LAM FACIAL PLASTICS

Hey all. Im new to the site but thought I might find some useful info here. I had some surgery done back in Feb which required cutting just under my nipple (Im Male by way, for the pictures I am posting lol) and anyhow its left a 'oh so lovely' mark just under. Ive been using a silicone based cream from CVS called ScarZone and recently picked up ScarAway sheets which are also silicone but havent started using yet.

With that said, I want to see what else I can do. Id rather not go any lasering/surgery to fix so hopefully I can find a solution.

Ive posted 2 pics. Advice is very welcome. Thank you all

this is a hypertrophic scar bordering on a keloid. the best treatment that i would consider starting is a combination of 5-FU injections NOT steroids and KTP or Pulsed Dye laser. you can also try something new that i have been trying with my patients based on new evidence which is topical 5% captropril cream. too early to say whether i see results yet with that. that medication requires a prescription from a physician. unfortunately, most of the things i mentioned above most doctors simply do not know about. they will probably look at you with a blank face. i would definitely consider trying conservative things before attempting surgery as surgery is what caused it in the first place and could worsen matters if cutting into an already hypertrophic scar.
best,
sml

dr. lam wrote:this is a hypertrophic scar bordering on a keloid. the best treatment that i would consider starting is a combination of 5-FU injections NOT steroids and KTP or Pulsed Dye laser. you can also try something new that i have been trying with my patients based on new evidence which is topical 5% captropril cream. too early to say whether i see results yet with that. that medication requires a prescription from a physician. unfortunately, most of the things i mentioned above most doctors simply do not know about. they will probably look at you with a blank face. i would definitely consider trying conservative things before attempting surgery as surgery is what caused it in the first place and could worsen matters if cutting into an already hypertrophic scar.
best,
sml

Hi Dr Lam,

I note that you have started putting your patients on captropril cream. Do you also prescribe the oral form to be taken in conjunction? Have you noted any preliminary results in terms of improvement on scar quality?

Also, on a somewhat irrelevant note, I observe that scars usually widen after a couple of months. In the beginning, they often look their best..ie a straight narrow line. Apart from taping, is there anything you have found to be of benefit in preventing their widening? How about pressure garments? Do intradermal buried vertical sutures really help?

Many thanks for your time.

MH

hi,
1. too early to tell with the results with captopril and too few patients on it to see whether it makes a difference. also, they are on captropril and other treatments so i am not doing a split scar study so i am hesitant to comment on any results so far. as far as the oral form, it has been shown to help but medico-legally i am not comfortable prescribing a pill that may cause unsafe drop in blood pressure. accordingly, i have composed a letter for my patients only that they can bring to their physician for a prescription of enalopril.
2. i definitely think buried sutures help tremendously to reduce stretch back. to me it is the most important thing. i oftentimes also botox the immediate surrounding tissue 2 weeks before to limit muscle stretch back. taping afterwards as mentioned helps. everything else you mentioned in my opinion is probably not that helpful.
best,
sml