Constant malar edema post hyalse injections to melt the filler. What can I do to resolve this?

Question

I had filler and results were great for the first two years. 3rd top up caused a reaction. It took 3 years and several round of hyalse to melt the filler. Now, I’m left with constant edema! Festoon. What can I do for this? I’ve had 3 Morpheous 8. The treatment feels good for about 4/5 month and then I’m back to square one. I fed up with this swelling! What can I do to resolve this? Thankyou!

Nelson Lee Novick, MD · Answer

The kind of lymphedema (lymphathic obstruction) that is described here is likely related to the obstruction of lymphatic drainage, usually secondary to the use of an inapporpriately robust or water absorbing filler and/or of injection of the filler too superficially into the skin of the region. It is admittedly a tough problem, but one that may be helped by the use of varying amounts and concentrations of anti-inflammatory agents, such as triamcinolone+/-5-FU+/-hyaluronidase. Make sure to consult a board certified cosmetic dermatologist with experience in treating this troubling complication and best of luck.

George Yang, MD · Answer

Hi, you can google this relatively new procedure, which is Doxycycline injections for malar festoons/edema/crescents. The technique has been published for other providers to follow. I recently started to offer it, and it appears to work. In the study, they graded the festoons (0 for no festoon, 1 for small, 2 for medium, and 3 for large.) In the study, the statistical average was an improvement from 2.5 (medium/large) to 0.9 which is a small. The average number of treatments required was 1.4 treatments which means some needed 2, while others only needed 1. I think the larger festoons needed 2 and medium festoons needed 1 treatment. The doxycycline burns quite a bit for the first 24-48 hours before subsiding. This mimics some of the burning sensation which patients describe with Kybella fat reducing injections. Both cause a significant amount of swelling post treatment for several weeks. It takes several weeks, but near the end the patients notice a tightening effect of the festoon. HOW DOES THIS HAPPEN? Doxycycline has been used in plastic surgery for treatment of seromas, which is a pocket of serum which sometimes accumulates after a hematoma (blood clot). Doxycycline has been used to shrink and prevent the seroma from reaccumulating by causing scar contraction within the seroma pocket. This idea was then translated into the malar festoon arena will some success. I will include the link to on of the papers from 2019. I hope you found this reply helpful. Good luck. Best, Dr. Yang

Constant malar edema post hyalse injections to melt the filler. What can I do to resolve this?

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Constant malar edema post hyalse injections to melt the filler. What can I do to resolve this?

Answers (2)

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Everything you need to know about Hyaluronidase

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