Best Hypertrophic Scar Treatment?

Basically, 2 years ago, I was playing football with friends, fell bad, and got this really bad "cut/gash" on my knee.

It eventually turned into a hypertrophic scar, and since then, I have gotten a number of hypertrophic scars on my body (2 small ones on my chest, 1 near my elbow, and the 1 on the knee).

Before this, I have never gotten a hypertrophic scar so its confusing. Basically, I would like to know the best way to treat these scars. I've heard the steroid injections are effective? Any creams (mederma, vitamin E pills) etc.?

Doctor Answers (13)

Hypertrophic scars and keloid treatment

+8

You must first distinguish between hypertrophic scars and keloids. The former generally tend to grow for up to two years but then mprove over time after that. Keloids tend to exhibit continuous growth.

Hypertrophic scars are commonly associated with wounds that exhibit delayed healing: tissue loss, healing by secondary intention, third degree (full thickness burns), etc.

IF your scars are hyperftophic, they will tendi to resolve. However, interventions which have been recommended include:

  1. Pressure
  2. Massage
  3. Topical paper tape therapy
  4. Topical or intralesional steroids
  5. Topical silicone gel preparations or sheeting

Although Cocoa butter, Vitamin E, or Mederma have been touted by other practitioners, there is minimal scientific data to fully support these claims.


Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Scar Treatment

+4

After distinguishing the difference between hypertrophic scars and keloids. 

I would recommend silicone gel sheets , massaging the scar, Kenalog injections. 

in extreme cases of Hypertrophic scars a scar revision can be done followed by the aforementioned methods to minimize scarring. 

Best of Luck!

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 25 reviews

Best hypertrophic scar treatment?

+2
Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process.

If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.  For hypertrophic scars, if that's what yours is and not a keloid scar, steroid injections will likely help  - to decrease the size, flatten, decrease redness/itching, etc. 

Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

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Hypertrophic scar treatment

+2

My approach to hypertrophic scars include:

1. intralesional cortisone +/- 5-Fluorouracil

2. Silicone (either sheeting or liquid paint-on silicone (available as a product called ScarGuard MD))

3. Manual massage

4. Vascular laser if the scar is not only thickened but pink/red.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 4 reviews

Silicone sheets, Kenolog, and compression

+2

The treatment of a hypertrphic scar include the following:

1-Silicone sheets. Easier to use on the limbs ,however some are designed for the trunk.

2-Kenolog injection: Dilute steroid injection is an effective treatment for hypertrphic scars.The scar will flaten,become less itchy. It will still be the a scar though.

3-Compression: Works well in limbs and faces.Used more commonly in burn scars.

Hope that helps!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 4 reviews

Hypertrophic Scar treatment

+1


Best Scar Management Practice – Advice from Dr. Larry Nichter:
 At this late point you may well need a scar revision, a minor office procedure to remove your scar and replace it with a new one. Below are what I feel is important to prevent a future bad scar:
Best Scar Management is important to minimize or completely hide from view, the tell tale signs of surgery – namely, scars. Both you and your surgeon want you to have the most minimal scarring possible from your surgery.  Patients with scars that are enlarged or not healing well after surgery can be from many causes. Unsightly scars are most commonly due to genetics, underlying medical conditions or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
1- Minimize tension on the scar – Steri Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar.  This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”.
2– Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. NEVER apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection contact your surgeon’s office immediately and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
3. –Protect your scars from the sun - staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.  .
4. – Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best.  There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum  or Kelo-Cote products and if the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
5. – Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical or injection of a steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
Unfortunately scars are permanent but they can often be made less noticeable.  Ways to improve scars range from injectable treatments (steroids, 5FU, etc), laser treatments, dermabrasion, surgical excision, and topical scar maturation treatments.. However, it is impossible that all traces of any scar will be totally gone. Consult with a board certified plastic surgeon or  dermatologist to determine the best course and what you can likely expect

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 43 reviews

Best and Safest Hypertrophic Scar Treatment if the 1540 Non Ablative Fractional Laser

+1

Pressure, massage, Silicone Tape and Steroids have been mainstays of the treatment of Hypertrophic Scars for years. MOst serious Hypertrophic Scars eventually are treated with either Steroid Skin Tape or Steroid injection.

However, although the Steroid does reduce the Hypertrophic Scar, all too often the Steroid Injection causes complications:

  • Atrophy of Fat-the fat beneath the scar dissolves and the wound or scar widens and becomes depressed and looks worse
  • The skin becomes very thin
  • New Blood Vessels grow on the surface of the skin and become very visible

A safer and more modern approach is the use of the 1540 Non ablative fractional Erbium Laser. These laser treatments reduce the bulk of the Hypertrophic Scar with no side effects. THe scar will return to a flat white scar without fat atrophy or blood vessels.

In addition to the 1540 laser IPL Intense Pulsed Light treatments will reduce the redness of the scar and is typically used first to reduce redness before starting the 1540 to reduce bulk.

The beauty of the 1540 and IPL is that there are no negative side effects of the treatment.

These modalities must be started early within the first 6 weeks to be most effective.

 

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 29 reviews

Hypertrophic scar treatment

+1
  • Injection of Kenalog and 5-fluorouracil into scar every 2 weeks until improvement seen  - may take up to 6-8 sessions
  • Combine these scar injections with pulsed dye laser treatment (Vbeam) every month

You will see reduction in size and thickness of scar, a softening of the scar, a reduction of the redness, improved texture and reduction of itch and pain if present.

Elizabeth F. Rostan, MD
Charlotte Dermatologist
4.5 out of 5 stars 11 reviews

Hyretrophic scars

+1

These can be a very difficult problem. I personally use low dose Kenalog injections done carefully and over time to adjust the scar as best as possible and not make the problem worse. I will also use a silicone cream ( ketacote ) on the area or even a silicone sheet if the patient will be compliant with it.  Some people have had success with laser therapy even though I have not.

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

PDL, Gemini, Tunable Dye, Hypertrophic scars, keloids

+1

I have found the PDL-Pulse Dye Laser to be most effective for hypertrophic scars or keloids. I have also used the KTP and Gemini and Tunable Dye laser effectively-especially when the keloid is peristing. This is best combined with Triamcinolone acetonide injection. In tough cases we only add interferon which may give cold symptoms and Cordran tape as well as other modalities. IPL is not risky in my experience.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.