Keloid flattened, scars won't turn white - Do I keep treating my keloid scars with laser or consider scar revision? (photos)

Question

Do I keep treating my keloid scars with laser or consider scar revision? They’re flat and the texture has improved, but the colour won’t come out of the scars. I am afraid of the keloids returning if I opt for surgery. I got a breast augmentation in October 2021 and had developed keloid scars a few months after the procedure. I got 3 rounds of cortisone injections from August 2022 onwards. Within only a few days of my first round, my keloids flattened. I have gotten 5 laser treatments so far.

Randal Haworth, MD, FACS · Answer

Keloid scars can be challenging to treat and require a personalized approach based on the individual's specific situation. In general, laser treatments can be effective in improving the texture and appearance of keloid scars. However, if the color of the scars remains unchanged despite multiple laser treatments, it may be time to consider other treatment options.

Scar revision surgery is an option to consider if the keloid scars are persistent and do not respond to other treatments. However, as you mentioned, there is a risk of the keloids returning after surgery. To reduce the risk of recurrence, a combination of surgical removal and other treatments may be used, such as cortisone injections, silicone sheeting, or radiation therapy.

It's important to discuss your concerns and treatment options with your dermatologist or plastic surgeon. They can evaluate your keloid scars and recommend the best course of action based on your specific needs and goals. They may also recommend a combination of treatments to achieve the best possible outcome, such as a series of cortisone injections followed by laser treatments or surgical removal.

Ultimately, the decision to continue with laser treatments or pursue scar revision surgery depends on the severity and extent of the keloid scars, as well as your personal preferences and goals. It's important to work with a qualified and experienced medical professional to ensure you receive the best possible care and achieve the best possible outcome.

Best of luck !

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

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