Objective: Despite the myriad options available, there is no universally the accepted treatment for keloids. Our objective was to compare three regiments and establish superiority in terms of objective and subjective outcomes. Approach: In this intervention study, 50 patients were enrolled. The Group I: included 26 patients with at least two keloid lesions subjected to intralesional triamcinolone acetonide in left-sided lesions and intralesional botulinum toxin type A in right-sided lesions. While group II included 24 patients subjected to a combination of both intralesional TAC and BTX-A. Injections were done for a total of three sessions 4weeks apart. Color Doppler ultrasound (CDU) was done before and one month after treatment. Results: In terms of thickness and surface area the keloids responded significantly better to combined TCA and BTX versus TCA alone or BTX alone (p .0001). Also improvement in transverse and longitudinal axis was significantly higher in combined therapy (p<.0001 and .004, respectively). Conclusion: Combined injection of intralesional steroids with BTX-A appears to be superior to either therapy alone and offer the best benefit of safer and more efficacious response with lesser side effects.