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.

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.