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Novalie

Excision of a hypertrophic...

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Posted

Hello,

I have about 7-8 hypertrophic scars on my back. My doc suggested that, for my biggest hypertrophic (about 1/3" wide and 1/8" raised), he could cut it out in an oval shape and stitch it up, so that I only have a thin lined scar.

This sounds like a good trade-off to me. But what steps can I take from the day that I get the stitches to ensure that the scar will remain flat and colorless and as small as possible? Are there any cremes or topicals that I should use after the excision to help the healing process?

Any had success with this procedure?

Thanks!

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Posted

Hi Novalie. I think looking into cortisone injections first might be worth a try, but be cautious because if injected inproperly or too potently, it can cause atrophy in surrounding areas (this happened to me once and it didn't even resolve the scar, though many have had success with this modality). For my own hypertrophic scar which was very persistent (excised twice, dermabraded once, cortisone injected once), what finally resolved it was the application of imiquimod (aldara) cream after an excision of sorts. This is a new form of attacking hypertrophic and keloidal scarring and for me it worked when nothing else did. I will say that after all of the other attempts, I am left with a bit of an indent (very small), but I would much rather have that than a bump. If you are interested in this, I could tell you about the imiquimod and how I went about this.

good luck,

--leo

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Posted

This is the main procedure I'm going to have done, so I'd be interested to hear how you get on. I would recommend that you look into the 'pre and post operative nutritional care' link in the FAQ to help optimise the healing of the excisions.

Good luck! smile.gif

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Posted

Leo - please describe your procedure.

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Posted

Imiquimod (brand name for Aldara) is manufactured by 3M and is in a class of new topicals known as immunoresponse modifiers. It was developed for use on genital warts but there are new studies that show that topical application of this cream (prescription only) to the suture line of recently excised hypertrophic or keloid scars radically decreases the probablitity that the scar will regrow. It doesn't work on already formed scars, unfortunately--so it's preventative more than curative. Generally, intralesional steroid injections or excision have been the standard. Often, however, a persistent scar will re-grow after being excised. Then the medical community discovered interferon which, if injected into the suture line after an excision, reduces the chances of regrowth. For some reason (cost maybe) very few docs use interferon. Imiquimod is new in that it generates local interferon at the application site. I believe that the science behind it is exactly the opposite of steroids, which work to reduce inflamation, thereby preventing the buildup of scar tissue, whereas interferon stiumlates the immune system and makes is really attack the area of application (=inflamation) in order to speed up the local metabolizing and breakdown of that tissue. Actually, that may be bad science, but I think it works somehow along those lines.

Anyway, the problem is, Imiquimod is by prescription only, but you can buy it online w/o one. The next problem is that it is expensive and is usually sold in 12 ampule packets (probably more than you'll need). I did find one site that sold it is 6 ampule packets and it was a bit cheaper.

The other drawback is that if you apply it too much, it can create a flu-like flare up of the immune system. This happened to me, but it resolved when I eased up. So this is powerful stuff but accordng to all of the studies, it is safe. I had had it wth my scar and was willing to experiment on myself and I'm so glad I did. Here is a good link to a credible study or just google the key words:

http://www.emedicine.com/DERM/topic205.htm

best of luck,

--leo

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Posted

So... just to clear things up, is any scar that's slightly raised considered a hypertrophic scar, or does that term refer specifically to those raised red scars? I ask this because I have a few hypopigmented scars on my back that are raised, but only very slightly and they are white as opposed to red.

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