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

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.