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Keloids have a tendency to respond poorly to physical injury or trauma. Surgical removal of keloids must be performed using structured approaches that maximize a volumetric decrease in scar volume and size; and minimize the longterm risk of keloid recurrence. Simply removing a keloid with surgery may have limited gain unless it is combined with a dedicated longterm approach to keloid modulation with injections, lasers, and topical treatment.   

Keloid Injections: 

Some keloids are in an active inflammatory state with high levels of inflammatory mediators and dense collagen deposition. The most common type of injection used on keloids is known as Kenalog, which is a coritcosteroid that is similar to hydrocortisone. Unlike hydrocortisone creams that tackle itching and eczema, Kenalog works to reduce inflammation and tissue overgrowth in the keloid itself. Injections of Kenalog are not necessarily painful, as a tiny needle is used to treat the keloid at its root. If used successfully, keloid injections with Kenalog can reverse inflammation, reduce collagen growth, and reduce the volume of collagen within the keloid scar. 

Preparing for Your Keloid Surgery: It is a good idea to report any changes in your medical condition prior to your surgery date. If you have had a recent cold or flu, it is always better to wait until you have recovered to undergo a procedure. We ask that you kindly arrange a ride home if you are planning to undergo a procedure under anesthesia. If your procedure is to be performed only under local anesthesia, you may drive yourself home provided the surgery does not impair your ability to drive home safely. If you are taking daily medications, it is safe to take your normal medications in the morning provided you are not being administered general anesthesia.

Try to arrive a few minutes earlier than your surgery appointment time to allow for unexpected delays and to give you enough time to fill out necessary paperwork, including informed consents for surgery. Do not wear makeup, perfume, nail polish, creams, lotions, or deodorant on the surgical site. You may consider bringing over your personal care items if your surgery requires an overnight stay in an aftercare facility or hospital.

Medications to Avoid Before Keloid Surgery: 

If you have scheduled a keloid surgery procedure, we would suggest that you avoid certain medications that can increase bleeding during your procedure. A general rule of thumb is to avoid aspirin, ibuprofen, NSAID analgesics, coumadin, and warfarin at least two weeks prior to a surgery. If you have scheduled a procedure and have not ceased taking these medications, call our office and discuss your concerns with our surgery scheduler. If it is safe to do so, Dr. Karamanoukian may proceed with the surgery or reschedule for a later date. Certain vitamins and herbs may also increase your risk for complications during surgery, these may include Vitamin E and Omega Fish Oils. Multivitamins containing these ingredients are usually safe before surgery. For a complete list of medications to avoid before scar or keloid surgery, please call our office at (310) 998-5533. 

If you need to take an analgesic prior to your surgery, discuss your concerns with Dr. Karamanoukian so that the pain medications do not interfere with your surgery. It is generally safe to use Tylenol or Acetaminophen analgesics for pain relief before and after your surgery.

If you have ASTHMA, bring your inhalers and medications with you on the day of your surgery. You are permitted to use your inhalers as needed throughout the day. Patients with DIABETES should bring their medications and glucose monitor with them on the day of the procedure.

Keloid Surgery Checklist before surgery: 

1. Arrive a few minutes earlier than your scheduled appointment so that you have time to ask questions, fill out forms, and speak to Dr. Karamanoukian about your procedure. If you require a topical lidocaine cream before your surgery, alot 30 minutes before your scheduled surgery to be numbed. 

2. Bring all of your current medications and supplements with you the morning of your surgery. If you take insulin, diabetic medications, or hypertension medications; you are advised to take your scheduled dose the morning of your surgery unless instructed otherwise. Insulin dependent diabetics are also advised to bring along their insulin, needle, and glucose monitor. 

3. Leave all valuable jewelry, watches, and personal items at home. 

4. You are instructed to shower or bathe the morning of your surgery. 

5. Do not eat or drink anything if your surgery is under anesthesia. Patients undergoing a local anesthetic case can eat or drink something the morning of their procedure. 

6. If you have a dental prosthesis or wear contacts, bring the storage container with some clean saline solution. 

7. Arrange for a responsible adult to drive you home after your surgery. 

8. Be honest and forthright with your nurse and surgeon about any issues that may interfere with a timely recovery. 

FAQ About Keloid Surgery: 

Q: What tests do I need before my surgery? A: There are required blood tests before procedures that require anesthesia. If you are undergoing a minor procedure under local anesthesia, Dr. Karamanoukian will determine whether you require preoperative laboratory tests prior to surgery. Some procedures will require preoperative EKGs, diagnostic tests, or biopsies. If there is a remote chance that your scar may represent an abnormal skin growth or cancer, a preoperative biopsy may be necessary. 

Q: What can I eat or drink before surgery? A: If your procedure is scheduled in an outpatient setting under local anesthesia, we suggest that you eat something prior to your procedure. If the surgery is scheduled under anesthesia (general or conscious sedation), then you may not eat or drink anything after midnight the evening before your surgery. Anesthesiologists recommend at least eight hours o fasting prior to induction of anesthesia. 

 

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