Keloid Scar Treatments – That WORK!

Keloids

Why the Keloid Clinics of Hillcrest Dermatology and Plastic Surgery?

We at the Keloid Clinics at Hillcrest Dermatology and Plastic Surgery have a strong interest in the treatment and care of keloids. We have a unique practice of plastic surgeons and dermatologists who together coordinate care in the various treatment modalities.   We are the only practice in the state of Florida to provide this type of care.  The key to treatment of keloids is to have the full range of treatment options available and to have a multidisciplinary approach to this treatment.    Hillcrest Dermatology and Plastic Surgery has the all of the tools for fighting keloids at their disposal.  Our superficial radiation machine, laser machine , cryotherapy,  and multiple drug modalities are all used in keloid treatment.    Our team of highly trained plastic surgeons use their unique skills in the excision and closure techniques that best minimizes the appearance of the scar.  The team then discusses the best treatment options and protocols for each individual patient.

 What are they? A keloid is an abnormal proliferation of scar tissue that forms at the site of skin injury (eg, on the site of a surgical incision or trauma)  Keloids do not regress and grow beyond the original margins of the scar. One should not confuse keloids with hypertrophic scars.  Hypertrophic scars do not grow beyond the boundaries of the original wound and can reduce over time.

Who gets keloids? Keloids are found only in humans and occur in 5-15% of wounds. They occur in both males and females.  They can cause pain, itching, affect wearing of clothes as well as catching on clothes and garments.   The frequency of keloid occurrence in persons with highly pigmented skin is 15 times higher than in persons with less pigmented skin.   The average age at onset is 10-30 years.  Of note, keloids are much less common in extreme ages.

What causes them?  Keloids are benign dermal fibroproliferative tumors with no malignant potential. They are not cancers.  The first description of keloids was recorded in the Smith papyrus regarding surgical techniques in Egypt around 1700 BC.  It is not entirely understood what causes keloids.  There are many cellular level responses that are thought to contribute.  Research into their causes and treatments continues to evolve and we at the keloid clinics of Hillcrest Dermatology and Plastic Surgery keeps abreast of all new developments and treatments.

 

How can you treat them? There are a many treatment options for keloids.  A combination of options are typically used in keloid treatment.   At your consult we will review your history and come up with a plan that best individually suits you.

Superficial Radiation: One of the newest and most exciting areas of treatment for keloids is superficial radiation treatment.  Radiation is used in combination with surgical excision in order to prevent recurrence.   Some studies have shown that radiation combined with surgical excision can achieve good to excellent cosmetic results with an 80-94% prevention of recurrence. Typical treatment has a patient getting radiation treatment post excision with just three 5 minute sessions of radiation without any painful injections of medications. Side effects include but not limited to hyperpigmentation and telangiectasias.

SRT-100 Machine Our superficial radiation treatment machine- a highly effective treatment for keloid scars.

SRT-100 Machine
Our superficial radiation treatment machine- a highly effective treatment for keloid scars.

Occlusive dressings  Silicone gel sheets and silicone occlusive dressings have been used with varied success in the treatment of keloids. The sheets can be worn for as long as 24 h/d for up to 1 year, with care to avoid contact dermatitis and skin breakdown. In some studies, the response rate has been as high as 79%, showing substantial reduction in redness, scar elevation, and itching.  Complete resolution has not been noted.

Compression  Mechanical compression dressings have been used for the treatment of keloid scars. Compression devices are usually custom-made for the patient and are most effective if worn 24 hours per day.  Pressure devices include Dacron spandex bobbinet fabric, support bandages, or zinc oxide adhesive plaster. Earlobe devices are available for keloids resulting from ear piercings.  The recommended level of pressure is 25 mm Hg, but good results have been observed with pressures as low as 5-15 mm Hg.   It is believed to reduce oxygen tension in the wound by occluding small vessels and affecting the keloid at the cellular level.

Corticosteroids: Steroid injections into the keloid have been used with some effectiveness for years.  These injections decrease dermal thickening.  Steroids can be used by themselves or in combination with other therapies including excision. They can be injected before surgery to decrease the size and then continued after surgery.

Some side effects of corticosteroid injections include atrophy of the subcutaneous tissue and hypopigmentation. Most of these adverse effects can be avoided by injecting the as little of the infusions as possible yet still remaining effective at treating the keloid.

Kenalog is a popular corticosteroid injected directly into scars to decrease size.

Kenalog is a popular corticosteroid injected directly into scars to decrease size.

Excisional surgery: Simple excisional surgery should involve the least amount of soft tissue handling to minimize trauma; also, plan the closure with minimal skin tension along relaxed skin tension lines. Unfortunately when used alone without other treatments the keloids have a very high rate of occurrence.  We do not recommend excision alone due to such high recurrence rates.

Cryosurgery:   Cryotherapy uses liquid nitrogen to cause cell damage and to affect the tiny blood vessels, causing the blood vessels to clot and thus decreasing oxygen delivery to the keloid. Side effects are pain and depigmentation. Cryotherapy used in combination with steroid injections has an even greater response rate, with objective success reported in 80+% of patients.

Picture of a cryotherapy canister. The liquid nitrogen inside is sprayed directly onto the scar.

Our cryotherapy canister

Laser therapy: Laser therapy by itself is not a very efficacious way of treating keloids.  It is used as in a multi treatment modality in decreasing recurrence of keloids.  It destroys the tiny vessels in the keloid scar thus reducing keloid recurrence.

Our laser used to treat keloids.

Our laser 

Interferon therapy: Another therapy is intralesional injection of a drug called inteferon. It acts by reducing substances at the cellular level that cause keloids.  This is also done in combination with excisional surgery.

5-Fluoruracil: 5-fluorouracil ( a drug used to treat skin cancers) is injected into the keloid and has been found to decrease the recurrence.  It can be combined with steroid injections to produce the best results.

Imiquimod therapy: Imiquimod is a cream that is placed on the keloid site after excision to decrease the rate of keloid recurrence.  Imiquimod is cream that is normally used to treat skin cancer.   Hyperpigmentation is a side effect.  

 

What to bring when you schedule a consult?  Medical history, currents medications, past surgery history. If you have had treatment of keloids by other physicians please bring in a history of the treatments.  We can develop a treatment plan based on what has and has not worked for you in the past.

 

 

 

 

Tagged , , , , , , , , , , , , , , | Comment on this Post

TCA CROSS Treatment Very Effective for Acne Scars

TCA CROSS (Trichloroacetic Chemical Resurfacing of Skin Scars) treatment is proving to be highly effective for the treatment of acne scars.  For best results, the treatment should be done once a month for about 4 to 6 months by a board certified plastic surgeon and should be accompanied by a medical grade skincare regimen.

The procedure is done right in the office in about an hour and requires very minimal downtime (if any). The TCA (acid) is placed deep into each individual scar triggering your skins

Treated with TCA CROSS Procedure for ice pick and pitting acne scars.

Treated with TCA CROSS Procedure for ice pick and pitting acne scars.

production of collagen.   This increased collagen production plumps the scar up and smooths it out over time.   You will have a few scabs that form over the treated scars which slough off on their own within a week or so.  Some patients, depending on their skin type, will require a ‘skin prep’ with Tretinoin and Hydroquinone for about 4 to 6 weeks prior to treatment which significantly decreases the risk of post procedure hyperpigmentation. Each patient is unique and treatment plans vary depending on skin type and scar severity.

Living with acne scars can be very difficult.  Call our office today and schedule a consultation to see if this procedure may be right for you.

 

 

 

Comment on this Post

Plastic Surgery after Extreme Weight Loss: What To Know Before You Go!

Surgery after extreme weight loss for the removal of excess sagging skin is usually inevitable.  That’s why it is so important for you to understand what your insurance does and does not cover.  Many patients believe the results a procedure that is ‘covered by their insurance’ will be the same result as paying out-of-pocket for plastic surgery. This could not be further from the truth.

Insurance companies only cover a procedure called a ‘panniculectomy’ (removal of the skin ‘apron’ that sags down the front of your legs and pubic region), they do NOT pay for anything else such as body contouring, liposuction, body lifting, thigh lifts, etc. which are also areas where excess sagging skin will be located.

When considering cosmetic procedures after extreme weight loss it is imperative that you do your research and explore all of your options.  A consultation with a board certified plastic surgeon who specializes in extreme weight loss surgery is always a good idea.

We understand the hard work and sacrifices it takes to lose an extreme amount of weight and it would be our honor to help you develop a surgical plan resulting in a more aesthetically pleasing outcome.  The photos below show the difference between the outcomes of insurance vs. paying out-of-pocket for plastic surgeon.

Case 1:  115 lb weight loss concerned about excess skin on abdomen, legs, thighs and buttocks.  Underwent high lateral abdominoplasty

Case 1:
115 lb weight loss
concerned about excess skin on abdomen, legs, thighs and buttocks.
Underwent high lateral abdominoplasty

Case 1:   Did not use insurance In stages patient underwent: lower body lift, high lateral tension abdominoplasty tummy tuck) with muscle tightening,, lateral thigh lift, and buttock lift.

Case 1: After
Did not use insurance
In stages patient underwent:
lower body lift, high lateral tension abdominoplasty tummy tuck) with muscle tightening,, lateral thigh lift, and buttock lift.

Case 2: Used Insurance The only skin removed was the 'panus' or 'apron' of skin sagging over her pubis. Insurance will NOT cover upper abdominal skin, thighs, arms, flanks, etc.

Case 2: Used Insurance
The only skin removed was the ‘panus’ or ‘apron’ of skin sagging over her pubis. Insurance will NOT cover upper abdominal skin, thighs, arms, flanks, etc.

Comment on this Post

No Longer Does Skin Cancer Have To Be Disfiguring

We understand just how nerve wrecking the diagnosis of skin cancer can be and how devastating the prognosis is when left untreated.

Before the combination of Mohs surgery, superficial radiotherapy, and reconstructive surgical interventions, the removal of cancers in sensitive areas such as the eyelids, nose, hands, face and neck meant being left with disfiguring scars. What makes this collaborative approach is that Mohs surgery spares as much healthy tissue as possible surrounding the cancerous area for functional and cosmetic purposes and when cosmetic closure by a board certified plastic surgeon is performed the probability of  having disfiguring scars is remarkably low.

Skin cancer can occur in ANY skin type.  Bob Marley died at age 36 due to an untreated melanoma mistaken to be an old soccer injury.

Our team of highly skilled, board certified Dermatologist and Plastic Surgeons offer a collaborative and comprehensive approach to the treatment of skin cancers ensuring the best and most beautiful aesthetic outcome possible.

If you or a loved one have been diagnosed with or ar currently dealing with recurrent skin cancer, contact us today to see how our team of professional Dermatologic and Plastic Surgeons can help. skin cancer pic symptoms-of-skin-cancer-036ituwa

Comment on this Post