Hypertrophic scar/ keloid scar buttocks after debridement - how can I fix this? (Photo)

Question

I have a hypertrophic/keloid scar after a large portion of my buttocks was debrided 4 times following necrosis. This Left a dent in my buttocks and a crease/ snag as it healed. I had cO2 laser on the scar and it turned more hypertrophic/ raised. I am wondering if it is best to have the scar surgically cut out, or just leave it on flatten it somehow and get a tattoo over the area. I also want to fill the dent out. I had hyaluronic acid fillers put in to try and fill in the dent and cO2 laser, but the laser weakened the skin and it leaked some of the product out. I am not sure I would want a butt implant to fill the volume back in. If I did have the scar surgically excised and cut out, how long before I could expand the buttock / use filler to make it bigger again and fix the dent? OR use another method to fill my butt. I want my butt cheeks to be symmetrical again and I would either like to cover the scar with a tattoo or remove it. Some small wounds where the fillers had leaked how just barely closed. Would I need to wait a year to tattoo the scar? The initial wound had finished closing in may of 2025. Thanks . Looking for a surgeon and timeline

Anna Chacon, MD, FAAD · Answer

I'm sorry you've had to go through such a long recovery. Based on your description, you're dealing with several separate issues: a hypertrophic scar, contour loss (the dent), and skin that has recently healed after filler leakage. Each of these should be addressed in the right order to achieve the safest and most predictable result.

Since the CO₂ laser caused the scar to become more raised, I would be cautious about repeating aggressive laser treatments until the scar has fully matured. Hypertrophic scars often respond well to treatments such as intralesional corticosteroid injections, sometimes combined with 5-fluorouracil (5-FU), silicone scar therapy, or pressure therapy depending on the location and thickness. These options may help flatten the scar without additional surgery.

Surgical scar revision can be an excellent option if the scar is mature, stable, and causing significant contour distortion. However, surgery alone carries a risk of another hypertrophic scar forming, particularly in areas under tension like the buttocks. Many surgeons combine scar excision with postoperative scar management (such as steroid injections or silicone therapy) to reduce that risk.

Regarding the contour defect, I would recommend waiting until the tissues are completely healed and stable before considering any additional filler or fat grafting. Because you've recently experienced filler leakage and small wounds that have only recently closed, your skin needs adequate time to recover. In many cases, surgeons prefer waiting several months after complete healing before performing fat grafting or other volume restoration procedures. Fat grafting is often favored over repeated hyaluronic acid fillers for larger contour defects because it can provide a more natural and longer-lasting correction.

For tattooing, I would wait until the scar has fully matured. Many tattoo artists and surgeons recommend waiting at least 12 months after complete wound healing, and only after the scar is no longer changing in color, thickness, or texture. Tattooing over an immature or active hypertrophic scar can produce unpredictable cosmetic results.

In general, a staged approach often produces the best outcome:

Allow complete wound healing and scar maturation.
Treat or revise the hypertrophic scar if needed.
Restore volume once the tissues are healthy and stable.
Consider tattoo camouflage only after the scar has fully matured.

Given your history of necrosis, multiple debridements, and previous filler complications, I would recommend working with a board-certified plastic surgeon experienced in complex scar reconstruction. They can evaluate the quality of the surrounding tissue and help determine whether scar revision, fat grafting, or another reconstructive approach would give you the best chance of restoring symmetry while minimizing the risk of further complications.

I hope this helps clarify the typical timeline and options available. Wishing you continued healing and the best possible outcome.

Hypertrophic scar/ keloid scar buttocks after debridement - how can I fix this? (Photo)

Answers (1)

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