Keloid is a benign hyperplastic scar which commonly occurs after any kind of injury and can lead to minor complaints to persistent complaints of itching and pain. The management includes either conservative management or surgical options followed by adjuvant treatment with radiation. The high rates of recurrences post conservative and surgical approaches have led to treatment with innovative techniques of either external beam radiation therapy or interstitial brachytherapy to treatment with heavy ions. Adjuvant treatment with radiation in any form has led to significant control in keloid recurrences and alleviation of symptoms. Hence, adjuvant radiation therapy has a key role in the management of recurrent, painful, and disfiguring keloids.