Background <p>To investigate the clinical effect of the combination of tunnel shaped excision with radiotherapy and injection of type A botulinum toxin in the treatment of auricular keloids.</p> Methods <p>From June 2017 to May 2023, a total of 52 cases with auricular keloids were treated with tunnel shaped excision combined with radiotherapy and the injection of type A botulinum toxin. The effects of this sequential treatment were analyzed and evaluated. </p> Results <p>No recurrence of keloids was observed in the enrolled patients, and no abnormal conditions such as ear deformities occurred. The postoperative auricle appearance of most patients was satisfactory and the shape was good.</p> Conclusion <p>The combination of tunnel shaped excision with radiotherapy and injection of type A botulinum toxin in the treatment of auricular keloids can achieve good therapeutic effects, resulting in satisfactory auricle morphology, and is worthy of clinical promotion.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>