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Biofilm Infection After Restylane Injections to Tear Troughs

I've had great results with Restylane to the...

I've had great results with Restylane to the glabella, naso-labial folds, and around the mouth, however, I've had a disastrous result with injections to my tear troughs.

Originally I wanted a lower bleph, but my ps talked me into Restylane instead. Big mistake!

I had one set of injections that didn't seem to make much difference. 8 months later, doc suggested injecting again. At the same time he did the 2nd set of injections to the tear troughs, he also administered Botox (Dysport) to my crow's feet (which I regret because I love my laugh lines).

Two months after the 2nd set of injections, my eyes began to swell. The swelling lasts a few days, and since then, recurs about every other week. When the swelling goes down, my undereye are is left swollen, lumpy, bumpy and bruised.

Researching on Real Self, I've discovered others who've experienced the exact same thing. My doctor thinks my body is having an immune reaction to the Restylane and wants to dissolve with hyaluronidase. But there are so many horror stories here of hyaluronidase making matters worse that I haven't done it yet.

After having a neck lift last year, my lower face looks youthful and attractive, but Retsylane has now battered my eyes, making them look old, bumpy and crepe-y, and leaving me depressed and self-conscious.

Restylane has not been FDA approved for use under the eyes, and I hope it never is. Please think long and hard before using Restylane to treat bags under the eyes.

So, here's the rest of my story since I last...

So, here's the rest of my story since I last posted.

For months, my doctor seemed puzzled about what was going on with me. He thought at first that I was having an immune response to the Restylane. I kept reporting to him the repeated episodes of swelling, nodules and tenderness under my eyes.

Finally, he emailed me to tell me that he had just been to a lecture on complications with injectable fillers, and told me that he suspected I had a biofilm infection. He sent me a link to an article, and indeed the description and photos seemed to match the symptoms -- nodules, lumpiness and recurrent swelling -- that I was experiencing.

Until recently it was believed that biofilms couldn't form on temporary fillers (they're usually associated with implants such as pacemakers, and the like). Many doctors on this site have dismissed the idea of biofilms from temporary fillers.

But there have been more and more reports of biofilm infections occurring after injections of Restylane and Juvederm. Usually the first swelling episode starts several weeks to a month after injection.

The usual treatment is six weeks of two powerful antibiotics. My doc immediately put me on Zithromax and Levaquin, which I took for about eight weeks. The swelling got better within 3 days of starting the antibiotics, which made me so hopeful! For the next month I had no swelling, but I the uneven lumpiness never went away.

Unfortunately, I had some swelling again after a month on the antibiotics, even though I was still taking them. Apparently, these biofilms are extremely antibiotic-resistant which is why such a long course is needed. They hide amid the filler and it's hard for the antibiotic to reach them. I was so depressed when the swelling returned (though it never got as bad as it was pre-antibiotics).

The other treatment that's recommended to eradicate the biofilm is to dissolve the filler with hyaluronidase (Vitrase). I was extremely wary to do this after reading so many horror stories here on RealSelf about hyaluronidase making things worse. For a long time, I decided I would try to ride this thing out until the Restylane dissolved naturally, even though my eyes looked like hell and I had no choice but to hide behind eyeglasses every day.

But the more I learned about biofilm infections, I realized that it was advisable, if not necessary, to dissolve the stuff so that the biofilm no longer has a place to hang out. Further, the Restylane can last for years in the tear trough area.

So just this past weekend, I traveled back to NY to have my doctor, a board-certified plastic surgeon, attempt to dissolve the Restylane with Vitrase.

I was nervous and scared that this would only make a bad situation worse. After the injections, my left eye bruised badly and was quite swollen, though my right eye looked better (back to normal, in fact). I was, however, terribly worried about my swollen and bruised left eye, which required more injections.

Well, now it is day four after the Vitrase injections, and while I still have bruising (hidden under many layers of concealer) the swelling is disappearing and I am starting to look like my old self again for the first time in nearly six months. I am ecstatic!

My old bags are back (you really only see them when I smile), but I realize now they are not so bad, and they are FAR preferable to the awful asymmetrical lumps and bulges I have endured for the last six months as a result of the infection.

My doctor told me that after the Vitrase I was probably going to ask myself why I didn't do this months earlier, and he is right. I'm still on the antibiotics for another week (he switched me from Levaquin to Clindamycin when the swelling started to return). I am hoping and praying that the swelling and nodules will be gone for good.

I am uncertain as to why so many people have reported such ill effects from Vitrase, but in reading the reviews, I did notice that more than half (66%) reported positive results. I think that people who've had complications are more apt to post a negative review than someone who has had a satisfactory outcome.

I am reserving final judgment, but I am hopeful that when all is said and done, I will be able to add another positive report.

When it comes to hyaluronidase, I've learned through my experience that:

1. It is essential to go to a board certified plastic surgeon or dermatologist who's had experience dissolving fillers.

2. That they use Vitrase (no mercury preservative) rather than Wydase (which has been discontinued).

3. That the Vitrase be dated, fresh, and kept refrigerated.

4. That in the case of a biofilm infection, it is advisable to attempt to remove all the filler at once, rather than a little bit at a time in several sessions.

Hope that this information proves helpful to anyone experiencing similar symptoms after filler injections.

Four Months Since Hyaluronidase. Results Disappointing.

While I was initially hopeful after the Vitrase injections, my eyes, unfortunately, look terrible. The repeated swelling episodes have stopped since I had the Restylane dissolved (thank goodness), but my undereye area looks worse than before I had the Restylane injections. I seem to have a small permanent nodule that still becomes intermittently tender. In addition, I am left with uneven bags and asymmetrical puffiness and lumpiness.

In a month-and-a-half it will have been a year since the Restylane injections. I can't tell if there's any Restylane left, or if all the stretching and swelling from the injections and the biofilm infection are what have left my undereye area such a mess.

I have been wearing glasses for the past year to hide my eyes and have lost much confidence about my appearance. So sad after the 8 confident months I spent enjoying the results of my neck lift.

I originally wanted surgery and am so sorry that I got talked into Restylane instead. I am worried about having surgery now, in case there's any Restylane left, and worried about surgery reawakening the nasty sleeping biofilm infection.

Like so many people here who have reported bad results, I am left feeling like it was karma for my vanity.

Scheduled for Surgery in Two Weeks

Well, it's been over a year since my biofilm infection from Restylane started, and it's been over six months since I was treated with antibiotics and had the Restylane dissolved.

I am now scheduled to have eyelid surgery in two weeks. I had a consult with an top oculoplastic surgeon in LA who also happened to have published a paper on biofilms.

He recommended upper and lower eyelid surgery. He said that while he is in there, he can flush out any remaining Restylane. He also recommended fat injections in my mid-cheek area to even out the hollowness. Since it is my own fat, it cannot harbor biofilms or cause an allergic reaction), and he recommended laser resurfacing under my eyes to tighten up the lumpiness and loose skin caused by the repeated swelling episodes from the infection.

I am excited and terrified at the same time -- excited at the thought that maybe I won't have to hide my eyes behind glasses for the rest of my life, and terrified that I could have a disastrous result like I did with the Restylane. Doctors keep saying how rare biofilm infections are. (I don't believe them -- I think that there are many cases that haven't been properly diagnosed), but because I had one experience with a rare complication, it's hard for me not to fear another.

Wish me luck. I'll keep you posted!

Biofilm Infection Confirmed - Restylane still present 15 months later

On January 24, 2014 I had eyelid surgery to address not only my original eye bags, but also the lumpiness and saggy skin as a result of my biofilm infection, and subsequent dissolving with Vitrase. After surgery, my oculoplastic surgeon told me that he found remaining Restylane just under my lower lash line, which he said was a very odd place to inject filler. He said it was possible that it migrated upward. But he also said that the Restylane was "encapsulated" and that there was much inflammation, consistent with a biofilm infection. The Vitrase obviously didn't dissolve it all, and I still had Restylane present 15 months after injection. My surgeon also said that he does not recommend temporary fillers to the tear trough, and feels that the procedure is being way overdone. He prefers to use a patient's own fat, which cannot cause a biofilm since it is not a foreign body.
Dr. George Yang

What this rating system doesn't allow for is results. Dr. Yang is the most kind and caring doctor I have ever met. Very responsive to phone calls and emails, and spends an incredible amount of time with his patients. I had an extraordinary result with a necklift/lower facelift that Dr. Yang performed, and couldn't be happier. I had a less fortunate experience with Restylane injections to the tear trough area and ended up with a biofilm infection, which caused episodes of intermittent swelling, lumpiness, and nodules. The cause, at first was a mystery, even to Dr. Yang, but eventually he identified a problem that most plastic surgeons are yet unfamiliar with, and successfully treated it. Based on my experience and research, the undereye area is a risky area to inject with fillers.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait tmes
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I had restylane in the eye trough 17 days ago and I'm very disappointed. Now I look worse because of eye bags that restylane created. The Dr. injected half a syringe only. I went to see him last week he massaged the area and told me to wait 2 weeks and if I'm still not happy then he will dissolve it. Do you recommend that I dissolve it? Thanks.
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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 :)
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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.
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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!
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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.
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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!
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I will. Can't wait to have it removed.
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Hi, sorry to hear about your troubles with restylane. Glad to hear though things are looking better for you. Question.... did you ever find out what caused the biofilm infection ? Was it bacteria in your body? Or from the needle?
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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.
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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.
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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!
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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?
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Sallify, I think your second photo shows improvement and looks like you are on the road to making progress. I want to thank you for posting about biofilm infection because after I had a few years of juvederm fillers, to fill in a doctor created hollow under my chin, the area ended up with subcutaneous nodules and lumps; recently when they were removed they were sent to path labs for analysis and they were inflammation granulomas, no doubt from bacteria but the lab didn't specify on the exact source and called it "foreign body." In my case it took a year and a half ago to finally decide to tackle the mess and get lump and defect free. and it took a total four doctors, one at a time. Since I read biofilm bacteria can get started from nonsterile conditions I started thinking back on conditions during my Juvederm injections and chin incisions and realized some didn't swab the skin well before injecting, or some marked the area with a pen in their bare hands after swabbing then put the gloves on to inject. Also, the last four surgeons who incised varied in their infection control. I recall how the first two marked skin with bare hands first and did not drape the area, and the next two didn't mark at all but swabbed, draped and cut in that order. It's' worth considering inadequate infection control as the source of your periorbital lumps, in my humble opinion. But having been through a nightmare result on my face like you I'm writing to encourage you to keep trying one step at a time and get as many consultations as possible. My two best consultations were free and I found them on Real Self, so keep treading carefully and weigh each persons opinion carefully one at a time so you don't go through unnecessary setbacks like I did. Meanwhile, the person who dissolved your lumps did a good job and best of luck on the next step.
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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!
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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.
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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!
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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.
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Hay wow I had similar story I was on antibiotic for 4 months through iv eventually I had surgery if u need q please email
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I went to an occioplastic surgeon. I was afraid of a boob guy doing my eyes. ;)
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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!
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You will do fantastic!
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Firstly, let me start by saying you have amazing eyes, the color is really unique and pretty. You've had a tough go of this procedure, I'm sorry it worked out that way. Please don't think it's karma for vanity. It was a very unfortunate experience but that has to be at least uncommon. Go into this with confidence that your one bad experience is behind you and you've got nothing but good results to look forward to. You have a good doctor and I know this will go well!! I look forward to hearing about your outcome. On another note, thank you so much for sharing your story, you've given some incredible information and facts and we will all be able to benefit from your info.
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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.
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I had the same thing happen with restylane injections in my tear trough. I never had it dissolved. What a nightmare! I just got a lower bleph, and hopeful I will look better! Please everyone, don't put this crap in your eyes!
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When you had your lower bleph, was there still Restylane present? Did your surgeon remove it?
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