Internal scar tissue - how can I get rid of this? (Photo)

I'm sorry to hear about the discomfort you're experiencing. Internal scar tissue, especially around the mouth, can indeed be challenging to manage. Here are some potential approaches to consider:

1. Corticosteroid Injections (Kenalog): You've already had some rounds of Kenalog (triamcinolone acetonide) injections, which are commonly used to reduce scar tissue. Discuss with your physician the possibility of adjusting the concentration or frequency of these injections. Sometimes, higher concentrations or more frequent injections can be more effective, but they also carry a higher risk of side effects, so this needs to be carefully managed by your healthcare provider.

2. Silicone Gel Sheets or Silicone Gel: These are often used for external scars but can sometimes help with internal scars as well. They help to flatten and soften scar tissue over time.

3. Physical Therapy and Massage: Specialized physical therapy techniques and scar massage can help to break down scar tissue and improve mobility. A physical therapist with experience in post-surgical rehabilitation might be able to provide specific exercises and manual therapy techniques to help.

4. Laser Therapy: Certain types of laser treatments, like fractional CO2 lasers, can be used to remodel scar tissue. This is a more advanced option and typically requires a specialist.

5. Microneedling: This involves using tiny needles to create micro-injuries in the scar tissue, which can stimulate the body’s natural healing process and break down scar tissue. This should be done by a professional to avoid complications.

6. 5-Fluorouracil (5-FU) Injections: Sometimes used in combination with corticosteroids, 5-FU can help to reduce scar tissue. This is less common but might be worth discussing with your physician.

7. Surgical Revision: In some cases, if the scar tissue is particularly problematic, surgical revision might be considered to remove the scar tissue and re-approximate the tissues in a way that reduces the likelihood of scar formation. This is typically considered a last resort.

8. Enzyme Injections: Some newer treatments involve the use of enzymes that can break down collagen in the scar tissue. These are still under investigation and may not be widely available.

9. Topical Treatments: There are various topical treatments that can help, including those with ingredients like onion extract, vitamin E, or hyaluronic acid. These are more commonly used for external scars but might be worth trying.

Important Considerations:
- Always consult with a healthcare professional before starting any new treatment.
- Be cautious about over-treating or using multiple treatments at once, as this can sometimes worsen the problem.
- Consider seeking a second opinion if you feel your current treatment plan isn't effective.

Given the complexity of your case and the discomfort you're experiencing, it might be beneficial to consult with a specialist in dermatology or a plastic surgeon who has experience with post-surgical scar management.