Asymmetry 1 year after Restylane injection - can this be fixed? (Photos)

Question

I had restylane injected on the under eye area over a year ago. My right eye looks fine, but my left eye has sort of an “expanded” tear trough. It’s not really noticeable with a resting face, but when i smile i can really see it. Can it be fixed?

Camille Cash, MD · Answer

I encourage you to visit with an experienced injector for an evaluation.  It may be that a touch up of filler is needed to improve your concern.  I've included a video I hope you find helpful.

Anna Chacon, MD, FAAD · Answer

Thank you for your question and for providing the photo. Tear trough asymmetry after filler is a relatively common concern, especially when only one side shows delayed or subtle irregularities after initial good results.

Since it has been over a year since your Restylane injection, here are your options:

1. Hyaluronidase (Filler Dissolver)
If the issue is due to lingering filler creating volume or puffiness, a small amount of hyaluronidase (an enzyme that dissolves hyaluronic acid fillers like Restylane) can help correct the asymmetry.

It can be used very precisely to minimize only the excess on the left side while keeping the right side intact.

This is especially helpful when asymmetry becomes more visible during facial expressions like smiling.

2. Additional Filler (Refinement Technique)
If the asymmetry is due to volume loss or incomplete correction rather than excess filler, a very conservative touch-up to the more deficient side may help even things out.

This should be done cautiously, particularly in the under-eye area, to avoid overcorrection or puffiness.

3. Wait It Out
While it’s been over a year, some residual filler can remain for extended periods, especially in low-movement areas like under the eyes. If the asymmetry is very subtle and only visible during expression, you might choose to observe before taking action.

4. Laser or RF-Based Skin Tightening (if needed)
In rare cases where skin laxity contributes to the look of asymmetry (especially with smiling), a non-invasive tightening treatment like RF microneedling may help, though this is less likely needed in your case.

Conclusion:
Yes, the asymmetry you're noticing can typically be improved. A skilled injector can assess whether it's a case of excess product (dissolve) or slight volume loss (add). Since your concern is more visible on animation (smiling), this suggests subtle excess volume or placement variation on one side—which is very treatable.

Kenneth D. Steinsapir, MD · Answer

Hyaluronidase is the injectable enzyme that breaks down Restylane and other hyaluronic acid fillers. While Restylane is sensitive to the enzyme, a squirt of enzyme will not get the job done. You may need 150 units of hyaluronidase or more. Don’t live with a bad treatment. Have this removed.

Asymmetry 1 year after Restylane injection - can this be fixed? (Photos)

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Everything you need to know about Restylane

Our mission is to create a world where every investment in modern beauty is Worth It.

Asymmetry 1 year after Restylane injection - can this be fixed? (Photos)

Answers (3)

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Recommended reading

Everything you need to know about Restylane

Our mission is to create a world where every investment in modern beauty is Worth It.