At our Surrey medical skincare clinic, we offer a common solution for scar removal and keloid removal, using a cortisone (i.e. steroid) injection. This is a great, middle-of-the-road solution to flatten abnormally-healed areas by dissolving the fibers contained in them. For many people, a series of less than 6 treatments is even permanent.
Raised, hypertrophic scars and keloids can form for a number of reasons, on multiple parts of the body. They can be discoloured (usually in red pigments), and deformed-looking. Unfortunately, they are also likely to return after invasive treatments. So, they are best treated by breaking down and suppressing their tissue formation over time, rather than by surgical removal, which can exacerbate the problem.
Generally speaking, raised scars and keloids are considered an aesthetic problem, causing loss of self confidence for the person who has them. These lesions can show up on visible areas of the body, such as the chest (from acne scars, for instance), the hand, behind the ears or even the face. However, they can technically form anywhere on the body. And, they can form in any size or shape, too. Even if they are painless, we have found that most people would prefer not to have them, if possible!
If you think your scar or keloid can be helped by cortisone injections, we encourage you to book an in-person consultation at our skin care clinic in Surrey, B.C. Since each scar is going to be unique, our on-staff doctor will be able to give you a fair assessment of the problem, and recommend a treatment plan we think will work for you. This may include a combination of solutions, together with the cortisone injections, depending on the type of scarring you have.
What is there to love about steroid injections for scars and keloids?
Using cortisone (steroid) injections for raised scars and keloids is about the best, and most cost-effective, solution we know of for this quality-of-life problem that many people face. It has a 50% – 100% chance of working on most people, especially if the scar or keloid formation is recent. Other solutions, such as surgical removal, can cause a recurrence (being that all surgeries cause scars, which the body will react to anyway). And, the less invasive options, like silicone sheeting, are only temporary.
While there are many other ways of dealing with scars and keloids, the right solution for each person can depend on the type of scar they have (i.e. depressed or raised, new or old), or the aspects of the scar that they want removed (such as pigments, for example). Other solutions for these other facets of scar removal range from tattooing over scars, to deep laser treatments, radiotherapy, cryotherapy, dermabrasion, chemical peels and more.
However, generally speaking, when it comes to raised tissues from a skin wound, the solution with the highest effectiveness rate is going to be intralesional corticosteroid injections.
The cortisone solution most popularly chosen to flatten scar tissue is called triamcinolone acetonide (TAC), sold under the brand name, Kenalog®. It has been used for over half a century. Its active ingredient is also applied to a large host of other medical conditions, from autoimmune disorders, to inflammation and even epidurals. It is thus fairly safe, when used under the guidance of a trained physician, and certainly well-known in the medical world.
What type of scars can triamcinolone acetonide (Kenalog®) injections be used for?
Different scars are treated in different ways. Not all scars will benefit from Kenalog® (triamcinolone acetonide). This solution can cause thinning of the skin, which can then cause concaves in some people (especially with improper administration of the drug). So, one would not want to use a steroid on already-depressed ‘ice pick’ acne scars, for instance.
Intralesional injections with the Kenalog® formula are usually only applied to raised, dense scars. These are known as hypertrophic scars, or keloid scars. They feel like a solid, overgrown ‘bump’ in the skin, rather than a ‘smoothed over’ area formed as a result of typical wound healing.
Scars of this type can certainly come from something as simple as old acne wounds. But they can also be from surgical cuts or other deep cuts that cause very visible scars.
If you have any type of scar you’d like removed, we encourage you to book an in-person consultation with a doctor at our skincare clinic. We have access to multiple solutions that may fit your case. But it all starts with a careful assessment of your specific type of scarring.
How does cortisone work to dissolve hypertrophic scars and keloids?
The occurrence of hypertrophic scars and keloids can be based on a person’s genetics. Some people are simply more prone to getting them than others. This is why, if you know your body has this tendency, it’s good to notify your medical practitioner before undergoing any invasive procedure – even if it’s only with needles. The doctor can then use the cortisone solution to prevent raised scars, and not just to treat them.
Generally, these types of scars are the body’s reaction to a skin trauma (i.e. a wound, or cut). In trying to heal after an abrasion, too much collagen is produced, creating excessive fibrous tissues where the original scar was. They can form over a long period of time; sometimes they don’t appear until years after the initial injury.
One might naturally think: let’s just cut it out! But, since a body that forms these excessive tissues is already prone to keloids, surgery could be counterintuitive in many cases. A new scar will form, thus causing a (possibly) even bigger keloid.
As a first resort, doctors usually prefer to break down the collagen that is forming the unsightly lump under the skin.
Triamcinolone acetonide corticosteroid is especially effective at doing this. It can reduce these lumpy scars and keloids with multiple actions, once injected. For example, it can:
- Reduce inflammation at the injection site.
- Prevent further scar tissue from forming by ‘suffocating’ the cells that do this.
- Slow down and prevent overactive collagen formation.
- Increase the body’s natural ability to remove collagen.
You can read more about the science behind this drug, here.
But, since many side effects are possible, triamcinolone acetonide is not something you want too much of. It is important that a doctor uses correct dosages to inject only a little bit of the solution at a time, per the needs and reaction of your own scar. A very high potency in one injection, or injecting at the wrong site, can cause an indented scar, which would also be unsightly.
A treatment session lasts only about 15 minutes (sometimes less). The injection site will be disinfected with rubbing alcohol. The doctor may mix the formula with an additive to reduce pain during the procedure, or simply for dilution. Depending on the size of the scar or keloid, usually 1 – 3 needle insertions will be needed. You might bleed a tiny bit, but not much at all. A simple alcohol-soaked cotton ball pressed on the scar for a few minutes afterwards will be offered. You shouldn’t touch the area after injection, to avoid infection.
Will the cortisone scar treatment be painful?
Discomfort during the procedure can vary from person to person. It can depend on the density of the scar or keloid, its location, and your pain tolerance level. Some find it painful (but certainly bearable), while others may only feel a little prick. For denser scars, more pressure will be needed to insert the needle (some keloids can be very hard!). These are also the scars that tend to hurt more during treatment. That goes especially if they are on sensitive areas of the body, such as the chest, or ‘boney’ places. However, it is highly unlikely someone would find the injection so painful that they’d rather keep their keloid! It is not that kind of pain. Plus, injections are over really quick!
How many cortisone injections are required to get rid of keloids and raised scars?
This is a hard question to give an estimate for, without seeing the actual scar in question. However, we can say that scar reductions with cortisone treatments are usually capped at around 5 treatments, which should be scheduled every 4 to 6 weeks.
Small keloids or hypertrophic scars that are say, 1 – 3 cm wide and under 1 cm high, can resolve within this time frame. But, this all depends on the density of the tissue, the location and age of the scar, the dosage being used, whether mixins are added to the injection formula, a person’s genetics and other factors.
No doctor will be able to say for sure how many treatments your scar will need, even after an assessment. And, remember, triamcinolone acetonide corticosteroid doesn’t work for all its subjects – sometimes it doesn’t work at all, and other times, it causes even more side effects.
Is there downtime with steroid scar injections? What about side effects?
There is no downtime with intralesional steroid injections for hypertrophic scars and keloids. It is an ‘in and out’ procedure. You may experience tenderness, bruising or redness at the injection site, though this should resolve on its own within a few days, and is not usually disruptive to ‘normal life.’
More severe side effects can vary, but they are rare. The most common, localized problems with this type of scar treatment (if they occur at all) are:
- Discoloured skin (such as a lighter tone, or redness remaining after it is flattened out).
- Indented skin (called atrophy, though this can also have to do with the method of injection).
- Enlargement of the keloid or scar as an opposite-effect reaction.
Some people react with unexpected, but mild (and rare) conditions like nausea and headache (especially when a lot of the formula is injected). Though, other extreme reactions are also possible. During your initial consultation with us, we’ll let you know what to be aware of. It will be very important to notify us of all medications you are taking, as well as your entire health history – even if you think it’s unrelated. This drug can react with other medications.
What is the cost of keloid and scar injections at your clinic?
A single treatment for a keloid injection can start at $250 and go up from there. The final price can depend on the size and number of keloids or scars being injected in each treatment, as well as the necessary amount of formula to be injected.
However, like we mentioned above, it can be hard for any doctor to say how many treatments your specific scar or keloid will require to be removed through cortisone injections. To find out a rough estimate for your case, we encourage you book an initial consultation at our clinic. We’ll be able to assess your scar or keloid, as well as recommend a course of treatment, which may include other solutions, or a combination of solutions.