Best Hypertrophic Scar Treatment?

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:

Pressure
Massage
Topical paper tape therapy
Topical or intralesional steroids
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.

The good news about scar treatment is that they can always be improved. Pigmented scars can be lightened, red and purple scars can be corrected, depressed scars can be raised, raised scars can be flattened and scar texture can improve. The reality is, it often takes multiple types of treatment to address each aspect of the scar, and even with great improvements, scars will never fully be gone. 
Lasers can help change the pigment, red or purple color and texture of the scar. Fillers and mechanical subcision can be used to raise depressed scars. Various injectable treatments can flatten scars. The right combination of those treatments will depend on your individual needs, goals and anatomy. It takes an expert in scar revision to help choose and present your options, and you need someone who has all of those mentioned treatment modalities available. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

There are many treatments for hypertrophic scars but the best
treatment really depends on the patient and their specific scar.  Some mild scars are best treated with daily
massage and over-the-counter silicone sheets. 
More significant scars can be injected with steroid to reduce their
substance.  Depending on your skin color,
lasers can be used to destroy scar tissue and redness.  However, lasers can cause skin of color to
change color and that is why it is very hard to speak in generalities.  Furthermore, dermabrasion or even scar
excision/revision are options.  Your
local board-certified dermatologist or plastic surgeon should be able to review
your specific needs and make a plan of care that works best for you.

Thanks for sharing.  Scars can be acquired from trauma or even after a surgical incision. Some people can be more prone to hypertrophic scarring and fortunately less commonly keloids.  Certain areas of the body can be more prone as well such as the sternum and deltoid areas.  There are effective treatment options which may include:TIME - almost all scars will improve with time.Silcone gel or sheetingScar massage/pressurepressure garments digital massageKenalog/Cortisone injections- may be repeated every 4-6 weeksLaser resurfacingFractions CO2Pulse Dye laserIPLSurgical excisionConsult with a board certified facial plastic or plastic surgeon to review your options.

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!

Hypertrophic scars occur when the body creates too much scar tissue after an injury or surgery. Often the scar will grow for several months and then stabilize. True keloid scars behave more like tumors and often continue to grow even years after the initial trauma to the skin. Even people who are not prone to hypertrophic scars can get them. Certain areas are more prone to poor scarring (over joints, the chest), and factors like infection, poor nutrition, tissue damage, and smoking can affect scar quality as well. Scar creams are non-invasive and can generally improve the appearance of most scars. They are best used right after an injury, but they can be used even years later. Creams that have silicone in them have more clinical evidence than
other treatments like vitamin E and Mederma, although Mederma does work
well for some patients.If the scar cream is not enough, the choice of treatment depends on what is bothersome about the scar. Tenderness, itching, and a raised appearance can be treated by massaging the scar, wearing silicone compression strips, and by injecting a small amount of steroid (usually Kenalog) into the scar. Redness and other discoloration can be treated with a laser that targets those types of pigments. One final option is to perform scar revision by cutting out the original scar. If the original scar was due to infection, significant trauma, or from other factors that are now under control, it will often heal better. Scar revision can also rearrange the direction of the scar or break up the scar with zig zags (called a Z plasty), which can make them less noticeable.

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

Bad scars can manifest in many different ways, including pigmentation, thickening, and depression of atrophic scars. Thick scars are best treated in my practice with IIT, cortisone injections, pressure management, and laser. 

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!

The best treatment for hypertrophic scars is to avoid them in the first place. Unfortunately, scars cannot always be avoided. However, if you know that you are a poor healer and tend to make excessive scars, you should always notify your surgeon first so that if you sustain another injury somewhere else or have to have surgery, then your surgeon can take further precautions to help maximize the appearance of your scar. If possible always avoid surgery in visible areas.
As far as treatment once a scar occurs, it is best to initiate treatment as early as possible during the healing process. If a scar is older than two years, it is unlikely that anything short of surgical removal or scar revision will work. Then if you have surgery to remove or correct those scars, then preventive treatment which includes items that will be listed below.
Basically, scars should be injected as soon as possible with kenalog or steroid injections. This should be followed with silastic or silicone gel sheeting. Pressure on the scars can also help. Finally, we have found laser treatment with a pulsed dye laser or intense pulse light or KTP or ND:YAG to be effective adjunctive therapy. Sometimes scar treatment can take many years to be successful.