or imiquimod locally. I recommend you schedule an appointment with a dermatologist

If keloids recur months or years or decades after they flattened with injections, they can be injected again. An alternative to injection is freezing the keloids.

Keloids on the earlobes are usually easier to treat than on any other area of the body. They can be flattened with cryosurgery with only minimal risk of recurrence. Surgical removal is an option on the earlobes as well. In general, the likelihood for keloids to recur in surgically treated areas is extremely high and it is expected that any new keloid is much bigger than the original one. Therefore, intralesional steroid injections are recommended into firm keloids to treat symptoms and to reduce these keloids.
If keloids soften or shrink but do not completely flatten after a series of up to 3 steroid injections, surgery may be performed. Steroid injections must be also be performed at time of surgery and every 2 weeks thereafter to prevent keloid formation at site of surgical trauma. Usually, 3 injections after surgery are required, to greatly minimize the risk for keloid formation.
All 4 keloids on the earlobe could be treated in a surgical manner.
Cryosurgery may be a good approach to the three on the back of your lobes but the one on the front of the lobe may be too small. The cost for Cryoshape, a specific technique that allows for treatment from the inside out on the back of the lobes, is currently $1000 for the first keloid and given the small size of your keloids $100 for each additional. Surgery and steroid injections for lesions up to 1 cm is $210 for each keloid or $250 for keloids between 1-2 cm. We charge $50 for each visit when steroid injections are performed. This includes all 4 sites. Assuming your keloids are smaller than 1 cm and all of your keloids could be excised, the cost would be between $1040 (including 1 injection prior to surgery and 3 after
surgery) and $1140 (including 3 injections prior to surgery and 3 after surgery). These quotes does not include the initial consultation fee of $115.

In our experience, combination of Kenalog and 5 fluorouracil sometimes works better than Kenalog alone. We do perform these treatments.

Cryosurgery (Cryoshape) is a technique in which a very cold gas (liquid
nitrogen) is freezing the keloid from its center through a probe. It is suitable for keloids that “sit” on the skin. This specific technology has recently become available and so far no treatment failure or worsening of the keloid has been reported. Smaller keloids reduce in one session. Larger keloids will shrink but not resolve in one session. Several sessions 2-3 months apart may be needed to flatten them. Temporary darkening
(hyperpigmentation) could occur due to the intentional inflammation that will resolve the keloid. Permanent hypopigmentation at the insertion site of the probe is possible but usually affects a tiny area. In sum, this is a great treatment for small keloids.

Large keloids are very difficult to treat. Radiation with or without surgery is often times the only option and is usually carried out at university centers where the dermatologist or plastic surgeon and radiation specialist work closely together. Usually, you would meet with a dermatologic surgeon or plastic surgeon at Jefferson University or University of Penn who will then coordinate the radiation treatments. I am sorry to hear that you were unable to find help in Philadelphia. For keloids the size of your hand, cryosurgery may not be feasible as its strength is treatment of much smaller, bean shaped keloids that appear to sit on top of the skin. 5 FU works for small keloids even if they appear embedded in the skin.

The types of keloids you describe should indeed lend themselves to pulsed dye laser treatment to remove the intense redness and flatten the keloid.
Laser removal is a bold term that I do not feel comfortable using when I attempt to flatten keloids by laser or injection or a combination of both.
Keloid removal suggests the use of a specific type of laser in a cutting mode but that can set you up for potential regrowth similar to the chance after classic surgical excision. Aetna usually covers the initial consultation unless your keloids are a “preexisting condition”. This is insurance jargon, which affects us occasionally when we switch plans. Aetna usually covers injections but does not usually cover pulsed dye laser treatment. The cost for each treatment for 5 lesions is $185 ($105 + 4 x $20). The number of treatments to flatten keloids to an acceptable level is variable and ranges between 4-8. Treatments are spaced 4-6 weeks apart.

The cost of removal depends on the size of your keloid. Injections in ear keloids are usually performed before the surgery to assess the efficacy of steroid to suppress keloid formation after any type of surgery. If your keloid on the earlobe softens in response to steroid injections, removal can be recommended and steroid injections will be performed after the procedure if needed to avoid post traumatic keloid formation. If a keloid does not soften with steroid injections, removal may not be recommended because a new keloid after surgery is usually much bigger than the original keloid.

The proposed treatment of excision followed by radiation is correct next advise for the description you have provided, especially since your keloids did not respond to injections. If hair growth contributed to keloid formation in this area at all, it may also be wise to consider laser hair reduction on the remainder of the neck to avoid keloids starting in other areas.

10+ dermatologists should give a reasonable perspective. Keloids are difficult to treat in general and depending on their position and shape, are sometimes limited in treatment options. It is however surprising that you had 15 injections when you have seen 10+ dermatologists. It implies that there has not been one main dermatologist treating your keloids. Keloids take many injections to flatten and the concentration of steroid, which in certain locations of the body can be mixed with 5 fluorouracil, is important. Sometimes laser treatments can be used to speed up the treatment but care must be taken not to change your natural pigment.

Excision of a keloid is never simple but on the ear it may be possible. Cost depends on size of keloid. Up to 3 steroid injections should be performed before and another three after surgery. Cost for removal of a keloid that measures up to 1 cm and allows simple shave excision, including injections, may start at $460. This fee does not include the initial consultation, which will be submitted to the insurance.

I am sorry to hear about your experience. Keloids are one of nature’s happenings that are very difficult to treat. Excision without after-treatment by injections or radiation is almost never recommended but even these modalities can fail as you have experienced. Steroid or 5 fluorouracil injections can alleviate pain and can shrink keloids. While I do not know your dermatologist, I cannot imagine that she recommended excision followed by radiation to cause an even bigger keloid. However, I do appreciate very much that you are sharing your experience and I hope that there will eventually be something that can control your pain.

Cryosurgery may be attempted to minimize a keloid but it is not a very efficient treatment modality for keloids. The cost per treatment in our office is $100 without insurance for the size of your keloid. Other treatment options include another excision ($230) followed by 3 post operative steroid injections ($50 each). The first injection is done immediately after surgery provided that your keloid has previously softened with steroid injections.

What you describe does not only sound like keloids but a severe inflammatory reaction in the hair bearing area. The inflammation should be diagnosed, brought under control quickly to avoid further keloid formation and only when quiet should keloid treatment be considered.

As you already mentioned, keloids can be tough to treat. As you may have heard, excision is not usually recommended due to high risk of the keloid recurring with a fear that it could be bigger than before. Injections with steroid or combination of steroid and 5 fluorouracil are currently accepted treatment strategies by most insurances. Additional treatment options (but not usually insurance covered) are a series of pulsed dye laser or CO2 laser treatments. Evaluation of the keloid is necessary to determine the best option for you.

Keloids are characterized by uninhibited scar formation. Medical and surgical (including laser) treatment is available and its efficacy and use depends on size and location of the keloid. While I have ample experience in the medical, surgical and laser treatment of keloids, I consider all dermatologists keloid specialists. Our office offers all aspects of keloid treatment.

Our fee for localized examination and consultation for keloids is $115. The likelihood for keloids to recur after surgical removal is extremely high and it is expected that any new keloid is much bigger than the original one.
Therefore, intralesional steroid injections are recommended into firm keloids to treat symptoms and to reduce these keloids. If keloids soften or shrink but do not completely flatten after a series of 3 intralesional steroid injections, surgery may be attempted. Steroid injections must also be performed at time of surgery and every 2 weeks thereafter to prevent keloid formation at the site of surgical removal. Usually, 3 injections after surgery are required to minimize the risk for keloid formation.
Keloids that do not respond (soften or flatten) to intralesional steroids may benefit from excision with subsequent radiation. Franziska Ringpfeil, MD

Hypertrophic scars and keloids are very different in their biologic behavior. Both cannot be removed without trace but both can often be injected with a steroid and will reduce significantly or may resolve to a flat scar. There are circumstances under which scar revision by excision for a hypertrophic scar may be preferred, especially when the expected scar is minimal. However, the chance of another keloid developing, when an existing keloid is excised, is about 90%, and therefore excision is usually not an alternative. If several steroid injections soften a keloid without flattening it, shave excision may be attempted with additional steroid injections at time of excision, as well 2 and 4 weeks after to minimize the risk of a returning keloid. In very rare instances, when a keloid does not respond to steroid injections or is so large that it cannot be injected, radiation may be necessary.
Cost of the procedure depends on the size of the lesion. We typically charge $50 per injection and anywhere between 1-3 may be needed for hypertrophic scars and between 2-10 treatments for keloids. Revision of hypertrophic scars by complete excision ranges between $150 (up to 5 mm) and $400 (over 4 mm). Shave removal of keloids may range between $130 (up to 5 mm) and $230 (over 2 cm). Three steroid injections needed after shave removal are charged in addition to the shave removal as mentioned above.
Radiation is not a service that our office performs because it is rarely needed.
While the revision of hypertrophic scars is not always an insurance covered service, most insurances cover the treatment of keloids.

I have a long keloid going straight down my stomach and two on my arm from surgery can they be treated and what procedure would be best for me

They may be flattened by injections, laser or internal cryosurgery (cryoshape) depending on size, color shape and your skin color. The abdomen and arms are usually poor sites for surgical revision.