June 2005
Dear Paula,
I am 25 years old, and a part-time model. Three days before a fashion show I felt a couple of large, deep pimples forming, and so I went to my dermatologist to see if some cortisone injections would help the situation. They did indeed eliminate the blemishes, but within a week I had large craters about the size and depth of a nickel at the injection sites!

I went back to my dermatologist, and she was as shocked as I was. She said I must have had an allergic reaction to the cortisone, and it had caused the matrix of my skin to disintegrate! Upon learning that it was permanent damage, I began to cry.

I began a battery of treatments with my dermatologist to improve the damage. The first treatment we tried was fillers. But this failed because the filler turned into hard lumps, shifted around, and left large dimples when I smiled.

After the filler had some time to deteriorate, she did a variation of deep, localized dermabrasion. The abraded areas bled, oozed, and eventually scabbed over. Three weeks later, the craters weren?t so deep! The fourth treatment resulted in no improvement, and a lot of new blood vessels had grown in with the new tissue, resulting in a very angry-looking red color. She did a series of three laser treatments to reduce this redness, with modest success.

She then suggested Thermage, in hopes it would encourage the development of more collagen in those areas. Six months and two follow-up exams later, I am happy to report that (with the exception of some slight discoloration) it worked! The craters are gone! The dermatologist (thank goodness) performed all of this work free of charge.

I want you to know I was very diligent about using your sunscreen, moisturizers, and other skin-care products throughout this healing process, and I know they helped a lot. The rest of my skin looks better than it did in high school, and my husband now uses your products, too!

Shanna, via email

Dear Shanna,
Your story sounds so frustrating and painful. I am so sorry you had to struggle with all that, especially during such an important time in your life. While I am impressed at your physician's dedication to correcting the problem, I'm confused why she was so shocked at what happened. What you experienced is a known side effect of cortisone injections. I'm assuming from what you wrote that you weren't informed of the risks that could occur when injecting cortisone into a blemish. Although cortisone injected directly into a cystic or swollen blemish, particularly an annoyingly large one, can be extremely effective in reducing swelling and redness, there is a risk it can cause a depression or dented area in the skin. This can happen when too much of the solution is injected, too strong a concentration is used, or if you have a reaction to the cortisone (which is why a patch test should have been done on some part of your body less obvious than your face). Often these demarcations go away without any intervention, but they can also be permanent. If you were told of this risk, you may have made other decisions.

I'm wondering now if you were warned about any of the risks associated with any of the procedures your doctor performed. Lumping is a known side effect of all dermal injections, and though dermabrasion does help smooth skin it can cause skin to become depigmented. Some lasers can help reduce the presence of surfaced blood vessels, but it is not always successful. Again, your doctor's diligence and dedication to correcting the mistake is admirable, but I think there was information missing along the way that could have waylaid some of the problems you encountered. I hope you continue to heal and that all traces of this problem are alleviated soon.