Scar removal revision - very red, hypertrophic scar. How can I improve this? (Photo)

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.


Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

I have had success in cases of persistent or recurrent hypertrophic scars and Keloids by first employing Scalpel Sculpting to debulk the scar down to being flush with the surrounding normal skin and then subsequently injecting the base of the scar with intralesional triamcinolone +/- 5-FU to suppress recurrence and diminish residual redness.
I have not found topical silicone gels and patches to be particularly effective and therefore do not prescribe them, nor have I found larger hypertrophic scars or keloids to be particularly responsive to intralesional anti-inflammatory injections until they have been significantly debunked in the manner described above. And, as you have found out unfortunaely the hard way, simple surgical excision without subsequent treatment all too often results in a recurrent hypertrophic or keloid scar.
You would be wise to consult with a board certified cosmetic dermatologist scar treatment expert and best of luck.

For a hypertrophic scar that remains red and raised after treatments like 5-fluorouracil (5-FU) injections and Clear V laser, there are several additional options you might consider to improve its appearance:

Silicone Gel Sheets or Creams: These can help flatten and reduce redness in hypertrophic scars over time. They work by hydrating the scar tissue and modulating collagen production.

Corticosteroid Injections: These can help reduce inflammation and flatten the scar. They are often used in combination with other treatments for better results.

Laser Therapy: Consider other types of laser treatments, such as fractional laser therapy or pulsed dye laser, which can help improve the texture and color of the scar.

Microneedling: This technique can improve scar texture by promoting collagen remodeling. It is often combined with topical treatments for enhanced results.

Pressure Therapy: Applying pressure garments can help flatten hypertrophic scars, particularly useful in larger areas.

Surgical Revision: In some cases, surgical excision of the scar followed by adjunctive therapies may be considered, especially if the scar is functionally or aesthetically problematic.

Cryotherapy: This involves freezing the scar tissue, which can help reduce its size and redness, particularly effective for smaller hypertrophic scars.

Consulting with a dermatologist or a plastic surgeon who specializes in scar treatments can provide a tailored approach based on the specific characteristics of your scar and your treatment history. They can assess your scar and recommend a combination of therapies that might be most effective for you.