Kenalog injection for a scar

[flex1appeal]

I am just curious if any plastic surgeon on this board would be able to alieve my concerns. I had gyno surgery about 3 years ago now. As a result I had some unwanted sagging skin that eventually my PS removed at no additional fee. He did warn me it would leave a scar. I was ok with that as in the past most scars tend to fade to white over a period of time. So here I am about 1.7 years later after he removed the skin under each pec. Both scars about 5" long. One side is raised a good amount while the other is slightly raise. But both sides are extremely red or inflamed looking still. I tried everything under the sun naturally to rid the scar or make it less noticeable. The best solution up till now was silicone sheets. I did it for about 4-5 months straight 12hrs per day. Still wearing them. It faded somewhat but nothing significant and you can still tell how bad they are. So, I went to my PS yesterday and he offered to do Kenalog shots. He at first thought it would take 2-3 sessions every 6 weeks maybe 2-3 times in all (3 sessions each side because he said he probably couldn't inject the entire scar all at once with one shot.). He managed to get the kenalog in the entire scar cause he said it went in easier than he anticipated it would which he also said was a good sign. It has now been 26 hours and I can't really tell if anything at all is happening. I guess if there is a reaction yet from it. How long is it usually before I would notice a difference from kenalog being injected? 3 days? 1 week? I assume it only lasts in the scar for about 3-6 weeks and that's why you have to go back for another session assuming the 1st didn't work? Does Kenalog always work and will it be reasonable to expect the raised hypertrophic scar to flatten completely? How about the redness? Will kenalog help it fade to white or will I always have redness? That's what I am most concerned about. If it was white, I could always get dark tanning and hide better. I tried to tatoo over it but the tattoo places said it was too raised and the scar probably wouldn't take the ink. That was disappointing. It's frustrating because the gyno is gone and my chest is good but now I have this scar that makes me still not want to take my shirt off in public and it's been 10 years now not going to the beach. I am planning a trip to Florida this april and want to know if the scar can possible be virtually unnoticeable by then taking kenalog? Any input greatly appreciated. Thanks

[Dr. Elliot Jacobs]

Kenalog will absolutely work on a scar to flatten it -- no human tissue is resistant to it.  It usually takes  up to 4-6 weeks for its full effect to be seen, so 3 days is much to early in the process. You can sometimes appreciate some softening within a week or so. Once it has taken its effect, it is time to evaluate to see if additional treatment is necessary.  That is why your surgeon told you to return in 6 weeks and that indeed you might need more than one treatment.  It is best to go slowly with this treatment because if you overdo it, there are not many remedies.

Kenalog will not change the color of the scar-- only its contour.  If the scar is red, as is common in young people, it will definitely fade in time.  But that time may be a year or even two.  Sometimes a laser can help with both the red color as well as some of the thickening.  It would be best to consult a dermatologist or plastic surgeon who is very knowledgeable in laser treatments for further info about this.

I would not postpone your upcoming Florida trip -- but be aware that sunlight on a scar will make it redder.  Therefore, would strongly recommend a good sunblock to be applied conscientiously to the scars several times a day.  Some sunblocks even have pigment in them to camouflage the scar.

Good luck!

Dr Jacobs

[flex1appeal]

Dr. Jacobs,

Thanks for the reply. Just a few other questions. If this scar is alread nearing 2 years old (in June), and this scar is still very bright red, what are the honest chances that if it hasn't lightened by now that it still will? My PS told me that Kenalog's main purpose is to flatten it which is great but he also mentioned that in some cases it can lighten it as well. Sounds like you think there is no chance it will do that? You mentioned laser treatment for that. How effective is laser treatment? How many shades lighter could one expect from laser treatment? How expensive would something like that typically be? I realize you can only speak from the perspective of your office and every PS has different rates for their procedures. Also, can the sun really make it worse even 1.7 years into it as I would suspect the scar has already settled into it's perm state by now? The last question is, a tattoo parlor tried telling me that a scar, especially raised, would not take ink and refused to try. I know you don't do tattoos and know very little about it probably but know you probably know a little about scars and it's composition to answer such a question. Could a scar take ink from a tattoo? And if it flattens completely would that make it easier to take ink? If al else fails I am thinking of getting a tattoo to cover the scar. Thanks for your help.

Oh, I almost forgot, do you think treatment from Kenalog is more effective than silicone sheets? I tried that already and it helped some but not anything noticeable like so many claim.

regards,

[Dr. Elliot Jacobs]

If your scar is still red at two years, it may be red for much longer.  Best choice would be laser treatments which can target the small blood vessels that provide the red color.

I do not use lasers in my practice at all -- so I cannot help you further about this -- you should see a dermatologist who is experienced with laser treatments.

Kenalog will flatten a raised scar -- but has very little effect on coloration of the scar. I think it is more effective than silicone sheets.

I would still play it safe and keep it out of the sun -- what is there to lose?  Just use some sun block on the scars.

As for a tattoo, I do not do them.  Further, I do not believe tattoos would work in a raised scar.  On the other hand, tattoos could work on a flat scar -- I have seen many scars disguised in this manner.

Dr Jacobs

[flex1appeal]

All excellent advice which I will take to heart! One last question. Is safe to assume that inevitibly in time the redness will fade to white whether it be another year or 5 years? Or is it possible that without laser treatment it will always stay red? Thanks for your time and I will investigate laser treatment after the scar is flattened.

regards,

[Dr. Elliot Jacobs]

Cannot answer how long it may remain red -- some scars will do so for a very long time.  Part of the reason may be your genetic background.

Dr Jacobs