Have mixed replies. what beter to reduce hems? cortisone? vasoconstrictor? any off-brands? do hems, ext and int, go back to norm or skin remain loose?

Depends : What to do depends on how big they are and if they are inside or outside. If small, sometimes cortizone (hydrocortisone) cream will help them to shrink. Larger ones will often eventually shrink but then leave a loose flappy fold of skin that can make it hard to clean. See an experienced colo-rectal surgeon and they can give you good advice for your situation.