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Minimizing Keloid Risk in Facial Surgery


Study authors determine the highest- and lowest-risk areas for keloids on the head and neck and advise surgeons to weigh risk factors before performing elective surgery.

The overgrowth of scar tissue that results in a keloid is not only undesirable in general but an especially negative possible outcome from a cosmetic surgery procedure designed to enhance the appearance.

In an effort to minimize the risk of keloids post cosmetic surgery, plastic surgeons conducted a review of related studies to determine which areas of the head and neck may be more prone to keloid development. The article, “Location Propensity for Keloids in the Head and Neck,” appears ahead of print in Facial Plastic Surgery & Aesthetic Medicine online.

In the study, researchers conducted medical database searches through January 2020, of PubMed, Ovid, Cochrane, and Embase, and had two independent reviewers use a predetermined protocol from which to collect data. A total of 1445 keloid studies were identified. Their final analysis included a total of nine keloid studies.

In total, study authors evaluated 1598 keloids on the head and neck. Their analysis returned the following data:

  • Three studies included 1194 ear keloid locations: 53% lobule, 22.9% cartilaginous region, 0.3% both, and 23.7% unspecified
  • One study included 82 keloids on the neck, the majority of which (72%) were located in the submental/submandibular area
  • Five studies included 322 head and neck keloids, primarily near the ear (70.2%), with much lower percentages in the peri-/post-auricular, beard, scalp/forehead/chin, lateral face, neck, and central face areas

Based on their findings, study authors conclude that keloids are most likely to occur in the ear, periauricular, beard, and submandibular/submental areas. The central face has the lowest risk of keloids.

With this knowledge, authors advise surgeons to carefully weigh risk factors in patients with keloid tendencies before undergoing elective surgery.


Wang JC, Fort CL, Hom DB. Location Propensity for Keloids in the Head and Neck. Facial Plast Surg Aesthet Med. 2020;

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