Background <p>There are many treatments for keloid. In recent years, botulinum toxin type A(BTX-A)has been proposed to treat keloid. The purpose of our study was to observe the clinical effect of BTX-A combined with superficial radiotherapy after chest keloid surgery.</p> Methods <p>60 patients with medium and large chest keloid treated from October 2021 to October 2023 were selected and randomly divided into group A and group B, with 30 cases in each group. Keloid resection was performed in both groups first, group A was treated with BTX-A combined with superficial radiotherapy, group B only received early superficial radiotherapy after surgery, and the therapeutic effect of the two groups was compared.</p> Results <p>After 6 months follow-up observation, the total effective rate and satisfaction of group A were higher than those of group B, and the Vancouver scar scale(VSS) score of group A was lower than that of group B, the difference was statistically significant (<i>P</i> &lt; 0.05).</p> Conclusions <p>We concluded that immediate injection of BTX-A combined with superficial radiotherapy after chest keloid surgery was superior to simple superficial radiotherapy after surgery, with higher patient satisfaction and lower recurrence rate, which was worthy of clinical application.</p> Level of Evidence II <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>