What can I do for hypertrophic scars on my face? The cyst marks are hard, elevated and skin colored. (Photo)

I've had cystic acne. 8 out of 10 cysts left permanent hypertrophic marks. The cyst marks are hard, elevated and skin colored. Oh yeah, the oldest one was injected with steroids and it is indented. It is on my cheek/upper lip area. Then my other concern is large! on my chin, one smaller sized right above it and one along my jawline. I need to plan a strategy and treat post accutane. Like TCA cross for the ice picks, dermarolling, ablatative laser and "something" to remove these scars.

Doctor Answers 2

Injectable steroid + Fractional laser for hypertrophic scars

In my practice, I fractionate hypertrophic scars, then apply injectable steroid over the fractionated scars so that the substance runs through the holes. This serves two objectives. Break the scars apart with fractional laser resurfacing and lower the immune response with the applied steroid. I agree that you have heavy mixed scarring. This will require a multi-pronged approach that will always take into consideration your skin's potential to heal with hypertrophic scars. This is because of your history of already having had hypertrophic scars. In my experience with patients who have propensity to hypertrophic scars, my approach is very gingerly and conservative.

Fresno Physician
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Combination treatment required

I agree that repeated steroid injections into the hypertrophic/keloid scars (4-6 weekly) would be the best option for those scars.  However, you have what we describe as heavy, mixed scarring, This will require a combination of punch excision, TCA CROSS, and resurfacing (erbium +/- CO2) perhaps followed by radio frequency or pulsed-dye laser treatment.  We usually plan to do this as a staged series of procedures over 6 months and requires various periods of down-time for each step.  Speak to a dermatologist experienced with acne scar treatments to get a personalised treatment plan to suit your circumstances.  All the best.

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