July 19 2005, 4:16 pm PT | Posted in: Scarring
I have a bad elevated, thick scar from my hair transplant incision. I was told by my doctor that this is a keloid scar. Can you explain this to me and what it means if I ever have another surgery?
In medicine, we always talk about the differential diagnosis of a particular problem or disease. Scars come in many flavors and we are focusing upon healing wounds with this question. Some scars stretch, some get red for a short period of time, some hold their redness for weeks (even months), others get elevated and some form tumor type growths which grow from them – the keloid scar. Many people, even some doctors use the term keloid scars when they are not really understanding what a keloid is. The keloid has become famous from photos in the annals of National Geographic, showing people creating these grape like tumors by cutting into the ears and applying a chemical irritant which produces the keloids. When keloids are found naturally in wounds, they are most often found in the darker skinned races. Doctors have been polled reflecting the cumulative experience of tens of thousands of patients, and keloids are almost unheard of when we talk about scalp scars. When a keloid exists, it is a proliferative process in which the scar significantly exceeds the boundaries of the original wound and is significantly elevated and often globular. Hypertrophic scars can be elevated or simply a thick scar. Burn scars can also be hypertrophic, but rarely keloidal. The trunk and shoulders develop widened and hypertrophic scars quite commonly after mole removal, and this would not be a contraindication for elective surgery. I have done scalp surgery on people who are known keloid formers, but I have never seen one appear in the scalp from which the donor area is harvested.