How Come Some People End Up with Bags After Having Restylane Injections?

While Restylane is a great filler for tear trough deformities (grooves that some people get under their eyes), improper placement can end up looking like a blue bulge.  This is usually the case if it is injected too superficially (close to the surface of the skin) or too much is injected.   Another, rarer cause of this problem is if the filler is accidently injected into the lymph vessels in this area.  If this happens it can block the normal circulation of lymphatic fluid and cause a persistent swelling that can look like a bag.  It is crucial to go to not only an experienced dermatologist or plastic surgeon but also one who does a lot of treatments in this area.  Some cosmetic physicians have limited experience in this area so ask before you make your appointment.

Hi Sarah.  In cases where under eye treatments create bags, the most likely reason is improper placement of the product.  There is a technique known generally as "under the muscle" that is used in this area.  The technique is different in the under eye area than say in the cheeks because of the delicate nature and thin skin found under the eye.  

Many inexperienced (and some experienced) injectors do not use this technique and it often results in the product creating lumps near the surface of the skin.  The best way to avoid this issue is ask what technique your injector uses and view their before and after photos.

We are located in Orange County, offer free consultations regarding this procedure and you can see photos of our work on the tear trough under eye procedure below.

Restylane to camoflage bags under the lower eyes usually works quite well in a properly selected patients. If someone's eyes look puffy after treatment it is usually due to one of three causes. The first is that the eyelids swell for two days following Restylane injections. Second, the best candidates have bags in their lower eyelids then a hollow area called the tear trough, then the cheek mound. Filling the valley between two hills usually works great. I feel the most common reason that lower eyelids look puffy is when a patient has hollowness uner the lower eyelids but not "hill-valley-hill." Filler may not be a good idea or should be put in slowly over a number of sessions to make sure it looks good.

Thinner hyaluronic acid filler products tend to migrate.  This is what makes them less likely to lump.  While this is a helpful characteristic in certain parts of the face, in my opinion it is not helpful in the under eye area.  This tendency for some fillers to drift may contribute to unexpected fullness under the eyes.

If a service is not skillfully placed, any of these fillers can cause these types of issues.  I also think this is more likely in individuals who are predisposed to developing festoons-that extra flag of fullness that forms at the top of the cheek just below the lower eyelid hollow.  The other situations that seem to predisposed to this type of issue including individuals who have had multiple lower eyelid surgeries and individuals with very thin lower eyelids.  In some cases, this issue can be very difficult to resolve without effectively removing every bit of filler.  An experienced injector will be reluctant to inject you if you are in one of these categories.  Having said that, I have numerous individuals who have had every one of these concerns and yet had spectacular results with under eye Restylane treatment.  

Another type of fullness that can be seen after an under eye filler service is a slight reflective highlight in the lower eyelid.  These represent very slight areas of overfill caused by the lower eyelid holding just a little too much tissue water in association with the treatment.  These are easily adjusted with an enzyme service.  Despite the ease with which these can be adjusted, many injecting physicians are not comfortable working with the enzyme.  I have seen many patients who were treated elsewhere and lived with this type of easily adjustable issue for well over a year before having this successfully adjusted by me with the enzyme in just one treatment session.  Hyaluronic  acid filler treatments are adjustable that is one of the reasons they are so popular.

The bags under the eyes from Restylane are usually from improper placement of the material. The role for Restylane to correct the lower eyelid is limited to the tear trough groove. If the groove is not filled in the right spot, then the fat in the lower eyelid can look even more prominent.

The best option of heavy lower eyelid bags is lower eyelid surgery (Blepharoplasty)

Regards

Dr. J

As others have said, there are so many variations in the anatomy of the lower eyelid that there is no one reason.  The best advice is to go to an experienced injector with knowledge of the anatomy.

If treated properly, Restylane should not produce lower lid bags. As you well note, the purpose of Restylane is to fill the hollows under the eyes in the tear trough area. Once injected in the correct location, Restylane should not migrate.

 Restylane, like all soft tissue fillers add volume and sometimes this volume occurs somewhere else besides where it is the most aesthetically correct.  This could easilly create relative "bags" of the lower eyelids.

I very much agree with Dr. Janjua on his assessment here. Usually undereye bags come from improper placement of the Restylane. If the eyelids are at all heavy or puffy to begin with, adding Restylane under them, in the tear troughs or upper cheeks, can actually make the eyelids appear bigger and baggier. If you are trying to correct under eyebags with Restylane you are simply choosing the wrong procedure. Restylane should be used for volume loss.

Hi.

The results can be very gratifying, but this is a tricky area.   As you say, it must not move!   You need a very experienced plastic surgeon or dermatologist.