Motivation – Keloids Sucks!!

If you’re one of the lucky ones, like me, who have keloid scars, then you know that they are very annoying in many ways, physically and mentally. I’m writing this blog to share my experience with Cryoshape with people who have keloids and considering the treatment. I am not making money writing this. I just hope that people with keloids can learn more about this relatively new procedure through my experience, and make your own decision about whether to do the procedure or not.

As of Nov 28, 2014, I’m satisfied that the pain and itchiness are gone. I just hope that they won’t come back. The keloid size reduction is not as impressive as I originally thought, but I feel like scars are shrinking every day and it might take a whole year to shrink. I understand that it probably won’t go completely flat.

–> updated… As of July 4, 2015, I’m still satisfied that the pain and itchiness have not come back.The keloids got smaller, and two of them seem to have gone completely flat. The others are smaller than before and appear pink. They’re still visible for sure, but I’m happy about the result. Current picture at the very bottom.

Background

I have had keloids on my chest and shoulders since late teenage. I suspect that when the acnes busted, the skin overhealed itself and turned into raised scars called keloids. The ones on my shoulders were no issues. They were pressed by my shirts every day and were basically flat on my skin. But the ones on my chest had been a problem. The keloid bumps looked like what an astronaut would get when they were infected with alien genes. I didn’t realize what they really were until I read more about it in college.

My keloids grow and fade out over time. My chest kinda look like a map of “keloid continents” moving around over time, with some big ones staying on my chest. They are sensitive and sometimes (very) itchy, especially when they rub against clothes with thicker fibers. They can be painful too especially when they’re brand new. I have to avoid them so much that, I tend to hunch in order to keep them from touching the undershirt over my chest. That’s how annoying they are. When I walk around top naked, people cannot help but to look at my chest, which I now get used to… (because I know that my abs has nothing to look at!!) One time, I went topless in a rave party in Portland. This girl came over and asked me what those things were and if she could touch it.

“What are those?”

“O.. I got some bad genes called keloids… It’s not contagious, no worries…”

“I’m sorry that you get this… it’s so weird…”

“Yah.. I know…”

She wanted to say ugly, but it was a word that she felt sorry to say. I tried not to go topless when I was young. As I got older, I now don’t care about it as much. I have to accept myself no matter how others look at me right? But, I am always a little jealous of the 99% of the people I see in the gym or beach or swimming pool and wonder why their chest look so clean…

 

What I’ve tried in the last 7 years…

I had two sets of steroid injections: 7 years ago when I was a junior in college, and 4 years ago after I started working. Each set of injections didn’t last more than 4 sessions, mainly because it was just difficult to keep a schedule to see a doctor every month or two when I didn’t see any results. And yes, the injection was a VERY painful experience. It felt like lots of large spiky crystals rushing into the keloids and puncturing the skin from inside. The sharp pain of steroid injection made me tear a few times. As your reference, I broke my right ankle in May 2014, had a splint, went through a surgery, had another splint, and two month PT sessions. I didn’t cry through out the whole deal.

The steroid injections lowered the keloid bumps for a few weeks, but they nearly always returned to pretty much the same size. Only one of the big ones got more flat through time. I was also prescribed steriod tapes to place over the keloids every day. It became a hassle to cut the tapes every day and pasted it on to the keloids, because I had to cut the tape to the right size. Otherwise, taping outside the keloid would affect the normal skin.

There’re other methods out there, which I’m sure you already know if you’re reading this. But I don’t think any of those are that effective.

 

How I found Cryoshape

After dropping out of steroid injections for 4 years, I wanted to try it out again. I felt… maybe now that I got older, the injections might be more useful? Just a wishful guess… I just wanted to try it again, and my insurance would pay for it anyways.

In late September 2014, I was trying to contact the dermatologist I saw 4 years ago. But his schedule was fully booked for the next 4 months! So I logged on to the insurance website and found Dr. Greene, whose office is close to my house. During the consultation, he suggested trying Cryoshape, which I had never heard before. One treatment would freeze the keloid inside out and greatly reduce its volume, if not flattened them out completely. It would also reduce pain or itchiness.

I then spent the next month or two procrastinating about it, partly due to busy work. But also, I felt that Cryoshape, a procedure suggested by a (cosmetic) dermatologist, just sounded too good to be true… I just wasn’t certain if I should dive into this relatively new technology: I called him up a few times to ask questions, and he told me that he had only treated 15 patients with Cryoshape at the time…

I googled around and read up about it. I also visited two other dermatologists I found on the Cryoshape website. Neither of them wanted to do the procedure and said that the traditional ways would be just as good. One dermatologist referred me to a cosmetic surgeon to do excisions. I was sure I didn’t want surgical excision on my chest because I believed that the chance of failure was high: The keloid could get much bigger. I’d prefer doing simple but painful steroid injections over surgical excision. The other dermatologist just simply suggested steroid injections and laser treatment to reduce pigment.

I procrastinated for a little longer, and I finally decided to go try Cryoshape. This was a binary go no-go decision… and these were the reasons why I chose to move forward:

1) The procedure is FDA approved. OK.. it might not go well, but at least it won’t be just some procedures dreamed up by a cosmetic surgeon. I also found a few academic papers regarding the procedures, even though they didn’t seem to be technical enough or rigorously reviewed. Clinical, Cosmetic and Investigational Dermatology, Cryobiology (2013)

2) Dr. Greene was very confident of the results. He had lots of yelp stars and was a lecturer in UW. I was sure he didn’t want his reputation to go bad. I came to conclude that he will probably take more risk than me if he screws up. The cost is reasonable compared to the risk he has to take.

3) My chest was already quite difficult to look at. If Dr. Greene screws up, it probably won’t be that much worse in terms of cosmetics.

4) I couldn’t find any extreme cases where Cryoshape went wrong on google.

5) I saw pictures in this blog and got a feel of what I could expect

And that’s it… I made up my mind one day and scheduled the procedure with Dr. Greene.

 

Day 1: Nov 13, 2014 Thursday

Arrived at 8:10am. We spent the next hour going over the procedures, signing consent forms… A nurse assistant placed numbing cream on the keloids.

Surgery started at around 9:15, lasted for about 45 mins. Doc worked on the 6 largest keloids on my chest. I had about a dozen if you count the small ones too.

He injected local anesthesia into the keloids until I could not feel anything when he pokes it. Then for each of the keloids, he poked the liquid nitrogen probe through it, like a BBQ skewer. After the probe came out the other side, the assistant opened the valve to let liquid nitrogen into the probe. She had to raise the nitrogen reservoir high up, and the liquid nitrogen flowed downward into the probe by gravity. When the reservoir was raised, it pulled the probe up and I felt like my skin was stretching quite a bit. For a while, it felt like my skin was detaching from my body. Also, the exit end of the probe was poking my chest at one point. They thickened the gauze underneath the probes on both sides of the keloids, to prevent the poking, and the cold surface of the probes / guide tube.

The biggest keloid needed about 2 mins of nitrogen flow, then a thawing for about 3 mins or so. (Thawing means just letting the probe sit inside the keloid to warm up). Then the Doc pulled the probe out, (there was a click sound when he start turning the probe) and went for the next one.

When all 6 keloids were treated, the nurse put antibacterial ointment, gauzes and band aids on them. They would keep oozing for the next few weeks I was told. Within half an hour after the surgery (more like when I left the clinic and started driving from the parking lot), I could feel the sharp pain of the surgery kicking in. It was about a degree 5 out of 10, if 10 was the most painful. You would know how that pain on the skin felt like if you had recovered from a surgery before. I drove to Target and bought some extra strength 500g Tylenol. Pop 2 pills in. Those were the only pills I took after the surgery. I also bought some antibiotic ointments and gauze so I could replace them every night.

I got back to my office at around 11am. I was able to focus on work, but I could definitely felt the pain around the chest for the next few hours. I could feel it when I’m walking, or filling up my water bottle, etc. By around 3pm, I could feel liquid weeping down my chest under the gauze padding. It probably got quite wet, but I didn’t check it in the office. The pain died down around 4pm or so.

By 7pm, I was not feeling the pain anymore. But when I was driving, I didn’t want to turn my head so much because I felt like that would stretch the skin on the chest. It was probably more psychological than anything else. The seat belt didn’t bother me even though it went right in front of my chest. I had thick clothing for a 0C night.

That night at around 11pm, I finally had the courage to take off my jacket to take a look. I found that my shirt and under shirt were stained with blood and body fluid. It was quite wet. I replaced the bottom gauze and band aid padding, but left the top coz i felt like it was not that wet. I wanted to avoid any additional stimulation to the site and I didn’t shower that night. I just changed my underwear.

Day 2: Nov 14, 2014 Friday

I found that my new undershirt was already stained, so I changed it out before going to work. I also replaced the top padding. After work, I had a chat with my Doc on the phone. I took a shower that night. I just let water flow down over those scars. Didn’t touch them. After shower, I dried them with a new towel. Placed antibacterial ointment on, then gauze and band aid. I was starting to get used to the routine. I also used a high pillow that night. The night before, the body fluid seeped towards my neck.

Day 3: Nov 15, 2014 Saturday

My under shirt was stained, but the stain was much smaller than the day before. I also start placing a towel between the padding and my undershirt whenever i could (when I’m indoor). Cannot do much besides studying (pilot license), watching documentaries or writing blogs / surfing internet.

Day 4; Nov 16, 2014 Sunday

The scar starts scabbing and some of them start turning black on the surface.

Day 5: Nov 17, 2014 Monday

Picked up DomeBoro from the Doc in the morning. That evening, I put one packet of those DomeBoro powder into warm water. Then I used a towel to soak up the solution and placed it on my chest. It is supposed to help with reducing the drainage and shrink the scar faster. I’m supposed to use it once a day, but I got lazy and just used it twice in the next week.

Day 8: Nov 20, 2014 Thursday

Most keloids have stopped draining except probably the top two keloids. The black scabbing also start sticking on to the gauze and make it a little difficult to pull it off.

Day 11: Nov 23, 2014 Sunday

Work out the first time since the surgery. The top keloid was the only one that was still leaking a little bit… but other than that.. nothing special~ I saw some of the scabs fell off and saw the scars.. they looked pink. I touched it with my fingers and they only felt the pressure, but not the touch. It felt a little bit like touching a callus, only that it’s harder and less elastic. At this point, they don’t look any smaller than before, but they are at least not itchy or painful.

Day 13: Nov 25, 2014 Tuesday

I had my first check up with Doc. He said it heals nicely, and it’ll take some time for the keloids to shrinks. I can stop putting gauze and band aid over them so that they can breath. Doc also told me to use DomeBoro every day to help with the leaking.

3 weeks: Dec. 3, 2014

Most scabbing has fallen off. It feels strange to touch the scars: it feels like the scars are outside my body. It seems like they cannot sense my finger touching…

1.5 Months: Jan 2, 2015

I went to Brazil for Christmas and New Year break… It was a Blast!!! 😀 It’s such an amazing country. When I was in Rio, I went to the beach, swam in the ocean, did lots of outdoor activities under the sun. And I guess the keloid scars didn’t really like it. One or two of them had skins peeling off a little bit and started bleeding. I felt like the skin over

the scars was really fragile and couldn’t stand all the stimulation. So I stopped swimming and tried to avoid direct sunshine on my chest afterwards. I also put antibiotic creams over it just in case. I was afraid that the cut would turn into keloids again. But they didn’t. They turned out okay afterwards.

But I could feel that there were new keloids popping up like before in other places. The small one on my top left (top right in the picture) was causing quite some pain from time to time… I did feel a little bit frustrated… How many times do I have to go through Cryoshape if these keloids don’t stop growing??

Late March / Early April 2015

I visited Dr. Greene for a checkup. He suggested me to get on Isotretinoin treatment to stop new cystic acnes from forming. Those acnes, unlikely the normal ones, grew very deep and are common pre-cursors to keloids. They had to be treated with a 6 month dosage of Isotretinoin… It’s a very strong drug… and it made me a little bit depressed. But since I’m normally a very outgoing extrovert. It calms me down… There will be a whole another blog if I have to talk about it. You can find lots of information about isotretinoin or accutane on google.

7.5 Months: July 2, 2015

This is how it looks like today. Again, I’m satisfied that I don’t have to constantly deal with the keloids pain and itch. The look.. O well.. I don’t think they’ll go completely flat… I just have to accept them as part of me… I guess I’m now old enough that I don’t care about how they look that much anymore. I’m just thankful that they’re not painful.