What Can I Do For Ugly Scars After Erbium Resurfacing?

Question

I had 4 sessions of Erbium laser for the fine wrinkles of the upper lip. The 4th one, was very painful and took 6 weeks to heal,and I ended up with a very ugly hypertrophic scar. There is any chance that in time the scar to vanish? Or any other remedies? I use silicone ointment and I massage the scars all the time. Thank you!

Ron Shelton, MD · Answer

hypertrophic scars are often treated with corticosteroid injections, V-beam laser, silastic sheeting dressings (more effective than silicone gel in a tube, and sometimes massaging. There are rare side effects with both the injections of corticosteroids and the v-beam laser so discuss this thoroughly with your doctor.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Richard H. Tholen, MD, FACS · Answer

I'm sorry your laser resurfacing treatment resulted in lip scars. Your last session was either one session too many, or simply too aggressive (too deep, too many passes, or too much energy), or abnormal healing was allowed to occur. Any resurfacing that does not heal in 7-10 days means there is a problem, and a hypertrophic scar is much more likely. Why did your lip take so long to get healed? Was it allowed to dry out? Was there infection? Did you retard healing with water compresses, hydrogen peroxide, or acetic acid (vinegar) soaks?

	Steroid injections, silicone sheeting, and tincture of time will all play a role in helping your scar be as minimal as possible. But, it will NOT disappear or go away; let's hope it becomes a very minimally-visible scar as time goes by. Good luck and best wishes! This will likely take as long as a year to improve maximally.

Lawrence Kass, MD · Answer

Tough problem. Repeated laser resurfacing is not always the best answer and you illustrate this all too clearly. But don't despair--the chances are the appearance will improve and certainly you are doing everything right. Time and patience are the most important additional things you need to have/do. A sympathetic doctor who is willing to follow you and perform repeated steroid injections within the scar, would also likely be beneficial. Good luck!

Philip Young, MD · Answer

The hypertrophic scars could use some steroids as one option. You could also require some excisional treatments. Pictures would be better and I would be happy to look at them. Erbium lasers are not the preferred route for laser resurfacing in my opinion. You ultimately get more heat dispersion from these lasers versus co2 lasers.

Eugene Mandrea, MD (retired) · Answer

Hypertrophic scars respond to treatment most of the time.

	Careful freezing with Liquid  Nitrogen followed by injections of Kenalog  (1%  the first time, then gradually higher concentrations) should gradually help the hypertrophic scar to normalize.

	Silicone sheets or creams are mildly effective.

	Cordran Tape is mildly effective also, but of used for too long, you may get some dilated blood vessels (Telangiectasias) and  thinning of the skin (Atrophy)

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