What steps should be taken if a patient has a known history of keloid formation?

• A. Proceed with caution, use conservative energy, avoid overly aggressive resurfacing, discuss alternative methods, and monitor healing closely.
• B. Increase energy to test tolerance.
• C. Avoid all treatment indefinitely.
• D. Apply aggressive resurfacing.

Answer: (A)

When a patient has a history of keloid formation, the priority is to minimize tissue trauma and inflammation to reduce the chance of triggering a new raised scar. That’s why the best approach is to proceed with caution, use conservative energy, avoid overly aggressive resurfacing, discuss alternative methods, and monitor healing closely. Each part matters: using conservative energy limits the depth and intensity of injury, which lowers the inflammatory response that can lead to keloids; avoiding aggressive resurfacing further reduces the risk of deep wound healing that can produce excessive scar tissue; discussing alternatives provides safer options that still aim to meet the patient’s goals; and close healing monitoring lets you spot early signs of abnormal scar formation and adjust care promptly.

Raising energy would increase tissue injury and inflammatory response, raising the risk of a keloid reaction. Avoiding treatment indefinitely is unnecessarily restrictive when safer, less traumatic options exist. Aggressive resurfacing carries a high risk of triggering abnormal scarring in someone prone to keloids.