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You Want To See Cortisone Atrophy? I'll Show You Atrophy.


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#81 hopeful503

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Posted 05 August 2013 - 10:56 PM

Thanks for the update. Please keep us posted on the saline injections.  I would be interested in trying it out because it is much cheaper!  

 

I took a closer look at my indentations this evening and it is looking like the indentations are still there--not completely filled in like I said earlier today.  It's been less than a week (today is Monday, had the filler Wednesday) so it must have looked more filled in because of swelling.  The filler was very lumpy at first but it smoothed out and feels natural.  I am going to go back this week for more. It will be free since I didn't go through the whole vial and have plenty left over.  I don't think the filler is wearing off---I just don't think enough was injected.  Everything seemed filled in when I left the office but he said give it two weeks and come back if you think you need more.  

 

Ugh, I hope this works out. 



#82 Supernova30

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Posted 10 August 2013 - 11:02 AM

Ok it's now been about 9 days since the saline injection. The plumping effect of the saline has been gradually wearing off - initially perfectly gone for a few days, then gradually sinking back down to maybe 70-80% improvement. The biggest change occurred after about 7-8 days, when I'd say it went down to about 40-50% improvement, which is about where I am now. I think. But honestly it's hard to say because the dark bruise is still there and makes it harder to judge the depth.

 

I will hold off on judgement about the saline injection until this bruise finally heals up. Right now I feel pretty terrible that I have a dark bruise AND a dent, making the whole area just a lot more noticeable, but if it helps with the dent in the long run I will consider it a success.

I'm not planning on having another saline injection for a few weeks - I actually read one statement from a doctor who uses the technique saying that one flush is usually enough and that the fat should re-build within 3-4 weeks, and at that point some people may need another flush. So since I'm wary of more bruising, I'm just going to wait and see what happens.

Will keep updating.



#83 2worriedmom

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Posted 11 August 2013 - 11:58 AM

HI Supernova30,  When did you have the dreadful cortisone shot that started this whole nightmare?

It sounds like we did our saline injection at about the same time.(my first saline was July 31; stupid cortisone on June 28)

How do you know that you got 5 cc of saline...did you ask the derm?  I think I got a very small amount of saline as I barely had a small bump for a while and never have enjoyed any improvement whatsoever in the dent. (Dent is easily a half inch long...truly looks like a scar from some type of accident!)

I go for another saline injection on August 21...I don't know, I think I have a very long road of embarassement ahead and am not quite a believer in this thing ever truly going away.  Thankfully there are some success stories on this thread so I try to hold on to some hope.

Ok it's now been about 9 days since the saline injection. The plumping effect of the saline has been gradually wearing off - initially perfectly gone for a few days, then gradually sinking back down to maybe 70-80% improvement. The biggest change occurred after about 7-8 days, when I'd say it went down to about 40-50% improvement, which is about where I am now. I think. But honestly it's hard to say because the dark bruise is still there and makes it harder to judge the depth.

 

I will hold off on judgement about the saline injection until this bruise finally heals up. Right now I feel pretty terrible that I have a dark bruise AND a dent, making the whole area just a lot more noticeable, but if it helps with the dent in the long run I will consider it a success.

I'm not planning on having another saline injection for a few weeks - I actually read one statement from a doctor who uses the technique saying that one flush is usually enough and that the fat should re-build within 3-4 weeks, and at that point some people may need another flush. So since I'm wary of more bruising, I'm just going to wait and see what happens.

Will keep updating.



#84 Supernova30

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Posted 11 August 2013 - 05:12 PM

Hello,

 

I had the cortisone injection May 8th - dent showed up a couple of weeks later, had the saline injection Aug 1. So I had had the dent already for about 2.5 months by the time I had the saline injection. It was starting to show some improvement already but veeeery slow, as I'm sure you can appreciate.

I knew that my doctor injected 5cc's because it was his first time doing a saline injection so he followed the directions from the journal article and that's what it recommended. I think he only stuck the needle in once (at an angle) but moved it around while it was under there and said he could feel it hitting scar tissue (gross). Maybe this movement caused the terrible bruise but maybe it also helped to spur along some collagen production, I don't know, but I'm optimistic it did something to help. This is on my chin and it initially looked like I had been punched but the swelling and redness subsided really fast. Maybe when you go in next, ask the dermatologist to do 5 cc's? I promise the swelling will go down fast but you might want to ice it if you bruise at all easily.

As I said before, right now it's really hard to tell how much improvement I have (I'm pretty sure at least some) - I'm trying to stay optimistic that I'll see some progress over the next month.

I fully sympathize with how awful this is. I'm holding out hope that we'll get decent resolution - even if it's not perfect - since the overwhelming majority of people do. 

 

 

 

HI Supernova30,  When did you have the dreadful cortisone shot that started this whole nightmare?

It sounds like we did our saline injection at about the same time.(my first saline was July 31; stupid cortisone on June 28)

How do you know that you got 5 cc of saline...did you ask the derm?  I think I got a very small amount of saline as I barely had a small bump for a while and never have enjoyed any improvement whatsoever in the dent. (Dent is easily a half inch long...truly looks like a scar from some type of accident!)

I go for another saline injection on August 21...I don't know, I think I have a very long road of embarassement ahead and am not quite a believer in this thing ever truly going away.  Thankfully there are some success stories on this thread so I try to hold on to some hope.

Ok it's now been about 9 days since the saline injection. The plumping effect of the saline has been gradually wearing off - initially perfectly gone for a few days, then gradually sinking back down to maybe 70-80% improvement. The biggest change occurred after about 7-8 days, when I'd say it went down to about 40-50% improvement, which is about where I am now. I think. But honestly it's hard to say because the dark bruise is still there and makes it harder to judge the depth.

 

I will hold off on judgement about the saline injection until this bruise finally heals up. Right now I feel pretty terrible that I have a dark bruise AND a dent, making the whole area just a lot more noticeable, but if it helps with the dent in the long run I will consider it a success.

I'm not planning on having another saline injection for a few weeks - I actually read one statement from a doctor who uses the technique saying that one flush is usually enough and that the fat should re-build within 3-4 weeks, and at that point some people may need another flush. So since I'm wary of more bruising, I'm just going to wait and see what happens.

Will keep updating.



#85 2worriedmom

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Posted 11 August 2013 - 05:33 PM

Yes, you are right...I too try to stay optimistice but then look in the mirror and get depressed everytime!! 

I think I am very very concerned because age is certainly not on my side..I am in my upper 40's...not exactly banner years for collagen production or quite frankly anything good related to my skin.  The last time I had so many skin woes I was a teenager and ended up taking accutane! 

Please keep me posted on your progress.

Thanks!!!



#86 Supernova30

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Posted 12 August 2013 - 06:44 PM

Just thought I'd post some information regarding saline injections used to treat cortisone atrophy since I have access to some journal subscriptions that others might not. There is the main article by Shumaker et al. You can read the abstract by googling "Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration"

 

And then there is this interesting response letter by Dr. Shiffman (excerpt provided here):

 

 

Letter to the Editor:
I read with great interest the article by Shumaker and colleagues concerning the use of normal saline injection for treating steroid fat atrophy in four patients with great success. ... I have lectured on the technique since 2000 in Germany, Mexico, Romania, Korea, Colombia, and Japan. I have received many e-mails from and made personal contacts at meetings over the years with physicians who have used the technique on a variety of areas of the face and body with successful results.

My personal theory as to why the saline injection works is that the steroid crystals in the tissues are placed back in suspension with the saline, and the body macropahges treat them as foreign bodies, removing the crystals from the local region. . . it is not necessary to reinject the saline every week because the fat reaccumulation will occur given enough time (approx 3–4 weeks). It may be necessary to give a second injection after 1 month in an occasional case if not enough saline is injected initially, which is why I prefer to tumesce the area with saline. Even on the face, the saline swelling will dissipate over night so that the patient can return to regular social contacts.

MELVIN A. SHIFFMAN, MD, JD
Section of Surgery, Newport Specialty Hospital,
Tustin, California



#87 Supernova30

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Posted 15 August 2013 - 08:37 AM

Quick update on progress 2 weeks after my first saline injection: I would say the dent has improved by about a third.

 

It hasn't been a miracle exactly but this is about the same amount of improvement I saw in the previous 1.5 months, so it definitely helped. Waiting another week or two to see if there is further improvement before I get another saline shot.

 

How are you guys doing?



#88 2worriedmom

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Posted 16 August 2013 - 05:11 AM

It has been 16 days since my first saline injection...no improvement here.  :(

I go for a second saline injection next week.  This is really getting me down and I'm sorry to be the downer on this thread. 

My situation may be a bit worse than others I guess because of my age(late 40's) which, of course, makes one assume collagen production not great; and because my dent is on the lower, front jaw area which is a very dynamic spot that dents in even further with movement.  When I talk, the dent gets deeper...lovely.

 

I am going to see if the derm will be a bit more aggressive with the quantity of saline injected on this second injection.  I believe she injected a low amount the first time  since I had minimal swelling.  According to the articles I have read, there should be a significant "wheal" (not misspelled!..quoting article) after the saline is injected.

 

Oh well, as advised by others who HAVE had success with this atrophy healing, I really need to stop analyzing this thing daily and look for progress perhaps monthly.  IF mine does ever go away, I am probably one of the people who will need 6 months~1 year of time to heal.  In the meantime, I have been trying to find a good filler/silicone makeup.  Dermaflage seems a bit tricky to use since it says one cannot use makeup over it. If anyone has suggestions on filler makeup, please advise.  I am not yet ready to do a cosmetic filler such as restalyn at this point.  Based on my bad luck with injections, I don't want to add anything else to this mess that is semipermanent and requires months of waiting to wear off.

 

I appreciate anyone who posts progress...sadly I check this thread way too often looking for hope!!!



#89 DudleyDoRight

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Posted 16 August 2013 - 06:14 PM

I would not self treat! It is in your best interests to leave it alone. I know it's hard.


It has been 4 months tomorrow and I can say it has actually gotten better, the two long lines are almost completely filled in its like a damn miracle. I still hate one of them but im trying to be patient. I will post pics but I want to see if it gets even better so I will post an update at 6 months.

I am glad the wait and see approach is working for you. I just read through this thread and I could feel your desperation.

#90 ughhhhh

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Posted 20 August 2013 - 11:04 AM

People have been asking me for an update so here it is. 

   

 

I'm starting to feel like a normal person again. I've been going to lunch, dressing up and going on with life as normal. It is just about 5 months this week and I am

confident it will continue to improve until it's back to normal. One of them has stopped improving and I'm pretty sure it's a scar, but I also think it will respond to subcision so I've decided to be patient and once I'm 6 months off accutane I will probably start treatment. 

 

I'm glad I made this thread because I was so upset and desperate and wasn't finding the answers I wanted. I really didn't think I would ever improve, and I did. I hope this thread helps people who are going through this ordeal, I wouldn't wish this mental torment on my worst enemy (well, maybe I would tongue.png

 

Now if anyone has any ideas on how to fade the scars (many are actual scars) I appreciate the advice! 

 

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Edited by ughhhhh, 20 August 2013 - 11:12 AM.


#91 2worriedmom

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Posted 20 August 2013 - 11:56 AM

WOW Ughhhh!! You look great! The healing over the past few months is tremendous!  SOOOO happy for you!

 

I am so thankful to you for starting this thread and posting photos.  As you know, I am at a very low point right now and your situation really gives me hope.

 

Please continue to post updates.  Thanks so much!!!



#92 mrsrobinson

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Posted 20 August 2013 - 12:00 PM

looks better, much better!

 

AHA for your marks, when your post accutane skin can handle it

 

patience is a very hard thing indeed isn't it!



#93 Supernova30

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Posted 20 August 2013 - 12:11 PM

Wow that's fantastic! I'm so happy for you! And thank you for posting and giving us all hope.

I'm trying to decide right now whether to have another saline injection. I would say my improvement in the 2.5 weeks since the first one is about 50% - which I'm so grateful for - however I had extremely dark bruising from it that lasted 2 weeks (at its worst for 10 days) so I am hesitant.

Happy to see that the wait and see approach can work too!

Edited by Supernova30, 20 August 2013 - 12:12 PM.


#94 hopeful503

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Posted 20 August 2013 - 10:49 PM

People have been asking me for an update so here it is. 
   
 
I'm starting to feel like a normal person again. I've been going to lunch, dressing up and going on with life as normal. It is just about 5 months this week and I am
confident it will continue to improve until it's back to normal. One of them has stopped improving and I'm pretty sure it's a scar, but I also think it will respond to subcision so I've decided to be patient and once I'm 6 months off accutane I will probably start treatment. 
 
I'm glad I made this thread because I was so upset and desperate and wasn't finding the answers I wanted. I really didn't think I would ever improve, and I did. I hope this thread helps people who are going through this ordeal, I wouldn't wish this mental torment on my worst enemy (well, maybe I would tongue.png
 
Now if anyone has any ideas on how to fade the scars (many are actual scars) I appreciate the advice! 
 



Uggh, did you use saline injections or did the healing occur on its own? You look great! Definitely giving me hope. Is the skin ou back to normal as well? My skin is thin where the depressions are.

#95 inicomozi

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Posted 20 August 2013 - 11:44 PM

Hey guys! This is my first time posting to this forum, but I wanted to write and give hope to those who may believe that their face is indented forever because of a steroid injections.  In late April, I got a a pimple injected and a pulsed dye laser on a pimple on my cheek.  Due to the bruising from the pulsed dye laser, which was supposed to last 1-2 weeks, I'm not sure exactly when the indent started (as the area was so dark).  But 17 days after the procedures, after I noted that the area was indented and still dark, I went back to see my doctor, who told me that it was not indented and that I was just experiencing hyperpigmentation from the laser.  As relieved as I was to hear him say that, I still worried that it was indented, so I went to Stanford University hospital for a second opinion.  They told me that the mark on my face was, indeed, indented and that it was from the steroid injection rather than the pulsed dye laser.  This was four months ago and it has been such an emotional rollercoaster since then.  I spent hours googling kenalog injection indentation, crying to my friends and mother, staring at my face, and avoiding the sun (as to not make it darker, per my doctor's recommendation).  Two months ago, I found the article on saline injection and brought it to Dr. Gladstone (in Palo Alto).  He consulted with one of the authors of the article (as Dr. Gladstone is an editor of the journal where it was published) and even connected me to that author (Dr. Goldman).  The author told me that he's done the saline procedure hundreds of times, and he 100% of the patients have gotten to 100% resolution.  This was a HUGE relief, because I was pretty sure that my face would be permanently damaged, as it had not improved in 2 months at all.  In face, at that point, Dr. Gladstone had injected the area with 3 cc's of saline, and it bruised horribly for 2 weeks that I was afraid the saline was making it worse.  A month ago, I proceeded with saline injections, but this time getting 10 cc'd injected instead of 3.  I put ice on the area immediately after each injection for 20 minutes, and my bruising has been extremely minimal since then.  At this point, I have had 5 weeks injections of saline, and the indentation appears to have resolved by 95% (my last injection was yesterday)!  I still have hyperpigmentation, so it's hard to say for sure, but the area appears to be smooth!  Saline injection works - it really does.  So if your skin is indented after a kenalog/steroid shot, don't worry - there is a way to fix it safely.  This whole nightmare seems to be almost over for me (although it's still dark, I'm just so grateful that it's not indented and that the color should be permanent) and I am happy to be there to help/support/listen to others who may be going through it.  Feel free to reach out to me to on here or on my gmail (inna.markus@gmail.com) at any time if you are going through this whole thing and need to talk.  And most importantly, don't stare at your indentation in the mirror for hours like I did, and don't give up hope that it will completely resolve - it will smile.png

 

Warmly,

Inna


Edited by inicomozi, 20 August 2013 - 11:46 PM.


#96 blahblah82

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Posted 21 August 2013 - 12:54 AM

Whew.... quite the emotional roller coaster.  I'm glad there was a positive outcome.  I know how tortured one can feel after a procedure goes awry. Documenting your experience will certainly help others.  



#97 Supernova30

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Posted 21 August 2013 - 09:04 AM

Hello Inna,

 

Thank you so much for sharing your experience - it really helps to hear success stories! And it's great your doctor spoke with the author of the article! 100% success rate sounds pretty damn good to me.

 

I was especially encouraged to hear that there might be an effective way to minimize bruising from the saline. I also bruised horribly from the first saline injection (5 cc's) and it looked so bad for nearly 2 weeks that I was almost deciding not to get another injection - but hearing your story is giving me hope that if I diligently ice it immediately afterward that I can at least minimize the bruising. 

 

Thanks again!



#98 inicomozi

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Posted 21 August 2013 - 11:44 AM

Supernova,

The icepack was so helpful - the bruising now either does not occur after injection or is only present for one day. That is completely different than the weeks of intensely black bruising I got the first time. Good luck and keep us posted on how things go!! I am confident that you will be part of the 100% of people for whom saline fixes the problem!

Warmly,
Inna

#99 JennaBean

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Posted 21 August 2013 - 02:33 PM

Ughhhhhh: I'm so happy for you!! You can't even tell you had any indentation at all!! I hope mine fills in. It's been 2 months since the atrophy occurred. I THINK it's slowly improving but I'm not sure. Can you post a picture of your other side? Mine looks similar to that one you had.

#100 ughhhhh

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Posted 22 August 2013 - 01:37 AM

Hey guys! This is my first time posting to this forum, but I wanted to write and give hope to those who may believe that their face is indented forever because of a steroid injections.  In late April, I got a a pimple injected and a pulsed dye laser on a pimple on my cheek.  Due to the bruising from the pulsed dye laser, which was supposed to last 1-2 weeks, I'm not sure exactly when the indent started (as the area was so dark).  But 17 days after the procedures, after I noted that the area was indented and still dark, I went back to see my doctor, who told me that it was not indented and that I was just experiencing hyperpigmentation from the laser.  As relieved as I was to hear him say that, I still worried that it was indented, so I went to Stanford University hospital for a second opinion.  They told me that the mark on my face was, indeed, indented and that it was from the steroid injection rather than the pulsed dye laser.  This was four months ago and it has been such an emotional rollercoaster since then.  I spent hours googling kenalog injection indentation, crying to my friends and mother, staring at my face, and avoiding the sun (as to not make it darker, per my doctor's recommendation).  Two months ago, I found the article on saline injection and brought it to Dr. Gladstone (in Palo Alto).  He consulted with one of the authors of the article (as Dr. Gladstone is an editor of the journal where it was published) and even connected me to that author (Dr. Goldman).  The author told me that he's done the saline procedure hundreds of times, and he 100% of the patients have gotten to 100% resolution.  This was a HUGE relief, because I was pretty sure that my face would be permanently damaged, as it had not improved in 2 months at all.  In face, at that point, Dr. Gladstone had injected the area with 3 cc's of saline, and it bruised horribly for 2 weeks that I was afraid the saline was making it worse.  A month ago, I proceeded with saline injections, but this time getting 10 cc'd injected instead of 3.  I put ice on the area immediately after each injection for 20 minutes, and my bruising has been extremely minimal since then.  At this point, I have had 5 weeks injections of saline, and the indentation appears to have resolved by 95% (my last injection was yesterday)!  I still have hyperpigmentation, so it's hard to say for sure, but the area appears to be smooth!  Saline injection works - it really does.  So if your skin is indented after a kenalog/steroid shot, don't worry - there is a way to fix it safely.  This whole nightmare seems to be almost over for me (although it's still dark, I'm just so grateful that it's not indented and that the color should be permanent) and I am happy to be there to help/support/listen to others who may be going through it.  Feel free to reach out to me to on here or on my gmail (inna.markus@gmail.com) at any time if you are going through this whole thing and need to talk.  And most importantly, don't stare at your indentation in the mirror for hours like I did, and don't give up hope that it will completely resolve - it will smile.png

 

Warmly,

Inna

That is great to hear! Who is your normal dermatologist? I'm in the SF Bay as well, so I can definitely tell you who NOT to see. I also saw Stanford, they basically told me that it wasn't noticeable (what?! ok then) and that I should seek subcision. I was planning on contacting Dr Gladstone as well, I will definitely email you.  I'm so glad this worked out for you! 



Ughhhhhh: I'm so happy for you!! You can't even tell you had any indentation at all!! I hope mine fills in. It's been 2 months since the atrophy occurred. I THINK it's slowly improving but I'm not sure. Can you post a picture of your other side? Mine looks similar to that one you had.

Yea like I said, it took about two months just to stop getting worse, I was FREAKING out, as documented :\ 

It started rapidly improving at 4 months, I know its a long time to wait but you will survive this. 

I noticed today that my other side is indeed better than it was a month ago... I'm still embarrassed by it though :( I think it's probably 1/4 of the size it

used to be and has much softer edges. Don't give up hope! One day you'll look back on this and wonder WTF happened. It's a story no one will ever believe... 






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