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Dr. Raffy Karamanoukian was featured on the Emmy Award winning television show, The Doctors, discussing his unique approach to keloid scars. He is a world authority on the management of difficult keloid scars on the face. Schedule an appointment with Dr. Raffy Karamanoukian by calling our office at (310) 998-5533. There are many ways to treat keloid scars. Historically, the basic management of keloids was conservative with slow progression of the keloid scar with time. Dr. Raffy Karamanoukian uses a specific keloid protocol that he developed that targets the fibroblast and hastens resolution of the keloid with a combination modality of IIT, Surgery, Intralesional Injections, TAC injections, Pressure Treatment, and Digital Pressure.
Some of the more common reasons that healthy individuals develop keloids include injuries to the skin, either from a surgery or medical procedure, or from trauma. In our office, we commonly see keloids that have arisen as a result of the following tissue injuries:
- Ear Piercings or Body Piercings
- Acne (Usually on the face, chest, and back)
- Chicken Pox and Shingles
- Abrasions on the skin
- Vaccination sites and Injection sites
- Surgical sites
- C-section scars
- Lasers and Cosmetic procedures
Dr. Karamanoukian is a double board certified plastic surgeon and has expertise in cosmetic plastic surgery, including breast implant revision, breast augmentation, tummy tucks, liposuction, rhinoplasty surgery, eyelid surgery, and facelifts. He advocates minimally-invasive cosmetic surgery that maximizes results while maintaining the natural look of the face and body.
KELOIDS OF THE EAR OR EARLOBE: Ear keloids can present a significant problem for patients, regardless of age, gender, or ethnicity. Most commonly, ear keloids arise from piercing of the earlobe or ear helix (rim of the ear). Progressive growth of the keloid prompts patients to seek treatment with Dr. Karamanoukian for keloid excision.
Patients may complain of progressive thickening and enlargement of the keloid scar with associated itching, burning, and pain. The symptoms may cause excessive pain and discomfort that is likely related to an abnormal histamine response. Patients with ear lobe keloids should seek immediate attention to avoid the potential complications associated with enlarging keloid scars. As the keloids become thicker and larger, they may begin to encroach on the scalp skin or the surrounding tissue of the ear. In addition keloids of the ear may encroach on the cartilaginous structural support of the ear, thereby destroying the very fabric of the ear’s inner support network. If the cartilage is destroyed, the ear keloids may disrupt the anatomy of the ear and cause significant and permanent deformity.
Earlobe keloids may occur as a result of dermal trauma or chronic inflammation. These causes may include infected piercings or an antibody reaction to sebum in the skin. Whatever the cause, keloids of the ear require immediate and definitive attention to ward off and prevent secondary deformities of the ear. If you are concerned about ear lobe keloids, schedule a consultation with one of the foremost authorities in keloid reconstruction. Dr. Karamanoukian has been featured on popular television shows discussing the surgical and nonsurgical management of keloid scars.
PUBIC KELOIDS: The pubic area is the area of hair-bearing skin above the mons pubis. Although this is a very sensitive issue for most women, keloids can occur in this area as a result of acne, ingrown hairs, or even a c section scar gone wrong. Most women who have pubic or pelvic keloids complain of itching and irritation, along with pain and discomfort. Our office has treated many patients with pubic keloids and the majority of patients seek treatment very late in the process. The treatment of pubic keloids follows some very simple principles that are shared among all types of keloids on the body. The one specific difference in pubic keloids is that hair removal (with laser) is an important part of finding a long term solution for the keloids.
Our office does not recommend radiation therapy for pubic keloids because of the location and the proximity to the pelvic lymph nodes and ovaries. Surgical resection and conservative laser and IIT therapies can improve pubic keloids dramatically. The first step in determining whether you are a candidate for keloid treatment is to schedule a consultation and determine whether you will need surgical or non-surgical therapy.
Linear keloids are one morphologically variant of keloid scars that can occur as a result of trauma, surgical incisions, or skin scratches. All too often, in our Los Angeles plastic surgery office, our clinicians see patients who have sustained a simple scratch or cut on the skin, only to develop a large linear keloid that begins to progressively thicken and enlarge. Linear keloids are often long scars that can eventually widen and raise above the plane of the skin. The most common question among patients is to question whether the linear keloid is in fact a keloid vs. a hypertrophic scar.
In our office, we focus on the physiology of a keloid scar, rather than its physical morphology. We incorporate the dynamic processes of keloid scar formation into our surgical or non-surgical plan in order to effect a proper treatment of your keloid scars. If a particular linear keloid is associated with inflammation, we tend to think of the scar as a keloid. In contrast, if a linear scar is purely widened with no associated inflammation, then we tend to treat the scar as a hypertrophic skin injury.
Linear keloids are often progressive with gradual or sudden onset thickening and widening. These scars often become red and thick, often resulting from chronic and uncontrolled inflammation and wound healing. As the body begins to deposit dense mats of collagen into the wound, the scar becomes hard, thick, and raised. In order to begin treatment for your linear keloid, it is best to begin with a consultation in which we examine the scar, delineate its keloid vs. hypertrophic attributes, and finally develop a formative treatment plan that incorporates IIT, intralesional injections, laser keloid therapy, pressure treatment, silicone therapy, and surgery. Not all linear keloids will respond to surgery, so some linear keloids may be treated with conservative therapy only before advancing to a more invasive modality.
Linear keloids are often contrasted with nodular keloids, which form hard round lumps within the deep and superficial layers of skin. Linear keloids often have a vertical growth phase in which collagen is deposited deep into the dermis as well as superficially above the plane of the skin. If you have a linear keloid, examine the keloid within your fingers to determine the depth of the keloid and its physical dimensions relative to your skin.
In our practice, we have seen linear keloids form on all parts of the face and body. Surgical incision sites, scratches, and trauma are often linked to the development of linear keloids. Facial keloids are not harder or easier to treat than body keloids, and we will provide you with a comprehensive treatment plan that incorporates cosmetic and medical goals. If you have recently begun to develop a linear keloid, it is best to start your therapy early, whereas patients who have had a linear keloid for a long time can benefit from earlier interventions as progressive keloids may begin to limit function and may invade adjacent tissues.
Once a consultation is made and the keloid is examined, it is important to note the history of the problem, the number and course of previous surgeries or treatments you have had for your linear keloids, the presence of inflammation, and the presence of redness, thickening of the skin, skin discoloration, and thinning of the skin.
If you have also had previous laser therapy or intralesional steroid injections, Dr. Raffy Karamanoukian will also identify iatrogenic development of blood vessels and feeding arteries and veins surrounding your keloid. Often, these feeding blood vessels will nourish the keloid, making treatment more difficult.
Linear keloid surgery is relatively routine and is often less involved than other types of keloids, including superficial spreading and nodular keloids. These linear keloids can be surgically removed and the normal skin resutured in order to begin conservative IIT and pressure therapy.
In our Los Angeles plastic surgery practice, we specialize in linear keloid management and linear keloid surgery. These surgical procedures are performed under local anesthesia in most cases, with administration of a numbing anesthetic prior to the initiation of surgery.
On the day of your procedure, provided that the surgery will be performed under local anesthesia, you will be allowed to eat or drink something on the morning of the procedure. Once you arrive in our office, you will be provided an informed consent for surgery, at which time you will our surgeon will review your medical history and go over your questions. Surgery is begun in an outpatient private operating room under local anesthesia. Once the surgery is complete, you will receive a dressing for the treated area and discharged to the care of a friend or on your own accord.
On follow up examination after your keloid surgery, your scar will be examined and any sutures will be removed if appropriate. We will provide you with aftercare instructions and a follow up appointment will be made thereafter.
Most patients with linear keloid scars do not require more aggressive therapy such as radiation therapy or chemotherapy 5FU. Our office provides national expertise in the management of keloid scars and we will make every attempt to treat you keloids without invasive procedures. Linear keloids may occur in association with nodular or superficial keloids and these can be addressed simultaneously with your linear keloid treatment.
After your keloid surgery, there is still a period of recovery followed by a period of time in which you may have a risk of keloid recurrence. Keloid recurrence can often be frustrating for patients who want to rid their body of the keloid process. Since there is a genetic link to the development of keloids, it is unfortunate but true that you may always be at an increased risk of keloid development.
If there is a small recurrence of a keloid scar at the site of the old linear keloid or along another site, the early keloid may respond to early and aggressive laser therapy and intralesional Kenalog.
Patients who also wish to undergo future cosmetic surgery, including breast augmentation, liposuction, or body contouring surgery may consider the increased risk of keloid development and opt to be treated with these procedures under the care of board certified plastic surgeon Dr. Raffy Karamanoukian as he can best manage your scars after treatment.
Keloid treatment should be performed under the expert management of Dr. Karamanoukian, a world expert in keloid development and care. He has been featured on television, including The Doctors, demonstrating his unique and uncompromising approach to keloid scars.
As a specialty plastic surgery practice specializing in keloid treatment, one of the first steps in keloid treatment is characterization and diagnosis of your keloid. On your body, you may have multiple keloids, but each one may behave a little differently, necessitating a tailored approach to therapy.
Flat keloids are those thickened scars that are not only inflamed, but also within the tissue plane of the skin. They tend to rise slightly above the skin, but have associated inflammation and vascularity that makes their features more akin to a keloid rather than a hypertrophic scar. Our office treats many different types of keloids, but flat keloids are particularly difficult to treat as their mode of progression is superficial and spreading, unlike nodular keloids which do spread into normal tissue as rapidly or readily. Flat keloids are often circular and have a central point of origin, followed by a centrifugal pattern of spread.
Flat keloids can occur in all ethnicities and can be found in the presence of nodular or linear keloids. The major downside to a flat keloid is their ability to expand into surrounding normal tissue. However, the good news about flat keloids is that they rarely spread into the deep tissue planes.
Our office offers consultation for keloid scars and for those patients who are seeking a second opinion. Flat keloids are seen in all ethnic types, including Asians, African Americans, and Caucasians. One of the most prevalent populations that develop keloids include patients of Polynesian or Pacific Islanders who can develop pigmented and rapidly enlarging keloids.
Flat keloids can be found at various stages of development. Our office frequently consults on patients who have a mixture of flat, nodular, and linear keloids simultaneously. Flat keloids can invade adjacent normal tissue and this is one of the main reasons why the keloids should be treated as early as possible. Most flat keloids can be treated with a combination of pressure treatment and IIT. Pulsed dye laser therapy also works well on flat keloids.
Combination therapy can decrease the size and rate of progression of flat keloids. The goal of keloid treatment is to reduce inflammation and keloid size. Once these two variables are treated, the keloid can be reduced to a regressing keloids.
Symptoms associated with flat keloids include pain, itching, burning, tingling, and even numbness. These keloids often become red and inflamed, resulting in discomfort when touched. Flat keloids on the chest can also cause difficulty with sleep and with normal physical activity. It is important that you discuss all of these problems with Dr. Karamanoukian during your consultation. Patients who have bleeding keloids or infected keloids should seek consultation early in order to minimize complications from your keloids.
Our office provides comprehensive keloid management for flat keloids, nodular keloids, and linear keloids. If you are having symptoms from your keloids, these symptoms of pain, itching, and burning may be an early warning sign that the keloid may be advancing and becoming worse. Inflammation and infection can set into a keloid, making non-surgical treatment more and more difficult. Early treatment of your flat keloids is preferable in order to prevent costly and time consuming surgical therapies.
Keloids rarely bleed, leading some to consider other diagnoses when faced with a patient with a bleeding keloid scar. If a keloid has been scratched or traumatized, it may bleed profusely, just like any other part of the body. However, keloid scars tend to heal quite well, so much so that a recurrent bleeding keloid is rare. In our practice, we see many keloids of all different shapes and sizes. Keloids may become infected, inflamed, and bleed, but these are complications arising from a keloid. If you have a lump or nodule on your skin and believe that it is a keloid, a surgical biopsy is recommended to make the correct diagnosis. Bleeding lesions can occur as a result of trauma, metaplasia, or other manifestation of tumor growth.
Our recommendations for a bleeding keloid, as rare as it may be, is to seek medical or surgical advice as soon as possible. The first step to diagnose your keloid would be a surgical biopsy, followed by definitive keloid therapy. If the area is not a keloid, an appropriate intervention should be made. As with all keloid scars, a combination therapy including surgery, IIT, pressure treatment, and laser may suffice.
Clinical observations among patients with keloids confirm the presence of itching among keloid lesions. A clinical study set out to determine the prevalence of itching among patients with keloids. Dr. SS. Lee et al studied keloid lesions among a group of keloid patients and found that 86% experienced itching along their keloid. A similar report noted that 46% had keloid-related pain. Of those that experienced itching at the site of their keloid, 92% also noted itching at the edge of their keloids. In our Los Angeles plastic surgery practice, we see many patients who have keloids that are itching; and have found that aggressive management of these symptoms can improve quality of life. The itching and burning along a keloid is likely a response to an inflammatory state. Treatment of the inflammation thus remains at the core of any keloid therapy.
Pubic keloids are embarrassing for those patients who have large, painful keloid scars on their pubic mound. This type of keloid is disfiguring and can cause both emotional and physical problems for patients. Because it is an area that can easily be hidden, patients often wait long periods of time before they seek therapy for pubic keloids.
Pubic keloids can occur in both men and women. In men, the three most common reasons to develop keloids include trauma ( a cut or scrape), acne, and ingrown hairs. We have all heard about trauma and keloid scars, but acne and ingrown hairs are less talked about when it comes to keloids. Acne and ingrown hairs can often be associated with bacteria and inflammation, inciting keloid growth and keloid formation. For women, in addition to trauma and acne and ingrown hairs, pubic keloids are formed as a result of a C-section gone wrong. Delayed wound healing, separation of an incision site, or infection of a C-section scar can all cause harm to a keloid, often resulting in further development of an abnormal scar.
If you have a keloid scar and have begun developing symptoms from the keloids, you may want to begin treatment as soon as possible in order to minimize the progression of the problem. Early intervention is ideal as the abnormal tissue has not yet grown into the normal tissue planes. Often, procedures for pubic keloids include a combination of surgery, cortisone injections, laser, and pressure treatment. Less commonly, cryotherapy is used to treat pubic keloids as there is a potential for hypopigmentation of the scar.
Symptoms from keloid scars include pain, itching, discomfort, burning, tingling, and even numbness. These symptoms can indicate a worsening of the keloid problem, resulting in underlying inflammation. In the pubic area, some keloids can become infected, discolored, and can even lead to progressive ingrown hairs. If your keloid has begun to bleed or you are worried that you may develop bleeding from your keloid, you should seek treatment with Dr. Raffy Karamanoukian as early as possible.
The first step in treatment is to schedule an appointment and consultation with keloid expert Dr. Raffy Karamanoukian at (310) 998-5533. Our office staff will expedite your appointment request and give you specific options for therapy. Laser keloid treatment, surgical keloid treatment, and cortisone keloid treatment are all considered viable options. In addition, Dr. Karamanoukian may also recommend laser hair removal for the area around the keloid in order to minimize ingrown hairs and further development of inflammation.
Are all pubic keloids treated with surgery? Not all pubic keloids are treated with surgical excision. Some keloids respond well to non surgical management, including cortisone injections, pressure treatment, cryotherapy, IIT, and laser. When you first come in for your keloid consultation in our Los Angeles plastic surgery practice, our board certified plastic surgeon will discuss all of your options and give you a plan that minimizes the risk of surgery.
How effective is pubic keloid treatment? One treatment cannot eradicate a keloid, as there are inflammatory and collagen scar related issues that need to be addressed. During your first consultation with Dr. Karamanoukian, he will advise you on the proper course of keloid treatment that he recommends given your specific pattern of scar formation. If these programs are followed, the keloid will begin to diminish in size, but more importantly, the associated inflammation will begin to reduce. The inflammation associated with a keloid scar is partly to blame for the pain, discomfort, and itching that is common among keloid scars. Once the scar begins to settle and the keloid inflammation begins to subside, then a more longlasting approach to keloid treatment is begun. In our vast experience with keloids, we have found the therapies to be longlasting and definitive. This is not to say that keloids cannot recur or you will not develop more keloids. It just means that the existing keloids can be well controlled and reduced in size and visibility. Long term solutions are relatively simple, once basic strategies are taken to reduce keloid growth and propagation.
Can I treat ingrown hairs arising from my pubic keloids? Ingrown hairs are usually associated with pubic keloids, making them a target for long term treatment of keloid scars in the area. If you have a large pubic keloid, then it is best to begin early treatment for the pubic keloids and continue on with laser hair removal treatment of the ingrown hairs. Infected and inflamed ingrown hairs can exacerbate the keloid problem, and even cause the keloid to expand. Dr. Karamanoukian will recommend a custom tailored laser hair removal option for you to treat these ingrown hairs.
How long do pubic keloids take to treat? Treatment times really depend on the severity of your keloid, the density of collagen within the keloid, how soon you have begun treatment, and how compliant you are with laser, IIT, cryo, and pressure management. In most cases, patients will begin to see a sizable improvement within two months of their treatment commencement.
Can I treat chest, back, and facial keloids at the same time as pubic keloids? Our office provides comprehensive treatment for keloid scars and we strive to treat all of your keloids simultaneously. If you have keloids on the face or body, please allow us the opportunity to examine these keloids and begin treatment. Patients are pleased with the course of treatment and should begin keloid management as soon as possible.
KELOID RESEARCH: Keloids scars are caused by an abnormal proliferation and deposition of collagen by the wound fibroblast. It is thought that the formation of thickened scars or keloids is caused by a defect in the activity of TGF beta 1 growth factors, among other mechanisms.
- A recent study from the Division of Plastic Surgery at the Federal University of Sao Paulo in Brazil, by Gragnani et al., documented the utility of topical Tamoxifen in the early management of keloid scars in burn patients. Tamoxifen is a non steroidal anti-estrogen medication that is a mainstay drug in the treatment of breast cancer patients.
- In the study reported in Arch Dermatol Res, July 28 2009; the authors believe that Tamoxifen may modulate the production and activity of TGF-beta 1, thus decreasing the fibroblast proliferation of collagen.The practice of using Tamoxifen in a clinical study awaits further trials but the drug may become an important adjunct in the treatment of keloid scars.
- A study from Sveti Duh Hospital in Zagreb Croatia discussed the treatment of ear keloids, particularly those behind the ear, and found that surgery and radiation were the best treatments in their patient. On the contrary, Dr. Karamanoukian has acheived high levels of success with surgical excision without radiation. If you are considering keloid scar revision and treatment, you may benefit from a consultation and discussion of options for keloid scars.
- A study from the Department of Dermatology at the Lady Herdinge Medical College evaluated the efficacy of cryotherapy in the treatment of keloids and evaluated factors affecting treatment outcome. The study noted that cryotherapy, among the different options available for the treatment of keloid scars, was an effective treatment modality for keloids of recent onset, especially smaller lesions. The most important factors affecting outcome with cryotherapy included the duration and thickness of the keloid scars. The average keloid flattening was noted at around 31% and 58% at 3 and 6 sessions, making it a timely process. In the keloid study, a total of 55% of patients noted a cosmetic improvement in the keloids. Nine out of eleven patients noted an improvement in itching, and 73% of patients noted the improvement to be good to excellent. The most common side effects of cryotherapy for keloids includes procedural pain and lesional depigmentation. The study also noted that the therapeutic effect of cryotherapy for keloids depends on freezing induced damage to the keloid tissue. Freezing induces vascular damage and circulatory stasis that leads to anoxia and necrosis. An average flattening of 58% was noted in one month after 6 sitting of cryotherapy. Almost all patients who underwent cryotherapy for keloids noted some lesional depigmentation of the skin.
QUESTIONS ABOUT KELOID REMOVAL IN LOS ANGELES?
- Do I need surgery to correct chest keloids?
- How common are keloid scars on the chest? Chest keloids are common after acne breakouts or surgery. Most of these chest keloid cases do not require surgery, but can be managed with a combination protocol developed by Dr. Raffy Karamanoukian.
- Can keloid scars occur in all ethnic types? Keloid scars are found in all ethnicities and skin types, from light colored skin to dark skin. Contrary to popular belief, keloids are not most common in patients with dark skin. We encounter patients from all ethnicities in our Los Angeles clinic. In fact, many of our patients are of Asian or Caucasian descent.
- How common are keloids in the Asian population? Many of our patients are of Asian descent. In our practice, we see many cases of acne keloids in Asians, particularly on the chest and back. In addition, immigrants who have had vaccinations on their shoulders in foreign countries commonly develop keloids.
- Are keloid scars genetic if there is a family history of keloids in my family?
- Is it possible for my keloid scars to recur? There is a lifetime risk of recurrence if you have keloids. The objective of our treatments is to reduce the size of the keloid and its rate of recurrence.
- What are the benefits of cryotherapy for keloid scars? Keloid scars can occur on any part of the body and have high recurrence rates. Recurrence mean that once the keloid is effectively removed and destroyed, there may be a chance that the keloid may grow back if left alone. For patients who have keloid problems and have found no long term solutions, Dr. Raffy Karamanoukian has several options that may benefit these recurrent keloids. The alternatives to surgical removal of keloids include IIT, pressure management, intralesional injections, laser therapy of keloids, and cryotherapy. Cryotherapy has received new sound support in the management of keloids and is an important modality for the treatment of recurrent keloids that should not undergo further surgical repair. The downtime of the cryotherapy include tissue swelling and tissue necrosis and the patients are advised to learn more about the alternatives to cryotherapy if they have a keloid on a very noticeable part of the face. Cryotherapy is an appealing option for keloid sufferers and can be used effectively alone or in combination with ancillary keloid procedures.
- Why is laser therapy important for keloids? Keloids are often associated with inflammation and proliferation of fibroblast within the skin. The entire inflammatory process may recruit blood vessels to feed the keloid, causing the characteristic redness and itching that is associated with an inflamed keloid. The treatments of keloid begins with a reduction in the inflammatory process wherein the redness and itching is reduced, therein reducing the size and severity of the keloid scars. If a surgeon can reduce the growth phase of a keloid, there is a potential for long term treatment. Most keloids are responsive to a combination of IIT, intralesional injections, pressure management, and laser. Laser remains an important and effective modality for the treatment of keloid scars as it can reduce the inflammatory cycle and reduce redness in the process. A vascular laser is employed that can destroy the feeding blood vessels to the superficial keloid.