kenalog - can the docs just explain what's involved & what to expect?

[michaelmorey]

Hi,
A lot of guys (myself included) are suffering with varying degrees of scar tissue after surgery, particularly behind/around the nipple. Could both docs please give their wisdom on kenalog? i.e. when to explore that option? process (is it one injection at one point in the scar tissue mass, or would the "ball" of scar tissue be injected at different points), changes post injection, expected results (some scar tissue remains etc?) and how long after injection one would expect to see final results.


Lastly, I read a statement somewhere on these boards that said something like, "The doc didn't want to inject me with too much kenalog because he didn't want to risk my chest becoming indented"??

what's that all about? does kenalog also dissolve breaqst tissue or fat? why would that statement apply?


Thanks, any answers to these points above would help a lot of people!

M

[Dr. Elliot Jacobs]

Kenalog is a steroid medication that dissipates scar tissue after being injected.  Too much will induce so much atrophy that you can over-do it and cause an indentation or depression.  Knowledge of how to do it, how much to use and when to use it is critical.

I generally like to wait for at least 4-6 months after surgery before beginning Kenalog treatment for scar tissue.  Oftentimes, massage is helpful and can avoid the need for Kenalog (Mother Nature does a good job if you give her enough time!).  If I do inject Kenalog, it is with care and only into the really tough scar tissue.  It does not work immediately but most people will begin to see some changes in 7-10 days.  Most of it's effects are gone by 4-6 weeks -- and then it is time to re-evaluate.  Perhaps another injection is needed or perhaps that one injection did the trick.

In my practice, I include these treatments as part of the original cost of the surgery -- ie,  I do not charge additionally for them.

Elliot Jacobs, MD, FACS

[George Pope, M.D.]

I agree with Dr. Jacobs.  I think it's best to wait at least 6 months before considering steroid injections such as Kenalog for resolution of scar tissue.  Kenalog will potentially shrink scar tissue whether it's under the skin, as is the case with gynecomastia, or on this skin itself, as is the case with hypertrophic scars or keloids on the skin surface. 

Kenalog injections, if helpful at all, often have to be repeated.  Repeat injections are usually done on a monthly basis, until the problem is resolved or until it's evident that the injections have stopped helping.  A couple of unwanted side effects include atrophy of tissue, which can cause a "sunken in" appearance, or even development of new blood vessels such as "spider veins" when injected into scars on the skin surface.  So, steroid injections should be considered cautiously.

Dr. Pope, M.D.

[michaelmorey]

fantastic answers from both docs..informative and straight to the point. Thanks a lot.your presence on these boards is very much appreciated!

M