Take steroids but want to do beautiful?

When the Cushing Syndrome patient walked in and said,

"I haven't taken care of myself for a long time because I'm sick. I want to be beautiful. I haven't done anything in years. Can you make me?"

... the doctor and the brain are starting to work hard together again. 🧠✨❤️

So today we want to share our approach to patients with Cushing Syndrome.

... what beauty operations can we choose for him?

... for safety and effective results.

Above all, what we need to clear with the patient is

... that the doctor who's been watching the patient for ten years has allowed or is he safe enough to do it?

... because he has looked at the patient's condition for a long time and is more adept at it. We must give him the highest honor in looking at this patient.

- - - - -

Next, start with Steroid.

🍀 Systemic Steroid can cause Skin atrophy, Telangiectasia, Striae, Purpura and Fat redistribution.

... so the patient's skin is usually thin, red, more veins, some fat.

Interesting Mechanisms like

🍂 Reduce epidermal growth factor

🍂 Reduce keratinocyte proliferation

... resulting in worse skin barriers and delayed wound healing.

🍂 reduce the generation of collagen type I, type III, elastin, glycosaminoglycan and hyaluronic acid.

... spoils the elasticity of the skin. The skin has less collagen (1).

🌸 effect on vasculature

... from less collagen, the brittle veins break easily.

... more likely to be bruised than normal people

Let's not forget that the likelihood of vascular complications is also greater.

- - - - -

The last ‼️, very important, is the risk of infection (1).

... Steroid Dosage can be divided into 5 major groups.

1.Low Dose (FIT 7.5 mg / day)

... rarely press the landscape. There are no severe side effects. ⚠️

* But to consider, long-term cases may have side effects such as thin skin, dilated and easily broken veins.

2.Medium Dose (> 7.5 mg but Due to 30 mg / day)

... starting to have long-term effects on metabolism and Bone Density.

3.High Dose (> 30 mg but Due to 100 mg / day) ⚠️

... immunosuppressive and strong immunosuppressive.

4. Very High Dose (> 100 mg / day)

5.Pulse Therapy (> 250 mg / day)

... the latter two groups are high dose and use only the case. Press terrain and press inflammation (2).

‼️ More in part to the CDC threshold.

... immunocompromised at 20 mg / day (> 14 days) (3)

- - - - - - - - -

👩🏻‍⚕️. The operation can be selected. The private is divided into 4 + 1.

1️⃣ Botulinum Toxin as Low Risk Can Do. Don't Worry Much

... Non-crosslinked HA is another Low Risk alternative, shallow injection, minimal dunk, comfortable.

2️⃣ Filler is a Moderate Risk.

... Prevent infection. Pay attention to Sterile Technique. Increase to 300%.

🌻 Meticulous Double Cleansing: 2% Chlorhexidine + 70% Alcohol (4)

🌻 Consider Antibiotics Prophylaxis - I don't give patients drugs, but I can consider them on a case-by-case basis.

... Injection Technique.

🌱 Don't forget that the patient's skin is very thin. Very easily brittle veins need to be done as carefully as possible.

🌱 With less collagen and elastin, the chances of filler melting may be huge. We will choose to inject in a deeper position rather than shallow.

🌱 Fragile vascular > > > For a check, usually we will draw back 10-12 seconds, it will increase longer than before (there is no clearly defined number. We will draw back at least 15 seconds).

* A little more, do whatever it takes to keep the pinhole to a minimum, reduce the chance of infection

3️⃣ Immune-mediated Biostimulator ❌ ABSOLUTE NO ❌

... especially the case where Corticosteroid is used to suppress immunity.

... because the patient is exposed to pressure drugs directly, it is expected that the function of the biostimulator group working with the immune does not function normally.

... and even scarier, the immune patient is disturbed, may have complications, may have Granuloma easier than others.

4️⃣ EBD - Energy-based Device (Non-ablative = Moderate Risk)

... This group is actually quite safe for patients, but don't forget about Atrophic skin.

... the patient's skin is less heat-resistant than the average person. Be careful about Burn.

... and I'd like to think a little. Groups focused on stimulating cytokines, any growth factor may not work 100% because they still need the patient's immune response.

* * Ablative Laser Section (Higher Risk)

... from heat-resistant skin, delayed wound healing and higher risk of infection.

Personally, if not necessary, we will not choose (1)

- - - - - - - - -

👩🏻‍⚕️ final summary for a little more consideration.

... After evaluating the patient, the case that can be comfortable, just more careful, is the low dose corticosteroid group.

... the moderate dose group. We recommend only low risk operations.

... high dose or more, predicting that the disease is not calm, avoided first.

📌 Don't forget to ask how the patient took the medicine.

... in case our patient took Prednisolone (5) 8 tabs qThursday (5.7 mg / day).

... Dose like this may be able to press the landscape during the first drug, so choose a mid-week operation such as Sunday or Monday (expect the ability to press the landscape to swing, and there are still days left for Wound Health).

📝 this case, we choose

1. Botulinum Toxin 50 units

2.Filler Temporary (Gunshot Technique) + Zygoma, because it is the safest spot and is thought to be the cleanest.

3.Filler Undereye area We only use 0.5 ml each side. Made with extreme caution. This person should not have infection problems, but skin and vascular problems.

💕 Finally, it is very proud of the patient to take care of the patient and to use all the knowledge accumulated in a systematic way.

💕 Thanks to the experience of med, emer med, sx, aesthetics, proud that the patient looked in the mirror to smile. A better walk home.

Reference

1.Tollefson MM, Bruckner AL. Glucocorticoid-induced skin changes. In: StatPearls.Treasure Island (FL): StatPearls Publishing; 2024. Available from: /

2.Buttgereit F, da Silva JAP, Boers M, Burmester GR, Cutolo M, Jacobs J, et al.Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology.Ann Rheum Dis.2002; 61 (8): 718-722.

3.Centers for Disease Control and Prevention. Immunocompromised travelers.In: CDC Yellow Book 2024: Health Information for International Travel.Atlanta: CDC; 2024.Available from: /

4.Darouiche RO, Wall MJ Jr, Itani KMF, Otterson MF, Webb AL, Carrick MM, et al.Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis.N Engl J Med.2010; 362 (1): 18-26.

# Steroids # Safe face injection # Doctor Cicada review