I just wanted to "chronicle" my ongoing ordeal with hypertrophic scars, and share with everyone in the hopes that it will help someone.
I am a 25 year old female, and have been dealing with hypertrophic scars for about 5 years now. I first started getting hypertrophic scars in college. I didn't know what they were at the time- just knew that it was disfiguring and unsightly.
My hypertrophic scars are all along the jawline and neck area. I have about 10 hypertrophic scars in this area, ranging in size from 0.5cm to quarter-sized.
My first visit to the dermatologist about 3 years ago was fairly discouraging. He could not offer me a treatment for the scars, but instead we worked to get the acne under control. I was then referred to a plastic surgeon who suggested that we excise one and see how it responds. At this point in time, injections/laser therapy was not widely used.
Acne is now largely under control, and I am just using benzoyl peroxide twice daily. I am fairly happy with the acne treatment currently.
The surgical excision was a very bad thing to do (for me). The scar grew back about twice the size of the original, which was very discouraging. I gave up treating them.
After reading the message boards here and doing some research online, I decided to give corticosteroid injections a try. I called around 2 places, and one offered them. I'm not sure how widely it is available, but it sounds like many dermatologists are doing it now.
The dermatologist I went to see is board certified and also teaches at the medical school in town, so I was very hopeful.
During my consultation (which was on 2/21/12), he told me that corticosteroid injections and pulse-dye laser were my two options. They are similar in treatment length and benefits, and both are covered under my insurance (although I have a large deductible to meet...)
I chose the corticosteroid injections only because I can get them done right in his office, while I would have to be referred to yet another place for the laser. He told me that the laser is "uncomfortable" while the injections, are well, injections, so they're also uncomfortable (or painful, depending on your level of needle-phobia)
I started the injections that day with the scars on the right side of my neck/jawline. I think we injected about 4 scars total. The injections were painful on the flatter scars and less painful on the large, "tall" scars. There is a tiny bit of bleeding and some pain for 1-2 hours after injecting. I have a fairly high tolerance to pain, and personally, it's a small price to pay for getting rid of these ugly scars!!
With steroid injections, there is minimal chance it will go in systemic, although you may want to take that into account if you're diabetic (steroids are anti-insulin). You can also get tissue atrophy is you inject them into healthy tissue, resulting in depressions in the skin, which are unsightly (it's like the opposite of keloids/hypretrophic scars!). So the dermatologist took great care not to inject them outside the scars.
Typically it takes a "few" injections to make the scars go away. The dermatologist told me about 5-6 injections. However, he was optimistic about the treatment, and said that he has had good success with them in the past.
I am supposed to return for my next round of innjections in one month.
This was very long, But I hope it helps people. I will edit/post back with my progress. (fingers crossed!!) I just want to be able to tie back my hair into a ponytail without feeling self-conscious!!
These are pictures of my scars currently (2/22/12)
I have been to the derm for two separate injections so far. There is mild improvement...
I have had the right side of my face injected twice now, and the left side injected once. I will be going back for my third treatment this week.
Right side of face/neck: On the one scar that was most raised, I have seen moderate improvements. This was the scar that I got surgically removed 2 years ago and then came back bigger. All other scars have not shown any response. Even the newest scars (less than one year old) have not responded to the injections.
On the left side of my face/neck, I have mild improvements on one scar; it is slightly "shorter" now. No responses with any other scars.
The results are a bit disappointing so far. After one more treatment, I may ask to be referred for laser therapy. But either way, after this week, I probably will be not be able to get any kind fo treatments for a year due to my schedule becoming extremely busy/unpredictable...
Still holding out for some delayed improvements though.. sigh.
Hi thanks for sharing your story. I have exactly the same situation as yours.
I'm a 27 guy from China and had suffered from severe acne before and left many raised scar on my jawline, which are really similar like yours in the pics.
I tried laser treatment and injections once in Beijing, and after that it did become better for a short time, but later on it got worse again.
Now I'm coming to work in US, and I want to see the derms here if there's any better options.
What concentration is the steroid you are receiving?
5 or 10 or 20 mg?
It's possible the steroids aren't working that great because you are getting the smallest concentration. 40 mg concentration is the highest I've ever heard, and doctors really resist going that high. I needed 30 mg concentration to see any results on my chest keloids.
By the way, I've had a ton of laser sessions and IMO those are much less painful than the needles.
Homer: I am not sure what concentrations they were; At my third (last) steroid treatment, I know he used a higher concentration, but I am not sure what.
Anyway, I saw about 15% improvement with these injections. Today I am going in for my first laser therapy. I am really hoping these will help.
Lately though, I have not been as concerned about my scars. I am not sure if this is because I've become so used them, or because they are slightly smaller/flatter now. I am also not sure if the slight flattening is due to the steroid injections, or just "time." (As hypertrophic scars can flatten over time.)
I wil post another, more thorough, update after my laser session with pictures.
Okay, I decided against putting up pictures because:
1. the keloids are really gross-looking after the laser
2. the hypertrophic scars don't look too different after the laser
I got the CO2 laser on my keloids on my back and pulse-dye on the hypertrophic scars on the neck/jaw line (I think.) I think the CO2 is supposed to take the redness down while the pulse-dye is better at taking the "height" of the scars down.
I got some numbing cream on my scars about 1 hr before laser. I didn't get it on the keloids, and I don't know why, because it hurt like crap without the numbing cream- felt like needles poking me but worse. With the numbing cream, however, it just felt like little prickles- very tolerable. And there was a faint smell of burning flesh.. really disturbing tbh.
The laser process only took about 10 minutes- the longest part was waiting around with the numbing cream.
Immediately afterwards, the keloids with CO2 looked like my skin was burnt or severely bruised- black/purple. Quite gross looking. It still looks like that, and will continue looking like that for 2-3 weeks. The hypertrophic scars looked white, like there was a sheet of frost over them. That went away with some aquaphor cream. Right now it is red, like a sunburn. Later, it's supposed to become scabby/brown (I think). The keloids sting right now, but the hypertrophic scars don't hurt at all.
I am not suppoed to put makeup over them (I don't know for how long though...) and I am to wash those areas with Cetaphil; put aquaphor on it few times a day to keep it moisturized.
My recheck is in 3 weeks, and if it looks ok at that point, I am getting another treatment a month from now.
yelloh,
All of those side effects are normal.
Do you remember the name of the CO2 laser? I've had a very hard time finding any doctor or medical literature that suggests CO2 lasers would improve redness. They all think of the PDL as a 'gold standard' even though it hasn't done jack shit for me.
I'm not trying to say you tried that laser for nothing; I'm trying to say congratulations on finding a doctor with the balls to try something aggressively.
By the way, when I received laser treatment after flattening my scars with corisone, some of them actually re-raised. So keep an eye on that, and by sure to FINISH your laser treatments before doing more cortisone.
I have pretty much the same problem in the same area but I have more it sucks. I get the steroid injection every 4 weeks done it about 8 times already. Does anybody know how to get rid of these like there has to be a laser surgery to really get rid of them without having it re appear ? Check out my profile and gallery please.
It's been a while since I've posted- mainly because there hasn't been any good news.
To correct my previous post, I had a fractional ablative laser on the scars on my jaw/neck, and I saw no improvement even after 3 sessions. The third session, I had the strength increased and it hurt like hell- but nothing!
I will be going back to ther derm on Feb 3 for laser + steroid therapy. I found this article and I am hoping this will give me some good news. I encourage you guys to read it as well and possibly talk to your dermatologist:
"Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery"
http://onlinelibrary.wiley.com/doi/10.1002/lsm.22120/pdf
It's basically using fractional laser and then applying triamcinolone suspension on the treated scars within 2 minutes. The laser creates a channel for the suspension to penetrate into the skin. The results are promising- but keep in mind that this was a small group of participants.
I know everyone with hypertrophic scars are desperate for ANYTHING! So I am giving it a shot... Just wish I could go in sooner. I will post an update after the session.
wishingitallaway: are you seeing any improvements with steroid injections? if they are helping, I would even consider that lucky- I would take continuous treatment over no improvements at all!
An update:
I have started a laser + steroid injection treatment.
It is two lasers in one session, followed by steroid injections.
I get IPL done for redness, then fractional for size reduction. Then all scars are injected with a steroid.
So far I have seen fair improvements. After the first session, I noticed that my scar on my chest is significantly less sensitive. Before, if I just scratched it the wrong way, it would hurt a lot. After the treatment, it has a more "normal" sensitivity level.
After the first session, I noticed that one of my most recent scars have gone down significantly in size, but this was about the only physically noticeable improvement.
After the second session,, That most recent scar and one of my older scars have decreased in size. Some other scars have also gone down very slightly in size. The chest scar has gone dowb about 25% in size. The back keloid has gone down about 15% in size.
Overall it's not a great improvement, but it is more than I have seen with any other treatments. It is enough of a difference for me to continue these treatments.
However I have to note that these treatments are veryyy expensive. They are $900 per session (two lasers + steroid injections), with insurance POSSIBLY covering 50% (I have not heard from my insurance company yet, and do not know if they will cover any of it). I could not afford this as a student. I can barely afford it now.
Also need to note that the steroid injections HURT A LOT. Getting these injections after laser seem to be more painful than just injections alone. Each injection feels like my skin is burning. (Ouch) The lasers themselves are tolerable with good numbing beforehand.
Overall, even considering the cost and the pain, the modest improvement is enough to make it worth it for now. I was expecting at least 3-5 treatments to see dramatic improvements, so we will see. I am currently doing 1 session every 4-5 weeks.
Also, the thing I mentioned in the previous post with deep fractional laser + topical steroid has not shown to be very effective for me, hence just going forward with injections.
Good luck to everyone!
An update:
I have started a laser + steroid injection treatment.
It is two lasers in one session, followed by steroid injections.
I get IPL done for redness, then fractional for size reduction. Then all scars are injected with a steroid.
So far I have seen fair improvements. After the first session, I noticed that my scar on my chest is significantly less sensitive. Before, if I just scratched it the wrong way, it would hurt a lot. After the treatment, it has a more "normal" sensitivity level.
After the first session, I noticed that one of my most recent scars have gone down significantly in size, but this was about the only physically noticeable improvement.
After the second session,, That most recent scar and one of my older scars have decreased in size. Some other scars have also gone down very slightly in size. The chest scar has gone dowb about 25% in size. The back keloid has gone down about 15% in size.
Overall it's not a great improvement, but it is more than I have seen with any other treatments. It is enough of a difference for me to continue these treatments.
However I have to note that these treatments are veryyy expensive. They are $900 per session (two lasers + steroid injections), with insurance POSSIBLY covering 50% (I have not heard from my insurance company yet, and do not know if they will cover any of it). I could not afford this as a student. I can barely afford it now.
Also need to note that the steroid injections HURT A LOT. Getting these injections after laser seem to be more painful than just injections alone. Each injection feels like my skin is burning. (Ouch) The lasers themselves are tolerable with good numbing beforehand.
Overall, even considering the cost and the pain, the modest improvement is enough to make it worth it for now. I was expecting at least 3-5 treatments to see dramatic improvements, so we will see. I am currently doing 1 session every 4-5 weeks.
Also, the thing I mentioned in the previous post with deep fractional laser + topical steroid has not shown to be very effective for me, hence just going forward with injections.
Good luck to everyone!
i just want to ask how old are your scars? because i got mine from college around 2002, and I have it in my nose area. Is it still ok to use steroid on them?
thanks