I had a small cyst injented with cortisone three weeks ago. It was the second time the dr. had injected the area (he had injected a cyst in the same spot 3-4 weeks prior). Because it was in the same spot, he said he was going to put more medicine in. He didn't even mention there could be any side effects.

One week after the injection, a large swelling appeared and I went in to see him, but he dismissed it. Several days later, a dent appeared at the site of the injection.

Now, 3 weeks since the injection, and the indentation has gotten worse (it is now a depression that runs up and down my forehead). I've read the previous posts about it, and most people say it should go away in 6 months. But, it's quite upsetting. Anyone who is self-conscious enough to get a cyst injected is obviously self-conscious, so Im not dealing with this well. Plus...6 months is a long time! And some people said it could take a year or be permanent.

Does anyone have any suggestions? Has anyone decided to seek treatment for these dents/depressions caused from cortisone i.e. seeing a plastic surgeon?

Thanks for your input.

I posted something simular to your post... but no one has really responded. I had a very large cyst on my forehead in the beginning on March. March 3rd to be exact. Well March passed by and the cyst went away fine so I was happy. But then April came along and I had a blueish shaddow start to form on my forehead where the cyst was injected. I wasn't sure what it was ..until I did my research online. And as April and May went along the discolored spot on my forehead began to dent. I was so so depressed and still am. I hear that cortisone atrophy is usually supposed to resolve itself with time but I'm still doubtful as it is now the end of June But I guess its only been 3 months since the dent showed....and I hear it takes 6 months or more for collagen to re-generate? Anyways about 2 weeks ago I spent 300$ on restylane... for the dent. Well I already feel as in the restylane is wearing off....and its supposed to last up to 6 months? Well I will continue to be severly depressed until this dent goes away... if it ever does? The derms I have seeen.... seem to think it will go away... BUT i'm very down..and not hopeful. Sorry I didn't have any great news for you. I can just relate. How is the dent going for you? Let me know.

It depends on the percentage of cortisone used. Ask the dermatologist. I currently have a dent in the middle of my forehead. The majority of dents fill in over time; however, this can take 6months or longer. My dent has been there since March so far. Your's shouldn't be as deep as it is now though for that whole time; mine has decreased in depth since the beginning stages.

Things like this makes me believe that if a pimple is meant to leave a cyst, it won't matter if you leave it alone, pop it or get a cortisone injection.

Well I personally have had great luck with injections. I have had tons of injections and only one sunk in (the one I have right now). If I was to leave them alone, they would take sometimes months to go away, and cortisone makes it decrease in size and redness dramatically in only a day or two!

BUT always ask your derm first about the possibility of it sinking in. Ask about the percentage of cortisone used because many places use a very mild substance, so it won't sink in permanently.

what is considered a small amount of steroid?
I had 10mg steroid at a 1to 10 parts 5fu injection.
Is that amount of steroid too much? Doc said it was diluted
but maybe a crystal got stuck in the needle? I think he was not
deep enough.

I am in the same situation as you guys. Over the last year I got VERY regular cortisone injections in many places on my face to reduce acne cysts. The steroid shots were very effective in reducing the size of the cysts in a short amount of time.

Unfortunately, after a month or so after some injections I would start noticing my skin caving in in the areas where I had some (not all) injections.

I REALLY, REALLY hope these indentations aren't permanent. The way I looked at getting the shots: I wanted to get rid of the cysts to avoid permanent scarring even if it meant possible temporary atrophy. What I was told by my derm is that the atrophy is caused by fat cell shrinkage, and that the area will plump up once the cortizone goes away. Unfortunately, the cortisone is like little crystals that look like dust... and it can stay in your skin for months and months continuing to cause worsening atrophy. Sometimes you won't notice the atrophy till many months later.

What can be done about this? My derm is giving me regular saline injections to "flush out" and dillute the remaining cortisone crystals to hopefully speed up the "replumping" process and fill in the indents. So far I have had a about 3 weekly saline injections, and I have seen some filling in... however slight. Apparently I need to keep going until it's all flushed out. Why aren't more people aware of this use of saline? And why don't more doctors use saline injections for this purpose? It's a mystery to me... but then again I've been disappointed over and over by the lack of knowledge of so many dermatologists. For more information about the saline injections to help with cortisone shot atrophy, look up on Google Dr. Mitch Goldman's paper... he describes the saline injection treatment and says he has had great success with it.

The areas where I got the indentations were injected by a different doc other than my normal derm and I believe he put in too much, or didn't dillute it enough.

Here's what I understand increases the risk of atrophy from cortisone shots:
1) Not dilluted enough
2) Injected too deeply into fat instead of directly in the middle of the cyst
3) Injected into too small a cyst
4) Too much injected
5) Solution not shaken up enough before injection; the cortisone is like dust crystals in a saline solution to dillute it (think of sand in water... or those ball-shaped Christmas decorations filled with water and white flakes that you shake to make it look like it's snowing)... and the solution must be thoroughly shaken so that it is of uniform consistency when injecting. If this is not done, then too many crystals can be injected at one time in one location, causing atrophy.

None of this should be difficult for a doctor or nurse. However, so many docs seem so rushed and overlook the most basic things sometimes!! Don't trust that your doc is aware of all these things... quiz them first, and if they aren't clued in, then find someone else!

Do I recommend cortisone shots if you have huge, deep cysts? YES, YES, YES. Cysts leave permanent scars. Plain and simple. No one wants that. You can get them while on accutane and even after accutane. For people who want to get rid of the cysts to avoid scarring, consider these shots!! Just make sure you find a doctor who will pay attention to all the different things I've talked about here.

Also, find a doctor who is willing to extract/lance/drain cysts (that are able to be drained) before injecting. The sebum and puss, etc. should be removed because that will speed up the shrinking of the cysts and make it less likely that the same cyst will come back later.

I assume you mean "if the pimple or cyst was meant to leave a scar..." In any case, you are wrong about this. The cortisone injection-related indents are NOT scars but rather fat cell shrinkage. Of course no one wants either, but permanent scars are much harder to fix. Leaving a cyst to linger around for weeks and weeks increases the chance of deep scarring... as the inflamed cysts have a tendency to "eat away" at our tissue leaving depressed scars. Steroid injections rapidly get rid of the cyst so you will be much less likely to get a scar from the cystic lesion... especially if caught very early. But the doctor must walk a fine line between putting in enough cortisone to reduce the cyst and also making sure he/she is doing all that is possible to reduce the risk of an indentation. This can be done... you just need a patient doc who is aware of all these issues. Cysts CAN BE CONTROLLED. There is no need to let a cyst linger for months at a time... that is likely going to leave a scar.

Things to remember:
DILUTE THE CORTISONE CRYSTALS WITH SALINE, ONLY USE A SMALL AMOUNT, PUT IT RIGHT INTO THE CENTER OF THE CYST, INJECT SALINE AFTER THE CYST IS GONE BECAUSE THOSE CORTISONE CRYSTALS WILL REMAIN THERE UNNEEDED FOR MONTHS AFTERWARDS AND WILL CONTINUE TO CAUSE ATROPHY UNLESS FLUSHED OUT WITH MULTIPLE SALINE INJECTIONS.

5FU is not a steroid and does not carry the same risk of atrophy. Is the 5FU being used in combination with cortisone?




Unfortunately doctors will always say they never see any indents from their own work. They will always say they use just a small amount. Only let them use 2.5% or less concentration! If they can't tell you exactly what concentration they use, find someone else.

The derms Ive talked to keep saying the dent will resolve in time....... what are everyones feelings on this???

yea it will resolve itself. I had a huge cyst on my upper left check about 2 years ago and i was a moron and messed with it and eventually popped it. Well this left a huge dent and i mean huge! it was the size of a dime i say and was very indented. A year and a half later and the dent was just about gone and now it is totally gone.

I have never had an injection but i can tell you that it will eventually go away but it is gonna take a long time. Just leave it alone and don't mess with it, you don't wanna make things worse.

Dear Truckg,
I am very interested to hear if you have had success with the resolution of your cortisone dent with saline injections. I have just developed a fairly major one in my chin, and have read Dr. Mitch Goldman's article. My derm is not convinced by the scholarship (which I find troubling), and I would like to be able to tell him that I have talked to other people for whom the procedure works. Could you tell me more about your history. Thanks so much

I wanted to let members of the discussion list--and anyone else who is reading--know that one week after my first saline shot to address my cortisone induced steroid shot, I am seeing improvement. Here is the situation:

1. Two and a half months ago I received a shot in a cyst of cortisone. A week or two later a really deep and fairly large "dent" appeared on my chin. (My brother who is a surgeon (not a dermatologist) called it an "impressive" "compromise" of my tissue. I called it something else! .) I did as much research as I could and came across the Goldschmidt article that Truckg recommends above.

2. After some wrestling with my derm, he agreed to try the saline protocol. Last monday, September 7, 2009 (again about 2 1/2 months of NO improvement in the depression) he injected me with saline, although not to the level advocated by the Goldschmidt article since he was, as I said, somewhat dubious about the procedure.

3. 6 days later the depression is about 70% resolved. There is still an area of depression but it is close to 3/4 less in depth than it was prior to the shot. (I really almost can't believe it.) The discoloration, which is a kind of deep purple/blue, is still present and unmitigated by the shot.

4. I will go in tomorrow afternoon for my second shot. And, I will keep the list posted on what improvements or problems I have with the course of treatments.

Right now, I am cautiously optimistic as to future and lasting benefits and very, very happy with the results that I am seeing now. (Truly, I looked like Kirk Douglas with that dent in my chin. Ugly!)

Oops, that is Goldman, not Goldschmidt. Sorry

So, onwards with the story of my attempts to get rid of this saline-induced dent in my chin.

After my first treatment I reported an 80% improvement some days after the injection. As the week wore on the improvement seemed to be less than I had originally noticed. Micro-swelling, or saline in the area, or whatever, caused the appearance of a larger improvement than I actually got. I would say that the improvement was about 50%, which is still really good, as far as I am concerned

I had my second treatment on Monday. The doc put 4ccs into the area this time, but I don't think that he got very deep into the dermis (as in under the pitting) as he did the first time.

I had no real immediate results as I did the first time, which was a bit hard. I so want this darn thing to disappear. I have, since Monday the 14th noticed steady improvement in the area. The pitting is visually still quite clear, but this is because of discoloration (which I can now actually almost conceal with the artful use of cover-up and powder). The skin in the area seems to be filling in. The slopes on the side of the dent are more rounded, and I can't feel the bone underneath the dent as much as I could, even after the initial improvement of 50% was achieved. I feel like I am on the mend, even though the results aren't terrible visually apparent.

So, I am holding at about 50-60% improvement. I will go in for my third shot next Monday, and will keep y'all apprised of post-treatment results.

Hello

I just wanted to add another success story with treating a HUGE dent from cortisone with saline.
I had saline injections done by DR. Sire in Orange County and then proceeded to have a friend do them....I am so grateful to him.

I have documented my story on saline treatment along with pictures and instructions in one of my posts if you care to look it up.

I would really recommended you guys to try saline treatment because if it helped my giant scar it will deff help you with yours

my dent is 98% gone at two month mark..yeah! I only had one saline flush.

Jaden,
That is so fabulous. I want to be able to say that my dent is 98% gone!

While I am doing the saline treatment, I'll keep posting until I run out of patience or this dent resolves itself.




Props to Jenya, who really does such great and encouraging work on the thread she makes reference to in her post. I have read it through about five times now, and am feeling much more informed and hopeful. Thanks so much Jenya.

Well, it is the Friday after my third treatment with the saline injections and the improvement is really tremendous. I estimate that, after three weeks with three injections, I have had about 80% restoration of the collagen/fat in the area. The discoloration is still present, although not as visible. The dent is not a huge divot, but a small depression. So, this process has really been working for my particular problem with fat atrophy in the area treated with cortisone. I will keep posting until I discontinue the treatments.

Thank you so much for updating your progress with the saline solution!! I had an injection in a pimple and three weeks later had a large dent in the center of my face, before reading your post I had Evolance filler injected to fix the area, this worked, but is temporary and cost $600. One week after my initial injection I had another pimple injected, two days ago I noticed this area start to 'sink' in- I printed Dr Goldschmidt abstract, took it to my derm and just had 5ml saline injected into the area, with an appt in a week for another 5ml (the saline swelling went down in less than an hour). It's too early to tell if this is effective, but it's worth a try. The filler (Evolence, Restolyn, etc) are a good fix while your body is reproducing collegen, but I'm hoping this saline works so I can save the $600. NO more cortisone for me!!!!

This post has been edited by hollie7B: Sep 29 2009, 08:41 AM

I know other people would disagree, but NO more cortisone for me either. Way too traumatizing to have your fat shrink back to the bone and the grand canyon open up on your face. Good luck with the injections, and thanks for the information on the Evolance. I was told by two derms not to put any filler into the depression while the healing process was taking place. Sigh. I sometimes wonder if all of medicine is guess work. I find that I have learned more from this forum than I have from the doctors I have spoken with. Good luck, Hollie!

(Rally the dent