Q1

Why do keloids often recur after simple surgical excision?

The recurrence rate of keloids after simple excision is very high. Dr. Sun Bianyou, the president of Bakkang Medical, stated at the conference: "Keloids are not over after being cut. The root cause is a problem with the skin's healing mechanism; fibroblasts are too 'excited.' If you cut it out, it will grow back."

Dr. Zhang Liang from Wuhan First Hospital also recalled that their team used to "aggressively excise scars" many years ago, but many patients experienced recurrence. "Simple surgery is like pulling out weeds without removing the roots; they will grow back after a while."

Therefore, the current consensus in the industry is that surgery is just the first step. Post-surgery, it must be combined with superficial radiotherapy. By using low-dose radiation during the wound healing period, the overactive cells can be "suppressed," significantly reducing the recurrence rate.

Q2

Do early, newly formed red hypertrophic scars need radiotherapy?

Not necessarily. Dr. Sun Bianyou, in response to Professor Huang Lei's question, clearly stated: superficial radiotherapy is effective but not the first choice.

For early, bright red hypertrophic scars, the preferred treatments are often pulsed dye laser or intense pulsed light, which are very effective in reducing redness. Only when laser and drug injection methods fail to control the scar, or when the scar is particularly thick and the risk of recurrence is very high, would superficial radiotherapy be considered.

In short: start with gentle treatments, and if they don't work, then use the "heavy weapons."

Q3

With so many methods available, such as injections, lasers, and punch grafting, which one is the most suitable for me?

There is no "one-size-fits-all solution." Dr. Wang Yong from Wuhan University People's Hospital shared his experience with punch grafting: punch grafting is particularly suitable for multiple, scattered small nodules, or those located in areas with high tension, such as joints or the dorsum of the foot, where large incisions are not feasible. Its advantages are minimally invasive, quick recovery, and the ability to treat dozens of points in one session, making it popular among students and working professionals.

For large, thick, and functionally impairing keloids, Dr. Wang Liang from Bakkang Medical uses "scar grafting": the excised nodule is thinned and re-implanted, solving the problem in one go without the need to take additional skin from healthy areas.

So, there is no best method, only the most suitable one for your specific situation. It is recommended to consult an experienced doctor for a personalized treatment plan.

Q4

Can eyelid scars that prevent complete eye closure be treated without surgery?

Yes. Dr. Hou Kai from Tongji Hospital, Huazhong University of Science and Technology, presented several cases of non-surgical treatment for eyelid scar contracture.

He used a combination of vascular and fractional lasers, subcutaneous release, and lid margin traction, successfully restoring eyelid closure function for many patients and avoiding surgical intervention. This approach is especially effective for vertical eyelid scars caused by trauma, especially with early intervention.

Therefore, not all eyelid scars require surgery; timely laser relaxation can also solve the problem.

Q5

Why is postoperative follow-up a critical part of scar treatment?

Dr. Li Huijun from Bakkang Medical Wuhan Branch illustrated the necessity of follow-up with a real case: a patient developed a small folliculitis after treatment, and the follow-up staff notified him to use medication, but he did not pay attention. Two years later, the folliculitis grew into a large nodule.

"Follow-up is not harassment; it's like having someone 'keep an eye on things' for you," said Dr. Li. Bakkang's follow-up system requires patients to regularly upload photos, allowing doctors to detect abnormalities, such as localized redness, elevation, or new small spots. "Early detection and intervention can control the issue with just a few days of medication. If it grows larger, it will be more expensive, painful, and less effective to treat."

Therefore, if a responsible doctor asks you to follow up, please cooperate. This is truly a "lifetime insurance" for the treatment's effectiveness.