Keloid Treatment Abroad: Scar Management Guide 2025

Understanding Keloids

Keloids are abnormal, excessive scar formations that extend beyond the boundaries of the original wound, resulting from an overactive wound healing response characterized by excessive collagen deposition. Unlike hypertrophic scars, which remain within the wound margins and often improve over time, keloids grow progressively beyond the original injury site, can continue to enlarge for years, and rarely resolve spontaneously. Keloids can be painful, itchy, cosmetically disfiguring, and functionally restrictive, particularly when they occur over joints or in areas subject to tension. The condition has a strong genetic predisposition, with keloid formation being 15 to 20 times more common in individuals of African, Asian, and Hispanic descent compared to Caucasians.

Keloids can develop from virtually any type of skin injury including surgical incisions, acne, piercings, burns, vaccinations, insect bites, and even minor scratches. Common locations include the earlobes, chest, shoulders, upper back, and jawline. The unpredictable nature of keloid formation means that some patients develop keloids after minor injuries while others heal normally after major surgery. Once a keloid has formed, treatment is challenging because the excessive wound healing response that created the keloid can also be triggered by the treatment itself, leading to keloid recurrence after surgical excision — a frustrating cycle that has historically made keloid management one of the most difficult problems in dermatology.

The cost of keloid treatment in the United States varies widely depending on the approach used, ranging from $200 to $600 per intralesional steroid injection session to $1,000 to $5,000 or more for surgical excision with adjuvant therapy. Comprehensive keloid management programs spanning several months of multimodal treatment can cost $3,000 to $10,000 or more. International dermatology centers offer the same treatment options at 50 to 78 percent lower cost. Acıbadem Maslak Hospital in Istanbul provides comprehensive keloid management programs combining the most effective treatment modalities under the guidance of experienced dermatologists who understand the unique challenges of treating this condition.

Keloid Treatment Options

Intralesional corticosteroid injection with triamcinolone acetonide is the most widely used and evidence-based treatment for keloids. The steroid is injected directly into the keloid tissue, where it inhibits collagen synthesis, promotes collagen degradation, and reduces inflammation, resulting in progressive flattening and softening of the keloid over multiple treatment sessions. Sessions are typically performed every three to four weeks for a series of three to six injections, with most keloids showing significant improvement. The technique requires expertise to achieve adequate drug distribution throughout the keloid while avoiding atrophy of surrounding normal tissue. At Estethica Ataşehir Hospital, dermatologists experienced in keloid management perform these injections with precision, often combining them with cryotherapy for enhanced efficacy.

Surgical excision alone has historically been associated with keloid recurrence rates of 50 to 80 percent, as the surgery itself triggers the same abnormal wound healing response that created the original keloid. However, when combined with adjuvant therapies administered immediately after surgery and during the healing period, recurrence rates can be reduced to 10 to 30 percent. The most effective adjuvant therapies include intralesional steroid injection beginning on the day of surgery and continuing monthly for six months, superficial radiation therapy delivered within 24 to 48 hours of excision, and silicone sheeting with pressure therapy beginning after wound closure.

Laser therapy using pulsed dye laser targets the vascular component of keloids, reducing redness, pruritus, and pliability while promoting remodeling of the excessive collagen. Fractional CO2 laser can improve the texture and height of keloids and may also enhance the penetration of topical treatments applied to the keloid surface. Cryotherapy, either alone or in combination with intralesional steroids, provides another effective approach, with intralesional cryotherapy (needlepoint cryoprobe inserted directly into the keloid) showing particularly promising results for large or resistant keloids. At Acıbadem Maslak Hospital, the dermatology team offers all these modalities and develops individualized treatment plans based on the keloid's size, location, age, and the patient's treatment history.

• Intralesional corticosteroids — first-line, flattens and softens keloids
• Surgical excision + adjuvant — for large keloids, with steroid or radiation
• Pulsed dye laser — reduces redness, itch, and promotes remodeling
• Cryotherapy — freezing to destroy keloid tissue
• Superficial radiation — post-excision adjuvant to prevent recurrence
• Silicone sheeting — compression therapy for prevention and treatment
• 5-FU injections — antimetabolite for resistant keloids
• Pressure earrings — for earlobe keloids post-excision

Cost Comparison for Keloid Treatment

Keloid Treatment Cost Comparison 2025

Multiple sessions required for most treatments. Combination approaches yield best results and lowest recurrence rates.

Turkey provides excellent value for keloid treatment, with steroid injection sessions at $50 to $150 and comprehensive excision with adjuvant therapy at $300 to $1,000 per keloid. A six-month comprehensive keloid management program including multiple injection sessions, laser treatments, and close follow-up costs $800 to $2,500 in Turkey compared to $3,000 to $10,000 in the US. For patients with multiple keloids requiring extended treatment, the cumulative savings make international treatment particularly attractive.

Combination Therapy for Best Results

The most effective keloid treatment strategies combine multiple modalities to address different aspects of the keloid pathophysiology simultaneously. A typical comprehensive approach for a moderate to large keloid might include surgical excision to debulk the keloid, immediate post-operative radiation therapy to suppress the fibroblast proliferation that drives recurrence, intralesional steroid injections beginning two weeks after surgery and continuing monthly for six months, and silicone sheeting or pressure therapy for ongoing scar management. This multimodal approach achieves the lowest recurrence rates, typically 10 to 20 percent, compared to 50 to 80 percent with surgery alone.

For keloids that are not candidates for excision, or for patients who prefer non-surgical management, a combination of intralesional steroid injections with cryotherapy and pulsed dye laser treatments can achieve significant improvement in keloid size, height, redness, and symptoms. The cryotherapy is performed immediately before the steroid injection, with the ice crystal formation in the keloid tissue enhancing drug penetration and distribution. Pulsed dye laser sessions are interspersed between injection sessions to address the vascular component. This approach is available at Acıbadem Maslak Hospital and typically achieves 50 to 80 percent improvement in keloid volume and symptoms over a course of three to six months.

Preventing Keloid Recurrence

Recurrence prevention is the greatest challenge in keloid management, as the underlying predisposition to excessive scar formation persists throughout the patient's life. After successful treatment of a keloid, ongoing preventive measures are essential to minimize the risk of regrowth. Silicone gel sheeting or silicone gel applied to the treated area for six to twelve months after treatment helps maintain pressure on the scar and modulate the healing response. Pressure therapy using custom-made garments or compression earrings for earlobe keloids provides continuous mechanical pressure that inhibits collagen overproduction.

For patients known to be keloid-prone, prevention of new keloid formation is equally important. This includes avoiding unnecessary skin injuries such as elective piercings, tattoos, and non-essential cosmetic procedures; treating acne aggressively to prevent inflammatory scarring; applying silicone gel to all new wounds immediately after closure; and seeking early dermatological evaluation for any wound that shows signs of excessive scarring. When surgery is medically necessary, keloid-prone patients should discuss preventive strategies with their surgeon before the procedure, including meticulous wound closure technique, post-operative steroid injection, and early silicone therapy.

My chest keloid had been growing for five years despite multiple steroid injections. The dermatology team in Istanbul combined excision with radiation and a six-month steroid injection course. Two years later, the keloid has not returned. The comprehensive treatment cost me $2,000 versus over $8,000 quoted in the US.

James O., keloid patient from the UK

Frequently Asked Questions