Which treatment options would help minimize the appearance of a subcutaneous hypertrophic scar? (photo)

Question

One year ago I had a subcision done on a small area of my cheek. One of the areas that were treated developed a hard, convex nodule of scar tissue underneath the skin. I have received multiple modalities to try and flatten the scar, including hydrocortisone/Kenalog injections, pulse-dye laser, c02 laser treatments, therapeutic ultrasound, massage, and silicone sheeting. All have been yielded only minor improvement. Besides excision, what can I do?

Nelson Lee Novick, MD · Answer

I have been performing subcisions on a regular basis since 1995 for elevating and smoothing all kinds of indented (atrophic, depressed) scars from all causes, including acne boxcar & rolling scars; post-surgical scars; traumatic scars & infection induced (e.g. chickenpox scars). The results of this simple, relatively inexpensive, and natural approach (that depends upon the individual synthesizing  his/her own new collagen & new elastic fibers) are gratifying and long-lasting. Frankly, in the literally tens of thousands of times I have performed subcision, I have seldom encountered a situation where the body overproduces excessive fibrous tissue in response to treatment--with a couple of notable exceptions. I have seen individuals produce excessive fibrous tissue and nodules following subcision performed elsewhere with the Taylor Liberator device, which is a very aggressive subcision approach. Likewise, I have seen individuals develop the kind of nodules shown here who have  undergone subcision that has been supplemented with a permanent filler, such as Bellafill. In general, if either scenario is the case here, I would not expect lasers to be of an real value, and certainly not the silicone sheeting. I am also not surprised that neither massage nor ultrasound worked.  The aforementioned kinds of problems related to the "liberator" or to the addition of a permanent filler tend to be quite difficult to treat. However, I have had success with using an algorithm combining varying combinations, concentrations, and amounts of intralesional anti-inflammatory agents to shrink the nodules. You would be wise to make sure that you are consulting an experienced, board certified cosmetic dermatologist. Best of luck and my best for the New Year.

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

Ajaya Kashyap, MD · Answer

Thankyou for your question. I would recommend another steroid injection possibly followed by dermabrasion procedure to flatten the scar.  Please find an experienced Board certified Plastic surgeon who can examine you and help you. All the best!

Which treatment options would help minimize the appearance of a subcutaneous hypertrophic scar? (photo)

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Which treatment options would help minimize the appearance of a subcutaneous hypertrophic scar? (photo)

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