Hypertrophic Scar Treatment

Hypertrophic scar treatment is commonly used for overly prominent scars that most commonly develop from surgery or traumatic injury. Hypertrophic scars have a characteristic appearance with thickening, widening and raised compared with the surrounding skin. Their prominent appearance can is because of an exaggerated healing response and is a common cosmetic nuisance. Hypertrophic scars can also cause functional disturbances including itchiness and discomfort. Hypertrophic scars differ from keloid scars in that they do not extend beyond the margins of the healing surgical incision or traumatic healing wound.

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Hypertrophic scars are more common in certain situations:

• Wounds under increased tension
• Patients with darker skin
• Scars in the region of the shoulders, chest or upper arms.
• Cosmetic procedures such as breast augmentation or abdominoplasty
• Areas of skin which are located over joints such as the front of the knee or back of the elbow.

Hypertrophic scars develop as a result of a controlled overproliferation of collagen, which is a result of the body’s inability to detect when adequate scarring has been completed. Collagen is made by local cells called myofibroblasts, and these cells are overactive, which results in hypertrophic scarring. The excessive scarring response results in an inflammatory process and proliferation of new blood vessels, which often gives rise to the red appearance found in hypertrophic scars. Hypertrophic scars can also cause itching and localised discomfort. Burn injuries are a very common cause of hypertrophic scarring. Untreated acne most commonly results in depressed atrophic scars but can also cause prominent hypertrophic scars. Patients with darker skin types can develop excessive scarring from even a small cut, and body piercings can also give rise to hypertrophic scars.

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Our specialists are renowned experts in the treatment of a wide range of scars and have access to the full range of gold-standard treatments, including lasers, for the effective treatment of hypertrophic scars.

Silicone gel

A topical gel is the first-line treatment for hypertrophic scars and keloid scars as it is non-invasive and has shown to be clinically effective. Early use of the product can interrupt and influence the healing process. The silicone gel forms a thin film membrane over the skin because of its lack of absorption and cross-linking properties, which acts as a barrier to protect the scar and enable hydration of the scar. Increased hydration of the scar inhibits the proliferation of fibroblasts, a key mediator in scar formation, and in turn inhibits the fibroblasts’ ability to deposit collagen. Silicone gel increases the softness of their skin, is easy to apply, dries easily on the skin, reduces the intensity of the colour of the scar, and reduces the height of the scar.

Steroid Injection for hypertrophic scars

Injection of steroids into scars is a very commonly used scar revision treatment. The steroid impairs the production of excessive scar tissue. This leads to scar shrinkage after the steroid injection. A limitation of steroid injections is that large and thick scars are difficult to treat because they are composed of tough and firm tissue. Therefore, the steroid cannot spread evenly throughout the thickened scar. Any improvement in scar appearance is often uneven. Thick and dense scars need more than steroid injection alone.

Laser and steroid combined treatment

Nd:YAG laser is a synergistic treatment when combined with steroid injection for hypertrophic scars. The laser acts deeply to interfere with blood vessel formation. By disrupting the blood vessels, the scar cannot proliferate further and decreases in size. Laser treatment alone works well for hypertrophic scars that are flatter and thinner. However, in thick and dense scars, the laser should be combined with steroid injection for optimum results. Both treatments act to reduce the blood supply to the scar. Nd:YAG laser also causes the scar to swell, facilitating a diffuse and even injection of steroid throughout the scar tissue. The combination of Nd:YAG laser and steroid injection is the optimal treatment for thick and dense scars and leads to faster healing than either treatment alone. The scar can be treated in fewer treatment sessions, and the cosmetic result is superior with combination treatment.

Fractional Erbium laser

The erbium laser in fractional mode works by creating multiple channels in the scarred tissue. The formation of these microscopic treatment zones triggers scar remodelling through the production of new collagen. The scarred tissue undergoes a process of maturation, and the newly formed tissue closely matches that of normal skin. Fractional laser treatment is a well-accepted treatment for both burn scars and acne scars. Our expert use of fractional laser leads to better matching of both traumatic and surgical scars with the texture and appearance of surrounding skin. The use of fractional erbium laser is also often combined with steroid treatment. The micro-channels enhance the spread of injected steroids for optimum treatment of thick and dense scars.

Fully ablative erbium laser for scar reduction

A fully ablative erbium laser using the Fotona SP Dynamis is not a definitive treatment for both hypertrophic and keloid scars. Using an ablative laser alone for these scars will probably lead to the scar recurring. For thick and dense hypertrophic scars, the erbium laser in fully ablative mode can be used to reduce the scar’s size through precise tissue vaporisation. The resulting smaller scar, once healed, is then ideally treated with other methods such as fractional laser in combination with steroid injection. The use of a fully ablative erbium laser is ideal for speeding up the treatment process and with fewer treatment sessions required for adequate scar treatment.

Morpheus8 fractional radiofrequency microneedling

Morpheus8 is an innovative fractional radiofrequency microneedling treatment that has shown excellent results in treating hypertrophic scars that can be many millimetres thick in some cases. The Morpheus8 device has specialised insulated micro needles that penetrate to over 5 mm into the skin and superficial subcutaneous tissue to induce connective tissue remodelling, making it ideal for especially thick fibrotic scars that require more intensive treatment. The tips of the needles emit radio frequency energy and, by doing so, induce an inflammatory cascade involving a range of growth factors and inflammatory proteins, including stimulation of dermal fibroblasts to secrete collagen and elastin. This leads to significant tissue remodelling with the formation of new blood vessels via a process known as angiogenesis. Improved blood supply helps to optimise scar healing, resulting in less thick scars with the potential to more closely resemble surrounding skin without the requirement for incisions, scars and downtime of invasive surgery.