Why did my doctor say l will inject half now and top up in 4 months? l had restylane 4 months ago in my tear troughs my doctor said he would top it up after 4 months. is this normal?
Is a Restylane "Top Off" Normal?
Doctor Answers (8)
This is risky business. Your physician may mean well, since he/she is probably trying to save you a buck. However, it would be more prudent for him/her to use the rest of the Restylane elsewhere in your face.
There is too much risk of contamination by bacteria. If there was such contamination your physician would be injecting a host of unwelcome if not dangerous microbes into your face. Restylane is a sugar molecule and as such a tasty treat for bacteria. Besides the hyaluronic acid is likely to dessicate in four months.
All in all a bad idea.
Topping off Restylane
A study was done showing that reinjection of filler before it all wore off made the filler last longer. If this is the effect your doctor is trying to achieve, that's fine, but I would rather use a smaller syringe of a filler so that there is not much waste as I don't store filler to avoid any possibility of reinjecting that filler into the wrong patient in the future. Furthermore, without saving the filler I don't have to worry about the concerns of a remote chance of infection developing from a stored previously opened product. You are having an elective procedure for cosmetic reasons. Minimize the chance of complications.
Saving unused filler product for future use is a bad idea
As my colleagues have already pointed out, saving unused filler for future use is not a good idea. The syringes of all dermal fillers are meant for single use. There is no preservative in the syringe to protect it from getting contaminated while be stored after unsealing the package initially and possibly causing an infection. Your physician should be able to provide you better options. I hope you find my answer helpful.
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I agree with conservative approach...
...But there are lots of other places to put the left-over Restylane: earlobes, cheek folds, eyebrows, lips, so there is no need to waste nor to save. Saved material cannot be guaranteed to be sterile after 4 months.
Restylane Top off
The instruction of "topping off " the Restylane after 4 months is correct. According to Medicis the makers of Restylane and Perlane full correction results can be extended from 9 months to 18 months when the patient receives refresher treatment somewhere between 4.5 months to 9 months. This touch up usually only requires just a fraction of the amount need for the first treatment. You can find all the data regarding this Protocol on the Restylane USA website.
The real issue of course is whether the product is being stored after opening. It is just a bad idea and should be discouraged for all the reasons already stated. In the case of the under eyes, if the doctor only needed 1/2 syringe for each visit then he should use a 0.4 ml syringe each visit.
Saving Restylane for future injection
I agree with the others that the practice of saving filler material for future injection is probably not a good idea for a couple of reasons. The initial treatment contaminates the product, and if the material is improperly labeled and stored, there is the possibility that your syringe could be mixed up and confused with other partial syringes. Restylane, and now Juvederm do come in smaller syringe sizes if you truly only need a small volume of product.
Although there have been studies showing no bacterial or fungal growth in a syringe of hyaluronic acid for up to two years, most physicians prefer to inject the entire syringe at one sitting.