Intralesional Triamcinolone Dosing for Hypertrophic Scars
For hypertrophic scars on inframammary incisions, use triamcinolone acetonide at a concentration of 10 mg/mL (which may be diluted to 5 mg/mL or 3.3 mg/mL), injecting 0.05-0.1 mL per injection site to cover approximately 0.5 cm diameter areas, with repeat injections every 3-4 weeks until the scar flattens. 1, 2
Recommended Concentration and Volume
- Start with 10 mg/mL concentration for hypertrophic scars, as recommended by the American Academy of Dermatology, with the option to dilute to 5 mg/mL or 3.3 mg/mL to minimize complications 1
- Lower concentrations (5-10 mg/mL) are specifically preferred for facial areas or regions at higher risk for atrophy 2
- Note that keloids require higher concentrations (40 mg/mL), but hypertrophic scars respond well to the lower 10 mg/mL concentration 2
Injection Technique
- Inject strictly intralesionally with proper placement confirmed by visible papule formation with blanching to ensure medication stays within target tissue 1, 3
- Target the upper subcutis just beneath the dermis, not into the scar substance itself 2
- Use 0.05-0.1 mL per injection site, which produces therapeutic effect in approximately 0.5 cm diameter area 2
Treatment Schedule
- Repeat injections every 3-4 weeks until the scar flattens or symptoms resolve 2
- Expected therapeutic response includes flattening within 48-72 hours after injection, with reduction in inflammation and pain relief 1
Safety Considerations with Recent Rhinoplasty and Tirzepatide
- No direct contraindication exists for intralesional steroid use in patients with recent rhinoplasty and concurrent tirzepatide use 1
- Systemic absorption from 0.4 cc intralesional injection is minimal and unlikely to affect rhinoplasty healing or interact with tirzepatide 1
- Adrenal suppression only occurs if doses exceed 4 mg/kg systemically, but localized injection at recommended volumes is well below this threshold 1
Critical Adverse Effects to Monitor
- Local tissue atrophy is the most consistent side effect and should be monitored at follow-up visits 1
- Hypopigmentation and pigmentary changes are common adverse effects that warrant patient counseling 1, 3
- Telangiectasias can develop at standard concentrations 1, 3
- Using lower concentrations and smaller volumes minimizes these complications 1, 3
Post-Injection Instructions
- Advise patients to avoid direct sunlight and heavily scented products for 24 hours following injection 1, 3
Evidence Supporting This Approach
Research demonstrates that triamcinolone acetonide suppresses scar formation in a dose-dependent manner, both phenotypically and mechanistically 4. A comparative study of bilateral hypertrophic inframammary scars showed substantial clinical and histologic improvement with intralesional corticosteroid treatment, with increased pliability and decreased symptoms after treatment 5. The systematic review evidence indicates that TAC at 20-40 mg/mL concentrations carries higher risk of skin atrophy compared to lower concentrations, supporting the use of 10 mg/mL or less for hypertrophic scars 6.