What are the risk for steroid injection for post surgery scar tissue? (photos)
Doctor Answers 3
Scar modulation with 5FU and Steroid
Now after any surgery, scar formation can occur, which is likely what is happening in the postop period of your hard palate graft. Scar modulation with injections of certain medicines can sometimes help minimize rebound retraction. I generally use a combination of 5 Fluorouracil, originally used as a chemotherapy drug intravenously, mixed with a lower concentration of Kenalog steroid. It is true that injection of steroids can cause tissue atrophy [some call it "melting" which sounds pretty scary]. But using a low concentration steroid with the 5FU will have a lower risk.
There have not been any good randomized trials that confirm these recommendations, and most of this is based on anecdotal evidence, but we feel that there is some benefit to this attempt at scar modulation.
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OK, I don't agree with Dr. Pacella.
Now regarding Dr. Pacella's comment about not using hard palate graft because "hard palate grafts, in particular are not often stiff enough to correct lid malposition," I would say this is silly. Hard palate grafts have much more structure than acelluar dermal matrix, also known as Alloderm. It makes me wonder if Dr. Pacella has actually ever used hard palate graft? Hard palate graft is difficult material to harvest and generally needs a special palate stent made by the dentist. Without this the roof of the mouth can bleed after surgery and feels very uncomfortable (like the worlds worst soup burn). However, hard palate graft has many very favorable qualities that Alloderm does not. Alloderm is very convenient because it does not take time during surgery to harvest from the roof of the mouth. A custom palate stent is not needed to protect the roof of the mouth. However, Alloderm is not a reliable spacer graft material for eyelid reconstruction. It does not have the power to control the shape of the lower eyelid. The graft itself disappears over the course of several months. It is primarily used in minor eyelid malposition cases where a permanent graft is not needed to control the shape of the eyelid. However, when definitive lower eyelid shaping is needed, which is quite common in post-blepharoplasty reconstruction, then nothing replaces a hard palate graft.
To summarize, I am not sure if a steroid injection is what you need. There is no substitute for an actual personal consultation.
Steroid Injection and Grafts
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