Earlobe keloid removal with CO₂ laser:
Protocol A and Protocol B, and how the choice is made

What an earlobe keloid is

A keloid is scar tissue that keeps growing past the edge of the original wound. On the earlobe it usually starts after a piercing, sometimes months later, as a firm lump at the front or back of the lobe that slowly enlarges. It can itch or feel tender, and it does not go away on its own. A tendency to keloids often runs in families and is more common in Asian and darker skin.

A keloid is not the same as a hypertrophic scar, which stays within the wound and often flattens with time. That difference matters, because a keloid tends to come back when it is simply cut away. The wider options for an ear keloid after piercing are set out separately; this page explains the two CO₂ laser protocols Dr Sin Yong uses.

Why a CO₂ laser, and why laser alone is not enough

The CO₂ laser (10,600 nm) cuts and seals at the same time, which keeps the field clean and lets the keloid be removed precisely on a small, soft earlobe. In fractional mode the same laser opens thousands of microscopic channels instead of cutting, which lets medicine reach deep into the scar. At the clinic this is done on the DEKA SmartXide Tetra Pro.

The laser is only one part of the plan. In a Singapore hospital series, all 13 patients whose earlobe keloids were debulked by CO₂ laser or cold steel had regrowth within 2 to 18 weeks. What keeps a keloid from returning is what happens afterwards: steroid treatment at the edges, pressure, and keeping every review. That is why both protocols below are planned as a course, not a single visit.

“The laser takes the keloid off the ear. What keeps it off is the steroid plan and the pressure earring afterwards, so I see patients through the months that follow, not just the day of removal.”

Dr Sin Yongon earlobe keloid removal

Protocol A: CO₂ excision, steroid and pressure

For: a bulky, rounded or stalked earlobe keloid that hangs from or bulges out of the lobe.

1. Soften first. A short course of steroid injections into the keloid beforehand makes it smaller and softer, so less tissue has to be removed.
2. CO₂ excision. The earlobe is numbed with a local anaesthetic nerve block. The laser is used as a cutting tool to free the keloid at its base. Where possible the cut stays within the keloid itself (a core or intralesional excision), which keeps tension low and avoids creating a new wound edge in normal skin.
3. Steroid to the edges. As the earlobe heals, steroid is injected into the healing margins at regular reviews over the following months. This is the step that most protects against regrowth.
4. Pressure earring. Once the wound has healed, a flat pressure earring is worn on the lobe for months, as many hours a day as advised.
5. Early signs of regrowth. Any firmness or new growth at a review is treated early, with steroid, sometimes cryotherapy, or by moving to Protocol B.

Keeping appointments matters as much as the procedure. In a published series of CO₂ laser ablation followed by steroid injections, 2 of 13 patients who attended regularly had a recurrence, compared with 7 of 10 who attended irregularly.

Protocol B: fractional CO₂ with steroid delivery

For: a flatter, firm keloid; a keloid that has not responded to steroid injections alone; or early regrowth after Protocol A. This approach is called laser-assisted drug delivery.

1. Micro-channels. A fractional CO₂ pass in a deep mode opens tiny columns through the keloid.
2. Steroid delivered. Steroid is applied straight away so it travels down the channels into the scar, sometimes with an injection as well.
3. Review and repeat. Sessions are repeated at intervals with a review each time. How many are needed depends on how the keloid responds, so it is not fixed in advance.

What is watched for: thinning of the skin, small visible blood vessels and lighter patches, which are more likely in darker skin. The steroid is kept to what the scar needs, and the plan changes if any of these appear.

Protocol A or B: how the choice is made

The choice depends on the shape, size and firmness of the keloid, how long it has been there, what has been tried before and how the skin has reacted to steroid. Some earlobes need both: Protocol A to remove the bulk, then Protocol B if the edge starts to thicken again.

Aftercare and the pressure earring

• Wound care: after Protocol A the earlobe is kept clean and dressed as instructed until it heals. After Protocol B the skin is kept gently moisturised while the fine crusts settle.
• Sun: protect the earlobe from the sun while it is pink, to lower the chance of darkening.
• Pressure: the pressure earring starts once the wound has closed and is worn daily for months. It should feel firm but not painful.
• Reviews: every review is part of the treatment, because that is when the healing edge is checked and treated.
• Re-piercing: a new piercing carries a real risk of a new keloid, so it is discussed case by case and never on the treated spot without that conversation.

When this is not the right plan

• A lump that does not look like a typical keloid is examined first, and sometimes sampled, before anything is removed.
• Infection, an open wound or a skin flare is treated first.
• During pregnancy or breastfeeding, treatment is usually deferred.
• Very large, multiple or repeatedly recurring keloids may need a plastic surgery specialist, and sometimes radiotherapy after excision; Dr Sin Yong refers where that is the better route.

Related: keloid steroid injection, keloid removal and treatment in Singapore, keloids and hypertrophic scars, and the Tetra Pro CO2 laser.

What happens at the consultation

Dr Sin Yong examines the keloid and both earlobes, asks when it started, what has been tried and whether keloids run in the family, and checks for anything that needs a different route. He then explains whether Protocol A, Protocol B, both or neither suits you, what the months afterwards involve, and gives the fee in writing, including the option of not treating.