There are a variety of methods available for the treatment of keloid scars or hypertrophic scars. The timing and severity of scar formation determine which approach is most appropriate. Silicone sheeting, or silastic, vitamin E and topical corticosteroids are used to prevent and treat early keloid scar formation within the first few months after surgery. Keloid scars that persist or worsen following topical treatment may be treated with injections of corticosteroids, or other anti-inflammatory agents, directly into the scar. This approach usually results in flattening of the scars and decreased redness, tenderness and itching. The overall appearance of keloid scars, however, may not significantly improve after corticosteroid injections. In order to significantly improve their appearance or to treat chronic scars or scars that do not otherwise improve with non-surgical treatments, surgical excision may be the best option. With true keloid scars, there is a high incidence of recurrence after surgical excision. For this reason, surgery should always be combined with either corticosteroid injection into the new wound edges or with low dose radiation of the wound after surgery.