Steroid injections for tummy tuck scar caused burst blood vessels & atrophy, what can I do? (Photos)

Steroids injected into hipertrophic scars is one of the least wise ideas ever... they produce the typical corticoid skin patch with atrophi, teleangiectasias (fine veins), yellowish or transparent look, etc, worsening the aesthetic outcome.

Le me be clear, we are talking about hipertrophic scars, not keloids.

Don't repeat, find other opinions to deal with your bad scarring, not always attributable to genetical cause, there might be technical options to improve the scars.

Good afternoon!

While a dilute steroid injection into a scar can help hypertrophic scarring, higher doses or repeat doses can lead to your exact problem- fat loss (which is causing the dent) as well as the vascular issue you are seeing. I

The best results would be for a re-excision of the scar and closure with vigorous scar therapy postoperatively. In my practice I prefer to wait at least 6 months after surgery before performing any sort of revision scar procedure.

I hope this helps

Steroids are a double-edged sword and while they breakdown collagen in the scar, they can do the same in normal skin and leave thinned, whitish skin with little blood vessels.
Treatments for your scar would best, in my opinion, be revision. Then since your have had scar hypertrophy, consider microbotox into the scar 20 units per side at the time of revision, then two weeks and two months later. I also use an erbium 1540 non ablative laser to treat preventively after surgery in such a case, and for treatment of scars becoming hypertrophic. Steroids and laser are not much use at this stage.
Aesthet Surg J. 2023 Mar 1;43(9):1015–1024. doi: 10.1093/asj/sjad044
Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars: A Roundtable on Integrating Intradermal Botulinum Toxin Type A Microdoses Into Clinical Practice

For reversing steroid atrophy, inject 10-30 cc of normal saline into the atrophic area. This gets rid of the repository of steroid and has been shown to reverse the atrophy.

While your scar likely softened with the steroid injections, unfortunately it has also thinned out some of the surrounding tissue. This is not an uncommon result. The best way to correct this is with scar revision, which can usually be done under local anesthetic in the clinic. Your hypertrophic scar may return or it may heal in more favorable way this time. Another consideration is postoperative radiation from a radiation oncologist. This substantially diminishes the risk of pathological scar formation. Make an appointment with your surgeon to discuss these options.

Thinning and teleangiectasia are a common side effects of intra-lesional steroid injections. This is the result of migration of the injection out of the thickened scar into the surrounding normal tissue. It is crucial that the injection be delivered precisely where it is needed.

Treatment is multifactorial and depends on the particular concerns of each patient. Visible vasculature can be treated with laser therapy. Thinning can be addressed via microneedling/RF microneedling. If possible, the entirety of the area can be revised via excision.

As always discuss your concerns with a board certified plastic surgeon (ABPS).

Hello,
thank you for your question.
It’s not uncommon for hypertrophic scars following abdominoplasty to be treated with intralesional steroid injections; however, side effects like telangiectasia (burst blood vessels) and localized atrophy or “dents” can occur, especially with repeated injections. The indentation you're noticing may be due to fat atrophy or dermal thinning from the steroid. At this point, management may include fractional laser therapy (e.g. Fraxel or CO2) to remodel the scar, vascular lasers (like pulsed dye or IPL) to reduce visible vessels, and in some cases microneedling with PRP or fat grafting to improve texture and volume loss. A consultation with a board-certified plastic surgeon or dermatologist with experience in scar revision would be ideal for a tailored treatment plan.

Your situation is common following abdominoplasty as there is sometimes unpredictable healing. You have a hypertrophic scar which has the following characteristics: thickened, discolored and raised tissue where ideally a flat, thin and less obvious healed scar would be desired. The blood vessels being visible following steroid injection happens because the normal surrounding skin has undergone thinning or atrophy of the dermis and underlying fat making those vessels much more obvious. Further steroid injections (in an attempt to thin the scar) will likely make the situation worse.

Things to consider are:
Does the thickened part of the scar extend the entirety of the incision or limited to one area such as the middle where there is the most tension?
Is it itchy or are there other symptoms?

If this is an isolated area and you are not a keloid or poor scar former, the definitive treatment would be to excise the unsightly scar full thickness and to close the incision with minimal tension and in multiple layers where the strength layer of the soft tissue called the fascia is recruited to provide a stable and reliable repair. This can be done under local anesthesia (awake) and also can be done in stages so that the surgeon and you can decide that it is the right path to take with a short recovery and the best chance for a good aesthetic result. Please consult a qualified plastic surgeon to evaluate it in person and good luck.

Based off your photos - the hypertrophic scars are still fresh (since still pink in color) - massage the scar deeply and thoroughly daily with scar gel / cream x 4-6 months to hopefully reverse of the hypertrophic areas. The flat areas are areas that the steroid has caused thinning of the scar and likely will be the endpoint of what your scar will look like in 8-12+ months. Review this with your surgeon to discuss all these concerns.

Thank you for your question. Glad to hear you are happy with your tummy tuck, however you have developed a bad scar. Steroid injections can be very unpredictable and can sometimes make things worse. I would recommend scar revision under local anesthesia, with a tension free closure. This has a much better chance of improving your scar, rather than further steroid injections.

It’s understandable to be concerned about the changes you’re noticing in your scar after steroid injections. Steroid injections, while effective in flattening hypertrophic scars, can sometimes lead to side effects such as thinning of the skin (atrophy), indentations, or visible blood vessels.
These side effects generally improve gradually as the steroid effect diminishes, although in some cases they can persist. To address your current concerns, options typically include: • Observation: Allowing several months to see if the tissue naturally recovers and the dent becomes less noticeable. • Laser Treatments: Vascular lasers or fractional laser resurfacing can reduce redness, burst vessels, and help smooth scar texture. • Fat Grafting or Fillers: Used carefully to correct indentations or skin depressions caused by tissue thinning. • Microneedling or PRP (Platelet-rich plasma): Can encourage collagen production and improve scar texture.
Given your situation, consulting with your surgeon or obtaining a second opinion from a specialist experienced in scar management would be advisable to evaluate and choose the most suitable treatment option.
I hope this information helps clarify your situation. Consulting with your surgeon or a scar management specialist would be beneficial in addressing these concerns.
— Güray Yeşiladalı, MD