Will Hypertrophic Scarring Recur After Scar Revision?

Q: Dr. Eppley, I have a neck scar that is hypertrophic. My dermatologist just finished 3 steriods injections spaced 2 weeks apart per session. He told me that if I want to do a scar revison I must let the doc know about the steriod injection as steriods will cause delay in tissue healing.What do you think? I also have some other questions about the scar revision.

1) What kind of excision pattern will you use to resect my scar?

2) Are the stitches used in the layers are dissolvable or permanent?

3) Also, what are the chances of hypertrophic scar recurring after removal? Mine is definitely not a keloid, but several doctors tell me that scar revision is not ideal as removal of hypertrophic scar will lead to hypertrophic scarring again. Is this true? 

Please kindly advise.

A: In answer to your questions:

The doctor who performs the scar revision should know about the steroids but they will not have a major effect on wound healing, particularly if there is some delay in moving forward with the scar revision.

1) Based on your scar shape, I would do a simple elliptical excisional pattern scar revision.

2) Sutures under the skin are always dissolveable. It is up to the doctor’s discretion and how easy it is for the patient to come back for follow-up as to whether sutures that are used on the outside will need to be removed or not.

3) There is always a chance of recurrent hypertrophic scarring. But the use of pre-revisional steriods before re-excision is a proven approach to lessen that risk.

Dr. Barry Eppley

Indianapolis, Indiana