How soon after excising a keloid do you inject kenalog?   

I ran into this issue in clinic a few months ago when I started doing keloid excisions on patients' ears - there's some decent data in the following article for doing immediate kenalog injections without impairing wound healing.Burusapat et al., PMID 34367855

I inject K10 immediate after surgery and then at 3-4 week intervals. There is a theoretical risk of delayed wound healing but studies show the is likely the most effective way. Lately, I have been applying Aldara to auricular keloids after shave removal with great results.Burusapat et al., PMID 3436...

When I possible, I prefer to shave and leave no suture behind. I inject with TAC at the time of the surgery. I wait a few weeks and then start topical imiquimod qohs x 6 weeks and have patients follow up then.

Please see re: imiquimod. Klotz et al., PMID 31587416 Ear lobule keloids are for some reason easier targets. Great paper by David Ozog as far as injection with triam and timing.Love Dr. @Rullan's comment on pressure. I do the same.

I inject immediately post procedure then 2 weeks afterwards then monthly for 6 months. Then Q 8 weeks for 6 months. I require patients with ear keloids to have purchased pressure earrings prior to agreeing to do the procedure. I feel the use of these are very important. 

In high risk areas (e.g. presternal), I will mix 2mg/Cc kenalog into the lidocaine I inject at time of surgery, then inject at 4 weeks, concentration altered depending on clinical findings.