The patient presented with a large, multi-lobulated keloid on the right ear lobule that had grown progressively from an old piercing site. The lesion was firm, pendulous, and tethered the lobule downward, distorting its natural shape and remaining clearly visible from any angle. Treatment was complete surgical excision of the keloid under local anaesthesia, with the lobule reconstructed using fine layered sutures to recreate a natural lobule contour. The accompanying photographs show the surgical site in the early post-operative period — the keloid bulk is fully removed and the closure is well-aligned, with healing in progress. Post-operative care includes silicone scar therapy and follow-up to reduce the risk of keloid recurrence. Performed by Dr. Pongsak at Pongsak Clinic, Hua Hin.