Las Vegas Kenalog - Ask Dr. Garcia Library - Page 19

NOTICE: Las Vegas Kenalog: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use. All responses regarding Las Vegas Kenalog are done personally by Julio Garcia.

• Hi Dr. Garcia: You are a wonderful physician and thank you again for sharing your knowledge. A few months ago, I explained that I had a mini tt, with three revisions and was left with scar tissue. You suggested Kenalog shots. I'm happy to report, that thanks to you I told my doctor and he gave me three series of shots. They are now soft and have began to flatten. In addition, there was a small area right below the scar tissue that seem to gather fluid, that has since dissipated. Anyway, it now seems that after one year I have the results I was looking for. God Bless you and thank you very much. Rachel

  Answer:  I am glad it all worked out, stay well. JG 9.14.05

• hi,i have a very big prob with keloid on my face on my, moustache.u told sudgery with kenalogeven it can cause reccurrance,i am in confusion whether i should prefer surgery now r not.what is the chance recurrence after takin all precautions, how much will it costs.....mouli..9-6-05

  Answer:  The chance of it coming back could be as high s 50%, depending on how tight the closure is, the tighter the closure the higher the chance of it forming a keloid again. JG 9.6.05

• is there any chances of recurrence of keloid after using kenalog after surgery.....mouli ...8-6-05

  Answer:  yes. JG 9.6.05

• hi doc, i am from india. i met with an accident and got keloid on my moustache. can u plz help what surgery should i prefer n whom should i consult.....mouli..9-6-05

  Answer:  It may benefit from having a plastic surgeon excise the scar and reclose it with a meticulous technique, then it could be followed by injections of kenalog to avoid the recurrence of the keloid. JG 9.5.05

• Dr Garcia Would a steroid injection smooth out the tip of my nose where the cartilage is poking out? Thanks

  Answer:  No, I don't think kenalog will do anything for that. JG 9.3.05

• i have been having kenalog injections over the past 6 months (the doctor is giving only small injections once a month to make sure he doesnt overdo it) for correcting an overfilled fat graft under my eyes. the results have been very good and it seems i may need only 2 to 3 more treatments n i will be satisfied. HOWEVER, my most recent injection was done 3 days ago, and seemed normal that evening. BUT the next morning, the whole area was RED, VERY PAINFUL and looked swollen (like there was some fluid beneath the skin)and though the injection was only 4 mg injected under one eye (in tear trough), the red swollen painful area extended in a crescent shape down to the end of the cheek, and at the end of the cheek, it was the reddest ( almost as if something had trickled down and concentrated there at the end of the cheek during the night, as i had slept on that side). it was so painful i cudnt eevn touch it. however, the next day (yesterday) the pain was less, but now today, ther is no pain in touching , but the skin ( rather below the skin) the area is red (like a rash almost). I HAVE HAD SO MANY INJECTIONS PREVIOUSLY BUT THIS HAS NEVER HAPPENED BEFORE. i have to make a speech in front of a large gathering tomorrow, and i wont be able to go like this. is there anything i can do to reduce the redness. i took serrapeptase so far. n last night i took 200mg ibuprofen. not much difference. what can i take (orally, which isnt too strong) and what can i apply topically to reduce the redness fast??? thanks.

  Answer:  I am sorry, but besides make up, there is nothing that will make a substantial difference. JG 8.30.05

• I had breast lift and aug about 4 years ago. Had problems with scars and the doc put steroid shots in them...after doing this a couple of times, they flattened and weren't painful. However, not there is a white pea size substance(looks like fat) that is in the scar and then it is purple from my veins around that area. Opinion on what that could be. I wish I could send a picture.

  Answer:  The pea is actually the kenalog material that was injected into the scar. The purple comes from the medicine leaking into the surrounding area and thins the skin out making the blood vessels more visible. JG 8.18.05

• I tip rhinoplasty that created polly beak deformity, severe crookedness, excessive swelling, and nostril asymetrical. Revision rhinoplasty a year later from a very experience dr, he said I had so much scar tissue, removed it, and took some more cartilage. 5 months later my nasal tip is still very swollen, he has given me kenalog injections once at 3 months and once at 5 months (2 days ago). I have very thick skin. I am wondering how many times can I have kenalog, and is there hope for my nasal swelling to go down? I cant have surgery to take any more cartilage but what if there is scar tissue formation again from the swelling, can that be surgically removed?

  Answer:  There is still hope the swelling can go down and as to how many times can kenalog be injected into your nasal tip, that will vary with the dose he/she injected each time. Removing scar tissue will just create new scar tissue in the same area and you will be back where you started I am afraid. JG 8.13.05

• thank you for yur response regarding white bumps from radiance injected into my lips. The Dr said he could inject some kenalog and they would go away. Will this work or is it a waste of time?

  Answer:  Kenalog does not dissolve the particles in the Radiance, it could dissolve your normal tissue though. So it is not only not an effective measure, but could make you worse. JG 8.2.05

• Dr. Garcia, I had CO2 laser around my eyes, I was told this would remove my bags, I'm 5 weeks post -op and still have bags and am very red. The doctor told me that if my bags did not go away he would inject kenalog into the bags so they would dissolve. Is this safe? Will it work? How long will this reddness last.

  Answer:  CO2 laer will not do anything for the bags if they are due to fat, it might tighten the skin a little bit on a festoon. Kenalog is worth a try but I woudl not expect dramtic results. The redness will last weeks, depending on how deep the laser was done. JG 7.27.05

• Hi Dr. Garcia: This is a wonderful website and you are a wonderful humanitarian to perform such a great task. A while back I wrote about scar tissue after mini tt and two revisions. You suggested possibly kenalog shots. Typically how long does it take to work, what is the typical results and how many shots does one need? To refresh you, I had a nice flat stomach on one side, some fluid accumulation on the other. It comes and goes. It's been three months since the revision, if I wear a binder it leaves, but when I take it off it returns and that part of the stomach is bigger and harder. rh

  Answer:  Kenalog shots are done in a series, usually 4-6 weeks apart and can encompass a number of shots, everyone's response is different and has to be individualized. If you are having a recurrent seroma you could consider injecting a sclerosing or irritating agent like tetracylcine to see if you can get the cavity to stick down too. All my best. JG 7.9.05

• About 14 months ago I started getting red marks that slowly turned into a very itchy lesion of some sort. I got them on my ankles both legs and arms and they left like a bruuising type purplish scar. About 4 months ago I had a terrible outbreak all over my back chest and stomach. Needless to say I'm covered with these terrible marks all over my skin. The Dr. gave me a shot of kenalog and 20mg prednisone for 15 days. That cleared it up, but I'm covered with these scar type marks. The Dr.thought it was psorisis, but 2 biopsies came back saying lichen plantus. I'm wonderng if you know of any creams or salves, that could take it away. I'm on by 2nd tube of bleaching cream but it doesn't seem to help any. Any help or info you may have will really help, as the Dr. did say it probably will come back. I also have rhuematoid arthritis that is mainly in remission thanks to plaquinil and antibiotics. I really think it's wonderful that you help so many people with their problems. Thank you, I hope you know of something to help me. Thanks Pat M

  Answer:  I am sorry but that would be more of a dermatology problem but my understanding is that lichen planus can be controlled but never gotten rid of totally. You may want to try some laser therapy to see if the spots can be faded. JG 7.9.05

• Hello. I had Radiance injected in the marionette lines in my chin and lower face area. Shortly thereafter I developed a very red, raised rash with little bumps that seem to have water in them in my chin area. I have been instructed to use my acne medication. Can fillers cause acne to flair? Could I have an infection? The area is not getting better. In addition to the rash I have one area that is a lump of filler. It looks like a small cyst. I can tell it's the filler material. If I have the reversal treatment done, is it likely it will leave an indentation? Thank you for your time.

  Answer:  I do not think your acne medication will help if there is fluid in the rash. It sounds more like an outbreak of herpes simplex I or cold sores, that can happen even if you never had a prior experience with it. Acne medicine will not do much and could make it worse. I would ask the doctor to look at it and maybe give you some antiviral therapy like Valtrex. As to the cyst, it could be a small over injection of the filler and if does not go away in a few weeks may need to be lanced and have the material pushed out. There is no reversal treatment for Radiance/Radiesse, just Restylane, kenalog does not help in this case and can make it worse and cause new problems like dents as you mentioned. JG 7.4.05

• had skin indenation atrophic scar after kenalog injection about one month after for cystic acne will it heal or is it going to be permanent . what would be the best treatment for that

  Answer:  It may take a few months to return. Whatever you have at six months will be like that, but you could have it filled in with fat injections. JG 6.24.05

• I would like to know if kenolog 40 steriod shots when used to treat keliod scars can one of the side effects be depigmentation as well as dentation of the scar and surrounding area and if not could it possibly be something esle,like vitiligo.

  Answer:  Indentation and depigmentation are very common problems when using kenalog 40 to treat keloid scars. It is not vitiligo, it is pigment loss form the kenalog. Fat injections or other dermal fillers can help the depression but the color loss may be difficult to correct, if not impossible. JG 6.19.05

• Hi,DOctor,I M a 21 year old female and I had explotory surgery when I was 13,In november I had a scar revision and now it still looks bad,before there were staple marks as well as the scar itself,making the scar about 5-6inches wide.Now there are no staple marks and the scar itself is almost the width it (the actual scar)was before the revision.The doctor that performed the revison injects it with kenalog to flatten it out,but what I have thus far, some parts are flat,some indented and withened areas around parts of the scar(the scar is on my abdonmen,It's from the bottom of my breast bone to the pelic area going straight down).Will the color to those withen areas return and will the scar eventually all be on texture(all be flat? Also the doc wants to redo the revsion to make it narrower(I,m a skinny girl with a muscular stomach and I know I have no extra skin)is it a good idea to try the revison again.Plus will it be better if I gained weight and then lost it,to provide that area with extra skin,or are there other procedures that I could try like tissue expansion.Is a tattoo another way to go after I allow it to heal some more.I'm sorry for the million and one questions I'm just very stressed about this.Also can you recommend some on in Seattle,Wa or around that area who would be able to help,because i am beginning to doubt the doctor I am currently with.Also I am africian american but I do not keliod.And I have no probelm coming to see you to see if you can do somethingh for me if there is no one around my area that can

  Answer:  The color and texture will never return to normal I am afraid. I also am doubtful that a repeat excision will look significantly better as you probably have tight skin and the tightness impacts on the end result. Gaining weight I think is pretty extreme though. A tattoo is an option but it is just as permanent.Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best.www.surgery.org/public/findasurgeon. JG 6.14.05

• my teenage daughter had scar revision surgery on a horizontal forehead scar last year. the incision looks good. but the swelling is still very noticeable. we have had several mild kenalog injections and it seems to help for a while. now the swelling is back and is creating a very dark and bruised appearance around the scar. it is almost as if the scar is sitting on a goose egg. is there anything that can be done for this swelling?

  Answer:  The darkness and bruise can actually be from the kenalog shots. I use kenalog myself for some scars and it usually does pretty well. You may just need more injections is all. JG 5.26.05

• Hi can 5-fu injections be combined with surgerical removal of a keloid scar. I never heard of this drug being combined with surgery and I was just wondering if this could be done and could it have a better effect than steriod injections.

  Answer:  yes, but you need to wait 6 weeks before starting the injections into the scar. I feel the 5FU is much better and safer than kenalog/cortisone. JG 5.12.05

• I am a NP and never knew that Kenalog can cause atrophy to the fat pad. A pt. now c/o a dimple in the area that the injection was given (she is conming in for us to see it). What options could I offer the patient to improve the appearance of the area? AE

  Answer:  Some regrowth of the fat can occur for about 6 months or so, otherwise they may need fat injections to correct the depression. It is supposed to be injected IM so it happens when you use a needle that is too short for the area. JG 5.11.05

• Hi Dr. Garcia. Thanks in advance for taking the time to answer my question. I already posted this question but didn't see an answer for it. I had a thyroidectomy in August. My scar was hypertrophic so my surgeon injected it with kenalog. I think he used way too much and now the skin has sunk down and thinned out too much. (the area is right in between my collarbone where most people have a slight indent anyway but mine is so noticeable). My questions are.. 1) can anything be done to fix this problem.. maybe fat injections? Would fat injections hold in this area? 2) Will the skin ever repair itself and thicken up or fill in? And if so, how long will it usually take? Thank you so so much for listening! JULIE 5/10/2005

  Answer:  Fat injectiosn are one option, you could also try other fillers like Restylane, neither one will be permanent I am afraid as for the fat to survive it has to be injected into muscle and there is no muscle in the area you speak of. The skin will regain its thickness in 6-12 months, anything left atrophic at that time will not get better. JG 5.10.05

• Dr. Garcia - One month ago I had an injection of kenalog 40 - 4ccs into my chin. I now have a long slightly mottled looking dent/ditch in my face. I have been told to keep massaging the area and not to worry - no big deal etc. Doctor said he could inject a filler - which I declined. Could the dent continue to grow. Should I have a filler of some sort injected. The injection site and a bit of surrounding area still tender to pressure. Thanks for your advice.

  Answer:  The effects of the Kenalog dissolving tissue can go on for a couple of months, A filler can be injected into the depression if it bothers you, and this can be done at any time. As to the disolorations, it is due to the thinning of the tissues and should get better as the area thickens again.Unfortunately, there may be some element of permanent depression, depending on how much kenalog was injected. I am unsure why you had the kenalog injected in the first place but using Kenalog 40 is quite a strong strength, typically we use kenolg 10 or Kenalog 5. JG 4.24.05

• please help. Had a revision rhino on tip only, 2 weeks later went for checkup. Dr. gave me a shot on the tip for swelling now i've developed some lumpiness that was not there before. So scared. will it go away???areyesalex@aol.com

  Answer:  Yes, it is most likely that the doctor injected Kenalog to assist in the resolution of the swelling you had from the revision. The lump should go away in time. JG 4.22.05

• Hi I just wanted to know what your experiences are with keloid removal and what seems to work on earlobe keloids. Even though mine are fairly small what aproach do u think I should try. Do steroid shots work to make keloids smaller and how long do they take to work. The plastic surgoen I saw refused to surgerically remove the keloid because of the risks of them coming back. But she seemed unexperienced because she said that there is a 50% chance that it can come back. But through my research with post op therapies there is a even less chance. She recomemended a steroid kenalog be injected. How should this drug be injected. I've heard if injected wrong it could cause some risks. Although this surgeon told me that she's seen many keloids she doesn't seem real reasuring in what she's talking about, but then again she is the doctor and I'm the patient.

  Answer:  I think a surgical excision followed by kenalog injections into the scar and compression earrings should help, but recurrance is fairly high. JG 3.31.05

• Are you familiar with any of the latest treatments for keloids, as I knnow of combination treatments like excision with radiation therapy, steroid injections, etc. What has proven to be most effective? Is there information available online on this topic? Thanks!

  Answer:  i have had good success with a combination of 5-FU with low dose kenalog, and verapamil injectiosn besides the options you have mentioned. Also topical Aldara cream has some benefits. JG 3.31.05

• Dear Dr. Garcia: I had a facelift 3 weeks ago and on my scar behind my left ear is a lumpy area. Will this go away or will I need some procedure to remove it? Thank you. This is a fabulous website.

  Answer:  Thank you for the kind comments. As to the scar, it should in time go down. At times we need to inject kenalog into the scar to speed it up but you should wait at least 6 weeks after the surgery before doing that as it can affect the wound healing. JG 3.20.05