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

Question

I got Restylane injections under the eye about 8 years ago. Some of it was dissolved shortly after because of the extra puffiness and Tyndall effect. The puffiness went down a bit but decided not to continue to have anyone prod and poke me to make it worse. However, 8 years later, I continue to have a lot of puffiness especially when I smile in my right eye. Is there more restylane to dissolve or is this a malar bag? Please point me in the right direction.

Nelson Lee Novick, MD · Answer

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.

Keshini Parbhu, MD · Answer

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

Leonard Grossman, MD · Answer

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.

Robert T. Buchanan, MD (retired) · Answer

What you have has nothing to do with the Restylane you had injected eight years ago. It is simply from changes that occur with time and with your normal anatomy. What you presently need is further injection in the area by a true expert, not someone who uses Restylane  in the area and put it superficial in order to create a Tyndall effect. What you need is a filler like in Juvederm Voluma or Radiesse placed deep on the muscle below the orbital ligament.

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

Answers (4)

Answer: Puffiness after Dissolved Restylane

Answer: Puffiness after Dissolved Restylane

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

Answers (4)

Answer: Puffiness after Dissolved Restylane

Answer: Puffiness after Dissolved Restylane

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.