Your Questions

Q: Have you heard of Cryoshape treatment for keloids and hypertrophic scars? I have read some favorable reviews on the internet about its success. What is your opinion of it?

A: I am familiar with the technology but must confess that I have never used it. Given the fact that keloids are the most difficult scar problem that exists, any potential treatment is welcome. Cryoshape is a method of delivering cold or freezing therapy via a probe that is inserted into the keloid. By freezing the keloid, it is hoped that it will not only stop growing but shrink down as well. This is another intralesional therapy for keloids of which the most commonly used is steroids and 5-FU injections.

I am certain that Cryoshape has its share of successful keloid reductions but it will have its failures also. Keloids are extremely refractory and difficult scar problems that no one treatment can be universally effective. Whether it is any more effective that steroid injections is unknown.

The value of Cryoshape, in my opinion, is as a pre-excisional treatment method like we currently use steroid injections. For those patients that want more than just a shrunken keloid, excision needs to be part of the keloid treatment approach.

Dr. Barry Eppley

Indianapolis Indiana

Q: I was just wondering if Dr. Eppley could do scar revision on old keloid acne scars. I went to a Dermatologist over 7 years ago and he told me that plastic surgeons could remove the scars with great success. I am very self conscious and I love to swim, but I haven’t really done it because I know people are staring and want to know why I have these ugly scars. I wish I could tell them to mind their own business but obviously I can’t. I have them on my shoulders, top of my biceps, and a couple on my chest area. I was just wondering if you had done this kind of surgery before and what was the outcome from the surgery?

A: The success of scar revision is measured by how much the scar appearance is improved. Improvement in problematic pathologioc scars as you decribe  is ultimately measured by whether hypertrophy or keloiding reappears. There is no question that scar revision is successful early because the previous scar is cut out and temporarily eliminated, trading off a thick raised scar for a more narrow scar line. But what does the scar look like three or six months later?

How successful scar revision is depends on many factors, including skin type, anatomic location of the scar, and what caused the scar. Hypertrophic or keloid scars in thicker skin with darker pigmentation over stretch out areas such as the sternum and shoulders can be very difficult scar problems with a high rate of recurrence. They remain a plastic surgery problem where a better understanding of the science of scar formation is needed before more effective treatments are developed.

Until that day arrives, we must consider traditional scar excision and see what happens. I would recommend to do just one of the scars and see what happens, using it as a ‘test’. Based on that outcome one can determine if the other scars are worth the surgical effort.

Dr. Barry Eppley

Indianapolis, Indiana