LAM FACIAL PLASTICS

Hello Dr. Lam!

I'm writing in regards to a scar I have on my tricep from the result of a scar revision of a previous hypertrophic (possible keloid?) scar. The original scar, from a biopsy, responded very well to steroid injections yet a laser did not touch the color on the thing. I had the biopsy scar excised in May of 2010 and for about 3-4 weeks post op it was a very nice pink thin scar and over the course of about two weeks it widened and became a very angry red color and raised and has not since grown. Last month I got a steroid/5-fu injection and it flattened it pretty well yet it is still wide and angry red in color.

I'm lucky compared to many people with bad scars but I still do not like this scar and I'm convinced I can get better results. I don't feel comfortable wearing long sleeve shirts often times because the deep red color is a big contrast to my skin tone as well as it being wide and not easy to distinguish as a scar. I had intentions of getting another course of steroid and 5-fu shots today but I told the Dr. I didn't think I'd be completely happy. I asked about his opinion on excision and he said he was pretty sure he could give me a better looking thin scar yet it would be a tiny bit longer in length from the excision. He said he would use 5-fu intraoperatively and also on follow ups as needed.

I know in every circumstance this scar has responded very well to steroid and/or 5-fu combo injections which gives me hope using it intraoperatively as well as early post op will yield better results before a ugly scar can form. Will steroid/5-fu prevent a worse scar from forming? Also the doctor said he would use dissovable stitches under the skin which kind of freaked me out because I've heard they can go to the surface and leave worse scars. I'd like your general take on this whole situation. I really want to go through with this because I have some faith it will work yet if not I risk having the same scar yet a bit longer.

also I'd be very interested in posting a pic but I use Flickr to store photos and it will not work

i am so very sorry but i do not perform scar revisions or speak of wounds of the body. they heal not as well and differently than ones on the face and neck.

I didn't realize you didn't work on keloids below the neck region.. I do apologize. I'll delete this post later today but I was wondering if you could just answer a few questions bring as you seem very well informed on the treatment options and their effectiveness.
1. Can 5-Fu intraoperatively and early post op prevent an actual widening and overgrowth of scar tissue?
2. In your experience with scars have you seen a significant difference in the 3-6month appearance of scars with 5fu as opposed to those with none.

Thanks for your time Doc. You do good things by taking time to visit the forum regularly. It's hard finding doctors in the Midwest with knowledge of tx for scars... You seem well educated on the subject

hi, no problem. please leave the posts so other people realize i do not do body keloids. that would help. there is always some pearl in someone's questions. here are your answers:
1. Can 5-Fu intraoperatively and early post op prevent an actual widening and overgrowth of scar tissue?
possibly, but i would only do that if someone has proven repeated scarring. it could lead to widening but limit overgrowth. widening occurs if not enough scar tissue occurs or a deep closure was not done and the scar weakens and the scar widens. the scar could also widen if it becomes hypertrophic and thicker in which case this type of widening could be limited with 5fu. what i prefer to do is to do KTP (which you could do Pulsed dye laser instead) at one week and then at 1 month to limit widening and scarring and redness without the risk of injecting 5fu early in a scar's healing.
2. In your experience with scars have you seen a significant difference in the 3-6month appearance of scars with 5fu as opposed to those with none.
no, i only use 5fu when needed. when it is needed then yes it can help tremendously.

Thanks a lot for the help Dr. Lam! I've decided I will try another injection of 5-fu and have the doc immediately follow up with pulsed dye laser before I resort to another excision.

If I do end up going the excision route.... what would be a good source for a "pressure dressing"? I use silicone strips with paper tape at the moment but I'm not sure that qualifies as a pressure dressing.

i really do not rely on pressure dressings so i don't know plus it is on your body. sorry cannot be of help on that one.
best,
sml