LAM FACIAL PLASTICS

When preventing hypertrophic scars after a surgical excision, I understand that 5-FU injections and the application of pressure during the initial acute healing period are among the various treatments available.

However, I have read that 5-FU injections should not be simultaneously combined with exerting pressure on the wound site, such as wearing a pressure garment. Is this true? If yes, what is the reason?

no idea about why not to combine at the same time. also, pressure is really not necessary for hypertrophic scars. they can be used effectively for keloids. i assume you know the difference. if not, read my scar revision faqs or watch the virtual consultation for explanation.

I am aware that you use KTP laser and 5-FU to treat hypertrophic scarring. In your experience with hypertrophic scars, what was the success rate of these treatments? After the treatments were finished, what was the recurrence rate?

I am referring to the process of first excising the hypertrophic scar, closing it into a thin line, and then applying laser, 5-FU, and paper tapes bridging the scar (for about 12 weeks?) in order to minimize skin tension.

very successful when the scar is hypertrophic. moderate to poor when it is a keloid. if it is hypertrophic, i usually do not have to cut it out. with keloids, i often have to cut it out. sometimes with keloids, i have to treat it with radiation to get it not to come back.

My hypertrophic scar is raised and wide. As you said in your response, you usually don't cut the scar out. But if I wish to reduce the width of the scar so that it has a better shape (like a thin 'nice' plastic surgical incision line), isn't it necessary to have it excised first? Simply applying laser and 5-FU may flatten / lighten the hypertrophic scar, but the only way to reduce the scar WIDTH is excision, right?

great question. i'm sorry about the lack of clarity of my answer. let me clarify. if the scar is angry and red, usually i can get it flat and almost gone with just injections. if it is simply raised and widened, then the first move is excision followed possibly by 5-FU injections, etc.

Thank you for your response.

Usually how many injections are needed, and at what frequency, to flatten a hypertrophic scar and make it almost gone?

And just as importantly, in your clinical experience what is the chance of recurrence of hypertrophy after the excision / injection / laser treatments?

typically 3 to 5 injections with laser. however, it could be more or fewer. success rate is high when it is an irritated hypertrophic scar (that is red and a bit itchy and painful) with a relatively low recurrence rate. if it is simply thicker it does not do too much. if it is a keloid, recurrence is high.

Could you elaborate a bit more on what you mean by high success rate? So for an irritated scar (red, widened, slightly raised, a bit thick, and itchy and painful at times), if it is excised and follow up with said treatments, is there a high possibility for the final scar to stay as a thin, nice, flat line?

Or will the scar remain flat, but inevitably widen over time no matter what?

there are no guarantees. i would say there is a good chance of improvement WITHOUT excision if it is irritated. if it is just raised and not red, then excision would be a start. if it is red, raised, painful, itchy, it should be treated with laser and 5-FU not excision. I don't want to give you percentages or false hopes but I have had good success with these kinds of scars so long as they are NOT keloids.

You mentioned that you use radiation to treat keloids to make sure they don't come back.

Would you recommend the use of radiation, such as strongtium-90, on hypertrophic scars to minimize chance of recurrence?

i have never done that or think it is necessary. in most cases, hypertrophic scars can be handed with radiation. i do not use radiation treatments lightly, only for difficult, recalcitrant keloids.
sml

How much does each 5-fu shot cost?

Also, could you please describe all the common side effects of 5-fu that you've seen in your clinical practice when used on Asian patients with Type IV skin, in their mid-20's?

I have read that some people (eg. cancer patients) lack the genes to metabolize 5-fu, resulting in ICU stays or even death. Is this a valid concern when treating hypertrophic scars? Should I go get tested for the 5-fu gene before receiving injections?

Thanks.

250 a shot. lasers are 350 a shot but i usually just throw in the 5-fu when you do a laser so in another words: 350 will get you a laser and 5-Fu injection. you usually need both to manage the condition. remember that it takes a few rounds and the price i quoted you is for one session. the minimum time between treatments is 3 weeks. it is not always successful but if the scar is angry, the combination works much better. as i said, if it is just a thick scar then you need to cut it out.

as far as the dangers of 5-FU, you are talking about megadose intravenous injections. this is a very weak and tiny injection into the skin. i have never seen an issue in any skin type. that is why i prefer it over steroid injections by massive margins. i really only add steroid to the equation in keloids or in nightmare hypertrophic scars that are hopefully in fairer skin patients.
best,
sml

So let's say the scar is deemed appropriate for excision. After the operation, how soon will the 5-fu/laser combination treatment begin? Is it right after the sutures come out and the wound is closed which is, if I am not mistaken, roughly 2 weeks post-op if there are no complications?

Also, I have read in some cases where C-section patients were injected with corticosteroids intraoperatively to prevent hypertrophic scarring. Knowing a patient is prone to hypertrophic scarring, is it beneficial to inject some 5-fu DURING the excision operation, in order to start the hypertrophy-prevention process as soon as possible? Will this delay normal wound healing?

I have read about laser side effects such as swelling and hyperpigmentation. Typically what is the energy density (J/cm2) and spot size (mm) at which you apply the laser on hypertrophic scars?

You mentioned that the 5-fu/laser treatment is not always successful. I understand that it adds little value to give a success percentage since it's different for everyone, but would you say there is at least a 50-50 chance of it being effective in preventing hypertrophy? I just want to know my chances before making a decision.

Thanks so much for your detailed responses.