Keloids in the HOF Medical History: How to Ask and Document

The question about healing usually takes up one line on the medical history form, between "allergies" and "medications". It is often answered with an automatic "no", because the patient does not know what a keloid is or never connected what they saw on their body with the term. Yet the information matters: orofacial harmonization (HOF) procedures are controlled trauma to the skin, and people with a predisposition to abnormal scarring may react differently to them. This guide shows how to investigate the topic, at a review level. The decision to treat, the method, and the technique belong to the qualified professional, according to the product label and the rules of their professional council.

What are keloids and hypertrophic scars?

They are two types of excessive scarring, often confused. See the full concept in hypertrophic scar and keloid.

There is also the atrophic scar, which is depressed, a different pattern that is not part of this discussion. For the HOF professional, what matters is recognizing that there is a spectrum of responses and that the patient's history is the best predictor.

Why does this matter in HOF?

HOF procedures involve puncture, tissue stretching, in some cases induced inflammation, and, in surface treatments, removal of layers of skin. In predisposed patients, these stimuli can trigger exaggerated scarring. The risk varies by procedure:

1. Isolated puncture (toxin, filler): small trauma; the risk of a keloid at the entry point is generally low, but not zero in predisposed patients.
2. Microneedling: multiple microinjuries; requires more caution. See microneedling: fundamentals.
3. Chemical peel: surface injury, which can be deep. See peels and HOF.
4. Fractional laser: controlled thermal damage, with variable recovery. See fractional laser and HOF.
5. Threads: the path and the material can cause a reaction; see complications with PDO threads.
6. Biostimulators: induce an intentional inflammatory reaction; see complications with biostimulators.

Even with small punctures, the professional weighs the whole picture: history, site, and number of points. For existing scars and filler, see scars and filler.

How do you ask so the patient understands?

The term "keloid" does not always mean something to the patient. Descriptive questions work better.

If the answer suggests predisposition, examine the visible scars (the earlobe is a good place to look) and document them. If the patient does not know, it may help to ask them to bring photos or to explain the family history.

Which areas and profiles deserve more attention?

The clinical literature describes greater predisposition in some situations:

• Personal history of keloid or hypertrophic scar, the strongest indicator.
• Family history, especially in first-degree relatives.
• More pigmented skin, where the reported incidence is higher. The Fitzpatrick phototype helps with reasoning but does not replace asking directly.
• Regions of greater skin tension or predisposition, such as earlobes, the sternal area, shoulders, and the jawline.
• Young age, when the tendency is described as greater.
• Tendency toward post-inflammatory marks, which signal an exaggerated inflammatory response. See post-inflammatory hyperpigmentation.

How does this information change the plan?

The answer guides management gradually, without fixed rules. In general terms:

• No history: follow the usual plan, with standard aftercare instructions.
• Mild or uncertain history: discuss the risk, prefer lower-trauma procedures, and monitor closely.
• Clear history of keloid: assess whether the procedure is truly needed, avoid extensive trauma, and consider starting with a discreet area to observe the response, at the professional's discretion.
• Active keloid near the area: postpone or avoid the area.
• Doubt about management: discuss with a dermatologist or surgeon experienced in scarring, with the patient's consent.

Any decision to proceed should come with specific consent that describes the risk of abnormal scarring. See informed consent.

What should you advise afterward?

The predisposed patient needs to know what to watch for. Useful points:

1. Watch the entry points and the treated skin over the following weeks.
2. Report any raising, hardening, itching, or persistent redness, rather than waiting.
3. Avoid touching, scratching, or squeezing the areas.
4. Protect the treated skin from the sun.
5. Come back for reassessment within the agreed time.

If an abnormal scar is suspected to be forming, early referral to a specialist is usually advantageous. The sooner the management, the greater the chance of control.

How do you document it?

Documenting this part of the medical history is usually brief, but decisive. In the patient record, record: answers to the questions, exam of the scars, photos (with permission), risk classification, conversation with the patient, decision made, and consent. Health information is sensitive personal data and must be handled as such.

If the patient denies the history but there are signs on exam (scars on the earlobe, for example), document the observation and talk with them. If they refuse to discuss the risk, note the refusal.

Which mistakes appear most often?

1. Not asking, assuming no one at the clinic has a keloid.
2. Asking with a term the patient does not understand.
3. Not examining visible scars.
4. Not recording the answer, leaving the field blank.
5. Choosing an extensive procedure in the first session for a predisposed patient.
6. Not scheduling a follow-up to observe the skin.
7. Treating a suspicious scar on your own, without referring.

To remember

Abnormal scarring does not rule out HOF, but it changes the conversation. Asking descriptively, examining scars, classifying risk, choosing lower-trauma approaches, counseling the patient on warning signs, and documenting everything turn one line on a form into safe practice.