Numerous therapeutic modalities have been espoused for the treatment of keloids. In the laboratory, great strides have been made in understanding the connective tissue pathobiology that underhes this problem. Unfortunately, no consistent treatment has been found to prevent the development of surface overhealing. Moreover, all forms of therapy designed to treat this condition have produced inconsistent results. This article documents the use of the Nd: YAG laser in the treatment of 20 patients with keloid scars. Candidates for the study included patients with no previous therapy and those who had prior treatment with steroids and/or surgery with no improvement. Although the use of Nd: YAG laser for keloids continues to be investigational, our results appear promising. Success of therapy was judged by softening and flattening of the scar. Laboratory studies provide a basis for understanding the possible effect of connective tissue metabohsm with the Nd: YAG.