Keloid scars can lead to significant patient morbidity and disfigurement, especially when located on the head and neck. Massive keloid scars are particularly difficult to manage due to ulceration, infection, pain, and high recurrence rates following excision. We report the successful treatment of a massive head and neck keloid scar with excision and grafting, post-excisional radiotherapy, and ablative fractional laser-assisted topical corticosteroid delivery.