Bumpy Restylane in smile lines settles to minimal improvement - expected of the product or issue with doctor's skill? (photo)

I had 1 syringe of Restylane injected 2 wks ago into nasolabial folds. Right after, I could feel hard bumps under the skin, but were not visible unless I pulled the skin taught. The smile lines looked erased. The bumps started decreasing over the next few days. Now 2 wks later, the lines are back and only minimal improvement seen. I can still see a slight bump near the nose if skin is pulled taught. Is this "settling" effect normal? Or is this an issue with the doc's technique and skill?

Doctor Answers 6

Disappointed. Is it the filler or the technique?

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Dear mrshmlopuf:

Sorry for your concerns. Your description of the changes following Restylane (one of many hyaluronic acid gel fillers) injection is spot on. Thanks for sharing your photos. To my eye, you have a very good result. 

Your photos note a nice improvement. I can only fault the lack of volume, ie only 1 cc of filler is not enough for a very large area to fill. 

I would recommend you return to your injector and consider more filler to achieve the volume and fold enhancement you seek. 

All the best!

Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Restylane injections in nasolabial folds

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Thank you for sharing your questions and photos. Your treatment looks good, but you could use a little more filler. Restylane is great for the smile lines, but if it is not sufficient, Restylane Lyft gives more volume. See an experienced injector for your treatments. 
Good luck,

Lumps After Fillers -- Not Normal, There are options!

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If you have lumps after fillers, these can be reversed with hyaluronidase. I suggest seeing an expert for injections.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

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The first thing you see within he first week is swelling and therefore they looked better. One string is often enough. You likely need another. 

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NLF and Restylane

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The initial improvement was from water coming in and at 2 weeks you should not have bumps.  it will not help to change to a different hyaluronic acid but you must be sure you are seeing a board certified dermatologist or plastic surgeon

Melvin Elson, MD
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5.0 out of 5 stars 7 reviews


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It is difficult to assess the problem from the photo. It is possible that you need more product or something thicker like Juvederm.  Please consult a board certified cosmetic dermatologist. Best, Dr. Green

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.