Aesthetic Approach to Refractory Auricular Keloid: Combining Laser Excision and Intralesional Corticosteroids
Kai Sun Teo and Kenneth Lee*
Dr Plus Aesthetics Clinic, Johor Bahru. Malaysia
*Corresponding author: Kenneth Lee, Dr Plus Aesthetics Clinic, Johor Bahru. Malaysia
Citation: Teo KS, Lee K. Past, Aesthetic Approach to Refractory Auricular Keloid: Combining Laser Excision and Intralesional Corticosteroids. Genesis J Surg Med. 5(1):1-07.
Received: April 11, 2026 | Published: April 23, 2026
Copyright© 2026 Genesis Pub by Teo KS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are properly credited.
DOI: https://doi.org/10.52793/GJSM.2026.5(1)-43
Abstract
Background: Auricular keloids remain a therapeutic challenge due to their high recurrence rates and resistance to monotherapy, particularly in aesthetically sensitive areas.
Case Presentation: A 32-year-old Asian woman presented with a 5-year history of a refractory keloid over the left auricular helix measuring 3 × 2 cm following ear piercing. The lesion persisted despite multiple sessions of intralesional corticosteroid therapy, with minimal clinical improvement.
Intervention: A multimodal treatment strategy was implemented, consisting of laser-assisted excision followed by immediate and serial postoperative intralesional triamcinolone acetonide injections.
Outcome: The combined approach aimed to achieve complete lesion removal while suppressing fibroproliferative activity to reduce recurrence risk and optimize cosmetic outcome.
Conclusion: This case highlights the efficacy of a combined surgical and pharmacologic approach in the management of refractory auricular keloids. Multimodal therapy remains essential in achieving durable results and satisfactory aesthetic outcomes in high-risk lesions.
Keywords
Auricular keloid; laser excision; intralesional corticosteroids; triamcinolone; aesthetic dermatology; scar management.
Introduction
Keloids are benign fibroproliferative scars characterized by excessive collagen deposition extending beyond the original wound margins [1,2]. Auricular keloids frequently arise after ear piercing and are a common concern in aesthetic practice due to their visibility and psychosocial impact.
Management is challenging because single-modality treatments are associated with high recurrence rates. Intralesional corticosteroids remain first-line therapy due to anti- inflammatory and anti-fibrotic effects [3]. However, long-standing or large lesions often respond poorly. Surgical excision alone carries recurrence rates of 50–100% [4], emphasizing the need for adjunctive therapy. Combination strategies—surgery with corticosteroids, silicone therapy, pressure therapy, or radiotherapy—are recommended to reduce recurrence and optimize aesthetic outcomes [5–8]. This report presents a case of a refractory auricular keloid successfully managed with laser excision and intralesional corticosteroids, highlighting a practical multimodal aesthetic approach.
Case Presentation
A 32-year-old Asian woman with no known underlying medical illnesses presented to the aesthetic clinic with concerns about a keloid over her left auricular helix. She reported that the keloid developed approximately five years ago following ear piercing. Since then, the lesion has progressively enlarged. She had previously undergone multiple intralesional injections (likely corticosteroids), but noted no significant reduction in the size of the keloid.
Her main concern was the persistent size of the lesion and her desire for removal, particularly due to work-related requirements and cosmetic reasons. She denied any prior history of aesthetic surgical procedures. There was no history of smoking, alcohol consumption, or known drug or environmental allergies.
On examination, there was a keloid located over the left ear helix measuring approximately 3× 2 cm. The lesion was firm, raised, and well-defined, extending beyond the original site of injury. There were no signs of acute inflammation such as erythema, warmth, or discharge. No tenderness was noted on palpation.
Following a detailed consultation, the patient was offered both conservative and surgical treatment options.
The patient was informed that conservative treatment would involve intralesional corticosteroid (ILSC) injections using triamcinolone acetonide (Shincort) at a concentration of 40 mg/mL. The injections would be administered into the keloid until blanching is observed. This treatment would be given at 3- week intervals, with a total of approximately 8–10 sessions required. She was counselled that this approach would require a longer duration and is expected to gradually reduce the size of the keloid rather than completely remove it.
The second option discussed was surgical removal using laser excision, followed by post- procedural intralesional corticosteroid injections to reduce the risk of recurrence.
She was informed that this approach offers faster results with complete removal of the keloid, but requires wound healing time and will result in a scar. The risks, benefits, and possible complications— including recurrence, infection, and scarring—were thoroughly explained.
After discussing both options, the patient expressed a preference for a faster and definitive treatment outcome due to occupational requirements. She understood the potential risks and complications and elected to proceed with surgical management, consisting of laser excision of the keloid followed by intralesional corticosteroid injections post-procedure. Informed consent was obtained for the treatment and clinical photography.
Figure 1: Preoperative image of left auricular helix keloid. (anterior).
Figure 2: Preoperative image of left auricular helix keloid. (posterior).
Procedure
The procedure was performed under aseptic conditions.
Local anesthesia with lidocaine was administered. Laser-assisted excision was carried out with careful dissection to achieve complete removal of the keloid while preserving adjacent normal tissue.
Immediate intralesional injection of triamcinolone acetonide (40 mg/mL) was administered into the wound margins following excision. The wound was subsequently closed using nylon 3/0 sutures. Hemostasis was achieved, and a topical antibiotic with sterile dressing was applied.
Figure 4: Post suture and left auricular helix keloid successful removed.
Postoperative Care and Follow-up Plan
Postoperative care included standard wound management with instructions to maintain cleanliness and dryness of the surgical site. Analgesics were prescribed as needed.
Serial intralesional corticosteroid injections were planned at 3-4-week intervals based on clinical assessment. The patient was counselled regarding the risk of recurrence and the importance of adherence to follow-up.
Follow-up evaluations were conducted at Day 7, Day 14 ,1 month, and 3 months post- procedure.
Results
Photographic Documentation: Standardized digital photography was performed at each visit using consistent lighting, angle, and background.
Figure 5: Post operatively Day 7.
Figure 6: Post operatively Day 14 and removed S.
Figure 7: Post operatively 3 months.
The postoperative course was uneventful, with satisfactory wound healing observed.
At 3-month follow-up, there was no clinical evidence of recurrence. The aesthetic outcome was favorable, with preservation of auricular contour and minimal scarring.
Discussion
Auricular keloids are challenging due to abnormal fibroblast activity and excessive collagen deposition. Chronic lesions often fail to respond to intralesional corticosteroids alone [3]. Surgical excision provides immediate reduction but is associated with high recurrence when used as monotherapy [4,5].
Laser-assisted excision offers advantages in precision, hemostasis, and tissue preservation in delicate auricular anatomy. Immediate postoperative corticosteroid injections suppress fibroblast proliferation and modulate early wound healing, reducing recurrence risk [5,6].
Evidence supports multimodal therapy as the most effective strategy for refractory keloids [6,7]. In aesthetically sensitive regions, combination therapy optimizes both clinical efficacy and cosmetic outcomes. Patient-centered decision-making is crucial, and in this case, the approach aligned with the patient’s desire for rapid and definitive resolution.
Conclusion
Refractory auricular keloids require a multimodal, individualized approach. Laser excision combined with intralesional corticosteroids can achieve effective lesion control, minimize recurrence, and maintain aesthetic contour. Early recognition of treatment resistance and timely escalation to combination therapy are essential in aesthetic practice.
References
- Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 17(1-2):113-25.
- Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. (2020) The keloid disorder: heterogeneity, histopathology, mechanisms and models. Front Cell Dev Biol. 8:360.
- Robles DT, Berg D. (2007) Abnormal wound healing: keloids. Clin Dermatol. 25(1):26-32.
- Berman B, Flores F. (1998) The treatment of hypertrophic scars and keloids. Eur J Dermatol. 8(8):591-5.
- Ogawa R. (2017) Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci.18(3):606.
- Gold MH, McGuire M, Mustoe TA, Pusic A, Sachdev M, et al. (2014) Updated international clinical recommendations on scar management. Dermatol Surg. 40(8):825-31.
- Davison SP, Mess S, Kauffman LC, Al-Attar A. (2006) Ineffective treatment of keloids with interferon alpha-2b. Plast Reconstr Surg. 117(1):247-52.
- Manuskiatti W, Fitzpatrick RE. (2002) Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 585-nm pulsed dye laser, and combined treatment. Arch Dermatol. 138(9):1149-55
Genesis Scientific Publication is licensed under CC BY-NC-ND 4.0
