Biofilm Infection After Restylane Injections to Tear Troughs

Don't know for sure, christylv, but my doctor seems to think it was bacteria introduced from the needle at the time of injection. I have since learned the importance of having a clean face, no makeup, and prepping the skin with Betadine before injection -- similar prep as for surgery.

Oh ok i see. Yikes! I get juvederm injections in my lips . I had recently got belotero in my eye area. I had the restylane at first which lasted a year +. So i tried the belotero this time. So far so good. My doctor uses a few alcohol wipes before he injects. I hope this never happens to you again.

Hi Sallify! Thanks for sharing your story! I'm on my 6th day of major swelling in my lips after restylane injections 11 weeks ago. The worst part is that I'm in another country on vacation. After reading your posts about biofilm, I think that's what I am dealing with. Should I start on antibiotics before I leave to travel back home on a 30 hour flight? I'm very concerned!

So sorry to hear it kimjonestcaf! When will you arrive home? I lived with a biofilm infection for months before it was diagnosed and I started antibiotics. It's a long, smoldering infection and takes a long course of antibiotics. I would say if you're heading home within a week it can wait. Are you able to contact the doctor who injected you in the meantime?

Hi zooster! Sorry to hear about your disapointment with restylane. Your eyes should def. not look worse. Usually it can take up to three weeks for swelling to go down 100%. I would wait a bit longer in case your are still having some swelling. The thing i found with restylane compared to the belotero i just received this fall. Is restylane is lumpier , not as smooth. Sometimes it can take a few months for the product to settle down. Its kind of like it finds a home and sort of melts into place. I know you do not have photos so i can not say for sure if maybe this is what you need ...which is to wait it out. But if it looks really bad then the Dr. may have put to much in or wasnt experienced enough with this area. Good luck :)

Thanks. He only injected half a syringe under both eyes. He was very careful and took his time to inject. One lady in the office had her restylane under the eyes injrcted bh the same doctor and her eyes look beautiful. On second day I didn't have any bruising or swelling. Then on the third day I noticed the swelling, or maybe it's the restylane itself, I'm not really sure. This is my 3rd week and I still have these bags under my eyes and I really hate it. It made me look 10 years older. I wish I didn't do it. Will wait another week and see. I I'm just worried that removing the product will cause more side. effects.

Hi Zooster, I also had Restylane injected in my tear troughs in September 2013 because I had loose skin and hollows. I did not like the results at all! He used one syringe to inject both eyes and afterward it just made my wrinkles and skin bunch up all the more when I smiled, so he injected botox in my crows feet just so that I wouldn't have eyes COMPLETELY surrounded by wrinkles. It looked weird. And then when it settled in it just sort of sat on the top of my cheekbones, like fat worms that you could see sometimes in the right light. I went to see someone else just about a month ago and she said the Restylane was pretty much gone (after 3 months) and she took a different approach. She injected Radiesse in 3 places under the muscle of each eye, about one inch below the eye socket bone (closer to the nose, center and then just below the outside corner of my eye). This is definitely better. Not great, but much better than the tear trough injection. What is did is sort of puff up the tops of my cheeks a little bit which also fills in the area below the eye a bit. I think that as a step before actual surgery, this is the best option. Just make sure you go to someone who REALLY knows their stuff - I found her online by reading great reviews - and you may not want to use Radiesse the first time you try it because, unlike the others, it cannot be dissolved if it doesn't work right. This practitioner inspired enough confidence in me that I let her use it. A little bonus is that my cheeks look a little fuller and "apply-er". I will never do the tear troughs again. Good luck!

Thanks michellenora- what are you describing about the effects of restylane is exactly what I am experiencing right now. it's as if you have put the words in my mouth. The wrinkles and skin that bunch up when I smile and the fact they are just sitting on the top my cheekbones, is exactly what i have seen from restylane. It did nothing to improve the hollowness of my eye troughs. I'm glad that it took only 3 months to go away in your case because most docs say it can take up to a year to disappear. I don't feel comfortable to try anything else right now. I think I look way better before the restylane injection. I will have it removed next week. I am glad things are better for you after the second procedure with Radiesse. I really appreciate sharing your experience with me. Take care.

You are welcome. And by the way, my doctor also told me the Restylane would last a year and it didn't, lucky in this case. I will be very curious if once you have it removed you realize that your eyes really were not so bad before. Please keep us posted on this. You may encourage me to just leave well enough alone!

I will. Can't wait to have it removed.

Well, my doctor didn't charge me for the hyaluronidase to dissolve it, a good reason for going back to one's original injector for dissolving, if you trust their expertise. I can't remember how much I spent on antibiotics, but even with my insurance, they were expensive. But the biggest expense, by far, was the money I spent on surgery to remove the last of the Restylane and fix the saggy mess under my eyes.

Please can you let us know how things are after all the treatments. I am at the start of this journey, third week on antibiotics and battling with side effects eg candida. I feel scared and regretful,for ever considering the fillers. Doctors should be obliged to warn patients about it. Thank you for posting. You have made me more informed as my ps denied that natural fillers can develop infection months later.

Dear Christy, I am so sorry to hear it. Were you treated with antibiotics? Most derms and plastic surgeons remain unfamiliar with diagnosing and treating a biofilm infection. If your doc is not treating you with antibiotics, please find a doc who is experienced with biofilms. It may mean traveling out-of-state.

Hi - I do have a great doctor treating me now. He's mot the who did the injections, actually he did mid face implants for me in 2012. And he's impeccable! Like the doctor who did inject the filler, both we're confused by the reaction especially so far out from the injection date (last Nov). The Dr. who injected it did do 2 rounds of hyaluronidase for free, but the problem persisted. Had to leave the country so I got in touch with the PS who did my implants - he's amazing, btw. (Dr. Achih Chen in Augusta, GA) I'm now on the antibiotic Bactrim and it's already getting better. He'll also do the final hyaluronidase. I'm so grateful for help fixing this and finding out more about bio films. And I am grateful to SadieBee (who looks fantastic now after all that craziness she went through. And other post from Art/resparta. These accounts have saved me! Otherwise I would have been utterly confused for god knows how long! Thanks for your reponse - :)

biggyc, Is the doctor who is treating you now familiar with biofilm infections from fillers? Very few doctors have ever seen this before. If he was, he wouldn't be confused by your symptoms occurring weeks or months after the injection. This is typical for a biofilm infection. I do not believe that Bactrim is an antibiotic of choice for treatment. The treatment usually requires at least six weeks of a combination of two powerful antibiotics. Have you discussed biofilm infection with the doctor who is treating you? If he has never treated such a case before, he should be researching. You might want to give him this link (and read it yourself): https://www.google.com/search?q=rhoda+narins&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a&channel=fflb#channel=fflb&q=rhoda+narins+biofilm&rls=org.mozilla:en-US:official Good luck to you!

Hi SadieBee - Yes, we are now approaching it as biofilm. I told him about that a week ago after I saw resparta's account on here - then I saw yours, which really confirmed it! He was not aware - but now he is. He is not the doctor who injected the Juvederm. The doctor I am letting treat me now is the PS who put my mid-face implants in 1.5 years ago. They look great! I went to him because it was confusing to me what was going on and the doctor who injected the juve went out of town for 2 weeks. I went in to get Juve in my nose to improve the appearance and he put the left over in the hollow of my left side. He knew I had implants. So this is only happening on my left cheek. I've never had issues before, so I was like, "sure, go ahead!" Anyway thank you for sending this link. The doctor treating me read your account, btw. I sent it to him so THANK YOU! You look great now, btw! I know it had to of been hell to get there...this last month has been for me and thanks to you and others who have reported biofilm issues here, I hopefully will get this taken care of soon! All the best, Christy

Dear Christy, you have no idea how happy it makes me to know that by sharing my story I was able to help someone else. Thank you so much for your kind words. I hope that all your symptoms clear up for good, and that you can put this behind you. Sally

Hi Sally, We are diligently making progress, but I still have does that it feels worse, looks different than previous days. It moves from on my cheek to under my eye. Did that ever happen to you? I've been on the bactrim for 2 weeks now, I think I will suggest the antibiotics you were on to my doctor (he's been super-responsive, even though he'd never run across this either). Plus I think you said you were on those for 6 weeks, is that correct? It sounds like each case is individual to the person, no easy catch all solution, in other words. But I really relate to your experience because you finally got to the bottom of it and have recovered! I have a feeling we may have to take out the mid face implant this doctor put in nearly 2 years ago. They were freaking PERFECT! And he is the best doctor ever (he's not the one who injected the juvederm!) But now, some hack has gone and possibly destroyed the great results I had. It's pretty devastating to think about it...but we both hold that in the back of our minds. If the next hyaluronidase injection doesn't take care of this, that may be what needs to happen. I am really furious and upset. And to think it was over a really nonchalant, "okay, sure, why not inject that area after my nose?" It NEVER occurred to me something like this could happen, because before (prior to getting the mid face implants) the filler I got was as if I went and rented a movie at Redbox - simple, no sweat, enjoyable, great! As you mentioned, I have also wondered about vanity karma - or knowing when to let well enough alone. Well, I think I have reached that realization. But the insult to injury is that I didn't even go in looking to have this injected in my tear trough hollow. It was for my freaking nose! I feel like I am venting my anger, frustration and fears here - sorry! I am usually optimistic and patient (well, mostly) but I am so over this experience. Anyway, back I go this week for hopefully the final hyaluronidase - and with Bactrim finished by then, again, I may suggest the antibiotics you were on to my doctor. If it doesn't kick this - I guess out comes the implant. [RS bleep]. (Pardon my french). Then more healing then reinserting. Really? God, please tell me this isn't the route. I really do meditate and pray that this biofilm has not reached the implant, but we're not sure. Wish me luck friends! And much appreciation for allowing me to vent - you're awesome! Christy

I sure can relate to the venting but at least you have a doctor that cares and didn't brush you off. I am the most upset over that and the fact that he is worried about getting sued and wants a release. I asked for my money back since I have to go and pay to get this fixed and although it isn't a huge sum of money, it is the principle. He should have offered since he was the one that said I need to find someone else. A caring doctor would make sure his patient's needs are the top priority, not running to their attorney. I have had 2 injections and am going for a third Thursday and have been on Biaxin for almost 10 days and will ask if I should continue. The original doctor said if it was a Biofilm infection, antibiotics would have no affect which I didn't understand. The redness is still there and seems to get worse at night but I have bruising that looks like I have been in a fight. The whole thing is a nightmare and I just want it to be over.

4halex...I hear you. From what I remember SadieBee and others saying, it took the combo of antibiotics and hyaluronidase to get the culprit out of there. At my last visit, my doctor asked the question, "I wonder if the biofilm is preventing the hyaluronidase from getting through?" Valid question that made me go faint of heart :( But he is very scientific, and in a weird way, so am I about it. I enjoy getting to the bottom of mysteries, I just wish this one wasn't on my freaking face! So, I think we'll keep experimenting until we get the remedy. He's 2 hours away from me, so having to go back and forth gets taxing but totally worth it. I'm even thinking of temporarily relocating to Augusta (GA) from Atlanta as we work this out. Take a freaking sabbatical. Your doctor sounds like a jerk! The one that injected me was caring, yet distant. He did give me 2 hyaluronidase injections for free, but then he went out of the country for 2 weeks. It was during that time I found out about biofilms. I wrote his nurse - she's the real jackass - and linked all the information I've found. She never responded to them. She called to say they reported this to Allergan about the Juvederm, which, okay. BUT I don't think it's the filler itself...I mean it could be...but most of what I've read points at the prep for injection. Most doctors are too casual and caviler. After this doctor injected my nose bridge (which is what I originally wanted) he then suggested the remainder going into my left side cheek hollow. I cannot remember if he even prepped it - this was last November. This is what I mean about casual. And you're right - it is the principle. I've asked for a refund, too and no response to that. I'm becoming more akin to SadieBee's thought about a class action suit. I do know an excellent attorney here in Atlanta and have thought about having him write the doctor a letter. He's good at sending one letter and getting appropriate response (he's the underdog's type of attorney - which I appreciate!) I hope you next injection does the trick and being on the antibiotic at least keeps it from spreading or must suppress it a bit. Only a hypothesis that I am running on now. It seems like the back and forth approach until the biofilm just gets broken down. SadieBee - if you read this, what would you say kicked it for you? Was it the surgery or did you get rid of biofilm before the bleph? Good luck and keep us updated! I'll do the same! Christy

Hey biggyc, I did read this. My infection was mostly kicked after 8 weeks of two powerful antibiotics and flooding my undereye area with hyluronidase (two treatments in two days). I took Clindamycin and I forget the name of the other. (Typical treatment of a biofilm infection is with Clindaymcin and Cefalexin, but I am allergic to Cefalexin, so my doc prescribed something else.) Yet in spite of this, I still had a remaining nodule under my right eye that sometimes still became tender. During my lower blepharoplasty, my surgeon found a remaining pocket of encapsulated Restylane which he removed. I am delighted to report that since my surgery I have had no further symptoms a biofilm infection or recurrences of swelling or tenderness. Here is another excellent source of information on the proper way to treat biofilm from fillers: http://drnaomi.com.au/dermal-filler-infections-restylane-subq-infections-2/

Hi SadieBee - thank you for sending this. I forwarded it to the doctor who'd treating me. I think we may need to get more radical as you guys did. I am hoping it will knock it out for good - and that the mid face implant is not affected. We're hoping that this is happening "above that area" and that I caught it before it spread. We'll see. Thank you again! You have been an incredible resource. In the meantime, I got a phone message from the doctor's nurse who did the injection. They are offering a refund of that visit - $499 dollars. They have not ever responded to all the biofilm info I have sent them, however. But I think they are sort of admitting that this is possibly what happened. I do have one last question to ask you...in your opinion, do you think this biofilm comes from the prep not being thorough enough or the product itself? It seems like to me it's the prep, or lack there of. Since you felt with a surgeon who knows a lot about it, I'm just curious, because the doctor who injected it wants to put it on Juvederm...however, the more I read, the more it seems like bad skin prep is the main culprit. Thank you! Biggyc

S.K.T., don't worry yourself. The risk of a biofilm is very low, which is why most doctors have never seen it before. Enjoy your results! But if you should happen to develop swelling, redness, or tenderness in the injected areas, seek proper medical attention at once. And if you continue to get fillers in the future, be sure that your skin is super, squeaky clean and that the doctor swab the area first with Betadine. Most doctors will scoff and tell you this is unnecessary, but insist on it for your health and don't worry about offending the doc.

I've been doing a little research and I think biofilm infections are being seen more & more due to injections of fillers. Quite a few cases of oral/tooth infections migrating to the filler have been reported. I feel lucky to have had such great results twice, but I think I may decide to not take unnecessary risks with my face and quit getting these injections. Maybe I'm paranoid but it does definitely concern me.

Thank you for your kind words of encouragement, TFitz! I've been in conversation with several people here who were experiencing similar symptoms. I think I've helped them find their way to a correct diagnosis and treatment which makes me happy.

Yes, me too. Even though I love the facial plastic surgeon who did my necklift (the kindest doctor in the world), and totally trust his skills as a surgeon, after my experience with the biofilm infection, I decided upon an oculoplastic surgeon who specializes in and does nothing but eyes. I wouldn't let a boob guy within 10 feet of my eyes!

You will do fantastic!

p.s. The last doctor who used the best infection control on my lower chin incision also did my tear trough injection with Restalyne and I've had absolutely no problems. I noticed he and his nurse took extra care to clean and swab the area and the insertion was gentle and seamless. They also iced up the area before every needle insertion and they told me not to touch the area at all for at least a day. He was the best most careful injector ever and that's just how he does it, so I'm still a believer in Restalyne and I'm getting a touch up in a couple of months. I guess if you can think back on your Restalyne injection and not all of those same steps were used than perhaps it was the injector who caused your lumps. Trust me, I'm not a sales rep. for Restalyne, I'm just saying I've had some cavalier injectors and they caused problems for me, under the chin. Also, eventhough I know you feel your under eyes look baggy and terrible they still look less lumpy than the first photo and patience is the key to improvement. Since it took me a long time to heal, I'm a believer in small incremental improvements and avoiding quick fix offers because those are what set me back, twice. I had a disastrous kenalog burn under my chin in 2005 and nine years of small incremental treatments each year I've finally minimized restored the skin to a more normal appearance. Of course eyes are much more visible and it's scary to have surgery on them but as long as you trust the doc who will perform surgery and his reputation is spotless you will no doubt get your best possible result and hope you will post pictures after the healing. Good luck!

CBaker, I'm sorry you had a similar experience to mine. My doctor who, after months, finally correctly diagnosed my problem as a biofilm infection said that he learned, after attending a lecture on filler complications, the importance of swabbing the skin with Betadine, just as if it was surgery prep, before injecting fillers. In my experience with Botox and fillers, the doctors of done a quick alcohol swipe and used their bare hands. The ocular plastic surgeon who just performed my upper and lower blepharoplasty yesterday said that he doesn't recommend temporary fillers like Restylane and Juvederm to the tear trough. He is an expert on biofilm infections. He prefers transfers of a patient's own fat, which he used to fill my tear troughs during surgery.

Wow! That's so interesting what your doctor said about biofilm infection! I hope injectors are reading these posts and learning because it makes perfect sense to me that infection control is important anytime you are puncturing the body. Betadine is exactly what the last two docs swabbed me with in my series of 4 chin incisions and the first two did not. So it was my theory they caused further swelling and fluid under the chin while the second surgeon kept trying to blame me for massaging my scar and lumps too much. Once you and your doc start disagreeing it's time to get away because it only caused me more suffering to be blamed for things. Fortunately, the two rounds of antibiotics I took for a dental problem also cleared up the chin swelling. I was considering fat transfer in the tear troughs because it's more permanent. I can't wait to see your results as soon as you are healed, and thank you for educating all of us out here who need answers and are undecided on our next step. Good luck with the healing process!

Thank you, CB. I feel on a mission to educate doctors and patients about the risk of biofilms from fillers since my unfortunate experience. It's shocking how many docs are unaware and unfamiliar with this risk, and how many people I've connected with here with the same symptoms who've been told it's an allergy or an immune response. It's a serious, smoldering INFECTION of bacteria that hide out in the filler, making it is very resistant to antibiotics and requires a long course of antibiotic treatment. Infection control is so important. And I think that injecting temporary fillers under the eyes is risky and still not FDA approved.

Hi I'm sorry you went through all that.im due for a lower byoplasty&fat grafting in two wks.i just turned 50&ive been told my strangers how tired I look.about 9 a months ago I got res&the other filler around my mouth& the comments ceased got now the luck

Great positive respond, Thank-you!

I am so sorry, LOZ. I, too, having been wishing for the past year that I could wear sunglasses inside. And I, too, wish for my old bags back.

In my case it was not an allergy, Sosad, but rather a biofilm infection,

That is interesting because I had juvederm to one cheek which left lumps which also appeared on my other cheek. When I returned the next day to see my raised lump (like a snake under my skin), the doctor said 'what is going on with your other cheek, I didn't touch that side'. So when I went a few years later and the lumpiness occurred on the cheek, this doctor didn't even attribute it might be an allergic reaction. So what happens then, how does one get rid of the lumpiness that occurs as a result of the allergic reaction? I don't believe any filler is still in my cheek but the lumpiness is still there.

I am so sorry to hear of your experience, Ozzie. I have not yet reported my experience yet to the manufacturer of Restylane, but I need to. And everyone who has posted their traumatic experiences on this site needs to, too. Based on the number of reports I have read here about disastrous results with injections under the eyes makes me think that fillers are too risky a treatment for eye hollows and eye bags and should never be approved for this purpose.