Acne Keloidalis Nuchae (AKN) is a chronic, idiopathic reaction to hair follicles on the nape of the neck. Various treatments are associated with recurrence and/or poor cosmetic results. We reviewed our consecutive series of patients treated with excision after tissue expansion. Methods: 9 patients (M:F 8:1, 24-45 years old) with advanced AKN refractory to previous medical and surgical therapy each had a Mentor Radovan Tissue Expander (75-400cc, rectangular or elliptical) inserted into a subcutaneous pocket and filled to tissue tolerance. Postoperatively, serial expansions were performed. Full thickness excision of AKN and TE removal were performed. The flap was advanced and inset over a closed drain. 6 patients underwent postoperative irradiation. Results: Three minor and two major complications occurred. Minor complications (i.e. ulcer, sinus tract, seroma) were treated with local wound care or aspiration while major complications (i.e. implant extrusion, infection with rupture) were treated with intravenous antibiotics and implant removal. All patients healed with good cosmetic results. No recurrences have been documented in average follow-up of 45 months following excision. Conclusion: AKN can be a very challenging problem that can be successfully treated with excision after tissue expansion and adjunctive postoperative irradiation.