Is there more Restylane to dissolve or is this a malar bag? (Photos)

The problem described here follows a typical course for infraorbital lymphedema--i.e. lymph accumulation under the eyes that may follow an inappropriate placement of the filler or improper choice of too robust a filler into the thin, delicate tissues in this region. The history of persistence or occurrence years after the filler treatment is typical of this condition in my experience. If this is indeed lymphedema, lymphatic obstruction, there is little likelihood at this stage of this spontaneously resolving. In such cases, I have found that several rounds of an algorithm of intralesional steroid injections, 5-FU and hyaluronidase in varying concentrations and amounts to be helpful in shrinking these sacs. Make sure that you consult with a board certified cosmetic dermatologist with experience and expertise in treating this frustrating problem. Best of luck.

Under eye puffiness following filler can be due to the filler hydrating or the filler can block lymphatic channels.

Since I’ve had a very long history of using restylane, I have found out that Restylane can last for decades in some individuals. The only way to establish if this is the effect of Restylane versus naturally occurring puffiness as the person ages, you would need to compare the photographs of you before and after the procedure. Judiciously performed injections of hyaluronidase should correct the situation after approximately three treatments. Using fat grafting instead of fillers will correct the situation once and for all as well. I hope this helps and good luck from New York City Plastic Surgery.