Facelift and neck lift BEWARE Dr. Abel and Gustavo Chajchir - Buenos Aires, Argentina

This is a revision of my previous review. I hope...

This is a revision of my previous review. I hope it meets the guidelines.

I had a facelist and Necklift done by Drs. Abel and Gustavo Chajir in Buenos Aires.

Sadly I am left with permanent disfiguring scars as shown in my photos.

 I  paid an additional $3000 in cash for an arm lift and I woke up to find it was not performed.   They wouldn't refund the money I gave them before going under.
 I woke up after surgery on the table, unable to move the entire right side of my face and body.

They were walking around the room cleaning up.  I told them (slurring because I could only move half of my mouth) "help I'm paralyzed". Dr. Abel Chajchir reprimanded me angrily saying, "You're not paralyzed."

As I went in and out of conciousness my legs started convulsing wildly.  I was terrified.

When I was ready to leave Argentina I asked for my money to be refunded for the armlift which they didn't perform,  Dr. Chajchir said "Ok" and put me in a recovery room in the basement to wait for them to get the cash $3000 US out of the safe.

I waited over an hour then finally went upstairs to the Office and was told the doctor had gone home.

I tried to save money by going abroad.  I regret my decision and can't afford the revisions.   I never thought  one of those "plastic surgery nightmare stories" would happen to me.  I am traumatized and left disfigured.

I will post my photos soon.  In having trouble doing it from my iPhone

2 years post surgery.

First surgery had poor result.
This is after the 2nd surgery done to repair my neck lift.


As one can see the final result of the revision surgery performed by Dr Chajchir is disastrous. I would never recommend Dr Abel or Gustavo Chajchir to anyone.

Neck lift by Dr Abel and Gustavo Chajchir

45 degree view of final result : (

Consult and surgical skills

Dr Chajchir approved a corticosteroid
that I was taking. The medicine causes bad wound healing. That accounts for the bad scars.
The result of the neck lift was not caused by the medicine but by poor surgical skills.
I let them do a second surgery to "fix "the initial neck lift.... I should not have gone back...it looks 100 times worse than some loose skin.
No wound-healing problems on the revision surgery though... I discontinued the corticosteroids before that one and healed within a week.

Reconstructive surgery, "Ask the doctor" responses

I posted my pics for surgeon suggestions. They remarked on the incorrect surgical techniques used.
They have suggested a completely new facelift and neck lift, fat transplants, surgical scar removal and more.
I feel discouraged and stupid for giving my hard earned money to foreign doctors and can not afford thousands more for to repair their mistakes.
I might make a home equity loan.
A friend was attracted by a dog and her nose was practically torn off.
She had it repaired by a reconstructive surgeon in Texas.
I will consult with him and decide if I will have a 3rd surgery with him.
I will continue to post the rest of my journey....
Argentina Plastic Surgeon

Recommended by a flight attendant.

1 out of 5 stars Overall rating
1 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
1 out of 5 stars Staff professionalism & courtesy
1 out of 5 stars Payment process
1 out of 5 stars Wait times
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Thank you for sharing. If you can add any further things like before pics or what your endocort dosage was it would be helpful to everyone in making an educated decision. Sorry you were not happy with your result.
Hi, I have written my own review and anyone can comment on it. I am sorry you are offended that I have an opinion, but we do live in the USA. I have not bullied you or made any vulgar retorts. We live in a free country. I would love to see before pictures. My Aunt (who is a bit rude has an old saying but I don't want you to take it the wrong way. As you can see, I posted before and after pics. A lot depends on what the surgeon is dealing with before to make the after presentable. They make improvements not miracles. If you look at mine though, you will see they sure did make a miracle for me. I never expected to look that great. I was in really great shape but there is a difference in age too. I had some complications because if my age and what my body had been through, but they made it right. If you haven't seen my before and after, you should look. It was like beauty and the beast with beauty in the end instead of the beginning. I hated how I looked. I wouldn't even look in a mirror. I couldn't make eye contact with anyone. I was ashamed of my appearance before the surgery. I had a turkey neck. My whole face sagged and I was so fat in my face before I lost the weight, my nose looked huge and drippy.
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I trusted them to be qualified about making decisions regarding my entocort and surgery. All they had to do is google it and they would have seen that steroids cause impaired wound healing. It was an open wound for weeks and that's why it got infected and developed gangrene (dead black skin.) that had to be cut out. After 18 days they brought in a general practitioner to figure out why my wounds would not close. He told us it was the Entocort. People should know that doctors in Argentina do not have the same qualifications as doctors in the states. I asked one if the students that treats patients for the Chajchirs, "why don't you move to the US and practice there when you graduate? Doctors in the states make lots more money ..." He laughed and said, "I could never pass the medical license exam! They need to have knowledge of every specialty to pass the exam. We only have to get tested on the type we are going to practice." This explains why they didn't know my medicine must not be taken before surgery. It's pretty scary. I googled it and within seconds saw that it stops wounds from healing.
Entocort can affect your immune system when in any trauma, but it varies by patient. I really think as I hear more of your story (and I don't mean to hurt your feelings), that you need to own the things you needed to do and didn't. I am not saying it was intentional but let me just refer again to my own experience maybe. Before I went to Argentina, I researched over 2000 surgeons from various oversea locations. I researched the surgery I was going to have and the cultures I was considering having them performed in. Going out of the USA is very different just in regular life, let alone medical conditions for surgery etc. I was even considering the Middle East for a while and when I was searching there, one of the worries I had was the toilet (you have to crouch down almost to the floor as they don't have toilets like we do), I did find that in the Medical facility and some very posh hotels and restaurants they had toilets like ours. Can you imagine though, if they just had their regular toilets and I had just traveled there expecting everything to be like USA? On top of all this research, I asked what pain medications I would be taking, and I researched what kind of special medical devices, if any that are customary to prevent sagging, scarring etc for the surgeries I wanted. I did ask all of the surgeons/facilities I was looking into if they provided ..compression garments ..for example before I decided where I would go for my procedures. I also did the one thing that I believe you did not and its the most important thing you have to do before any overseas or US surgery. I went to see my doctor for a health check up and informed him that I was going to have surgery. He should have then been the one to tell you whether or not to continue your meds because he was prescribing them. I am really surprised, that you didn't do this before getting your surgery done. Again, I don't want to be mean, but you took a terrible risk. I was on progesterone at the time I went for my surgery and I honestly would not have ever relied on anyone but my GP to tell me whether or not I should be taking this when I had surgery. The reason is because the surgeons are just seeing you for the first time. Your regular doctor knows about your medical history and they should have a good idea if you are healthy enough to undergo surgery in the first place, and if your immune system is strong enough so that you wouldn't be one of the minority individuals who would be affected by taking a medication like you did, where there is a risk of this happening. Also, this GP that saw you in Argentina, did he do anything but look at you to make that presumption about it being the medication? I talk a lot because I studied medicine and I know more about things than people that just post their opinions here. For him to be sure of what caused you to have any issues, he needed to do more than talk about it, is what I am getting at. Did he do any testing at all? I would honestly if I were you get some testing done and the reason why I say this is that there are a lot of other things that could cause problems like what you describe. I really like the Spanish countries but they have some serious contagions there. During my visit to Argentina, the clinic was locked up tight. The swine flu was all over and they messed up my flight. I had to stop over in Chili. Almost everyone on that plane had a mask on. People were coughing and looked really sick. I was scared to death. I could see why they were so sick because everyone on that plane looked dirty. In Buenos Aires it was better, about only half the people had masks. Everyone coming into the clinic was required to wash their hands though. They have things like flesh eating bacteria in Argentina. Only in the Spanish countries and Florida have I gotten flesh eating bacteria food poisoning. You can get flesh eating bacteria, which will also cause what you describe, by just touching a stair rail in the subway there. You can transfer it by touching a wound. As for foreign doctors, as I said the whole medical industry is difference between overseas and USA. Medications that we won't use, they will use and visa versa. Also, do understand that if you had the same surgery in say..India..they would boot you out the door and tell you go home and follow up with your doctor. They wouldn't bring in a GP to try and help you. Culture plays a part in how people answer your questions too. That student may not leave because he has family there and unless most of the family decides to leave, their culture is family oriented. They are not people to talk about their culture or family openly. If you ask such a question they will give you an answer they think will sound good to you so it doesn't get into their personal affairs. The other thing is that they feel ashamed to talk about the other main reason they might not come here. You are required to take the tests in English. They do not let you become a doctor here unless you can read, write and speak English. Many foreigners, even if they speak well, have a problem reading and writing English and to them it's shameful like the way an illiterate American feels shame. Its very common for a foreigner to apologize when they try to speak English. There just like here you test to be a medical doctor, you take additional education and testing for your specialty and you do not need to know all specialties. If you are a plastic surgeon you don't test or get education for veterinary medicine or cardiac specialty. I really am sorry that you had such a bad experience, and I hope that I have widened your perspective a little more without offending you. Science isn't exact and often even the most experienced and accomplished specialists run into unforeseen issues. For example, they are doing a long surgery and the tissue becomes swollen fast and afterward when the person's out of surgery, the swelling goes down and they see the alignment is not perfect. Then it is a matter of what they do next. In my experience, the Chajchirs will try to help the situation. I had a friend who had plastic surgery in USA. It looked fake, even to me. I went with her to the doctor and she said "It looked great," but if my friend was dissatisfied, we could discuss alteration surgery that would have cost at least an additional $5000. I also had a good idea about what it was like to have surgery in the USA before I went to Argentina. I don't know if you realize, but most surgeons are unable to do plastic surgery in USA without using blood. They are now starting to have people donate their own blood in advance sometimes for surgery but that is in USA. Overseas, you have a good chance of getting contaminated blood. The Chajchirs did all my surgery without using blood. That was another reason why I decided on them. I almost made a terrible mistake as it was down to two surgeons for me. The facility in India and the Chajchirs. After many emails I started to notice the Indian facility was really not respecting what I wanted. They wanted to do one of my surgeries in a way where I would have bad scarring and when I refused this, they became really nasty. The Chajchirs wanted to do things the way I felt comfortable. The Indian facility was giving surgery like an assembly line..they would do ABC and it would look like DFG. The Chajchirs were interested in improving a patient case by case.
Ok thank you...
Thanks.... I'll work on it...
Ok... I have a new phone... I will work on it... Thanks for your help...
I would like to add that it says "was this review helpful" but there is only a "yes" to click on. Is there a glitch here?
There is no glitch. This is the same for everyone's review.
Hi helenofknots,

You can click "yes" if the review is helpful. If it wasn't, you just go on your way. Please send me a PM if you have further questions.

Thank you Angie.
Thank you Angie.
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Sometimes there are complications in cosmetic surgery when the person has other conditions such as diabetes and doesn't disclose this. I had 6 surgeries with the Chajchirs and your story doesn't add up. I have been in their clinic. There is no basement. The lowest floor is where they have patient rooms and there is a surgical area. It isn't a basement at all. You say they prescribed some dangerous drug. What was it? They are really careful with what they prescribe even for pain. Doctor Abel, is not a mean man so I think maybe you were still out of the loop and maybe hallucinated. Dr. Abel Chajchir gave me his pants to wear because the clothes I brought would have caused me pain to wear afterward.
Also, that picture you still have your stitches in. You said you would post more pics but there are none. It looks like you have an infection. Do you have diabetes or an immunity deficiency? Were you taking the antibiotics they gave you because you shouldn't have had an infection if you were. After the stitches come out there is a certain amount of personal care you must do, like applying vitamin E oil to your scars, using silicon for scar healing etc. These things aren't included. I had to buy a compression suit for example. It cost me almost $150 and I had to buy vitamin E oil etc.
I will respond to your comments in order. 1) I have collagenous colitis. I take Entocort. I told him this 3 times (twice by email , and once again the day before my surgery when I gave him the cash ). Gustavo said, " what's that for ?" I said, "Collagenous colitis", he said , "it's ok for surgery." He did not look it up, but obviously did not know the medication. 2). I can not speak to your experience with these two. I can only tell you what happened to me. 3)it is a basement floor, the windows are at street level. That is not the point. The point is that they put me away in a patient room to wait for them to get the $3,000 from the safe, but instead left me there, and went home. 3) I did not say they prescribed a dangerous drug; I said I was taking Entocort which I know now impedes healing. I bled for 20 days in Argentina and could not go home. Sole let it slip that, "she had never seen that happen to anyone." 4) the pain medicine they prescribe is equivalent to extra strength Tylenol. While my room mate and I were in our gowns waiting to go into surgery, we asked if they give Percocet or another standard opioid for pain. Dr Chajchir said no be cause he said people would break into the clinic and steal Percocet. We were scared, but had come this far and went through with it anyway. 5). I did not hallucinate. He said mean things to me, " YOU ARE NOT PARALYZED!" "You need to get a boyfriend". "DONT ASK THE NURSE ABOUT YOUR STITCHES! ONLY ME!" He was mean and mad me me cry. It is true. He was nice when I went for the first botched surgery. And mean when I came to get it repaired. Maybe he was annoyed that he had to do it for free. I can not speak to his frame of mind. 6) He did not give me his pants to wear. I did have to purchase a $90 head gaent for the surgery to try to fix the first one. It came out even worse. The underside of my jaw is lumpy and ugly. Even if he had lent be a pair of pants, it would not have made up for the nightmare I went through with these two. They are all about the money in my opinion.
I will respond, but I've gotta run now.
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I think that the Chajchirs have asked you to come here and somehow blame me for their incompetence . Yes I did my due diligence pertaining to research prior to my surgery. Yes, I bought and wore the correct compression garment for the correct amount of time. Yes I took all the antibiotics given to me. Yes, I performed correct wound care. 1) they F'd up by telling me a medicine they never heard of was safe. 2) their surgical result was very very very bad. 3) the scars, the folds, the lumps under my chin prove that their technique is incorrect. The scars are a result of their negligence in approving a contraindicated drug for surgery. The lumps and folds are a permanent result if the poor surgical technique. I did not mention before, but the type of stitch they used on my face was the "railroad track type" and not the "strait line" technique. This is incorrect and results in a scar with dots running along either side of the long center scar.... ON MY FACE!
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That is funny because I was thinking the same of you as your story has really begun to become very personal towards them. I will again tell you that you were wrong not to talk to your prescribing doctor. A small percentage of people using entocort will have a problem, just like you are advised, even in the USA that a small percent of people will have surgical complications. These are risks we take when undergoing any surgery. What is usually done there is concern about the corticosteroid you are taking, is YOU would talk to the prescribing doctor and he may put you on a different dosage. I don't know how to make this clearer for you?? The Chajchirs DID NOT prescribe this medicine, so asking them about it is not what you are supposed to do. Here is an article that you should read, since apparently you are not listening to anything anyone says that isn't in your cheerleading squad. How to Reduce Drug Side Effects Theodore R. Fields, MD, FACP Attending Physician, Hospital for Special Surgery Professor of Clinical Medicine, Weill Cornell Medical College Corticosteroids, often called just steroids, are anti-inflammatory drugs. Most are synthetic forms of cortisone, a hormone naturally made in your adrenal glands. These include: prednisone (sold under many brand names, such as Deltasone and Sterapred), methylprednisolone (Medrol), prednisolone (Prelone, Pediapred), dexamethasone (Decadron, Hexadrol), and hydrocortisone (Acticort, Cortef). Note: This article and the information below do not refer to "androgenic" or "anabolic" steroids, which are properly used only to treat a deficiency of sex hormones in men, but are often abused for muscle-building. They share some chemical similarities but act quite differently - and are not used in treating inflammation. Corticosteroids come in many forms; these medications can be taken orally or injected (into a joint, into a muscle, or via intravenous infusion) - all of which may be used in inflammatory arthritis. They may also be applied to the skin as a cream or ointment, used for rashes including those of lupus, or inhaled, as is done for asthma and nasal allergy. Understanding Corticosteroid Side Effects Steroids are often extremely effective in relieving the pain and other symptoms of inflammatory arthritis and other forms of rheumatic disease. In some cases, they may be life-saving. However, like all drugs, corticosteroids can have negative side effects. The degree to which they occur is usually dose-dependent: the higher the daily dose and the longer the period of time you take the drug, the greater your risk of side effects. If your dose is low, your risk of serious side effects is quite small, especially if you take the precautions below and any others your physician recommends. Sometimes your physician will arrange for you to take steroids on alternate days, which can decrease side effects. Reading about these side effects may make you uncomfortable about taking steroids. While you should be fully aware of the risks before starting these medications, please be reassured that many people take steroids with minor or no side-effects. If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician. With long-term use, corticosteroids can result in the following side effects. But taking care of yourself as discussed below may reduce the risks. Altered Response to Physical Stress If you have taken steroids for more than two weeks, even if you then stop, your body may have a decreased ability to respond to physical stress - because your adrenal glands may not react as they should normally. This effect can last as long as a year after steroid discontinuation. If you have a surgical procedure, develop a new serious illness, or experience serious trauma (such as a car accident), your body may not be able to respond to the physical stress. Your blood pressure could drop, and other physical effects can occur, which at times can be very serious. This condition, called adrenal insufficiency, can be avoided by taking "stress dose steroids" should such illness or injury occur while you are taking steroids or during the year after you have been on them. The stress dose makes up for the sluggishness of your adrenal glands and provides your body with the steroid it needs to handle the physical stress. After a year off steroids, essentially all patients have been shown to have recovery of adrenal gland function and are able to respond properly to the physical stress of surgery or major illness. Self-care tips: If you are taking or have taken steroids in the past two years, be sure to tell your doctor or dentist. You may need a higher dose of steroid at times of major stress, such as surgery or very extensive dental work or serious infection. Discuss this possibility with the surgeon or dentist, etc., taking care of you at the time. Steroid Withdrawal Syndrome Rapid withdrawal of steroids, particularly if you have taken these medications for more than two weeks, may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever. These symptoms could be hard to separate from those of your underlying disease. That's why steroids should never be withdrawn suddenly, but rather must be tapered slowly. Self-care tips: If you get symptoms like these when you taper your steroids, discuss them with your doctor. Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease. On each visit, discuss with your physician whether it is possible to decrease your steroid dose. Even if you develop a side effect that requires stopping or rapidly reducing your steroid therapy, you still need to taper the dose-never stopping or decreasing the dose abruptly. The adverse effects of an abrupt decrease of steroid dose are often worse than the side effect you were concerned about. Infection Long-term steroids can suppress the protective role of your immune system and increase your risk of infection. Self-care-tips: Have a yearly flu shot as long as you are on steroids. If you are on steroids for a prolonged period of time, discuss with your doctor the possibility of getting Pneumovax - a vaccination against a certain type of pneumonia. Get immediate medical attention for signs of possible infection, such as high fever, productive cough, pain while passing urine, or large "boils" on the skin. If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor. Gastrointestinal Ulcers or Bleeding Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. Self-care tips: Take the steroid medication after a full meal or with antacid as this may help reduce irritation of the stomach. If you experience frequent heartburn, discuss it with your doctor. An acid-reducing medicine may be prescribed. Call your doctor right away if you have any severe, persisting abdominal pain or black, tarry stools. Osteoporosis Thinning of the bones, with an increase in fracture risk, can be a result of steroid therapy. At the beginning or before the start of steroid therapy, many physicians ask their patients to have a bone density test, especially if the steroid dose is high. The test will be repeated in the future, to assess the effectiveness of measures to prevent bone loss. Self-care tips: Take calcium supplements and milk products, like cheese or yogurt, to get your calcium intake to at least 1500 mg of calcium a day. It is essential that calcium be taken throughout steroid therapy, since one can lose 10-20% of bone mass within the first 6 months of corticosteroid therapy. Take a multivitamin to be sure you get a minimum of 400 IU of vitamin D a day, because it helps the absorption of calcium. Some physicians recommend 800 IU of vitamin D a day. Smoking and alcohol increase the risk of osteoporosis, so reduce or eliminate these habits as much as possible. Weight-bearing exercises, such as walking, running, and dancing, are helpful in stabilizing bone mass. Exercise will also improve your balance and flexibility and decrease your risk of falls. Ask your doctor about which kinds of exercises are appropriate for you. Other bone-preserving medications that your doctor may prescribe depending on your individual medical history include: alendronate (Fosamax), calcitonin (Miacalcin), raloxifene (Evista), and risedronate (Actonel). If women have hot flashes after menopause and are treated with estrogen, this will also help preserve bone density. Assess your risk of falls. Thoroughly examine your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night-lights. Weight gain Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen. Self-care tips: Watch your calories and exercise regularly to try to prevent excessive weight gain. But don't let weight gain damage your self-esteem. Know that the weight will come off - and your stomach return to its normal size - relatively easily in the six months to a year after you discontinue steroids. Insomnia Steroids may impair your ability to fall asleep, especially when they are taken in the evening. Self-care tips: Ask your physician if you can take your entire daily dose in the morning. Try to establish a regular hour for getting into bed and small rituals that help you prepare for sleep. Make sure your bedroom is cool and dark and free of noise. Learn relaxation exercises to help you get rid of the day's tension. If all of this doesn't work, ask your doctor about other options. Mood Changes Especially in doses over 30 milligrams per day, steroids can affect your moods. Some people can feel depressed, some extremely "up" and others go up and down for no apparent reason. You also may feel irritable or anxious. Self-care tips: Just being aware that steroids can do this sometimes makes it less of a problem, but this side effect at times requires that the steroid dosage be decreased. When the steroid dose is absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family and friends know about this possible side effect - so they will know what's going on if you respond in an unexpected way. Ideally, tell your family and friends about this possible side effect as you start the medication, so that they can help you detect any changes in your behavior. Fluid Retention and Elevated Blood Pressure Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure. Self-care tips: A low sodium diet helps reduce fluid accumulation and helps control blood pressure. Look for low-salt versions of typically high-salt foods, such as chips, soups, canned vegetables, salad dressings, and prepared foods. You'll get more salt "taste" if you salt food at the table rather than during cooking. Watch for swelling of your ankles, and report it to your doctor. Have your blood pressure checked regularly, especially if you have a history of hypertension. In some instances, your physician may prescribe diuretics (water pills) or other medications to manage these problems. Elevated Blood Sugar: Since cortisone is involved in maintaining normal levels of glucose (sugar) in the blood, long-term use may lead to elevated blood sugar or even diabetes. Self-care tips: See your doctor regularly for blood sugar checks while you are on steroids. If you already have diabetes, follow your prescribed medical and dietary regimen with care, including regular monitoring of your sugar levels, ideally both at home and in your physician's office. Eye Problems: Steroids can sometimes cause cataracts or glaucoma or worsen these conditions if they are already present. Self-care tips: If you have a history of glaucoma or cataract, tell your ophthalmologist if you are started on steroids because a special schedule of check-ups may be needed. If you develop any visual problems while on steroids, see your ophthalmologist promptly. Some steroid-caused blurred vision may be temporary and not serious. However, ophthalmology evaluation should always be arranged for any new visual symptoms while on steroids. Let your ophthalmologist decide if the symptom is serious. Atherosclerosis (Hardening of the Arteries) Steroids may increase the rate of development of atherosclerosis, which could increase your risk of heart disease. This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose. Self-care tips: Follow a heart-healthy lifestyle - a low-cholesterol and low-fat diet, regular exercise, and stress management. If you develop signs suggesting a heart problem, such as chest pain, get medical attention quickly. Make sure that your cholesterol and blood pressure have been checked and treated if necessary. Aseptic Necrosis Steroids, particularly at higher doses, can sometimes lead to a form of damage to bones called "aseptic necrosis" - the death of parts of bone. This can occur in a number of bones, but the bone at the hip joint is the most common. You can reread this article at: http://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp