Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis. Recurrence rates as high as 100％ have been reported following surgical excision alone. Consequently, a variety of post-surgical techniques have been employed to prevent keloid recurrence, including the use of radiation. Although numerous studies have shown that post-excisional X-rays, electron beams, lasers, and brachytherapy can reduce the rate of keloid recurrence, numerous inconsistencies, including a wide range of definitions for keloid recurrence, render it difficult to compare the outcomes. The treatment of severe keloids in children is much more challenging, and there have been few previous reports. It is generally believed that children with keloids should be treated with non-surgical treatment such as hormone injections and radiotherapy. For severe keloids, these methods require a long treatment period, and their efficacy is not ideal. Moreover, the side effects of the treatment can affect children's health. If keloid scars are not effectively treated, they will often seriously affect the physical and mental health of children. The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery. In this case, the deep-embedded circular mattress suture technique (LBD, the looped, broad, and deep buried suturing technique) was used in the scar resection. After 18 months of follow-up, the surgical scar was evaluated using the Vancouver Scar Scale (VSS). The scar was stable and did not recur. The child was satisfied. This case shows that it is completely feasible to treat severe keloids with surgery alone, as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.