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 18

Scar Treatment

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!


New York Plastic Surgeon
5.0 out of 5 stars 55 reviews

Hypertrophic scars and keloid 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:

  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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 72 reviews

Best hypertrophic scar treatment?

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 20 reviews

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

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.

 

Hypertrophic scar treatment

  • 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.

Hypertrophic scar treatment

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 5 reviews

Silicone sheets, Kenolog, and compression

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 19 reviews

Best Hypertrophic Scar treatment

In order to give you the best advice, please submit a photo of the scars your are concerned with. Keloids are very large scars that continue to grow outside the boundries of the original scar. I treat small keloids with steroids. Larger keloids I treat with excision and injection with steroids +/- radiation. Hypertrophic scars are amenable to re-excision.

Scar treatment options

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:
  1. TIME - almost all scars will improve with time.
  2. Silcone gel or sheeting
  3. Scar massage/pressure
    1. pressure garments 
    2. digital massage
  4. Kenalog/Cortisone injections- may be repeated every 4-6 weeks
  5. Laser resurfacing
    1. Fractions CO2
    2. Pulse Dye laser
    3. IPL
  6. Surgical excision
Consult with a board certified facial plastic or plastic surgeon to review your options.

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 64 reviews

Combo therapy best for hypertrophic scars

Daily scar massage helps to mobilize and flatten the scar. Silicone gel or sheets will help to flatten scar and minimize hyperpigmentation (dark coloring) of the scar (wear daily and/or nightly for best results). Laser or IPL treatments can help minimize the pink/red pigment of the scar. Wearing SPF 30-50 is essential to prevent hyperpigmentation if the scar is exposed to sunlight. Steroid injections (1-3 treatments) at 6 week intervals as needed to flatten scar- but overuse can cause atrophic scars where the skin thins and becomes sunken down, so dont want to overdo it with the steroid.

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.