Will Intra-oral Incision to Remove Restylane Lump Cause Facial Sagging?

I have a large lump, which I think is a scar tissue on my cheek, caused by (Restylane) done over 4 years ago. I already had kenalog and hylauronidase, but they didn't do much. So I must have it cut out, but I don't know which incision to go with. It's just below the cheek bone, and can be reached from inside the mouth. But I was told by my doctor that an intra-oral incision will have its side effects on my face in the future, and it would be better to just cut it out from the surface (meaning I'll have a visible scar). Will it also cause facial sagging in the future? Which incision would you suggest?

Doctor Answers 4

Incision not usually needed

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Restylane can usually be removed by simply injecting Hyaluronidase into the area of excessive fullness. This will break down the Restylane and allow the area to return to its pre-injected status. If the lump is caused by something else such as scar tissue or a salivary gland issue etc.. - then an incision may be required to be performed through the lining of the mouth. Rarely, a branch of the motor or sensory nerves supplying the face may be affected.

I would suggest a comprehensive consultation with a board-certified plastic or ENT surgeon before deciding on a course of action.

New York Plastic Surgeon

Restylane removal through surgery inside mouth is risky

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I do not worry about surgical removal of Restylane causing facial sag--it should not.

However, going through an intraoral incision to remove Restylane under the skin could very easily damage important branches of the facial nerve which could cause paralysis of the muscles that support your smile-if this occurs it would be devastating to your facial appearance.

Lump on The Face From Restylane

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This issue appears confusing. The lump likely is not Restylane itself. It is unlikely to be scar tissuue either. So, it makes it more important to know the nature of this mass.

You should obtain at least one more consultation to figure out the exact nature of this mass. You might even need to do an MRI.

Once its established that the mass needs to be removed the incision should be placed closer to the mass. If the mass is close to skin then incision on the skin and it should heal well. If mass is deep and easily palpable from inside the mouth then incision should be transoral (through the mouth).


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

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My guess is that you didn't receive Restylane as that wouldn't have caused this

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It is important to figure out what you received as there are different treatments for each. If this were truly restylane, it would be treatable with a simple injection of hyaluronidase, so it seems unlikely that this is what you are treating.

For this reason, it is possible that you will have to have it cut out, sadly! I would take an xray to see what is going on as well as this sounds quite unusual. Good luck!

Joel Schlessinger, MD
Omaha Dermatologic Surgeon
4.9 out of 5 stars 50 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.