The otoplasty scar: where it sits, how it evolves and the risk of keloid

The incision runs behind the ear, in the groove that separates it from the skull, so in the usual position it cannot be seen. It is one of the good things about this operation: the anatomy itself hides the scar, with no need to disguise it.

That said, the other half has to be told. The region behind the ear is an area prone to forming keloids, and that conditions who is operated on and how. It is not common, but when it happens it is the complication that takes the most work to resolve, and it is better known beforehand than afterwards.

The general risks of the operation, with their frequencies, are in the otoplasty guide. This page is only about the scar.

Where the scar sits

On the back of the ear, following the groove that separates it from the head. When the ear returns to its corrected position that groove closes over itself and the line stops being visible unless you deliberately fold the ear forward.

So in this operation the conversation about the scar is not usually “how do I hide it?” but “how do I heal?”. The location is already sorted; what remains to be known is how your skin responds.

In the incisionless variant there is no line, because the work is done through punctures. It has its own, narrow indication, and it is explained on the page about the percutaneous technique.

How it changes, month by month

The timings are approximate and every skin goes at its own pace, but the pattern repeats:

• Weeks 2 to 6. A fine line, pink or reddish, with the area still somewhat firm to the touch.
• Months 2 and 3. This is the worst point, and it is normal. The scar looks redder and slightly more raised. A lot of people take fright right here, convinced it is getting worse.
• Months 4 to 6. It begins to flatten and lose colour.
• From a year on. Pale and flat, blending in with the surrounding skin.

Two forms of care that do change the result:

• Keeping it out of the sun. A recent scar that burns becomes pigmented, and that pigmentation takes many months to go. It matters particularly with summer operations.
• Massaging the scar. This is the main thing and, in practice, not much else is needed: because it is hidden in the groove, this scar does not demand the armoury recommended elsewhere.
• If you want to refine the result, the laser scar protocol can be applied. It is an optional step, not the rule.

What a keloid is, and why the ear is a high-risk site

As it heals, the body makes new tissue. When it makes too much, the scar becomes lumpy. Two things that are constantly confused have to be separated here:

• Hypertrophic scar. Thickened and raised, but it stays within the limits of the original wound. It usually improves with time and responds well to treatment.
• Keloid. It spills beyond the limits of the wound and grows over skin that was never injured. It does not resolve on its own, it can itch or hurt, and it tends to come back after treatment.

The auricular region — the lobe and the back of the ear — is one of the classic keloid sites, along with the sternum, the shoulders and the back. It is often seen after ear piercings, and that is precisely the most useful clue: if a piercing left you with a lump, that is something to bring to the consultation.

Across otoplasty as a whole, healing problems appear in around 1.6% of cases according to the largest systematic review published. It is uncommon. What happens is that, when it does occur, it is the hardest thing to put right.

How to know your risk before surgery

There is no test that predicts it, but there is a conversation that narrows it down considerably. At the assessment we ask about:

• A personal history of keloid or hypertrophic scarring, anywhere on the body.
• Family history. There is clear familial clustering.
• How previous wounds or operations healed, including small ones.
• Ear piercings and how they went.
• Skin phototype. The risk is higher in darker skin.

Those facts do not produce a percentage, but they do distinguish a case with no warning signs from one where there is a long conversation to have before deciding.

What can be done if a keloid appears

It can be treated, and there are options. But the figures are worth giving, because they are the part almost nobody publishes:

• Corticosteroid injections. This is the first-line treatment. In the published reviews, recurrence rates described for triamcinolone run from 6.6% to 33%, depending on the series.
• Silicone sheets and gels, and compression therapy. Compression therapy at auricular sites describes recurrences of around 10.7-14%.
• Surgery on its own: no. Excising a keloid with nothing else is the worst option: in a series looking specifically at auricular sites, recurrence after excision alone was 47.4%, against 17.1% when radiotherapy was added.
• Excision combined with cryotherapy and active follow-up. A retrospective study of 61 patients with auricular keloids achieved complete remission in 90%, with recurrence in 38% at a median of 6 months; 63% of those recurrences were subsequently controlled with intralesional corticosteroid or vascular laser.
• Brachytherapy. Described with recurrences of 3.1% to 15%.

Two readings of all this. First, that there are treatments that work. Second, that keloids frequently come back, that follow-up matters as much as the initial treatment, and that anyone promising to get rid of it for good is promising something the literature does not support.

In children there is a further practical consideration: the injections are uncomfortable, and specific pain-management protocols exist for the intralesional treatment of post-otoplasty keloids in paediatric patients, precisely because the problem of tolerance is a real one.

With a history of keloids, can we operate on you?

It depends, and this is one of the situations where the answer may be no.

What we do is weigh the balance case by case: how much the ears bother you, what specific history you have, where and how it happened, and what risk you are taking on. An otoplasty is elective surgery — it is done to feel better, not to cure a disease — and that changes the bar: it makes no sense to take on the risk of an auricular keloid for a cosmetic improvement if the risk is high.

When the decision is to operate on a patient with a strong tendency to keloids, prophylaxis can be added to the scar after surgery, with corticosteroid or with 5-fluorouracil. It does not remove the risk, but it is the way of not leaving it to chance. And when the decision is not to operate, we say so and explain why.

Frequently asked questions

Where is the otoplasty scar? Is it visible?

In the groove behind the ear. With the ear in its corrected position that groove closes and the scar cannot be seen unless you deliberately fold the ear forward.

Why has the scar gone redder at two months?

Because that is what it does. The scar reaches its point of maximum colour and prominence at around the second or third month and from then on begins to flatten and fade. It is the moment when most people take fright and, unless there are other signs, it is normal. If you have doubts, we look at it at your review.

What is the difference between a hypertrophic scar and a keloid?

A hypertrophic scar stays within the limits of the wound and tends to improve with time. A keloid spills beyond those limits, grows over healthy skin, does not resolve on its own and tends to reappear after treatment.

Why is the ear a high-risk site for keloids?

It is one of the classic sites, along with the sternum, the shoulders and the back. It is often seen after ear piercings, and that history is one of the most useful clues at the pre-operative consultation.

My child has developed a keloid after an otoplasty, what can be done?

There is treatment and it is best started early: corticosteroid injections as first line, silicone and compression, and in selected cases excision combined with an adjuvant treatment. What you need to know is that recurrence is frequent — the published series describe widely varying figures depending on the technique — and that follow-up is part of the treatment. Excising it with no associated treatment is the option with the worst results.

Can a keloid be got rid of completely?

It can be greatly reduced and in many cases controlled, but nobody can promise that it will disappear and not come back. The published recurrence rates make that clear, and any serious treatment starts by saying so.

How do I know before surgery whether I am at risk of keloids?

There is no test, but there are facts that guide us: a personal or family history of keloids, how previous wounds and operations healed, how ear piercings went, and skin phototype. We ask at the assessment.

If I have a history, will you operate on me anyway?

Not necessarily. We weigh up the individual balance between how much the ears bother you and the specific risk you carry, and sometimes the recommendation is not to operate. If we do operate, it is planned with closer follow-up.

Can the scar pull or become uncomfortable over time?

It can feel tight or sensitive during the first few months, along with the itching and altered sensation that are usual. If persistent pain, intense itching or growth of the scar appears, we assess it, because those are the signs that it is not settling as it should.

How do I look after the scar?

By massaging it. That is the main thing and, as this scar is hidden in the groove behind the ear, not much else is usually needed. If you want to refine the result, the laser scar protocol can be applied, which is optional.

I have a strong tendency to keloids. If you operate on me, can it be prevented?

The risk can be reduced, not removed. In patients with a strong tendency, prophylaxis can be applied to the scar after surgery, with corticosteroid or with 5-fluorouracil. It is a decision taken at the assessment, along with whether to operate at all.

Can I sunbathe with a recent scar?

Better not. A recent scar exposed to the sun becomes pigmented and that pigmentation takes many months to fade. Wear your hair down, a cap or high protection, and do so for months.

Sources

• Kumar SIS, Katta T, Anderson M, et al. Regional Differences in Postexcision Outcomes of Keloids: A Focus on Auricular Versus Nonauricular Sites. Ann Plast Surg. 2026;97(1):24-29. PMID 42184131 — At auricular sites, recurrence of 47.37% after excision alone against 17.07% when radiotherapy is added; side effects of radiotherapy in 20% of auricular cases. This is the source for surgery alone not being an option.
• Zagala R, Cogrel O, Beylot-Barry M. Excision-cryosurgery of auricular keloids associated with active follow-up: A retrospective study of 61 patients. Ann Dermatol Venereol. 2026;153(2):103486. PMID 42019255 — Complete remission in 90% and recurrence of 38% at a median of 6 months, with 63% of recurrences controlled with intralesional corticosteroid or vascular laser.
• Wojarska M, Kokot K, Ossowska B, et al. Surgical Excision with Adjuvant Therapies in the Management of Keloids: A Systematic Review. Medicina (Kaunas). 2026;62(5):916. PMID 42195168 — Recurrences described of 3.1-15% with brachytherapy, 10.66-14% with compression therapy at auricular sites and 6.6-33% with triamcinolone injections.
• Andersen YMF, Krontoft ASB, Elberling J. Comfort-based Pain Management for Intralesional Treatment of Pediatric Post-otoplasty Keloids. Acta Derm Venereol. 2026;106:adv-2025-0152. PMID 41610343 — Pain management for the intralesional treatment of post-otoplasty keloids in paediatric patients; supports the section on how well children tolerate the injections.
• LaMonte O, Pauley A, Hom DB. Should a Tissue Cuff Be Preserved During Auricular Lobule Keloid Excision to Reduce Recurrence? Ear Nose Throat J. 2026. PMID 42410973 — Residual tissue, particularly the peripheral margin, may contain proliferative fibroblasts associated with recurrence; recommends serial corticosteroid injections as postoperative adjuvant treatment.
• Sadhra SS, Motahariasl S, Hardwicke JT. Complications after prominent ear correction: A systematic review of the literature. J Plast Reconstr Aesthet Surg. 2017. PMID 28602268 — 28 studies and 3,493 patients: healing problems in 1.6% of cases.

Book your consultation

If you have a history of keloids and are considering surgery, that is exactly the reason to come to a consultation rather than to a search engine: it is a case where the answer depends on your particular history and where we sometimes recommend against operating.

And if you have already had surgery and the scar is not settling as you expected, it can be assessed. The sooner it is looked at, the more options there are.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.