HOW DO I TREAT KELOIDS AND HYPERTROPHIC SCARS (SCARS THAT STICK UP FROM THE SKIN SURFACE)
This photo is unrelated to the post. It's my friend Reid on the trip of a lifetime in Patagonia, at the tip of South America, where he went to climb a difficult mountain.
Everyone skin has a different degree of reactivity, and if your skin is darker, sometimes its reactivity is such that any surgery produces a lump of scar. In the area where a necklace would hang on your neck, scars are particularly common and active. Scars are almost always treatable with injection therapy, although some “keloid” scars are almost like tumors that need to be cut out and then treated with injections aggressively afterwards. The public and many surgeons know all about silicon sheeting therapy, which entails silicon material placed over the scar for most of the day in order to flatten the scar. No one is quite sure how this works, but it is moderately effective.
Our patients are often ethnic individuals who have trouble with scarring and we treat this routinely in follow up with injections and silicon sheeting. We use several medications. One, a cortisone agent called triamcinolone is used in varying amounts or concentrations. These concentrations vary from a very weak concentration which is used to inject acne pimples. Higher concentrations are used to inject scars and make them shrink. If the acne pimple were to be injected with high concentrations of triamcinolone, an indented area would occur and this is certainly not desirable. The art of the process is to determine the concentration or quantity of the triamcinolone that is required to produce proper shrinkage with any given skin problem.
We offer injections of two other agents for the most difficult scars. These are “off label use of on-label products” in other words, the FDA has approved these medications for use in other conditions but not for scarring. In the quantities used for scarring, very small quantities, no side effects or problems are to be expected except for treatment of scar area. These other medications are 5-flourourecil (5-FU) and bleomycin. These agents are quite effective in shrinking scars.
The side effect of cortisone injection or injection of these other agents, sometimes (rarely) involves lightening of the skin or too much shrinkage—formation of a sort of depression of the skin. Both side effects usually go away on their own within 6 to 12 months, or can be corrected by a minor procedure or sun exposure.
Cosmetic surgery patients, breast lift and implant patients, facelift patients, and even occasionally blepharoplasty patients from Fresno to Pasadena to Los Angeles all sometimes need scar treatment, and we include it at no charge after any surgery. Even liposuction patients have scar problems and may need treatment, and sometimes even revision of their incision scars.
