Treatment of keloid by surgical excision alone has not been satisfactory accounting to its high recurrence rate. Since the role of adjuvant treatment is increasing, here we compare the result of postoperative radiotherapy in two cases. A 31-year-old woman had 10x2 cm sized linear erythematous hypertrophied scar on pubic area with a history of two prior surgical revisions. Another patient, a 44 year-old-woman, had 5x7 cm sized hypertrophied scar with severe contracture on right neck. Cosmetic excision with modified pulley suture and z-plasty was performed for both patients. Postoperative radiotherapy at dose of 12 Gy in three fractions and 14 Gy in two fractions was performed for each patient. After the surgery, the first patient visited 4 months later after 3 short-term follow up sessions. The later patient visited regularly at 1 to 2 weeks interval in the initial and visited at 1 month interval for another 6 months. Careful postoperative management was performed using intra-lesional triamcinolone injection and 595nm pulse dye laser. Despite the similarity in surgical procedure and method of postoperative radiotherapy, the first patient newly developed linear hypertrophic scar along the incision at 6 months of follow up. Not only the postoperative radiotherapy but also the patients’ compliance and postoperative wound care of the practitioners are crucial factors for the cosmetic results in the management of keloids.