Treatment of Localized Involutional Lipoatrophy after Local Injection of Corticosteroids into a Keloidal Scar with Fat Injection

I t is reported that localized involutional lipoatrophy improves or completely heals naturally within 1 year in the majority of cases. 1 However, there are no signs of improvement in some cases, and surgical treatment is necessary for them. We treated localized involution-al lipoatrophy after local injection of corticosteroids into a keloidal scar with autologous fat injection. A 24-year-old woman presented with a keloidal scar on her left upper arm. We first performed surgical removal and postoperative 15-Gy-electron-beam irradiation to prevent recurrence. The postopera-tive scar was slightly raised and displayed redness 6 months after the excision of the keloidal scar. We then administered local intracutaneous corticoste-roid (triamcinolone acetonide) injections to the proximal and distal sides of the scar once a month for 5 months. At month 7 after the last administration, she visited us with a 45 × 15 mm concave area present on the distal side of the scar (Fig. 1). Magnetic resonance imaging (MRI) revealed thinning of the fatty layer of the subcutaneous tissue in this region without inflammation of the surrounding tissues. Our diagnosis was localized involutional lipoatrophy caused by local injection of corticosteroids. Thus, we performed autologous fat injection 4 months after the diagnosis. Under local anesthesia, the fat injection was performed according to the method reported by Coleman. 2 Autologous fat was obtained from the lower abdomen, and a total of 5.5 cm 3 of refined fatty tissue was injected into the concave area. MRI at 3 months after the fat injection revealed that the injected fatty tissue was not distinguishable from the circumambient subcutaneous tissue. One year after the fat injection, no concavities or pigmentation was detected on physical examination except for a raised red scar overlaying the injected fatty tissue (Fig. 2). According to Dahl et al 3 in 1996, local injection of corticosteroids or antibiotics was present in 62% of cases of localized involutional lipoatrophy. All of the patients except for one 5-year-old boy were young and female. From the above information, we diagnosed our patient with localized involutional lipoatrophy. In the present case, we performed fat injection at 4 months after diagnosis with localized Unauthorized reproduction of this article is prohibited. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or …