SALINE Injections in NYC? For Cortisone Atrophy...Steroid injection-DEEP PIT.

Question

Any doctors here NY Metro area based that have use the saline technique to flush out cortisone from a cortisone injection? My skin has a major dent and I am on month 3. I have tried fillers and it just seems to go right in and not make a difference, making me think their is still steriod in my skin. Anyone have experience with injecting saline to help? NYC based...HELP !

Joel Schlessinger, MD · Answer

Steroid injections can cause this and this is something that luckily should reverse itself soon.  Soon may be a month or a year, so you have to be a little patient unless you are wanting to do something immediately.  I would say that fillers are a better idea, but it is really really important NOT to do a permanent filler like Artefill/Bellafill or even a longer term filler like Radiesse or Sculptra or when it does come back you will have a lump there.This is a very tricky thing to manage so make sure you go to a dermatologist who is expert in fillers and does their own injections and not to a practice where the nurse or extender does them.  Good luck!

Jason Emer, MD · Answer

Saline and/or filler will not help this.  This atrophy/scar is too large and the skin texture is irregular even if it was flat it still would be noticeable.  A few other options include microneedling, subcision, or surgical removal/scar revision with subsequent laser or microneedling on top.  No one treatment or one session will remove this.  Even with the best of treatment, you will never have completely normal skin there again.  I suggest you come see me an we do an inperson or skype consultation.  I am leaning towards surgery with laser or microneedling for treatment for you.  Unfortunately, there is no standard of care for treatment with this type of scar.  I am sorry this happened to you.  Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

In most cases, a tincture of time (usually about six months) works well for steroid atrophy resulting from intralesional steroid injections. In cases that have not resolved completely, I  have used saline injections for many years now in my Upper East Side Manhattan practice. It has been my experience that it typically takes more than one treatment session to treat the condition. If necessary, subcision treatments, about which you can find more detail in the archives of Realself.com,  can be combined with the saline injections to "jump start" the laying down of new, native collagen and better ensure a more permanent fix.

Joseph A. Eviatar, MD, FACS · Answer

This is a frustrating problem.  There is no evidence that injecting saline will help and in fact if anything, it will just further traumatize the area.  The damage has already been done from the steroid injection.  Given that this often improves to some degree over time, I'd recommend filler which will both help the visible defect and create a bit of collagen stimulation for long term improvement.  It's impossible to recommend which filler from the photo but sometimes Belotero can work well injected into the skin itself and sometimes you can layer fillers such as Radiesse (which is thicker and stimulates collagen) deep and Belotero into the skin.   See an experienced injector.  In my experience, surgery at this point may leave a prominent scar which may be hard to camoflouge.Best of luck,

Kevin Tehrani, MD, FACS · Answer

Sorry to hear about your atrophy after steroid injection. Good news is that this will reverse, however in the meantime you should undergo temporary Saline/fillers to provide normal contour. Recommend undergoing subcision and injection with Juvéderm Ultra Plus in this area.

Ken Landow, MD · Answer

but the good news is that the depression will go away by itself in about 6 months or so...assuming it's entirely due to the injection...unfortunately the saline is worthless and won't wash away the steroid that's long since left the scene...(kind of like botox...you can't wash it out once in the skin)...I'd shy away from any surgical correction since the problem will be self-limited and you're probably half way there...while cutting it out may help, you may not like the results especially if the effects of the cortisone are still active...while fillers may help, they didn't in your case...I'd opt for watchful waiting...best

Darryl J. Blinski, MD · Answer

Without complete medical history very hard to advise. But to me the only way to correct is excision and layered closure of this facial induced dent...

Jo Herzog, MD · Answer

Saline injections can be used to help raise a surface up, not really to flush out steroids, After a few of these injections the skin will often be less bound down and might do better with fillers then it would have been before.

Karen Stolman, MD · Answer

I find that filler, when done well, works faster and better than saline.  Filler may need to be repeated 2-3x though.   I also use this treatment successfully for some atrophic or thinned acne scars.  I recommend trying Perlane.  Beletero and Restylane are least likely to give blue Tyndall effect but they're thinner and  would need to repeated much more.

SALINE Injections in NYC? For Cortisone Atrophy...Steroid injection-DEEP PIT.

Answers (9)

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