Hypertrophic scar on chin (pebble stone scar) and interested in steroid injections. Other options?

Question

I have an old hypertrophic scar (8-9 years) on my chin. I tried two sessions of fractional C02 but it didn't do anything. I know Steroid injections are the first option for hypertrophic scars , buy I'm scared of ending with a dent or getting hypopigmentation (or both). Are this side effects always so prevalent as the internet make it seems or it can be a safe method? What other options are for this type of scarring?

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

without pictures nobody will be able to help. there are many options for scars.

Scars need aerify, enlighten, or Cosmelan peels post surgery. Vivatia foam, Restorsea 10x, skinceuticals phyto +, Cosmelan 2 cream, and reve skin fortified bleaching cream all help.  Scars can be punch out and removed in the office.

there are many options for hypertrophic/red/discolored scars:
1. vascular lasers (yellow laser, vbeam, excel v)
2. fractional lasers (fraxel, erbium, co2)
3. microneedling/PRP
4. silicone based scar gels with growth factors
5. excision +/- radiation
see an expert
Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

Intralesional triamcinolone+/-5 FU  is the treatment of choice for hypertrophic scars. And while indentation and hypopigmentation are possible, they are not common adverse reactions, especially when appropriate doses and concentrations of the above are used by experienced, board certified cosmetic dermatologists or other aesthetic core physicians. Frankly, there was likely a greater risk of pigmentary problems from the use of the fraxel lasers. What's more, I am not surprised by the lack of efficacy of the fraxel, since there is a lot more marketing hype to support there use than there is real hard science to back them up. Hope this helps. Best of luck.

Amy Y. Paul, DO, FAAD · Answer

Most hypertrophic scars can be improved with the use of intralesional kenalog.  You should see your dermatologist so they can examine the scar and make some recommendations.  Intralesional kenalog done properly should not result in indentation or hypopigmentation.  Sometimes that is an unintended consequence, but you could always start slow rather than having a lot of kenalog injected at once.  Your dermatologist who is trained in these sorts of procedures will be able to help.  Please see an expert, and good luck!

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question. Intralesional steroid injections are effective in treating hypertrophic scars, but yes, a risk of indentation or discoloration is possible. However, the indentation or discoloration is not permanent and will reverse itself over time. But those risks are also dependent on the dose of steroid and how deep the medication is injected. I highly recommend you consult with a board certified dermatologist to have your skin evaluation and to discuss appropriate treatment options.

Hypertrophic scar on chin (pebble stone scar) and interested in steroid injections. Other options?

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