Thought I'd post this as a resource for those who might need it.

I'm about 10 months post op and have been experiencing some deep internal hyper granulation. I had three silver nitrate treatments (which I personally found very uncomfortable, though many do pretty okay with them). To my dismay, the three treatments did not have any positive effect - in fact, a speculum exam after the third revealed my issue had actually gotten worse over the course of the treatments.

I was offered the option of a medicated ointment called Viaderm KC which is bascially a corticosteroid plus an anti bacterial and anti fungal. I was instructed to apply it with an applicator (like the kind for yeast infection creams, etc) once a day for four days, wait seven days, and then repeat this cycle two more times. Much to my delight, my next follow up showed a significant reduction in the hypergranulation tissue. I was beyond relieved! I have gotten the go-ahead to repeat the viaderm treatment again to take care of the remainder.

Hopefully this is something that can be useful to others dealing with persistent or silver nitrate-resistant hypergranulation. At the very least its something one could discuss with their doctor. For reference, this is a technique used by the surgeon at the new gender surgery program in Vancouver, Canada.