Keloids are treated by dermatologists, plastic surgeons, and occasionally general surgeons, typically in outpatient clinic or office settings. The best place to start is with a board-certified dermatologist who has experience treating scars, since most keloid treatment begins with non-surgical options and only moves to excision when those don’t work. Where you go and what treatment you receive depends on the size, location, and severity of your keloid.
Which Specialists Treat Keloids
Dermatologists are the most common first stop for keloid treatment. Many offer steroid injections, cryotherapy, and laser treatments right in their office. For keloids that need surgical removal, a dermatologist trained in skin surgery or a plastic surgeon is typically the next step. Some dermatologists specialize in both, handling everything from injections to excision in one practice.
Plastic surgeons become especially relevant for large keloids in visible or tension-prone areas like the chest, shoulders, or jawline. These areas require careful surgical planning to minimize tension on the wound, which is a major factor in whether the keloid comes back. If radiation therapy is recommended after surgery, you may also be referred to a radiation oncologist for follow-up sessions.
Look for providers who specifically list keloid or scar treatment in their practice. General dermatologists can handle straightforward cases, but complex or recurring keloids benefit from someone who regularly deals with them. University medical centers and academic dermatology departments often have scar clinics with multi-specialty teams.
Non-Surgical Options That Come First
Most providers will try non-surgical treatments before recommending excision, and for good reason: surgery alone has a recurrence rate of 45% to 100%. Steroid injections are the most widely used first-line treatment. A corticosteroid is injected directly into the keloid to flatten and soften it, typically once a month for up to six months. The concentration is adjusted based on the keloid’s size and location, with larger keloids on the trunk or limbs generally requiring higher doses. In one long-term study, four injections led to full flattening in 71% of treated keloids.
Cryotherapy freezes the scar tissue, and there are two types worth knowing about. Surface cryotherapy sprays liquid nitrogen on top of the keloid, which works for small keloids but only freezes the outer layers. Intralesional cryotherapy uses a needle probe inserted into the keloid to freeze it from the inside out, which is significantly more effective. Studies show intralesional cryotherapy reduces scar volume by roughly 50% to 65% after a single treatment, compared to about 23% with surface freezing. Non-response rates are low, between 3% and 7%.
Laser treatments can reduce redness and improve texture but are generally used alongside other therapies rather than as standalone treatments.
When Surgery Is Recommended
If steroid injections and cryotherapy haven’t worked, your provider may recommend surgical removal. This is almost always combined with additional therapy to prevent the keloid from growing back. The combination matters enormously. Surgery alone fails the majority of the time, but newer techniques that shave the keloid from within (called intralesional excision, which removes scar tissue while preserving the outer skin) have brought recurrence rates down to around 13% in pooled research data covering over 600 keloids.
Superficial radiation therapy after surgical excision is one of the most effective combinations available. Low-dose radiation is applied to the surgical site in the days following removal, which disrupts the overactive wound-healing process that causes keloids to form. This approach has shown strong results in reducing recurrence, though protocols for dosing and number of sessions still vary between providers. Radiation is generally not used for children or pregnant women.
For chest keloids, surgeons often follow a size guideline: if the keloid is under about 6 centimeters tall, it can typically be excised and closed directly. Larger keloids may need a local skin flap to close the wound without excessive tension.
What to Expect After Removal
Post-removal care is just as important as the procedure itself. Stitches come out around 7 to 10 days after surgery. You’ll likely be given compression garments or pressure dressings to wear over the site, and consistency with these is critical. Compression dressings need to be worn 12 to 24 hours a day for 4 to 6 months to be effective. For ear keloids, custom pressure earrings serve the same purpose.
Many providers also prescribe silicone gel sheets or a corticosteroid ointment to massage into the scar twice daily. If mild thickening appears in the weeks after surgery, scar massage and continued pressure therapy can often resolve it without further intervention. Recurrences that do develop are usually caught within the first year and can be managed with steroid injections.
Insurance Coverage for Keloid Removal
Insurance coverage depends on whether your keloid is classified as a medical issue or a cosmetic concern. Keloids that cause pain, itching, restricted movement, or functional problems are more likely to be covered as medically necessary. Medicare and most private insurers follow similar logic: if the keloid is asymptomatic and poses no threat to health or function, removal is considered cosmetic and won’t be covered.
If your keloid causes symptoms, make sure your provider documents them thoroughly. Notes about pain, itching, tenderness, interference with clothing or movement, and any previous treatments that failed all strengthen a medical necessity case. Your provider should be able to tell you before the procedure whether they expect insurance to cover it. If the claim is denied, the documented symptom history becomes the basis for an appeal.
Out-of-pocket costs vary widely depending on the treatment type and location. Steroid injections are on the lower end, while surgical excision combined with radiation therapy is significantly more expensive. Getting a clear cost estimate upfront, especially if you’re paying out of pocket, helps you compare options between providers.
Finding the Right Provider
Start by searching for dermatologists or plastic surgeons in your area who specifically mention keloid treatment. Hospital-affiliated practices and academic medical centers tend to offer the widest range of treatment options, including radiation therapy, which standalone clinics may not have on-site. If you’re in a rural area, telehealth consultations with scar specialists can help you get an initial assessment and treatment plan before traveling for a procedure.
During a consultation, ask what combination approach the provider recommends and what their recurrence rates look like. A provider who plans to excise a keloid without any adjuvant therapy is a red flag. The current standard of care involves combining surgery with at least one additional treatment, whether that’s steroid injections, radiation, or compression therapy. The goal isn’t just removal; it’s removal that lasts.