Biofilm Infection After Restylane Injections to Tear Troughs

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 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.

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.

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!

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.