Skin graft or skin flap. Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when the area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
Another issue with usage of intra-lesional steroids is the size, length and thickness of the needle used to inject the keloid lesions. Some physicians falsely believe that a large and thick needle should be used to inject large keloid lesions. This belief comes from the fact that injecting some old and dense keloid lesions is a rather difficult task. In treating keloid lesions, the smaller and thinner the needle is, the less damage it causes to the keloid tissue. Dr. Tirgan only uses the smallest and thinnest needles, those that are used to inject insulin under the skin. With this method, Dr. Tirgan is able to inject any keloid.