Will saline and microneedling help my steroid atrophy? (Photos)

Question

I was injected incorrectly around 3 weeks ago. I had a hypertrophic scar (below the new dent) that was supposed to be injected, but for some reason the nurse also injected a small zit without asking me first. After I realized what she had done, I freaked out and she promised that no damage would occur since she 'only put a little'. I trusted her but clearly I was right to assume the worst. The clinic is providing a free saline injection. Will this + microneedling work? What are my other options?

Nelson Lee Novick, MD · Answer

Steroid atrophy is a well-known potential complication of intralesional steroid injections, especially when higher concentrations and amounts are injected. Higher concentrations are typically needed to treat hypertrophic scars, and if this same concentration was used to treat an ordinary acne papule, this would explain the dent you are now experiencing. Typically, intralesional steroids depot in the region of the injection for a period of three to four weeks, so the timeline here fits. The good news is that many cases of steroid injection-induced atrophy (although not all)  spontaneously resolve over time, usually on the order of about six months. A series of three to four saline injection sessions can be helpful, especially if there are still crystals of steroid under the skin, by breaking up, dissolving and diluting them. The physical trauma under the skin of the injection needles by itself may stimulate new collagen fiber synthesis. There is generally little harm to the saline injection therapy, and probably little additional benefit from the microneedling. However, you still might want to consider giving the region more time to spontaneously resolve before embarking on any treatment regimen. Going forward, you may wish to consult with a board certified aesthetic dermatologist for these particular issues. Wishing you the best of luck.

Raffy Karamanoukian, MD, FACS · Answer

There are many options available for scar revision depending on the type of scar that you have. 
Scar revision requires a disciplined approach to address the different characteristics of scars including texture, color, level of inflammation, vascularity, and hypertrophy. Our office specializes in scar revision because we have both cosmetic dermatologists, plastic surgeons, and general surgeons within our center. The ideal scar treatment is combination therapy that incorporates vascular lasers, microfractional RF and laser, microneedling, Micro-ionization ablation, PRP, topical growth serums and polysiloxane topical gels, and surgery if indicated. 
I recommend Melarase PM for patients that have dark and discolored scars and Plato’s Scar Serum twice daily for all new and hypertrophic scars prior to any treatment. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

These scars can be improved with a combination of vascular lasers like yellow laser, Aerolase, microneedling/prp, skin lightening, peels, and skin care. Sun protection is essential. I recommend getting a formal evaluation with an scarring expert. Silagen gel should be used twice daily with jan marini's bioshield. Best, Dr. Emer

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question and photographs.A common side effect / risk of intralesional steroid injections is atrophy (indentation). The atrophy will resolve on its own but can take months to reverse itself. Saline injections can be effective in reversing the atrophy, but often times, multiple injections are required. I highly recommend you consult with a board certified dermatologist to have your skin evaluated and to discuss appropriate treatment options. Take care and good luck.

Will saline and microneedling help my steroid atrophy? (Photos)

Answers (4)

Answer: Skin evaluation

Answer: Skin evaluation

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Will saline and microneedling help my steroid atrophy? (Photos)

Answers (4)

Answer: Skin evaluation

Answer: Skin evaluation

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