I have a 3.5 inch scar resulting from a fall and blunt force trauma. The scar is a deep purple. It has been 9 months. (Photo)

Question

Because it is on the knee, the scar appears to be expanding. Given the difficult location of the scar, what are the best treatment options to minimize the appearance? I have been recommended laser treatment and excision of the scar. I am thinking laser first because it is less invasive, but if it is not effective, I would rather go straight to the surgery. I have enclosed some pictures for your reference. I appreciate your opinions!

Ryan A. Stanton, MD · Answer

It appears that you may have a hypertrophic scar. You very well may benefit from one of the personalized topical scar creams I formulate for my own patients, see below.  The gold standard for hypertrophic (thickened, raised and red &/or darkly pigmented) scar therapy is pressure and time - occasionally a year or more. If this fails then scar revision surgery may be considered.  However, not infrequently potential patients avoid surgery because fear of an unsightly scar. To remedy this, I now utilize and formulate compounded topical creams to treat, relieve and minimize scars for each of my patients:• new scars• old scars• surgical scars• keloid scars• stretch marks• hypertrophic scars• hyperpigmented (dark) scars• various acne scars, burn scars and more...These scar removal creams contain prescription strength medications each individually known to reduce and/or reverse the scarring process but never before compounded together into one high potency formulation. These medications are added to a base of anhydrous silicone (the most common ingredient in everyday topical scar therapy) and Pracaxi oil, found in the Amazon rainforest and known for its anti-inflammatory, antioxidant, antibacterial, and antifungal properties. Many health insurance plans actually cover the cost of the creams and they can be delivered directly to the patients door step. In other words, no need for multiple trips to the doctor for expensive and painful laser treatments, or wasted money on minimally effective over-the-counter topical scar therapy gels or silicone sheets that are unsightly and/or fail to stay on. Instead, with just two applications a day my patients now perform scar therapy in the comfort of their own home. Glad to help.

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

Jason Emer, MD · Answer

To be honest you really need a formal evaluation.  I specialize in scar removal and use both lasers, surgery, and topical creams for improvement.  Based on the pictures, you likely do need a formal scar revision, then followed with both laser and creams.  Microneedling may be useful with PRP.  I suggest you come see me and we can decide what is best.  No one treatment or one procedure will do it best for you, you will likely need a combination.  One think you should not do is steroid injections as they will likely atrophy the area and make it much more difficult to improve.  I wish you the best and hope to see you in the office.  Best, Dr. Emer.

I have a 3.5 inch scar resulting from a fall and blunt force trauma. The scar is a deep purple. It has been 9 months. (Photo)

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