Keloids frequently recur after surgical excision alone, with reported rates exceeding 50–100%. Consequently, multimodal adjuvant therapy has become central to contemporary keloid management. Radiotherapy remains the most consistently effective adjuvant modality, supported by a variety of techniques and dose regimens. Intralesional injection therapies, including triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), and botulinum toxin type A (BTA), are also widely employed, either as standalone treatments or in combination with other modalities. With the use of these adjuvant therapies, the recurrence rate after keloid excision can be significantly reduced.