Can I treat a client who scars with keloids?

Short answer: yes for most treatments — but anything that deliberately breaks the skin needs a test patch and a documented conversation first.

A keloid is scar tissue that keeps growing past the original wound. Unlike a hypertrophic scar, it doesn't settle down on its own, and it can appear months after a tiny injury. Once one forms, removing it often triggers a bigger one.

Treatments that carry real keloid risk:

• Microneedling, dermaplaning, and medium-to-deep peels
• Ear, nose, and body piercing — especially cartilage and the earlobe
• Cosmetic tattooing: microblading, SMP, lip blush
• Ablative laser resurfacing, and any IPL or laser burn that blisters
• Electrolysis, and waxing that lifts skin on retinoid-thinned areas

Treatments that are generally fine: massage, facials without needling, lash and brow work, manicures, spray tan, non-ablative light on intact skin.

What to do in the chair:

• Ask directly: "Have you or a close family member ever had a scar that kept growing?" Self-reported history is the single best predictor.
• Test a discreet area — behind the ear, inner arm — and review at four to six weeks, not four days. Keloids are slow.
• Record the answer and your decision in the client's notes, dated. If a keloid forms later, that record is your evidence.
• Refer to a GP or dermatologist rather than treating an existing keloid yourself.

Keloids are markedly more common in Fitzpatrick IV–VI skin, but do not turn a client away on skin tone alone — that risks an Equality Act 2010 discrimination claim. Assess the individual's own scarring history, and offer a lower-risk alternative rather than a flat no.