Sir:FigureWe read with great interest the article entitled “Outcomes of Surgical Excision with Pressure Therapy Using Magnets and Identification of Risk Factors for Recurrent Keloids” by Park et al.,1 and we congratulate the authors for their wide patient population and statistical analysis. In recent decades, multiple studies on keloid formation have been conducted, leading to a plethora of therapeutic strategies. However, no clear guidelines have been given, probably because of poor understanding of the complex underlying mechanisms.2 Recent studies suggest that only an integrated approach can be a valid solution.3,4 We therefore would like to add our experience of a small series of patients suffering for earlobe keloids. Seven keloids were excised completely under local anesthesia by means of a new carbon dioxide laser (Smartxide2; Deka M.E.L.A., Calenzano, Italy). This laser uses a radiofrequency source to generate perfectly controlled energy pulses. This technology develops a different pulse shape (D pulse) that acts more incisively on the reticular dermis, inducing greater shrinkage and more circumscribed coagulation. Thus, a sort of “cold” ablation is achieved on the redundant scarring tissue that seems to inhibit the immediate inflammatory response. Moreover, starting 5 days after surgical excision, patients applied, on the treated area, N-butyl cyanoacrylate glue (Wipescar; Fasel S.r.l., Bologna, Italy), renewing it every 5 days for a period of 3 months. The glue polymerizes as soon as it is dabbed on the superficial moisture of the scar, producing a rigid mechanical membrane. This cap aims to decrease skin tension and protects the scar from microbial infection, ensuring a favorable microenvironment for its maturation. The patient in Figure 1 is a 19-year-old woman with Fitzpatrick skin type II, presenting with an itchy keloid on her left earlobe measuring 2 × 1.6 cm, which had been pierced 5 years earlier.Fig. 1: Keloid of the ear lobule preoperatively (left) and 1 year postoperatively (right).The patient in Figure 2 is a 15-year-old girl with Fitzpatrick skin type III, who showed a 9 × 4.7-cm keloid on the posterior surface of the auricle caused by a piercing. This girl had already experienced keloid excision followed by pressure therapy three times over the past years, with the last operation having been performed 3.5 years ago. Photographs showing surgical excision with the laser and 10-month follow-up are presented.Fig. 2: Keloid on the left posterior auricular area preoperatively (left), intraoperatively (center), and 10 months postoperatively (right).Despite the limited number of cases, we believe that this approach can be an adjunctive tool for keloid management, without significant risk of adverse sequelae. The results obtained are good, and all patients are satisfied with the treatment. However, larger studies and longer follow-up are necessary to confirm the long-term efficacy of this novel treatment modality. Stefania Tenna, M.D., Ph.D. Achille Aveta, M.D. Angela Filoni, M.D. Paolo Persichetti, M.D., Ph.D. Plastic Surgery Unit, “Campus Bio-Medico” University, Rome, Italy DISCLOSURE The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work.