I've been dealing with intermittent swelling under my eye caused by HA filler for 9 months. No dr has been able to help (Photo)

Question

I got Restylane Lyft injected under my eyes and in my cheek bone area in Dec 2018. In Mar 2019, the area under and the side of my left eye started to swell. This has been happening intermittently since then with the amount of time in-between flare ups ranging from a week to 3 weeks and each flare up lasting 3-4 days. I have seen a handful of doctors with 3 of them attempting to dissolve the filler with Hyaluronidase. I think the filler is in my lymph nodes and thats what causing the swelling.

Anna Petropoulos, MD, FRCS · Answer

Dear Ms. Resourceful,I am sorry you have to go through this difficult time. We do a lot of cases similar to yours in our office with hypomalar projection from ground zero. The caveat is to  ensure  a radiofrequency tightening of the lymphatic vessels occurs BEFORE proceeding with filler placement.The second caveat is to know where to put the filler and build up an inferior orbital rim / medial zygoma first BEFORE considering injecting eyelid filler.  This sequence of events has served us well over a decade and a half in safely creating beautiful youthful contours of the mid face and eyelid junction with fillers alone. Treatments performed elsewhere with similar problems to yours (and much worse)  come to us to fix them. We have found that a "salvage" radio frequency treatment to the lower eyelids tightens the dilated lymphatic channels and also tightens the skin and dissolves the erroneously placed filler. Then the tissue is ready to receive the proper contouring that it needs. It is unfortunate that the public thinks any doctor or nurse knows how to  inject in this very tricky area (or other areas for that matter). It takes a lot of skill, background knowledge and experience with the different anatomical structures and planes that typically are only gained in a plastic surgery residency/ fellowship, followed by years of experience. Please do not despair and know that your situation is easily treatable in the right hands. Best Wishes in your quest, Dr. Anna PetropoulosBoard Certified Facial Plastic SurgeonBoston's North Shore

Nima Shemirani, MD · Answer

Hi @aml001. Thank you for sharing your photos. I am sorry you are dealing with this. I recommend an in person consultation with a board certified facial plastic surgeon.

Best of luck,

Dr. Nima

Nelson Lee Novick, MD · Answer

I have had a number of patients injected elsewhere come to me for a similar problem following treatment with an under eye filler, particularly with fillers like Restylane (and Juvederm, another common filler that some physicians inappropriately use for this very delicate superficial region).  The swelling is believed to be related, as you suggest, to lymphatic obstruction. So, admittedly this can be a troublesome and persistent problem in this region where treatment effects for the good, as well as the not-so-good, as in your case, can persist for a very long time. I have personally found that hyaluronidase used alone seldom is sufficiently effective. However, I have had success when it has been combined with appropriate concentrations and doses of an antiinflammatory triamcinolone repeated several times at monthly intervals. Make sure you see someone experienced in dealing with this issue. Best of luck.

Leonard Grossman, MD · Answer

You still have a considerable amount of hollowness in the lower eyelid and cheek area. I would stop using hyaluronidase. If you go to a plastic surgeon who is well-versed in fat grafting techniques, they should be able to even out both sides of your face and at the same time the swelling that you see you should go away through the use of stem cells that is present in properly selected fatty tissue. This procedure when expertly done has 100% success rate. I hope this helps and good luck from New York City plastic surgery

Robert T. Buchanan, MD (retired) · Answer

I too am sorry you are having so much trouble finding someone who can give you definitive answers to what you should do next. I agree with all 3 of the previous commenters. This is an extremely hard area to treat properly and the majority of injectors really do not know how to treat it. The "knee jerk" reaction is to inject with hyaluronidase, but this may not be what you need. Unfortunately, reactions like yours are more common than thought,and not documented well in the literature. Only a direct exam by a true expert when the area is reactive will allow proper decision making. Triamcinolone could be a reasonable option. Further fill, with either the proper filler or fat, could also be an option. Boston is large enough that you should be able to find someone to help.

I've been dealing with intermittent swelling under my eye caused by HA filler for 9 months. No dr has been able to help (Photo)

Answers (5)

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