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Catieca

Lumps 6 months after subcision

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Lumps won't go away. It has been 6 months since my treatment. Had 3 cortisone injections so far. Massaged area 2x a day for months as advised per dermatologist. I have 2 lumps on the left side of my face and one on my right.  Juat won't go away. What else can I try?

it is really sad to go through this procedure to make my face more presentable and then end up with lumps!! 

Anybody has advice on what else I can do? The doctor does not seem worried. But I would like these lumps gone... and soon... if i had known it ends up like this i would have not done the procedure...

Help... thank you for taking the time to read this.

Ps. My skin looks a little better than whats in the picture, the laser treatments I did helped so it is not red like on the pictures. But the lumps you see are still there.

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Edited by Catieca

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1. Original paper in the 80s described paradoxical scarring. Namely lumps due to fibrotic or collagen that just will not heal in the correct manner- hence why you have scars in the first place. Yes, that sux. 
2. Was filler used at the same time? Is this a cross reaction pattern, is this an infection (unlikely cause lots of lumps not one). 
3. What was the before and after like? Subcsion maybe successfully but age related fat loss may occur. Was filler ever used or fat transfer at all? 
So, solution. 
1. Continue ILCS - steroid injections. Higher %
2. 5Fu- not good idea .. 10% ulcer rate. 
3. Co2 deep (e.g.. Lumenis, or you laser stacked - not ideal, or erbium drill- not ideal, or 3.0 very powerful microneewlign e.g. Instnsif over Infini), creates channels, then drip ILCS and occlude. Some papers I read somewhere said this was good. Not many doctors know about this, but it is in the literature. 
4. Excision (not ideal, more scars) 
5. Build volume around the lumps ( needs good doctor with skill sets to do this). 

Sorry to hear, its a bummer when you want scars fixed, but get more, BUT always a solution ... always... 

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I have seen this before, they could have hit a blood vessel or artery, caused blood pooling and hematoma. This area with fibrosis can have these under the skin. Do what Obiwan suggests about steroid. Filler can correct this as he said and even out things fill and even out the other areas. Some are prone to keloid scarring.   1064nm laser can help also if they heat it warm enough to do some non ablative remodeling 

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Kenalog / cortisone is very powerful and will almost certainly flatten this bump if a high enough percentage is used.  I'm pretty sure the doctor is afraid to cause overcorrection and give you atrophy, so he may only be using a very diluted amount.  Kenalog can go anywhere from a low % of 2.5mg/ml (what's typically used for cysts) all the way up to Kenalog 40.   Kenalog 40 would leave a golf ball sized dent.   I would try to ask him to bump up the percentage incrementally to see if the bump will flatten.  

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Aggressive subcsion with NOKOR will result in haematoma formation in 5-10% of case, this give fibrosis like BA has suggested. Most good derma-plastics warn this to the patient. If haematoma or seroma forms due to blood pooling, early massage, and dilute ILCS injections with 5% or less can dissipate the clot, and stop encapsulation of the clot. Drainage can help. This prevents hard fibrotic lumps down the track. Solutions always possible. If too hard to inject, good papers to suggest CO2 low density but vvv high energy e.g.. 3%-5% with 200 mj - 230 mj to get to the base or at least into the fibrotic tissue can help, occluded with A10. Papers out about 4 years ago. Good specialist practice this as mainstream now a days. 

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Thank you everyone for the replies. I have one more laser treatment and next time I see my doctor I will definitely discuss what else we can do about the lumps.

I appreciate the help so much.

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