cortisone induced skin atrophy on cheek

[cdubb16]

I have a cortisone induced atrophy on my right cheek from a series of 3 cortisone injecctions used to treat a cyst on my cheek.  About 2 weeks after getting the third injection, a depression formed. It has now been 4 months since the last injection and the improvement has been nominal.  I consulted a plastic surgeon and it was his opinion that it would not heal on it's own and I would need to have something done.  He did not recommend dermal fillers because they are temporary. He recommended taking fat from another part of my body and injecting it into the area. I have read on the dermatology forum that these sorts of cortisone induced depressions will resolve themselves, but the Plastic surgeon that I consulted did not feel it would go away because the buccal fat had all been deteriorated and the skin itself is not the same quality.  I am concerned because I do not want to make the problem worse.

Without actually seeing me, what would your recommeendations be based upon your experience? Should I give it more time to heal on its own or should, should I obtain a 2nd plastic surgery opinion or does the fat injection seem like a reasonable course of action to pursue?  Also, what are your thoughts on dermal fillers like Restalyne?

[Howard Rosenberg, MD]

Steroid fat atrophy is a well know complication with repeated subcutaneous injections.  There is some anecdotal evidence that it may be due to precipitation of crystaline steroids that stay in the tissues.  For this reason, it has been advocated that merely injection of saline into the affected area will dissolve the cystals and permit regrowth of fat cells inhibited by the steroids.  I have tried this once, with questionable results, but it is certainly a benign technique.

Dermal fillers such as Restylane, Perlane, Sculptura can be used, but the results will obviously be temporary.  A more permanent injectable like Artefil may also work, but its use will be off-lable and there are reported risks of chronic granulomas.  I think fat injections may be your best bet, but the fat may disappear if it does not survive after the transplantation to your cheek.  Repeat injections may be necessary.

[lulu 17]

I had a brow lift a 2 years ago and the tissue around my right eye socket has felt very tight, to the degree that I felt I couldn't open my eye all the way when I looked up. I asked the doctor if I might have adhesions or nerve damage and he suggested cortison shots along the nerve in my forehead leading to my brow. He made about 4 tiny injection both above and below the brow. 6 weeks later I now have an indentation on that eyebrow, like a frown crease,  that slightly changes the shape of that brow. If this is tissue loss as I have lately read (I thought cortisone only dissolved scar tissue!), will this tissue regenerate?