Is this a keloid or hypertrophic scar? (Photo)

Question

I would like to look into scar treatment option - if possible. Are these keloid or hypertrophic scars? They are 15 years old. They have previously been treated with microneedling and fraxel. Thank you!

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. 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 decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Hypertrophic scars are elevated scars that are confined to the wound borders of whatever wound or condition preceded and caused them. Keloid scars, by contrast, are elevated scars that spill out beyond the borders of the antecedent wound or condition. At least from the photos, these are elevated and confined to the borders, so they would be hypertrophic scars. Microneedling had little chance of helping these, since it is best reserved for treating very superficial, surface color and/or textural irregularities. Fraxel lasers, too, would not have been my choice, since the use for these expensive, energy-based "bells and whistles" is supported far more by marketing and advertising hype and social media buzz than hard science. The first line of treated for both hypertrophic scars and keloids is intralesional injections of anti-inflammatory agents, such as triamcinolone in varying concentrations and amounts and sometimes combined with other anti-inflammatory agents to shrink and flatten them. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps.

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