Huge pockets of fluid under eyes after Restylane. 1 month post op. Did the filler migrate? (photos)

Hard to tell based on the photos you submitted...but if you don’t like the results you can reverse it with hyaluronidase. It is unlikely for the filler to migrate unless it is something permanent like silicone. Permanent fillers can create inflammatory responses that cause migration. 

Hi @littlegrasshopper! There are a few reasons for this swelling. One being that the filler was 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. Another reason for the prolonged swelling can be due to the fact that too much facial filler product was used. 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, Dr. Nima!

Thanks for your question. There should not be so much swelling after 1 month. You may have an over corrected result and some may need to be dissolved. See an expert! Dr. Aldo

Hi LGH.  It looks like it's possible that the filler was placed superficially below the eye.  In this area, we usually place the product beneath the muscle that surrounds the eye.  In this way, we get a very even fill and smoother appearance.  We also avoid the product migration you express concerns about.  
Hyaluronidase (Vitrase) is an enzyme that can be used to help dissolve the dermal filler if it is Hyaluronic acid based (Like Restylane or Juvederm).  Hopefully getting the reversal solves the problem.  

If you're unhappy with your final results, you can have it reversed with hyaluronidase and try a different technique next time. See an expert. Best, Dr. Emer

Your images suggest that one or more of the following has happened: 
- Too much filler, esp. a particularly hygroscopic (= attracts water) type such as Restylane, which would then set-up a vicious cycle of locally impaired lymphatic drainage (i.e. more fluid is kept under your eyes); 
- Incorrect plane of placement, e.g. too close to the skin. 
... exacerbated by your lean facial habitus. 
Since filler in the infraorbital area may take years to disappear, the best solution is to use hyaluronidase to breakdown some, or all, of the hyaluronate-based filler.

Thank you for your question. It is not typical to have so much swelling 1 month after filler injection to the tear troughs. From your photos, it appears you may have been overcorrected and the filler can be dissolved with hyaluronidase. I recommend having a follow up with your injector for an evaluation. Best of Luck!

It is very unlikely that the filler migrated but more likely that it was misplaced. You can wait for it to simply go away or hyaluronidase will remove it but be sure you are seeing a board certified dermatologist as these things are not simple

Hi. I appreciate you are not happy with this. There are a couple of possibilities. It could be filler - in which case it will feel firm to the touch. More likely is that there is now a collection of fluid in your lower eye lid. This will feel very soft to the touch. I think this is much more likely. Unfortunately Hyaluronic fillers like Restylane do attract water. Also placing them under the lower eye lid can obstruct lymphatic flow leading to build up. Because you do not have a lot of volume in your face anyway, as you point out, anything like this will be that much more obvious.
I honestly believe the best course of action is to have at least some of the Restylane removed with Hyaluronidase injection. Possibly only a little treatment is needed to improve lymphatic flow. This will improve it almost overnight. If left it is likely to persist like this for months.
Hope that helps
Dr Chris Leat