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foreign [Music] s are one of the most frustrating scars to have they can be itchy they can be painful theyre bulky and we just dont have really great treatments for keloids the best advice that we as plastic surgeons can give patients who have a tendency to form keloids its just to be very very careful with their skin and to do everything to avoid injury to the skin as much as possible part of the reason why we have such a hard time treating keloids is we dont have a really great understanding of how they happen in the first place we know a couple Tendencies of keloids we know that they have a tendency to form more frequently in people of color and we know that they have a tendency to form more frequently in certain anatomical areas for example areas that are on stretch so in this paper by Minetta at all from tokushima University in Japan what the authors did was try to understand what stretch has to do with keloid formation what they did is they took normal skin cells and they to