Deeper Restylane Injection to Lessen Chance of Doughnut-like Scarring?

Previously, I had Restylane in cheeks to replace lost volume and to fill depressed acne scars. Initial results/swelling were fantastic, but eventual result was some acne scars became more pronounced, though cheeks were fuller.

It seems the filler settled around scars - there was a more pounced ridge around several of the depressed scars. I waited 8 months for filler to dissolve, but eventually opted for Hyaluronidase, which returned me to a less full/youthful appearance but also a less noticeably-scarred face.

Could Restylane be injected deeper to avoid scar "donutting"? How else can I increase volume without risking scar donutting?

Doctor Answers 2

Acne scars, Resylane treatment

For the deeper acne scars, fillers will not do the job alone. Subcision by special needles is done to release the tethering scar tissue underneath the scar. The other option is to excise the scar and either close the resulting defect with suturing; or refill the defect with a graft of healthy skin, usually obtained from behind the ear.

Detroit Dermatologic Surgeon

Deeper Restylane injections

I think your results are a reflection of the injector's clinical judgment and skill NOT of the product. Allow me to explain.

A scar is a full thickness tethering and pulling of the overlying skin to much deeper structures. If a scar dimples the skin, YOU KNOW, the pull its deeper cords exert on the skin itself easily outweigh the forces of any fat / water and in your case, Restylane, to bulge out and fill out the skin (just like a wind would fill a sail). Put in another way, NO FILLER would ever cut / weaken or remove the inward pulling of scar tissue.

For your pitting to be corrected, a special needle has to be fitted on the Restylane syringe. The needle is used to cut the scar cord and Restylane is then placed to fill and push the depressed skin forward. The Restylane buffer is also used to keep the cut scar cord apart to stop them from reuniting and pulling the scar back down again. The medical term for this is Subcision.

Instead of breaking the Restylane up with Hyaluronidase, I would have gone after the scar cords, cut them and ADDED more volume in those locations.

I hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

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