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

Question

I got Restylane a month ago. My eyes look horrid. The doctor says that it is because my face is so hollow from medically related weight loss. But this is clearly the filler. So swollen and odd shape. Should I dissolve the filler? I looked so much better before. Now just huge pockets of fluid. This is not normal. Please advise. He also says that below the right trough I have developed a fat pocket. Which I never had until he injected too low last year. Filler that migrated? How do I deal with this?

Nirmal Nathan, MD · Answer

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.

Nima Shemirani, MD · Answer

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!

Aldo Guerra, MD · Answer

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

Harold J. Kaplan, MD · Answer

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.

Jason Emer, MD · Answer

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

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

Answers (5)