Cortisone injection or laser for treatment of scars after upper blepharoplasty??

Question

Hi, I have keloid scars at the outer corners of eyes after a upper blepharoplasty. They are very visible. What is the safest & most affective way to improve/remove them? One eye doctor has suggested C02 laser and another said that cortisone injection would be best? Would cortisone not thin the eye skin too much? I am 40 yrs old and would also like to tighten and improve the eye area, but I am worried about a C02 laser causing irreversible damage.....is it the best option? Any advice appreciated.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Rod J. Rohrich, MD · Answer

The optimal treatment for
scarring is usually to allow time
to go by, let the scar mature for 6-12 months. It is unusual to see a keloid
scar in these areas.
The way to treat slightly hypertrophic scars if they persist more than 3-6
months is with
a diluted intralesional steroid injection. This should be done in the hands of
a Board Certified
Plastic Surgeon.

Raymond E. Lee, MD · Answer

Thanks for posting your questions.  Almost all surgical scars improve with time. Darker skin patients may have a higher incidence of scar thickening or hypertrophic scars.  The term keloid is a rare super thickening of a hypertrophic scar and is many times overused. In general treatment starts from most conservative to surgical.  I would start with using silicone gel like kelocote.  Depending on the exam, diluted corticoosteroid injections can be performed and repeated 4-6 weeks later if indicated.  Fractional CO2 laser is an option and it would be the next step if further treatment is needed.  Lastly, would be surgical scar revision.

Scott Trimas, MD · Answer

Either option with the laser or steroid injections may be appropriate. It is most likely hypertrophic scars which typically responds to various scar treatments. Some of the options that work best depend upon the age of the scars. If they are greater than a year, then steroid injections will unlikely help very much. Topical scar treatments such as silicone sheeting can be useful as well.

John J. Martin, Jr., MD · Answer

When did you do the surgery?  You most likely have  a hypertrophic scar and not a keloid. These scars can improve with a variety of modalities.  Injections of a mild steroid, often combined with something called 5-FU can flatten a scar.  May need one or two injections.  Non-ablative fractionated resurfacing is a great way to improve scars, and may need 2-3 treatments as well.  CO2 laser should also help to flatten and improve a scar.  I would start with the injections first as they work well with no downtime.

Oliver Pope Simmons, MD, FACS · Answer

Most of the time blepharoplasty scars heal without any visible signs of scarring or thickening. Sometimes the scars in the crows feet area can get thicken and in large simply because they are placed along the line of relaxed skin tension. If this is the case I would probably recommend re-excise in those areas and carefully closing them. CO2 laser and steroid injections will only be helpful if the scar is in the proper orientation

David Saadat, MD · Answer

It
depends. Cortisone is done for raised scars. Laser are typically done for
redness of scar. Thank you for your question.

Cortisone injection or laser for treatment of scars after upper blepharoplasty??

Answers (7)

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