Atrophy from cortisone injection on cheek. Can this be fixed with Restylane?

Question

30yr old female with healthy lifestyle. I received a cortisone injection for a cystic pimple that had been on my cheek for less than a week. 2 weeks after the injection it began to atrophy. I have done 1 saline injection about a week ago and haven’t notice results. At my age, how long is the expected wait time for the atrophy to fill back in? If I were to get Restalyne, is there a possibility of over correction if the dent starts healing before the filler wears off?

Camille Cash, MD · Answer

If you are not having improvement with the saline injections, dermal fillers are an option.  If over correction of the area occurs, HA fillers such as Restylane can be dissolved with hyaluronidase.  See an expert injector near you to learn more.

Robin A. Sykes, MD · Answer

Your question is hard to answer, because you hate to not do something at this time!  However, there is no way to know how long the atrophy will last or how bad it will be.  Also, the steroid is going to continue working for an unknown period of time.  Injecting a filler at this time is going to muddy the waters even further, and may even create other side effects.  
My best advice would be to wait for the area to settle down for a few more weeks and even longer to get an idea which way it is going, and then reassess and see if you even need filler to the area.  A little light massage to the area might be in order, to help settle things down.  I would recommend that you see a doctor for more specific advice, after they have seen the problem and considered all of the ramifications.

Blue Medi Spa - Sherman Oaks - Account Suspended · Answer

Hi thank you for your question. Atrophy of the skin is a common side effect of cortisone injections. The good news is this can sometimes resolve on its own over a period of months. If waiting does not seem the best option to you there are things that can be done. I recommend massaging the area a few times a day as this increases blood flow and hopefully collagen stimulation as well. Saline injections are an option if you are willing to have them done a few times. In my experience I have not seen this work with just one treatment. As others have said, soft HA fillers such as (Restylane Refyne, Defyne, Volbella, etc) would be the best choice as well as PDO threads. Best of luck!

Dean P. Kane, MD, FACS · Answer

Dear Cookie420, 
Thanks for sharing your photo. This is a well known side-effect of steroid injection for a acne cyst. The inflammation goes away but so does the fat and the skin tractions down to the superficial fascia.

Review with the injector or obtain a second opinion from a skilled and experienced Board Certified Plastic Surgeon the following options.

•	Skin undermining (called subcision) to lift the scarred down skin will need a “fill” to keep it cushioned. Using Restylane, Radiesse and now the use of PDO injectable threads has worked reasonably. Fat grafting would be my filler of choice. 
•	With these new minimally invasive techniques, surgical excision is not my first recommendation but is an option.
Before and thereafter, use a retinoid such as tretinoin to exfoliate, diminish oil and reduce the recurrence of further acne and cysts.

All the best!

Jo Herzog, MD · Answer

I would subcise and inject saline a few times first. If flattens with saline but does not fil in on its own I do think that restylane would be good choice of filler.

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