I know this topic has been covered multiple times before but I wanted put out a warning and vent a little. 
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I visited my derm to get an ingrown hair drained. He offered cortisone. I told him I was afraid of the side effects, the denting due to atrophy of the fatty tissues (I have read way too much about this stuff over the last 12 years of issues). He told me it was a very diluted dose and that if it did dent it should go away in a few weeks. I was still hesitant. Then he asked "Do you want it gone?" I said yes. It was probably the worst decision of my life.
1. It's not just the dose that determines the denting but also the technique.
2. There's no way to judge a doctors injection technique before being injected.
3. A doctor with a brilliant mind for connecting the dots and solving our issues may have hands of stone and not the delicate hands of an artist.
He plunged that needle into my face. I was shocked by just how deep he went. IMHO, definitely into subcutaneous tissue. Then a second shot which I truly didn't expect. I trusted him cause he is the best doctor I ever had in other areas.
3.5 months later I still have two dents in my face. I've been a shut-in and really have stopped enjoying life. A follow-up visit didn't help. The solutions offered were to cut out the dent/scar and replace it with a slightly better scar or microneedling where the derm jabs your face with a needle to stimulate collagen growth. If there's scar tissue they can also try to jab away at it to break it up.
People will say they've had cortisone shots in their face and everything went fine and I'm sure this is true but they were gambling. Bad technique and your face can be ruined. It's called a cortisone injury and it can be so severe that the body may not recover to normalcy. As you all know cortisone doesn't just reduce inflammation it causes other tissues to atrophy.
I'm going to try some non-invasive approaches in January as a last ditch effort to save the day. I really hope & pray it works. With all my other skin issues I've always been able to find a solution but atrophic dents are the trickiest to solve and there's not many solid solutions on the web. American doctors, in general, are WAY too eager to give steroids. Almost like their bored unless they can break out the cortisone and stick you with needles.
So if you're offered cortisone injections you may want to consider holding off. You can always go back to the derm a week later and get the shot if needed but it may turn out that some antibiotics(topical & oral) will heal you up fine. I wish I had stayed on that route.
If anyone has any success fixing their dens/redness caused by cortisone over many months (over 4 months) please let me know your solutions. I'm open to all non-invasive approaches. Fasting, topical, excercise microcurrent etc.
It seemed that saline solution was seen as merely a temporary solution on these boards...
michi31 have you seen good results on other people with subcision???
One guy on YouTube did a serious of vids on his subcisions and etc. but I couldn't really tell if it improved that much...
Agreed. I regret getting cortisone shots everyday. I got a bunch when I had a cystic outbreak a year ago and now have atrophy. I'm hoping to get subcision soon and then go from there.
Yes - on the scar treatment board there are many who have had good results with subcision. It's actually best for "tethered scars" which are scars that when you stretch the skin they don't disappear. Usually dents that are caused by cortisone shots aren't tethered, but I believe mine are. So perhaps mine are a combination of actual scarring and cortisone atrophy. Although some people have claimed subcision helped them even if their scars weren't tethered so who knows. Like anything else, it's not a guarantee by any stretch. If your dents aren't tethered you could try a filler although it's a temporary solution.
During my follow-up visit my Derm said he couldn't tell if there was definitely scar tissue. I tried stretching it quickly this morning and it didn't totally flatten out but it does get a little shallower. I will try again tonight when I have more time. Now when I smile I have two strange dimple dents. Smiling actually makes them look worse. I'm going to try to stay positive for and during my treatments in January.
Cortisone was def. my biggest mistake ever, going against my own beliefs and trusting a doctor was a HUGE mistake.
It's a combination of LED, ultrasound, microcurrent but the esthetician may change it up depending on how it goes. I have half-heartedly started to compile a list of plastic surgeons in case it fails but I really don't want to go that route and have no idea who to trust and what fair prices would be. At the same time I'd like to get my life back & skin back. I'm sure you're feeling similarly.
I learned it all here from other members. You can do a search on this site and see discussions and pictures of members who have had it done. I'm not sure whether your dents would be appropriate or not. Mine is more of a rolling scar, not just a little atrophied dent. If yours is an untethered dent then a filler could work just fine.
This seems to be a "beat up on cortisone shots" thread, but I'll just chime in w/ the opposite - because it not only represents my personal experience, but I'll bet statistically the overwhelming likelihood for anyone considering this treatment.
I'll bet I've had more than 50 cortisone shots over the decades that I've had fairly sporadic, but stubborn cystic lesions. I've had the shots given to me by about 6 or 7 physicians, even one or two that weren't derms, but family practice or general internists. When traveling on business or personal, if I had what I could tell was going to be a good cyst starting up (yes, you can predict after you've been through it for a few years), I would commonly just go to the Yellow Pages and call around dermotologists until I could find one who would take me as a walk in. Many (MANY) of them have a policy of accomidating these sort of quick and easy procedures. i've probably done this in 4 or 5 cities over the years. I do know that my regular derm would fit me in on any given day, especially if I could drop in first thing in the morning. She was happy to do it and felt it was one of the easiest and most productive thing she could do for cystic acne sufferers.
If you read any clinical guide, the technique is dead easy, and it would take true incompetence, or very bad luck to get it wrong.
OK, I have had "dents". Sometimes nothing, but sometimes noticable. But I'll tell you, I've never had a dent that was noticable after about 2 months, worst case. In the vast majority of injections, either there was no dent, or the dent would last far shorter and be far less noticable than the cyst would have been.
I also found - and the reason my derm was so accomidating - that if I could feel a cyst coming on, even if it was barely noticable at the time, the smaller it was, the more effective the injection was in just making it go away, virtually preventing it. It also took a far smaller volume of the cortisone solution, and therefore far less trauma to the skin.
But even with large, established cysts, at the very worst, the cyst would go away in about 3 days to where it was not a big deal, and the denting would last a month or so, with no residual scarring - unlike a large cyst when left to its own devices can last a month or two and leave a scar.
So, my advice is to get cortisone injections as early and as often as possible to combat cystic acne - in conjunction with a good treatment such as isotretinoin (which I've taken 3 full courses of over 25 years).
Well Zoilo,
I think we all agree that the vast majority of those who receive cortisone shots are okay after a few weeks or a few months. However, fatty atrophy/denting is 100% a real risk and it's listed as a side effect. You say "the technique is dead easy" but, yes, even doctors sometimes make mistakes, have a bad day, don't have steady hands and I believe it's pretty easy to inject too deeply and that some people and areas are more sensitive to cortisone than others.
I'm happy for you Zoilo, I think you're amazingly lucky getting through it all unscathed but some of us are suffering with long term cortisone injury. Cortisone injury is not really discussed much and it sucks. A lifetime of regular filler injections or surgery could have been easily avoided for many of us. The psychological pain (never mind the expense of trying to fix it) it has caused me is huge.
I don't think you should shove aside our outcomes because everything went great for you. I wouldn't wish my outcome on anyone. My warning is this, if you have a large pimple forming give antibiotics a shot first. You can always come back for a cortisone shot if its really necessary. The shot only takes a few seconds but the damage can last & last & last.
Age may also be a factor in the potential of bouncing back from cortisone injections in the facial area.
Yeah I agree that most people seem to be fine with cortisone shots - which is why I decided to get more even though I knew I had slight indents from previous shots..ugh I'm such an idiot. Anyway, the PA that did it used such a diluted injection because of the previous indents and still, this happened. I have been to derms who will not do cortisone shots because of this - and I'm so glad they denied me the shot because then things would be worse. Anyway, yes most people seem to be fine (and I'm so jealous of them), but others have experienced permanent atrophy that some doctors even admit to.
Well, can you tell me some details about your exact HA filler type?
How long ago did you have it done? Do you think the results are permanent or do you have maintain with more injections?
Was the dented area still red when you had it done?
I haven't gone this route because I'm not in the mood right now to be injected with anything. That's what got me into this mess to begin with and also I'm trying another treatment in January. I heard fillers were temporary fixes. That you have to get injected regularly but perhaps this is wrong???
Why haven't you just gotten filler put in the dents.
I've had cortisone/and or cyst scarring before and getting HA filler put in worked wonders.
It was like it was never even there.
Well, can you tell me some details about your exact HA filler type?
How long ago did you have it done? Do you think the results are permanent or do you have maintain with more injections?
Was the dented area still red when you had it done?
I haven't gone this route because I'm not in the mood right now to be injected with anything. That's what got me into this mess to begin with and also I'm trying another treatment in January. I heard fillers were temporary fixes. That you have to get injected regularly but perhaps this is wrong???
Why haven't you just gotten filler put in the dents.
I've had cortisone/and or cyst scarring before and getting HA filler put in worked wonders.
It was like it was never even there.
I had it done a year and a half ago.
Yes the results are permanent for me but keep in mind there's no way to know if it's filler or my scar naturally healing. Cortisone atrophy is not permanent and it can take 3-6 months to fill in although sometimes it only takes a month or two. Anyways, yes the filler is supposed to be temporary; lasting about 6-12 months. So it's hard to say if my filler lasted 6-12 months and meanwhile the scar healed? Or maybe the filler is still there; I really don't care I'm just glad I did it.
I got perlane but any HA filler will work; such as restylane. I got perlane because the molecule size is larger and my scar was very deep.
The area was red but that was from the cyst; it's gonna be red anyways; injecting filler WILL NOT make it redder. Redness just takes time to heal.
Don't be worried about filler; I highly recommend it but make your own decision; do your research and read up on it on the scar forums too.
ANYTHING you research you can find good and bad results on but the truth is; filler is temporary; you really can't mess up your face with it because even if you did it'd go away.
Another great thing about restylane/perlane is that it helps build up/restore your natural collegen levels.
I only had 1 injection. Never had need for another.
I just realized that on the inside on my cheek/upper chin I can feel exactly where the dents are when I run my tongue over the corresponding area. It feels rough. I looked in the mirror and yep it seems I can make out the cortisone damage from inside my mouth.
Once again, I knew better but I was feeling vulnerable AND the doctor told me it shouldn't be an issue, diluted dose, blah blah blah. I told him my reservations and he still pushed it and he's otherwise the best doctor I've ever had. I agreed cause I liked him as person. Four months later and I'm still suffering. HUGE mistake. It has caused damage and injury. The two shots clearly went too deep. Terrible stuff for me. Had I gone to any other doctor/derm I never would have allowed this. I was wishy-washy cause I had been down that day cause I was thinking of a family member that passed earlier in the year.
I think many doctors want to be heroes and pro-active and it trumps "first do no harm".
They mean well but are too eager to inject drugs and prescribe steroids.
My life sucks now. Trying to stay positive and optimistic about my upcoming treatments. Getting this healed would be like getting a new lease on life.
I just realized that on the inside on my cheek/upper chin I can feel exactly where the dents are when I run my tongue over the corresponding area. It feels rough. I looked in the mirror and yep it seems I can make out the cortisone damage from inside my mouth.
Once again, I knew better but I was feeling vulnerable AND the doctor told me it shouldn't be an issue, diluted dose, blah blah blah. I told him my reservations and he still pushed it and he's otherwise the best doctor I've ever had. I agreed cause I liked him as person. Four months later and I'm still suffering. HUGE mistake. It has caused damage and injury. The two shots clearly went too deep. Terrible stuff for me. Had I gone to any other doctor/derm I never would have allowed this. I was wishy-washy cause I had been down that day cause I was thinking of a family member that passed earlier in the year.
I think many doctors want to be heroes and pro-active and it trumps "first do no harm".
They mean well but are too eager to inject drugs and prescribe steroids.
My life sucks now. Trying to stay positive and optimistic about my upcoming treatments. Getting this healed would be like getting a new lease on life.
I have 3 comments.
1. I have been dealing with 2 cysts for a while now; got cortisone shots and I'm getting atrophy in one of them now. I STILL DON'T REGRET THE CORTISONE BECAUSE I KNOW ITS TEMPORARY AND FIXABLE! And the dent is better than having a huge cyst on my face.
2. If it stays more than a couple months I'll get some filler put in.
Just get some filler put in seriously! It saved the day for me. As you said "getting it healed would give you a new lease on life."
That's what it did for me.
I don't know why you're so dismal when I just told you something that could fix it!
It may or may not work but you don't know until you try it! Don't waste negative energy when theres a possible solution you haven't tried yet.
Just get it from someone who's really experienced; find out how long they've been doing it or even drive a ways if you have to; although this isn't like plastic surgery; it's really not that complicated.
3. About this comment you made: "My life sucks now"
I've been there. Don't do that to yourself. Every time you do that you can be contributing to not healing; this is not a guilt trip for feeling bad this is wisdom I've learned personally as well as from research. Time and time again I've come across reports of people with the same issue and the people who had good attitude healed better. Don't waste your time on being upset. You really can choose your attitude; you're not a victim to your emotions. Do some research on the healing power of positivity; hope and joy and the effect it has on your body. When you're stressed you increase your cortisol levels; stress your adrenals; drain your vitamin C and B levels and tons of other factors which contribute to harm to the body and slowed healing.
Approaching 5 months since two deep cortisone shots dented my face. They are still there and have not improved on their own. I recently started some treatments that have helped a little and I'm trusting the process.
These shots have damaged me and my life. I would give just about anything to back in time and say NO.
Okay so I wanted to post a happy story to make people feel hopeful. I us to get cortisone shots for my acne cysts when I was suffering from acne. My doctor use to tell me to be very careful who you go to to get these shots because they can atrophy. I never had any problems when I got them done. At the time we didn't have internet and also later on I just never really understood the risks.
Well recently I went through a very traumatic experience and had a lot of stress and I am perimenopause so I started to break out in cysts again. I had two on my face not super bad but big enough that they were bothering me. I went to another dermatologist and asked him if he would inject them. I asked him about atrophy and he said well it can happen but its only happen once for him. I asked if how much do you use and do you dilute it with saline. He said he uses .1 cc and yes he dilutes it (I honestly dont believe it makes it safer if you do this-it can happen to any doctor). I went ahead and did it not really worried that anything would happen.
Well after a week the cyst went down but now it was atrophying. By the way I had it on my cheek where all can see. I started to freak out and went to my other derma who said why didn't you come to me? He started to do saline injections and it really didn't seem to be doing much. I was freaking out to the point I was obsessing about it, not eating and looking every where on the internet for into. This also freak me out because I was hearing so many horror stories and not many successes. I really wish I had realized how bad this can be because if I had I would have dealt with the darn cyst. Any way I just had my third saline shot. The night of the shot it looked good of course because it was filled up. The next day it looked even more indent then the day I had the saline shot! I really went over the edge then. The next day, which is today, I noticed it actually looked much better and right now it looks better then it has since it all happened. I feel very hopeful right now and after research I decided I would get it filled in even though it could still be healing. I decided I just cant wait for it to fill in but now I think I can wait if it stays like this. I have been massaging it with Vi-c and other collagen products. I will keep you posted but I really feel good about it right now and just imagine it filling up. No matter what I think fillers are the way to go. Just think if it takes from 1 month to a year to fill in you might as was well have it filled in so you can have a peace of mind. I will NEVER have a cortisone shot any where on my body!! It just isnt worth the risk!!
i had 2 shots indent recently which is like the first time ever for me and the one is filling in pretty well and the other one that was like a huge indent a month ago is already filling in alot but i do take 1000mg of vitamin c a day and i think it helps. i have read that its best to take 1000mg twice a day so i might try doing that as well. i also massage the area too. you could try that for a bit and see if it works but i think my derm did say it could take 6 months or longer to totally fill in so give it more time.
I had 2 cortisone shots last month that caused atrophy.
But it filled in on its own within 2 weeks. No big deal.
I have also had atrophy from cortisone stay for months and that time I got it filled with HA filler and it was as good as new after that. Problem solved.
My BIGGEST mistake of my life was NOT getting cortisone shots; posts like this one caused me to get scared so I let a mountainous cyst grow until it was the size of a quarter. I finally then gave in and got a cortisone shot.
I wish I had done it earlier because I most likely would have saved myself the scarring from the cyst.
Lesson learned. The next time (hopefully never) that I get a cyst I'm having it injected as soon as I know its going to be big and stop it in its tracks.
Just my 2 cents from my personal experience.