Treating Dent Scar from Injection on a 2 Year Old?

Question

My 2 year old son recently had to have a steroid injection. Several weeks later, we noticed a large indent at the injection site.  Upon doing several Internet searches and seeing a specialist, we were told that it was due to the injection.  Is this something that will go away?
Our son actually refers to it as "his hole".  We do not want him to be self conscious about it.  Is there any long term effects?  We were told that it is permanent. Is there any treatment or procedure that would eliminate the indent?  If so, what would be first steps in looking into.  Thanks

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Bryan K. Chen, MD · Answer

I would simply observe the site for 6-8 weeks.  Most cases of corticosteroid-associated atrophy will resolve spontaneously with time. 
If the fat does not recover, as others have mentioned, you do have options.  I probably would not consider these options until the child is mature enough to participate in the decision-making process.
Good luck.

D.J. Verret, MD · Answer

As the other physicians have noted, it is likely that this will resolve over time. There are a couple of options though, some which can be undertaken even at this point. There are several case reports that injecting salt water under the skin on a daily basis for a couple of weeks can speed the recovery. Unfortunately, this may be too traumatic for a two year old to deal with. As the other physicians have noted as well, if this does not resolve within several months, fat grafting or excision is another option.

Hisham Seify, MD, PhD, FACS · Answer

Steroids can induce fat atrophy when injected into the superficial tissues. However, the good news is his age. A 2-year-old should heal and build enough tissue to offset the deformity. I would wait for at least one year before I would attempt any corrective surgery. Fat grafting is usually the best treatment for this condition. Hope that helps!

Arnold R. Oppenheim, MD (retired) · Answer

What happened here is that the steroid injection was not given deep enough into the muscle and instead entered the fat. Steroids can cause lipoatrophy and this accounts for the dent...the fat cells have been destroyed.
    The good news is that the surrounding fat cells will divide and take the place of the damaged ones.  Oftentimes this can take many months, sometimes as many as six months.
   It is felt that messaging the area periodically might help hasten this process. 
   Since it does not seem to be bother your son, it should not bother you. It is perfectly harmless.
   If the area has not returned to normal in six months, I would wait another two and then consult with a dermatologist or plastic surgeon. Fat grafts might help at that point.

Treating Dent Scar from Injection on a 2 Year Old?

Answers (5)

Answer: Wait for one more year before corrective surgery on 2-year-old

Answer: Wait for one more year before corrective surgery on 2-year-old

Answer: Steroid Lipoatrophy

Answer: Steroid Lipoatrophy

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Treating Dent Scar from Injection on a 2 Year Old?

Answers (5)

Answer: Wait for one more year before corrective surgery on 2-year-old

Answer: Wait for one more year before corrective surgery on 2-year-old

Answer: Steroid Lipoatrophy

Answer: Steroid Lipoatrophy

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Recommended reading

Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.