Options for removing or minimizing 2 quarter-shaped hypertrophic scars along shin?(Photos)

Question

I am African American with dark skin. Scars are from 2019 chemical burn. They are not getting better. I had a third one that got better but it was much smaller. I do not get keloids. What are my options, both surgical and laser?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing these details so clearly. I understand how frustrating it can be to deal with scars that haven’t improved over time—especially in a visible area like the shin. The good news is that even older hypertrophic scars can still be treated, though they often require a gradual and combination-based approach.

What You’re Likely Dealing With

Hypertrophic scars are:

Raised, firm, and confined to the original injury
Common after burns, like your chemical burn in 2019
Sometimes darker or lighter than your natural skin tone

Since you mentioned you do not form keloids, that’s a helpful distinction—hypertrophic scars are generally more responsive to treatment.

Special Considerations for Darker Skin

With melanin-rich skin, we always want to carefully avoid:

Post-inflammatory hyperpigmentation (darkening after irritation)
Hypopigmentation (light spots)
Recurrence of thickened scars

This doesn’t limit your options—it just means treatments should be gentle, controlled, and staged properly.

Non-Surgical Options (Typically First-Line)
1. Steroid Injections (Intralesional Corticosteroids)
Help flatten and soften raised scars
Usually done every 4–6 weeks in a series
One of the most effective treatments for hypertrophic scars
2. Silicone Gel or Silicone Sheets
Help reduce thickness and improve texture over time
Require consistent daily use for several months
3. Laser Treatments

Different types of lasers can help depending on your scar’s features:

Pulsed Dye Laser (PDL):
Targets redness and can help flatten the scar
Non-ablative fractional lasers:
Improve texture and blending with surrounding skin

For darker skin tones, we typically choose safer, lower-energy settings and space treatments out to minimize pigmentation risks.

4. Combination Therapy

In many cases, the best results come from combining:

Steroid injections
Laser treatments
Silicone therapy

This layered approach often produces more noticeable and stable improvement.

Surgical Options (Used Selectively)
Scar Excision

This involves surgically removing the scar and closing the skin more precisely.

However, for the shin:

There is higher tension, which increases the risk of recurrence
There’s also a risk of developing another hypertrophic scar

If surgery is considered, it is usually combined with:

Post-operative steroid injections
Sometimes laser therapy to prevent recurrence
What I Would Typically Recommend

Given your history (larger, long-standing scars on the shin and darker skin tone), a careful stepwise plan is usually best:

Start with steroid injections to flatten the scars
Add laser treatments to improve color and texture
Consider surgical revision only if necessary, and with preventive measures
Realistic Expectations

It’s important to set expectations appropriately:

These scars can be significantly improved, but not completely erased
The goal is to make them:
Flatter
Softer
Less noticeable in color and texture
Bottom Line
You do have effective options, even several years after the injury
Non-surgical treatments are typically safest and most effective initially
A combination approach tends to give the best long-term results

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Options for removing or minimizing 2 quarter-shaped hypertrophic scars along shin?(Photos)

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