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         Keloid Treatment Center

 Acne keloidalis nuchae (AKN) is a condition characterized by follicular-based papules and pustules that form hypertrophic or keloid-like scars. AKN typically occurs on the occipital scalp and posterior neck and develops almost exclusively in young, African-American men

                                      What is Keloid Scarring 


Keloids are highly visible, exaggerated scars that are particularly common in darker skin. They can develop after surgery, after major skin trauma, or even after very minor skin damage like acne scars. Strangely, they may also develop even if there’s no obvious damage to the skin at all. They are shiny and hairless, feel hard and rubbery and usually occur on the upper chest and shoulders – particularly over the breastbone – and on the earlobes. In people with dark skin they often occur in the beard area and on the scalp.

There is a whole range of different ways in which people scar, the poorest types of scarring are Hypertrophic and Keloid Scarring.

Cicatrix, Keloid scar

A scar is a permanent patch of skin that grows over a wound. It forms when your body heals itself after a cut, scrape, burn or sore. You can also get scars from surgery that cuts through the skin, from infections like chickenpox, or skin conditions like acne. Scars are often thicker, as well as pinker, redder or shinier, than the rest of your skin.

   Hypertrophic Scarring



 This is a form of heavy scarring that appears around a wound; this type of scarring would be slightly raised, red and perhaps itchy for a few months, importantly the scar will never be bigger than the wound itself. These generally become flatter and paler with time. Hypertrophic scars develop within a month of receiving the wound and may take several months to retract.

Keloid Scarring

These may be similar at first but whereas a hypertrophic scar will not go outside of the boundaries of the wound a Keloid scar would, patients can have a single keloid or a number of them. 

Keloid scars do not stop growing and spread outwards away from the site of the original wound and the scar can often become far bigger than the actual wound. The exact causes of keloids is not fully understood, but it is an abnormality of wound healing. A problem in Keloid scarring is that the fibroblasts that produce collagen to make a scar, over produce collagen and the keloid continues to grow. They may not appear right away and can often begin to develop months after the initial wound has been made. Keloids are made up of dense fibrous tissue (made up of collagen), where the collagen fibres are both thicker and bigger than those found in normal scarring.

Keloid Scarring

In normal scarring the scar you get is dependent upon the wound, Keloids differ and in people susceptible to them they can occur after very minor skin damage such as piercings, acne spots, cuts from shaving and even scratching. Keloids are usually hairless and raised, they may be shiny and when you feel them can be hard and rubbery. The number of keloids someone can get can vary, from one or two to many depending. These can be diagnosed by Dr. Gary  just by looking and examining them. It is important to remember that Keloids are not contagious and are totally benign and there is no risk of these becoming cancerous.

Examples of Keloids

Who gets Keloid Scarring

Anyone at any age can get keloid scarring. But studies have shown that there are some skin types and ages were keloids are more common and it has been found that there is a higher incidence of keloids between the ages of Keloids 10 and 30 years, with the average age of keloid sufferers being in their early 20's they are not so common in the elderly and children, and equally common in men and women, although women in general may have more keloids due to a higher incidence of piercings.

Dr. Gary is a world authority on the management of difficult keloid scars on the face.  

 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. Gary uses a specific keloid protocol that he has developed that targets the fibroblast and hastens resolution of the keloid with a combination modality of 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. Gary  is a minimally-invasive cosmetic surgeon and cosmetic dermatologist 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. Gary 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 earlobe keloids, schedule a consultation with one of the foremost authorities in keloid reconstruction. 

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 Dermatology and Cosmetic  Surgery
 office,  Dr. Gary  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  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. Gary 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 re sutured in order to begin conservative IIT and pressure therapy.
In our Park Avenue practice, we specialize in linear keloid management and linear keloid surgery. 

Most patients with linear keloid scars do not require more aggressive therapy such as radiation therapy or chemotherapy 5 FU. 

 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. 
Keloid treatment should be performed under the expert management of Dr. Rothfeld a world expert in keloid development and care. He has demonstrated his unique and uncompromising approach to keloid scars.
 Flat Keloids:
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.  
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. Gary  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.
Bleeding keloids:
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, pressure treatment, and laser may suffice.
Itching Keloids:

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. 

 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  Park Avenue 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.  
 Laser keloid treatment, surgical keloid treatment, and cortisone keloid treatment are all considered viable options.  In addition, Dr. Gary 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 we 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. Rothfeld , 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 long lasting approach to keloid treatment is begun. In our vast experience with keloids, we have found the therapies to be long lasting 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. Gary 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. 

It has also been found that certain skin types are also more susceptible to Keloid formation. With there being a higher incidence in both darker skin types such as Afro-American and South Asians and well as very fair individuals, up to15% of darker skinned ethnicities are at risk of developing keloids.. 

Although it is important to note that any skin type can still develop keloids. Family history is also important and currently evidence is pointing to there being a genetic cause involved in keloid formation, and if a family member has them you are more likely to develop them and even more so if a twin has developed keloids.

Who gets Keloid Scarring

Where people get Keloid Scarring

Keloids can occur anywhere where there is trauma to the skin and are frequently seen in locations where there have been piercings such as the ear lobes. It is thought that stretching of the skin may increase keloid formation where a wound has occurred, and sites where keloids commonly form are often subject to stretching and tension with the exception of the ear where there are piercings.

Otherwise they can occur commonly on the front of the chest, neck, shoulder, scapular and suprapubic region (the area between your groin and your stomach). It is also possible for keloids to occur spontaneously, these also can be anywhere but have a predisposition of occurring on the chest.

What they look like

The majority of the symptoms caused by keloids are cosmetic but the scar can sometimes be tender to touch and painful, especially around the edges. It may also be itchy and occasionally bleed.

Keloids grow outside the boundaries of the original site of trauma and is likely to raised, it often feels rubbery, is shiny and irregular. The colour of the keloid can often change with time and usually is red in the early stages and changes with age becoming paler and brown.

If the keloid is over a joint, such as the elbow or knee it can also restrict movement.

Keloids can continue growing from months to years, and although growth is usually slow it can be rapid in some patients. Although they do not regress spontaneously without treatment they may stop growing.

Some scars grow lumpy and larger than the wound they are healing. This is called keloid scarring. It can happen to anybody, but is more common in people with dark skin, such as people from African, African-Caribbean and south Indian communities.

The body's tissue naturally heals itself when it is damaged. This healing process can cause scars to appear. 
If the skin is broken (for example, by a cut, bite, scratch, burn, acne or piercing), the body produces more of a protein called collagen.  

What are keloid scars?
Collagen gathers around the damage and builds up to help the wound seal over. The resulting scar usually fades over time, becoming smoother and less noticeable.

However, some scars don't stop growing. They invade the surrounding healthy skin and become bigger than the original wound. These are known as keloid scars.

Some scars become red and raised within the size of the original wound. These are called hypertrophic scars. Find out more about hypertrophic scars.

A keloid scar is an overgrown scar that can spread outside the original area of skin damage. Keloid scars are shiny and hairless, they're raised above the surrounding skin, and can feel hard and rubbery.

Keloids affect around 10-15% of all wounds. They can appear anywhere on the body, but usually form on the shoulders, head and neck.

They can last for years and sometimes don't form until months or years after the initial injury. 

New keloid scars are sometimes red or purple. They're not usually painful, but some people feel embarrassed or upset if they think the scar is disfiguring them.

Who gets keloid scars?
Keloid scars can affect anyone, but some people are more likely than others to get them. People with dark skin get keloids much more easily than people with fairer skin, and it's common in people with black skin.  It's thought that keloid scarring may run in families.

Keloid scars can develop after even a very minor injury. Burns, acne scars and wounds that get infected are particularly likely to form keloids.

You're at higher risk of getting a keloid scar if you have had one before.

Can I reduce the risk?
You can't stop a keloid happening, but you can avoid any deliberate cuts or breaks in the skin, such as tattoos or piercings, including on the ear lobes.

What is the treatment for keloid scars?
There are several treatments available, but none have been shown to be more effective than others. Treatment can be difficult and isn't always successful. 

Treatments that may help flatten a keloid include:
steroid injections
applying steroid-impregnated tape to the area for 12 hours a day
applying silicone gel sheeting to the area for several months
Intralesional cortisone injections are first-line therapy for most keloids.  30 years of experience I have found that many of my patients  respond well to the keloid injections. 

Following injection treatments, Fraxel laser keloid scar removal can improve the keloid scar remnants in most patients. 

Scar removal surgery is not recommended except in Keloid removal of the earlobe because it may create similar or worse scars than the one being treated. 

Other options are:
Freezing early keloids with liquid nitrogen(Cryosurgery) (Cryotherapy) to stop them from growing
Laser treatment to lessen redness 
Surgery (Cold Steel Excision) (Keloid Earlobes) to remove the keloid with 6 steroid injections done 1 week apart then wearing Cordran tape (steroid tape)  for the next year to prevent recurrence.
treatment for keloid scars varies. There is no one simple cure for keloid scars. Recurrence after treatment is common. Treatment may include the following:

Steroid injections. Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to decrease the size of the scar and soften the scar tissue.

Cryotherapy. Cryotherapy involves the scar being frozen off.

Pressure therapy. Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to 4 to 6 months.

Silicone dioxide. Applied in the form of a gel or pad, this can help soften and decrease the redness of keloids. 

Surgery. If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Surgery is not performed often on hypertrophic scars and keloids due to the high rate of recurrence. 

Another option is laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy. Pulse dye laser is a good choice to use for keloids. 

Radiation. This can be used for scars that do not respond to other treatments.

Hypertrophic scars. Hypertrophic scars are similar to keloid scars; however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.

In treating hypertrophic scars, steroids may be the first line of therapy, although there is not 1 simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to 2 years after the surgery to help maximize healing and decrease the chance of the scar returning. Like keloids, hypertrophic scars may respond to topical silicone dioxide application.

Contractures. Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement.

There are many different surgical treatment options for contractures, including the following:

Skin graft or skin flap. Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when the area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.

Z-plasty. A Z-plasty is a type of procedure that is used to revise a scar by using a Z-shaped incision to help decrease the amount of contractures of the surrounding skin. It also may attempt to relocate the scar so that its edges look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.

Tissue expansion. Tissue expansion is a newer technique being used. It involves a process that increases the amount of existing tissue available for reconstructive purposes. This procedure is often used in addition to the flap surgery.

Adhesions. Another type of scarring, called adhesions, may form between unconnected internal organs. Adhesions may cause complications during certain surgeries.

Recovery from scar revision surgery

As with all surgeries, it is important to follow all instructions to help maximize recovery and healing. Your physician will advise you on all activity restrictions, depending on the type of surgery that was performed. Scars cannot be removed completely. Many factors will be involved in the degree of healing of your particular scar. Some scars take more than a year to show improvement in appearance following surgery.

If you're bothered by a keloid scar and want help
Please Call Today (212) 644-4484

How your scar looks depends on 

How big and deep your wound is 
Where it is 
How long it takes to heal 
Your age 
Your inherited tendency to scar 
Scars usually fade over time but never go away completely. If the way a scar looks bothers you, various treatments might minimize it. These include surgical revision, dermabrasion, laser treatments, injections, chemical peels and creams. Dr. Gary is a board certified dermatologist who can evaluate you for the proper treatment at the Keloid NYC Treatment Center in New York, NY

New York Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.  A Park Avenue practice with an international reputation in general, cosmetic, and surgical dermatology.

Dr. Rothfeld, recognized by the entertainment industry of America as one of the best dermatologists who has treated some of Hollywood's hottest faces and world renowned for his contributions for many of today's cosmetic procedures has organized a comprehensive skin care center offering personalized state of the art services including medical, pediatric, and cosmetic dermatology.  Every treatment is customized to fit each patient's needs. 

I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicians often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their hair and skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results 

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Dr. Rothfeld, recognized by the by the entertainment industry of America as one of the best dermatologists in Manhattan, has organized a comprehensive skin care center offering personalized state of the art services including medical,pediatric, and cosmetic dermatology. 
New York Dermatology serves the following neighborhoods within New York (NY), which are in close proximity to our office:
Upper East Side Dermatology, Fifth Avenue Dermatology, Park Avenue Dermatology, Madison Avenue Dermatology, Upper West Side Dermatology, Midtown Dermatology, Lower East Side Dermatology,Chelsea Dermatology, Gramercy Park Dermatology, Murray Hill Dermatology,  Greenwich Village Dermatology, East Village Dermatology, West Village Dermatology, Soho Dermatology, Tribeca Dermatology, Meatpacking District Dermatology, Sutton Place Dermatology, Wall Street Dermatology, Hells Kitchen Dermatology, and the boroughs of Brooklyn Dermatology , Bronx Dermatology, Queens Dermatology and Staten Island Dermatology.
Dr. Gary Rothfeld is recognized as one of the best Dermatologist in New York, NY, Manhattan, NYC, New York City and the nation by the entertainment industry in the United States of America. At New York Dermatology headed by board certified Dermatologist Dr. Rothfeld, sees patients  7 days a week including Saturday and Sunday.
                  We accept all credit cards  as well as debit cards for payment of services.

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Board Certified Dermatologist