Hypertrophic Scars After Laser Tattoo Removal: Solutions and Insights

Laser tattoo removal can cause hypertrophic scars?

Hello, Doctor: Recently, I underwent laser tattoo removal, and after two or three sessions, the area where the red dye was initially present has raised up, forming what is known as a hypertrophic scar.
Despite receiving several treatments with scar-reducing injections, there has been no improvement; the area remains raised and itchy.
The aesthetic clinic informed me that I might have to live with this condition for life and advised me not to pursue further removal.
I feel very angry and confused about this situation.
I would like to know if this constitutes a medical malpractice on their part, or is it simply an issue related to my personal physiology? Currently, I have half of the tattoo removed along with the hypertrophic scar, which looks very unattractive.
Is there really no way to address this issue, or do they simply not want to handle it? I have read online that hypertrophic scars can also be treated through surgical excision or laser treatments to reduce them.
Can I first use one of these methods to eliminate the scar and then continue with the tattoo removal afterward? What would you recommend as the best course of action? At this point, I don’t care whether the tattoo is removed; I just want my hand to be okay.
I have been feeling very anxious and upset about this issue for a long time.
Please, Doctor, help me understand how I should proceed.
Thank you.

Xiao Mei, 20~29 year old female. Ask Date: 2020/11/18

Dr. Lu Daokuan reply Plastic Surgery

To achieve a long-lasting tattoo, it needs to be placed at the bottom of the dermis (therefore, if you are considering getting a tattoo, it's best not to think about removal).
Tattoo removal is performed using lasers, which target deeper colors as they absorb more energy, thereby breaking down the accumulation of dye.
You mentioned that red tattoos tend to scar because the energy concentration of red is lower than that of black or blue, leading to the potential for scar formation due to energy overflow.
If the affected area is one that experiences a lot of movement (such as the shoulder, chest, elbow, or wrist), surgical removal is not an option, and conservative treatment is the only choice.
For other tattoos that have not been removed, dye lasers can be considered.

Reply Date: 2020/11/18

More Info

Hypertrophic scars can be a frustrating and distressing outcome following laser tattoo removal, and it's understandable that you are feeling anxious and confused about your situation. Let's break down the issues at hand and explore potential solutions.

Understanding Hypertrophic Scars
Hypertrophic scars are raised scars that occur when the body produces too much collagen during the healing process. They can develop after various skin injuries, including surgical procedures, trauma, or in your case, laser treatments. The fact that you experienced hypertrophic scarring specifically in the areas where red dye was present in your tattoo is not uncommon. Red pigments can sometimes provoke a more intense inflammatory response compared to darker pigments, leading to an increased risk of scarring.

Medical Responsibility vs. Personal Factors
Determining whether the outcome you experienced is due to medical negligence or your individual skin type can be complex. Medical professionals should provide clear information about potential risks and outcomes before proceeding with treatments. If the clinic did not adequately inform you about the possibility of hypertrophic scarring or did not follow appropriate protocols during the procedure, there may be grounds for questioning their practices. However, individual skin responses can vary widely, and some people are simply more prone to developing hypertrophic scars due to genetic factors or skin type.

Treatment Options for Hypertrophic Scars
There are several approaches to managing hypertrophic scars, and it is crucial to consult with a qualified dermatologist or plastic surgeon who specializes in scar treatment. Here are some common options:
1. Silicone Gel Sheets or Silicone Gel: These are often recommended as a first-line treatment for hypertrophic scars. They can help flatten the scar and reduce itching and discomfort.

2. Steroid Injections: Corticosteroid injections can help reduce inflammation and flatten hypertrophic scars. This treatment may require multiple sessions.

3. Laser Therapy: After the scar has matured, laser treatments can be effective in reducing the appearance of hypertrophic scars. Different types of lasers can target the scar tissue and promote collagen remodeling.

4. Surgical Excision: In some cases, if the scar is particularly bothersome, surgical removal may be an option. However, this should be approached with caution, as it can lead to new scarring.

5. Microneedling: This technique involves using fine needles to create micro-injuries in the skin, which can stimulate collagen production and improve the texture of the scar.

Next Steps
Given your situation, it would be advisable to seek a second opinion from a dermatologist who specializes in scar management. They can assess your scars and recommend a tailored treatment plan. If you are considering further laser treatments for tattoo removal, it is essential to discuss your concerns about the hypertrophic scars with your provider. They may suggest waiting until the scars have stabilized before proceeding with additional laser treatments.

Emotional and Psychological Support
It's also important to address the emotional impact that this situation has had on you. Scarring can affect self-esteem and body image, and seeking support from friends, family, or even a mental health professional can be beneficial. Many people find comfort in discussing their feelings and experiences with others who have gone through similar situations.

In conclusion, while hypertrophic scars can be a challenging outcome of laser tattoo removal, there are various treatment options available. It is crucial to work closely with a qualified medical professional to explore these options and find the best path forward for your skin health and emotional well-being.

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