What Will Help My Raised Scars Look Better?
Q: Sir, I have a couple two to four inch long hypertrophic scar on my inner forearm and it looks HORRIBLE. I have been using silicone sheets and scarguard with little help. I heard that steroid injections canhelp unbulk the scar and was wondering what your recommendations were?
A: Based on your pictures, you have a common scar condition known as hypertrophic scars. While often confused with keloids, they are not. They are still a normal scar process in which the scar tissue raises above the level of the surrounding skin bit still stays within the original boundaries of the scar. They also reach a certain point of hypertrophy and then get no higher. In the early phases of scar healing, a hypertrophic scar has the potential to be improved by numerous topical therapies including silicone sheeting and topical products. When collagen is being laid down, ti can be suppressed and even flattened by these type of scar approaches. This is also the period when steroid injections may also be useful. Once the scar is mature, however, these non-surgical therapies are unlikely to work. A mature scar is when collagen formation is no longer active and this is why the cross-linking of the collagen molecules is unlikely to be reversed.
At this point, scar excision and re-closure is the most assured method for improvement. The scars will get much narrower this way from the beginning. When the scar is removed in this controlled fashion, hypertrophy is less likely to occur. After scar revision, it is still appropriate and helpful to do topical scar therapies from the very beginning of new scar healing.
Dr. Barry Eppley