The map left on her face: why keloids “shout where they should whisper”
What Dr. León’s chapter reveals — and how hypertrophic scars are treated today
When fire closes a wound, it doesn’t always do so quietly. Sometimes the skin rises, reddens, and keeps growing long after the wound has already healed. That’s a keloid: scar tissue that doesn’t stop where it should.
In The First Kiss: Hell in the Skin, Uyanic describes the moment Dr. León first measures the thickness of a keloid on her jaw. His explanation stayed with her, word for word, in the book:
“This keloid is like a story the body is writing with too much emphasis. It’s shouting where it should whisper. Our job is to teach it to modulate its voice.”
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The treatment back then: needles, blood, and patience
The protocol described in the book was, for its time, the available standard: triamcinolone injections (a corticosteroid) delivered directly into the base of the keloid with a very fine needle, session after session, across the jaw and cheekbone. The doctor explains it himself in the text:
“It’s not bleeding from injury; it’s blood being released. The needle breaks down the keloid’s fibrous tissue, the corticosteroid softens it.”
The result, described chapter by chapter: the keloids — “miniature mountain ranges,” in Uyanic’s words — gradually flattened over time, but the process was slow, painful, and required repeated visits over months.
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What changed: keloid treatment today
Four decades later, intralesional triamcinolone is still, surprisingly, the first-line treatment with the strongest evidence — the book isn’t describing an outdated technique, but one that’s still standard practice. What did change is everything doctors now combine it with.
1. Combined therapy, not a single method
It’s no longer just “needles until it flattens.” Today’s standard approach combines corticosteroid injections with silicone sheeting worn continuously, sustained pressure, and strict sun protection — very close in spirit to the contact mesh Dr. León was already using, but with more effective materials.
2. Laser instead of surgery alone
Fractional and non-ablative lasers now allow doctors to work on a keloid’s texture and color without surgical removal, which on its own carries a very high recurrence rate (up to 50–80% when done without complementary therapy).
3. Adjuvant radiotherapy for resistant cases
For keloids that don’t respond to corticosteroids or laser, radiotherapy is now used immediately after surgical excision — it reduces recurrence by leaving the tissue less able to regenerate excess collagen.
4. A better understanding of “why”
A keloid is no longer treated as just an “ugly scar”: it’s now understood as a dysregulated response of fibroblasts and collagen, with an identifiable genetic component — which makes it possible to anticipate risk before a surgery or burn, not just treat it afterward.
Between the testimony and the protocol
None of this takes anything away from what the book describes. Dr. León, with the tools available at the time, did with precision what still remains the foundation of treatment today — that foundation just now comes with more options and less trial and error.
Frequently asked questions about keloids
Does a keloid go away on its own?
No. Unlike a normal scar, a keloid keeps growing beyond the border of the original wound and rarely recedes without treatment.
Does triamcinolone treatment hurt?
Yes, it’s a needle-based procedure that can cause discomfort and mild bleeding at the injection site, just as described in the book. That’s still true today, though it’s now often paired with topical anesthetic.
What is “The First Kiss” about?
It’s the real-life testimony of Uyanic, who survived a fire at age 10 and, among other things, describes the long treatment process for her scars with Dr. León.
Want the rest of the story? Discover how that process continued in The First Kiss: Hell in the Skin.
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