Q: Dr. Eppley, I had a fat graft 4 years ago that I am unhappy with. I have too much fat particularly along the jowl line and near my masseter/jaw area. It feels as if some of the fat near the sides of my jaw/masseter has calcified. Do you think that either 5FU or diluted Kenalog could help in either of these locations? I realize that Kenalog could cause a dent, but perhaps a dent near the jowl would look good versus an area where there is soft tissue only?
A: While injected fat grafts have the potential to undergo located areas of calcification, that is more common in the breasts and buttocks where large volumes of fat are placed. Calcified areas in facial fat grafting are much more unlikely due too smaller graft sizes and better blood supply of the facial tissues. If a fat graft is calcified, I doubt at this point that this fat can be ‘dissolved’. However if the fat is soft even though it is an ‘old graft’, it still may be susceptible to the effects of triamcinolone. (Kenalog) I would start off with a very low concentration (like 5mg/ml) and give it 4 to 6 weeks before repeating or increasing the concentration. If steroids are injected in low concentrations over time you should have success of thinning it out without creating the reverse problem of indentations.
Dr. Barry Eppley
Q: Dr. Eppley, I am seeking steroid injections after gynecomastia reduction surgery. I had gynecomastia surgery almost two years ago. The surgery was fine, but of course I dealt with scar tissue problems afterwards. I got Kenalog shots and it really reduced it alot! I have a bout a pea size piece sticking literally right behind the nipple itself. When my nipple is hard or semi hard the scar tissue is jagged and literally sticks out just like my nipple (protruding my nipple out too much for me to live with for the rest of my life and extremely bothers me) But this is so small for surgery so I don’t want to risk it. I was wondering if you would hit me with a 5FU or 5FU/Kenalog controlled shot to flatten this jagged connective tissue that makes my middle nipple area still stick out.
A: It is very common after gynecomastia reduction surgery to have scar tissue form behind/beneath the nipple. When the initial gynecomastia problem is relatively small, any nipple scar tissue formation can leave one with a still persistently nipple protrusion problem. In the first year after surgery (really the first six months) steroid injections can be very helpful in breaking down any scar tissue formations. After one year the success of steroid injections to reduce prominent scar tissue diminishes considerably as the bonding of the collagen in the scar tissue becomes very mature. There is no harm in doing further steroid injections but be aware that the success of them at this far out from surgery may not be like what had occurred earlier after surgery. Should this fail you should consider a small revision through an open incision under local anesthesia as an office procedure. This can remove the problematic small area of scar with little risk of recurrence. I have done this numerous times in secondary areolar gynecomastia reduction surgery.
Dr. Barry Eppley