Hi,
This post is for people who have had repeated cortisone shots for cystic acne and were left with huge dents in their face from it.
I was reading on the internet the other day about this problem and at MedHelp the plastic surgeon said that steroid fat atrophy is due to the precipitation of crystalline steroids that stay in the tissues, inhibiting the regrowth of fat cells. He said that simply injecting saline into the affected area will dissolve the crystals and permit the regrowth of fat cells inhibited by the steroid. You can read the complete response here: http://www.medhelp.org/forums/Cosmetic-Sur...essages/92.html
I went looking for more information and read about a study in the medical journal Dermatologic Surgery, in which patients were given weekly saline injections and experienced COMPLETE RESOLUTION of skin atrophy and restoration of surface contour within 4 to 8 weeks. To read the abstract go here: http://www.ncbi.nlm.nih.gov/sites/entrez?c...p;dopt=Abstract
I printed the abstract and showed it to my GP yesterday, who is an excellent doctor, and he was convinced this procedure would help me and gave me a referral to see Dr. Weinberg, who is an outstanding plastic surgeon at Trillium in Mississauga. I just called this morning to book an appointment and am waiting for the receptionist to get back to me after she asks the doctor if he will perform this procedure for me.
I am so excited at the idea of having my dents filled in. I have had them for 4 years and they are on my right cheek also. One is 1" long and the other is 1.5" long and the two scars run parallel to each other. I know 100% that the dents in my face were caused by cortisone shots because a) a reputable plastic surgeon told me so, and b) because of the way the dents emerged: after the 3rd shot or so, the area just sunk in dramatically, overnight, and the surface skin looked sickly and thin. That's what cortisone atrophy looks like.
Since the dents have smoothed out substantially over the years, I know that the body is capable of breaking down these crystals on its own, however it takes a very, very long time. For me, I figure another good 3 to 4 years before I can see complete resolution.
If saline injections are the answer, I cannot believe how long I have suffered with this. I will post updates about my progress when I have the procedure done. I'm keeping my fingers crossed!! Wish me luck. 
thank you for posting this! i have a few of those stupid dents too, needless to say i do NOT get cortisone injections anymore. i was told the atrophy shouldn't be permanent, but 2 years down the road, it definitely is. i am also in the mississauga area and have been so frustrated with trying to revise these scars! thanks a tonne!
edited to add.. GOOD LUCK! definitely keep us posted! also.. i saw dr weinberg myself, but i was only a few months post accutane i believe, so he only offered noninvasive laser treatments.. let me know if he's willing to do the saline injections!
My scars are practically all from cortisone injections. I hadn't read the articles you did but I did have saline injections. Many treatments, and the only dents that the saline got totally rid of were the ones that were brand new. My scars were over 5 years old when I started getting them injected. Was there any mention of how old the dents could be to see improvement? Because for me it was a deciding factor.
I did think I got improvement from Saline injections but not nearly as much as I got from Fraxel. There is no comparison.
I'd like to hear how your progress goes, keep us posted.
And for those of you who want cortisone shots, be very careful and ask to have it watered down. I like it 20% of the 10% strength.
violet,
i read the whole article at work b/c the u of t computers have access to this journal and the authors of the study state that this should work for prolonged cutaneous atrophy due to cortisone shots. they mention in the introduction of the paper that corticosteroid induced atrophy can resolve spontaneously within 1 or 2 years, however atrophy has been documented even after 5 years.
The authors mention in the discussion of the paper two possible explanations for why saline works even for prolonged cutaneous atrophy (i.e. several years or more). One explanation is that saline dissolves the crystal corticosteroids left in the tissues, enabling cutaneous fat to grow back, as growth is no longer inhibited by the crystals. The other explanation, which applies especially to cystic acne patients, is that the mere pressure of the saline injected into the skin frees microscopic particles of the cyst that are tethered to the cutaneous tissues. therefore, (at least according to the study) the duration of the atrophy should not be a factor in the effectiveness of this treatment.
you said that saline shots didn't work for your older dents. did you have a series of saline injections into the affected areas or just one or two injections? because in the study the authors found a step-wise improvement in all patients, in which atrophy resolved more and more after each injection. for the cystic patients, atrophy was completely resolved within 4 to 5 injections, with patients getting injections once a week for 5 consecutive weeks.
It *may* be that the dents in your face can be better attributed to the presence of scar tissue than corticosteroid induced atrophy. fraxel breaks up the scar tissue in the skin so that cutaneous fat can grow back. so if this worked for you and saline didn't, it seems that you probably had some scar tissue.
I know that in my case it was definitely the cortisone b/c i was going for shots every 2 weeks for almost 4 months and twice the doctor emptied an entire bottle of kenalog into my face on the side of my face that was atrophied very badly. in my case, within about 3 months after the initial injections, areas of my face where i had had the shots started sinking in all of a sudden and very dramatically. this timeline fits exactly with what the authors say in the study (that atrophy typically emerges within 2 to 3 months after initial injection). also, the skin in the affected areas became thin and had a bluish coloration, indicating that blood vessels were probably atrophied by the cortisone as well and could therefore not permit proper blood flow to the affected areas.
regarding the saline shots though; did you have them done by a dermatologist or a plastic surgeon? i'm really trying to find someone to administer them for me right now and don't know if i'm barking up the wrong tree by going after a plastic surgeon...
When one has had cystic acne, as I have, how can you tell if the scar/depression was caused by the cortisone shot, or if the cystic acne by itself would have caused the residual depression? I never had cortisone shots and still had depressed scarring. Nonetheless, this sounds like a promising option.
krugstoneco,
you will know if the dent is steroid induced by having a plastic surgeon diagnose you with corticosteroid induced cutaneous atrophy. alternatively, you can read my post to violet for a description of what this condition looks like, as i was diagnosed by a plastic surgeon last may.
Dr. Weingberg just e-mailed me back today and he told me that he has never done this and does not know anyone else who has either. Since this study was only published a little over a year and a half ago (oct. 2005), i'm guessing that most doctors haven't even heard about the effectiveness of saline for treating corticosteroid induced atrophy yet.
I showed my family doctor the complete article yesterday and he looked at the abstract and immediately told me to contact Women's College Hospital (in Toronto) because they've got a really good dermatology department. I just called there this morning and left my name and telephone number on their answering machine and they said they'll get back to me to schedule an appointment.
It's funny how no one here knows about this. The study was published in California and the plastic surgeon who mentioned this as a treatment option on MedHelp (see my first post in this thread for the link) has his practice in California also. So it seems like the information just hasn't been widely disseminated yet. No one has even cited the study yet (I did a search on scholar's portal at the university). Probably because it's too recent and it takes at least a year to carry out and publish a study. This is really leading edge then.
Actually, people have posted about this in the past on this board. One poster had a complete fill in of her indent. I think she even had pictures. The doctor is Dr Sire in fullerton, you need to search past posts. The reason I believe that more doctors don't learn about it is because it's a very cheap procedure. A lot of people on here have injected themselves with saline, myself included. I don't have cortisone indentions so I'm not sure if it helped.
I'm having trouble finding someone in the greater toronto area that will give me saline injections. I wouldn't dare start injecting shit into my own face, so if no one will do it, then I'll just have to wait until the dents fill in on their own.
I had a consultation with a plastic surgeon a week ago and he offered me Restylane, which I do not want. I really don't think he was being honest with me either, b/c when I asked about possible risks he said there were "none." I felt like he was misleading me here b/c EVERY procedure has it's risks. So i probed him further (e.g. possiblility of developing acne-like formations, having it migrate under the skin, etc.) and he just said, "well I've never had that happen," etc. and that the only possible side effect is a "little bit of bruising."
This is bullshit. i read about all the risks on the Restylane website (www.restylane.ca) and in the Restylane pamphlet while sitting in his office! I even told him that I have hypersensitive skin w/ a proneness to developing boils/cysts. He still told me the procedure is 100% risk-free. I know for a fact that on the Restylane website, they state that 1 in every 2,000 people will experience side effects, usually those with hypersensitive skin. so even though it's UNLIKELY that nothing will happen, there is still a POSSIBLILITY of an adverse reaction, which i think should be discussed seriously. afterall, i would be injecting a foreign substance (gram-positive bacteria) into my face here
this just reminds me too much of when i had all those cortisone shots 4 years ago. the dermatologist jsut told me to lie down and then just gave me shots. he didn't even tell me what he was giving me or what the side effects were. then when something goes wrong, he doesn't fess up to it. so just b/c cortisone doesn't ALWAYS cause atrophy, that gives the doctor the right to neglect to tell the patient of the possible adverse reactions that the shot may produce? if i had known then that atrophy was a possible risk, i would NEVER had consented to having the shots. NEVER. and since i never agreed to accept the risks in WRITING, i still think the doctor is 100% liable.
but back to the plastic surgeon.... after telling me he can give me restylane for the cortisone atrophy (or scarring-- he said he really can't tell), he starts pointing out OTHER little flaws on my face (from the boil i had back in october 2006, which is STILL HEALING) and saying he can fix those with Restylane too! i just wanted to leave at that point. he is obviously just after teh money.
I had many cortisone shots and scarred afterward, I had never scarred before in my whole life before this, so believe it contributed. However, I believe I also have some thick scar tissue build up in areas. I did my own saline injections, you can read on past threads here. It is so easy to give yourself a saline injection. But I understand if you don't want to. You could call a tatto artist and get them to needle you with saline. They do this to break up tatoos when removing I think I read. However, some have given needling for scarring if you call around. Then you would have the benefits of the needling and saline. Any derm who knows how to give a cortisone injection should be able to inject a big lump of saline under a scar. Any diabetic could do it. You just stick the needle under the scar at an angle and keep injecting till there is a big lump. You want to bruise some if you can. The saline disappears very fast, about an hour for me, and you will have some residual swelling.
The saline injections helped some, but did not fix me 100%. Don't get your hopes too high.
Okay, if you have cystic acne, if you dont get shots, what is there that you can really do to prevent them from scarring?
yeah i'd like to know the answer to this as well. i've been getting cortisone shots around my jawline on both sides of my cheeks pretty frequently and havent noticed the "dents". i was not aware of this possible outcome. now that i know, i'll prolly stop getting 'em.
....so what can you do about a cyst to prevent the scarring?
I currently have a somewhat large dent in between my eyebrows where I was injected 2.5 weeks ago. This same area has had problems with probably 3 stubborn cysts in the past few months and I'd say I've had 4 injections in it or so.. which seemed fine until the last one where it immediately started to sink in. I was devestated and it got to the point where makeup wouldn't hide it and it's at my eyeline where people look into your eyes so bangs can't cover it and EVERYONE notices it.
I saw this thread yesterday and went straight to my derm's office within hours. My doc never heard of using saline and said he was sorry but I'd just have to wait it out and not consider filler or anything for months to come. I reasoned with him and said I understand the steriod stays in your skin for 3 months... so what would it hurt to try to flush it out with saline a few times? He agreed and injected me yesterday. I was so relieved. I am going back next week or so for another and pray it just goes away. I am in a small city in Canada, so honestly if I can get these injections here, they shouldn't be hard to get at other derms with understanding docs. So if any of you are interested, I'll keep you up to date on my little crater/new premature wrinkle.
[For background info: I'm 24 and have had occasional cortisone injections for cystic acne since I was 17. From the ages of 18-23 I went on b.c. (diane 35, then tricyclene sp?) and it seriously cured my skin but completely messed up my hormonal network in my body. I worried about long-terms effects but every time I tried to get off of them I broke out horribly. So I literally tried to wean off of them.
There was a point where I had 3 periods in a year. It was hell and my skin was the worst it had ever been. So the past two years have been riddled with these silly injections I wish I didn't rely on so heavily I cannot even count how many injections I have had.. I can't even guess.
I eat organic and well, but recently I have cut all dairy out and consume soy products like a crazy woman in an effort to keep my estrogen higher... I had my hormones tested a few months ago and they are "normal", but my testosterone is actually almost at the maximum threshold of normal. I am avoiding accutane, etc as I am a health nut and really want to do things as naturally as possible... (yeah besides the shots... but what else can I do?) Since my change in diet I have noticed fewer cysts... much much fewer.. so I seriously think it's somewhat linked. When my period nears... I start guzzling the soy milk.]
I currently have a somewhat large dent in between my eyebrows where I was injected 2.5 weeks ago. This same area has had problems with probably 3 stubborn cysts in the past few months and I'd say I've had 4 injections in it or so.. which seemed fine until the last one where it immediately started to sink in. I was devestated and it got to the point where makeup wouldn't hide it and it's at my eyeline where people look into your eyes so bangs can't cover it and EVERYONE notices it.I saw this thread yesterday and went straight to my derm's office within hours. My doc never heard of using saline and said he was sorry but I'd just have to wait it out and not consider filler or anything for months to come. I reasoned with him and said I understand the steriod stays in your skin for 3 months... so what would it hurt to try to flush it out with saline a few times? He agreed and injected me yesterday. I was so relieved. I am going back next week or so for another and pray it just goes away. I am in a small city in Canada, so honestly if I can get these injections here, they shouldn't be hard to get at other derms with understanding docs. So if any of you are interested, I'll keep you up to date on my little crater/new premature wrinkle.
[For background info: I'm 24 and have had occasional cortisone injections for cystic acne since I was 17. From the ages of 18-23 I went on b.c. (diane 35, then tricyclene sp?) and it seriously cured my skin but completely messed up my hormonal network in my body. I worried about long-terms effects but every time I tried to get off of them I broke out horribly. So I literally tried to wean off of them.
There was a point where I had 3 periods in a year. It was hell and my skin was the worst it had ever been. So the past two years have been riddled with these silly injections I wish I didn't rely on so heavily I cannot even count how many injections I have had.. I can't even guess.
I eat organic and well, but recently I have cut all dairy out and consume soy products like a crazy woman in an effort to keep my estrogen higher... I had my hormones tested a few months ago and they are "normal", but my testosterone is actually almost at the maximum threshold of normal. I am avoiding accutane, etc as I am a health nut and really want to do things as naturally as possible... (yeah besides the shots... but what else can I do?) Since my change in diet I have noticed fewer cysts... much much fewer.. so I seriously think it's somewhat linked. When my period nears... I start guzzling the soy milk.]
Actually, I have taken spironolactone (unfortunately I saw no difference in my skin... when I should have been noticing a difference, things were actually getting worse from what I remember), as well as prednisone (which made me incredibly sick), even minocin (which darkens your teeth).... and I have to say I am pretty frustrated with pharmaceuticals altogether. Seems like when I take something to treat this...something else has to give. I curse pharm companies! But either way, it's good to hear that it's done something noticible for you.
Well I might as well provide updates with these saline shots. The dent is still very large, I even cut bangs so the attention to the mark is diverted.. it just looked so bad on a forehead with long hair framing my face.
Yesterday I went in to have another saline injection.. the head derm told the derm working with this dent that it should eventually fill in, however I do know the head derm and know he hasn't seen the atrophy so he can't actually be so sure... he has seen a small one on my nose once but this is the size of my thumb, and it is almost down to the bone. So I am skeptical. My nose took something like 9 months to fill in so who knows how long it takes to grow some of your forehead back. We talked about using Restylane to fill in the dent but the derm wants to wait a few months-- which sucks because of course like anyone else I want a fix ASAP. My derm said that the Kenalog starts in powder form and you mix it with solution.. and he says it's possible there was a concentrated chunk not completely dissolved that may have been injected- causing the significant atrophy.
I'm really hoping these saline injections flush it out somewhat.. the spot looks bruised after two saline treatments and is tender but I am hopeful. I do have a hole in my head that I have to live with for now, but it could be a lot worse like some people who have had flesh eating disease where they lose their entire face and have to rely on prosthetics or others who have experienced terrible accidents and suffer irrepairable damage to their faces/heads/bodies. So besides this ugly gaping dent smack dab between my eyebrows, I am still living a functional happy life and I am trying my best not to let this get the best of me.
Oh and just a little note, the derm said otherwise my skin on my face is "beautiful". Which seriously makes me happy as I have had years of acne and finally cut out all dairy and been ingesting large amounts of soy in hopes that my hormones would calm down. Wooo hoo! It seems to be working!!!
Alright, update time. I don't know if anyone reads this but I figure I might as well continue posting what's happening.
I didn't have a saline injection last week as my derm was booked full, and I won't go in for another week from tomorrow. Sucks but at least I got 2 shots weekly in so far. The spot is more tender, I can't say it's grown much deeper in size.. thankfully! It still is somewhat ugly and when I frown it's huge!! When I hold the skin taut it disappears so I hope the fat grows back soon. I'm very hopeful.. if it doesn't I am considering Restylane in about 4 months or so.
Well, that's all I have for now. Until next time