I have a small keloid scar on my chest as a result of a surgery done in 2009. Ever since then the scar has always been red and a little bit bumpy. The red color seems never to fade away. When I press down the area where there is a little bumpiness, it hurts a little bit (even 3 years later). Some dermathologists have already told me to leave the scar as it is since any further treatment may make it worse. My question is whether there is a way to make the scar look less visible.
Keloid Scar on my Chest, Can It Be Treated? (profile)
Doctor Answers 2
General Information About Scar Revision In Reference To Scar On Chest
Unfortunately, there are no medical or surgical treatments to remove scars completely. All scar treatments or revisions are very individualized procedures that depend upon the appearance, characteristics, and size of the scar.
Scar excision and revision involves a surgical procedure to cut out the scar and then close the skin, followed by months of care to try to optimize the healing and maturation of the closure. Often times we will recommend certain skin care products be used topically before and after the surgical procedure.
Surgical scar treatment/revision, of any kind, does involve certain risks. These risks include changes in pigmentation (hyperpigmentation or hypopigmentation), possible red coloration or occasionally fine visible capillaries within a scar, infection, and surface texture changes (hypertrophy or atrophy). When a keloid scar is present, the recurrence of that keloid is also a risk. These would be explained in relationship to the scarring you have and your skin type. It is important to consider these risks when evaluating a scar for possible treatment options for improvement.
Scar massage, the application of pressure, steroid injections into the scar, application of steroid creams or gel sheeting, and laser resurfacing are some of the treatments/products that may be considered post-operatively.
Scars located in regions of significant motion, or that are subjected to frequent tension, often develop a less desirable appearance because of widening, and the atrophy or hypertrophy that accompanies it. Areas on the upper back, shoulders and upper arms, upper/mid chest, elbows, and knees often produce scars that are raised and widened, or thinned and widened. Scars oriented perpendicular to relaxed skin tension lines can also experience problems.
In general we would evaluate a scar and determine if some reasonable improvement could be obtained. Scar revision is better undertaken if there is good probability for at least moderate improvement.
Unfortunately the photo you provided is a bit grainy. I see what appears to be a transverse scar line with some surrounding redness (more redness below than above the scar). From what I see, this does not appear to be a keloid scar; but the bumpiness you describe may represent some mild hypertrophy. A keloid scar is a thickened and raised scar that exceeds the boundaries of the initial injury; the scar forms outside the area of the original surgical incision. A hypertrophic scar is a thickened or raised scar that is confined to the area of initial injury. Based upon what I see, I would not recommend re-excision of this scar. But there are other treatments that may be helpful,
The redness is likely due to superficial dilated capillaries in this area. These could be improved or eliminated with a light-based treatment such as intense pulsed light (IPL) or a Nd:YAG laser. The scar does not appear to be significantly raised. Very small amounts of carefully placed steroid may improve the bumpiness of the scar. Both the light therapy and the steroid may reduce the inflammatory nature of the scar, which should reduce the tenderness. A fractionated laser (Fraxel laser) may be another option to improve the bumpiness and blend the area. The recommended application of these treatments depends upon the exact appearance of the scar and surrounding tissue, and is best done by the examining physician. I would recommend you see a plastic surgeon -- s/he is likely to have more to offer you than a dermatologist in terms of providing you with treatment options. Be sure to have a detailed conversation so you understand the expectations each option provides.
Best wishes, Ken Dembny
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.