Straightforward answers to common scar & keloid questions.

A keloid is a type of raised scar that grows beyond the boundary of the original wound and doesn't regress on its own. Unlike hypertrophic scars, which stay within the wound margin and often flatten over time, keloids keep expanding into surrounding skin. They're driven by an overactive wound-healing response with excess collagen deposition.

Keloids are more common in people with darker skin tones and often run in families, suggesting a genetic component. They most often form on the ears, chest, shoulders, and upper back, especially after skin trauma, piercings, acne, or surgery.

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There is no single standout for every keloid. Current clinical guidelines favor combination approaches — for example, steroid injections plus silicone sheets, or surgical excision plus post-op radiation — because monotherapy tends to have higher recurrence. The right choice depends on scar size, age, location, and what you've already tried. A dermatologist can match the protocol to your situation.

Steroid injections often produce softening within 4-6 weeks and visible flattening over 3-6 months. Silicone sheets and pressure therapy show results over 3-6 months. Surgical excision produces immediate volume reduction but the real outcome is judged at 12-24 months based on recurrence. Red light and pressure options require months of consistent use.

Recurrence is common, which is why combination protocols exist. Surgery alone can recur in up to 100% of cases. Post-op radiation, long-term pressure therapy, or follow-up steroid injections bring recurrence down to around 10-30% in many studies. Expect a maintenance phase after any major intervention.

The evidence for red and near-infrared light on keloids specifically is still emerging. Laboratory data and small clinical studies suggest benefits for scar redness, itch, and texture, but high-quality randomized trials focused on keloids are limited. Consider it a low-risk adjunct, not a primary therapy.

The most commonly studied wavelengths are 630-660 nm (red) and 810-850 nm (near-infrared). A device that offers both ranges gives you flexibility. Beyond wavelength, irradiance at your treatment distance, flicker, and beam angle affect real-world dosing. Independent irradiance testing matters more than marketing.

Steroid injections and medically necessary excisions are often covered when documented as treatment for a symptomatic keloid. Silicone sheets, red light therapy, and some adjunct treatments are usually considered cosmetic and paid out of pocket. Coverage varies by payer — ask your dermatologist's billing office to verify in advance.

Silicone sheets or gel, pressure therapy (clips and garments), and red or near-infrared light therapy are the main home-use options. They work best as adjuncts to clinical care or as prevention after minor skin injury. Large, symptomatic, or long-standing keloids usually need clinical intervention.

If you're prone to keloids, prevention is the highest-leverage play. Start silicone sheets or gel as soon as the wound is closed, minimize tension across the scar, and ask your surgeon about pressure therapy or low-dose post-op steroid injections for high-risk sites (chest, shoulders, ears).