Sagging skin due to long-term prednisone use, what are my treatment options?

Question

I have lupus, I’ve been on prednisone high and low doses for 10 years. I’m 33 and I look 80. I tried Ultherapy 2 yrs ago and it didn’t help. My eyelids, jaw line and cheeks are droopy. After facials, creams, vitamins and light threatments I’m ready for results. I started an infusion treatment for lupus 2 months ago, and I’m tapping prednisone to stop it. I want myself back. What kind of treatment would be suitable for me? my skin heals fine. I had a c-section 3 yrs ago with no issue.

Stephen M. Krant, MD, FACS · Answer

Make sure you coordinate care with you plastic surgeon and rheumatologist/immunologist. With your history, you have to be very upfront with your plastic surgeon and other MD's.
The biggest problem would be wound healing, especially since you have been on extended prednisone treatments for many years. This will "thin" the skin/dermis and decrease your normal wound healing. 
Start taking your homeopathic medicines, such as Vitamin C, pre-op Vitamedica and others that will help healing. Good luck!

Ronald Schuster, MD · Answer

Prednisone is sometimes used for the treatment of chronic immunologic disorders. It can be very effective but also has some very bad side effects, especially to bones, skin and conective tissue. It basically decreases the body's normal construction of new collagen and other building blocks to support bone and skin. It also decreases the body's ability to fight infection. Surgery, including facelift surgery can safely be done in patients who have been on Prednisone in the past bas well as patients who need to continue taking Prenisone. It is important to tell your surgeon that you are taking Prednisone in order to prepare you properly both before and after the surgery. Good luck.

Anil R. Shah, MD · Answer

There are much better options for facial laxity for patients in their 30's than previous years.  Facetite (RF delivered underneath the skin) is an option, as is combination facial fillers and laser resurfacing.  Often times laxity can be a result of volume loss.  It is unusual for a patient in their early 30's to have a facelift.  Best Dr. Anil Shah

Ronald J. Edelson, MD · Answer

it doesn't sound like a non surgical treatment will do you any good.  You sound too young for a facelift but I have occasionally performed this in someone your age.  You say your eyelids are an issue.  You might want to start with an eyelid lift.  It can be done under local anesthesia and the recovery isn't bad at all.  Not a bad option to begin with.

Jeffrey M. Darrow, MD · Answer

My recommendation would be to first talk with your medical Doctor who is treating you for your lupus to see whether it is safe for you to undergo surgery of this type. Second, you need an in person consultation and examination with a board-certified plastic surgeon  Who can examine your tissues and help you understand what can be achieved, short term and long term.  Only after examining the integrity and quality of your skin could one give a valid recommendation as to what could be accomplished and your likely result.   Best wishes.

Andres Bustillo, MD, FACS · Answer

Without pictures it is very difficult to give the best answer. There are times when premature aging can be treated with a facelift. Longterm storied therapy can possibly cause this. I would suggest meeting with a surgeon that has experience with facelifts to see if you are a candidate.

Nicholas S. Karter, MD · Answer

It is a little unusual to do a facelift on someone so young, however there are rare circumstances when this would be the most effective treatment. It is hard to say if you would benefit from a facelift or not without seeing you. I would also mention that in my experience having a condition like lupus can impact the healing process and because of that surgery does carry a higher risk than in a non-rheumatologic patient. Please make sure when you have a consultation in your area that you share this history with your surgeon. I typically limit my skin flaps and am less aggressive in a patient with a strong history of rheumatologic conditions. It is not worth the added risk of skin compromise and subsequent scarring to be overly aggressive. You should be able to find a surgeon in your area who can help you achieve your goals while balancing risks. I hope this helps, good luck!!

Jeffrey Thaxton, MD FACS · Answer

Thank you for your question.  Without photos it is not possible offer very specific recommendations.  If you truly have fairly severe laxity then most likely the only good options will be surgical.  I think Thermitight works a little better than Ultherapy for nonoperative tightening but it is also minimally invasive rather than non invasive.  Various operative treatments may be appropriate to address your concerns such as facelift, blephroplasty and or brow lift.  In order to determine the best treatment for you an in person consultation with a board certified plastic surgeon would be needed.  Make sure you see a board certified plastic surgeon and don't be fooled by someone claiming to be a board certified physician but not clarifying by what board.  Or claiming board certification by some board not recognized by the american board of medical specialties such as the cosmetic surgery board.Jeffrey Thaxton, MD FACSCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem but an examination is needed so go on some complimentary consultations with experts and compare recommendations and become fully informed what procedure might give you the best result Dr Corbin

Edward J. Domanskis, MD (in memoriam) · Answer

Unfortunately, once you have sagging anywhere, then it most likely will need to be excised. The non-surgical does work but to limited amount as you experiuences.But, you should experience a good result with excision.

Sagging skin due to long-term prednisone use, what are my treatment options?

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