Can a hypertrophic scar be removed with excision?

My 10 year old son gashed his forehead last summer. It healed as a raised scar. He is being treated by a pediatric plastic surgeon who has recommended massage with oil.  We have been doing this for the past 7 months and the scar has improved considerably. It is almost flat. During our last visit the surgeon also recommended pressure dressings to help flatten the scar further.  He also said that he could do a revision on the scar since it is wide and make it a much thinner line. My questions are as follows:Does a hypertrophic scar need to be completely flat before a revision can be done or can the scar tissue be removed during the surgery?  I am not sure why he wants to wait another 6 months given that the scar is now a year oldMy son has 10 and the Dr. has recommended doing the revision now (before he starts puberty) or later (once he's done with puberty) so that the scar does not widen as he grows.  Any recommendations/thoughts on when would be the best time to do this?Thank you

Doctor Answers 5

Scar therapy

The gold standard for hypertrophic scar therapy is pressure and time - occasionally a year or more.  If this fails then scar revision surgery may be considered. Although the results of scar therapy vary from person to person and scar to scar, the results are considered permanent.  Basically, your pediatric plastic surgeon is absolutely correct in everything he is recommending.

Not infrequently potential patients avoid surgery because fear of an unsightly scar. To remedy this, I now utilize and formulate compounded topical creams to treat, relieve and minimize scars for each of my patients:

• new scars

• old scars

• surgical scars

• keloid scars

• stretch marks

• hypertrophic scars

• hyperpigmented (dark) scars

• various acne scars, and more...

These scar removal creams contain prescription strength medications each individually known to reduce and/or reverse the scarring process but never before compounded together into one high potency formulation. These medications are added to a base of anhydrous silicone (the most common ingredient in everyday topical scar therapy) and Pracaxi oil, found in the Amazon rainforest and known for its anti-inflammatory, antioxidant, antibacterial, and antifungal properties. Many health insurance plans actually cover the cost of the creams and they can be delivered directly to the patients door step. In other words, no need for multiple trips to the doctor for expensive and painful laser treatments, or wasted money on minimally effective over-the-counter topical scar therapy gels or silicone sheets that are unsightly and/or fail to stay on. Instead, with just two applications a day my patients now perform scar therapy in the comfort of their own home.  Glad to help.

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 116 reviews

Laser treatments often better option for scars

There are a number of non-surgical laser options for scar enhancement/improvement. Better outcomes are achieved when laser treatments are started early - soon after injury. These laser treatment include pulsed dye laser and fractional laser treatments and have zero or minimal downtime. They are often combined with injections to flatten the scar. I would strongly encourage you to explore these options prior to any surgery.

Elizabeth F. Rostan, MD
Charlotte Dermatologist
4.4 out of 5 stars 18 reviews

Scar revision

You do not have to wait, although I personally would wait till he is done growing so that the scar does not enlarge any further. There is always a risk that the hypertrophic scar returns following an excision, but typically there are measures taken (intralesional kenalong injections) to prevent this. Topical scar creams with silicone and sunscreen are another option which can help his scar in the meantime. 

Jerome Obed, DO, FAOCD
Fort Lauderdale Dermatologist
5.0 out of 5 stars 1 review

Facial scar in a 10 year old.

Your discussion failed to include an important bit of information. How does your son feel about the scar? Is he concerned about its appearance or does he not care? If he doesn't care my advice would be to do nothing at this time. 
It frequently takes up to 18 months to two years in a child for a scar to mature or to be the way it will look for the remainder of the patient's life; so it still may improve with time. By the same token if a scar looks lousy after 12 months, it will probably not look that great in another 6 to 12 months.
Although your son is a minor, I would leave the decision about timing up to him. Kids become body conscious at the time of puberty, about 10 years in girls and somewhat later in boys, so right now it may be not a problem, and if that were the case, I would wait until he requests it.

John Newkirk, MD
Columbia Plastic Surgeon
4.0 out of 5 stars 10 reviews

Hypertrophic scars and treatment in Los Angeles

Hypertrophic scars respond well to IIT, laser therapy, and topical application of Plato's Scar Serum. Cosmetic improvement can be acheived with fractional laser. 

Raffy Karamanoukian MD FACS

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

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.