Do I Have The Tyndall Effect? 3 weeks post. (photo(

Question

Tyndall effect and puffy under eyes. I had half syringe of Restylane under each eye almost 3 weeks ago. Now I have a bluish/dark color under each eye. I also still have puffy under eyes. Can I have Belotero layered on top to fill in and take a way dark color and correct puffy under eyes? What recommendations do you have?

Kenneth D. Steinsapir, MD · Answer

Tyndall once meant something. Now it means any unwanted color change after a filler service. Mostly this just looks like a lumpy service. The lump can be removed by judicious use of the enzyme hyaluronidase. These filler services are fussy. You need to have a an injector who knows their anatomy and is fussy.  I have folks who fly in to see me for these services as far away as London and Dubai. That tells you how hard it is to find this service done well. Injecting this area with the runny filler Belotero is a terrible idea.  Don't do this.

Nima Shemirani, MD · Answer

Hi @Candygirl55! I don't believe you have a tyndall effect. The filler was most likely not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by Hyaluronidase injections. Best of luck to you, Dr. Nima!

Steven H. Williams, MD · Answer

Hi,Thank you for your question and sharing your photos.It doesn't look like the Tyndall effect. Looks more like too much filler was placed or possibly too superficially.I would recommend follow up with your injector for re-evaluation and possibly some dissolver.Hope this helps!

Jason Emer, MD · Answer

if you are worried about your filler results because there is swelling, lumps or bumps, give it 2 weeks to settle and then consider reversing it with hyaluronidase.   in the mean time you can use redlight such as lightstim, radiofrequency such as exilis ultra and venus legacy.  The cheeks always should be injected when doing the under eye and you maybe swollen because of poor techniue so see an expert for the best treatment and management.  Best, Dr. Emer

Monika Soni, MD · Answer

Thank you for your question! There are two main causes for the blueish effect that you see in this photo. The first in an actual Tyndall effect, which is the way light reflects through a clear filler under the skin. The second cause is blood trapped or swirled throughout the filler that is under the skin. Both of these causes require a reversal agent to dissolve the filler first. Adding Belotero to an existing Tyndall effect generally does not improve and may worsen the results. The best solution is to dissolve the filler, wait at least one week, then inject Belotero into a deeper plane so that the filler is not visible near the surface. Best of luck!

Mark M. Youssef, MD · Answer

There are two main causes for the blueish effect that you see in this photo. The first in an actual Tyndall effect, which is the way light reflects through a clear filler under the skin. The second cause is blood trapped or swirled throughout the filler that is under the skin. Both of these causes require a reversal agent to dissolve the filler first. Adding Belotero to an existing Tyndall effect generally does not improve and may worsen the results.
The best solution is to dissolve the filler, wait at least one week, then inject Belotero into a deeper plane so that the filler is not visible near the surface.

Haena Kim MD, FACS · Answer

You seem to have filler that has been placed a bit close to the surface and causing the puffiness that you see. Based on the pictures that you have I do not see a Tyndall effect, but there may be some chronic skin discoloration or bruising. In darker skinned patients the skin itself may be discolored and may or may not improve with filler to the tear trough area. You also may have fat herniation which can lead to a prolonged swelling in the tear trough area. In patients that have fat herniation and hollowing of the tear trough you have to be careful of prolonged swelling, sometimes up to a month after injection. For the uneven areas I would recommend hyaluronidase to remove the filler.

Steven F. Weiner, MD · Answer

I don't believe you have a tyndall effect. I haven't seen it in darker skin types. It appears to be more like PIH or a resolving bruise. The puffiness is filler and can be reduced with hyaluronidase. Sometimes mild massage is able to correct the lumps as well. For the darkness, I would use hydroquinone, and maybe chemical peels. I do think that actually need more filler because the medial cheeks always need correction when doing tear troughs and that was not done. What is the experience of your provider? This is always a tough area to do, even for the most experienced injector. Were cannulas used? I think this is the one area that requires cannulas for optimal results and the least amount of bruising.

Vilma Di Maria, MBBS · Answer

Thankyou for your question but please do not have anymore filler in the tear trough. You are puffy so the filler is either too superficial, too much or affecting the lymphatic drainage. All this means is that you need some of the filler dissolved. Anymore filler will cause further puffiness..Your injector can dissolve some of the product.Good luck

Ahad Mahootchi, MD · Answer

We don't have the benefit of the before pictures but based on what you have sent I would agree with Tyndall effect being in play.I don't think Belotero on top would help. See an experienced injector who could locally reverse that and try something different or different placement of injection.

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