Should I use hyaluronidase & is it possible to reduce puffiness rather than remove it all? (Photos)

Question

I had under eye/upper cheek filler in 2021 (three vials of Restylane). 1yr ago they started attracting water, becoming increasingly puffy particularly under one eye. When I'm not smiling or laughing, it's no problem. 1yr ago I had temple/outer cheek filler, maybe impacting lymphatic drainage. Would anyone recommend me dissolving and if so, is it possible to reduce puffiness rather than remove it all? Any use cases of hyaluronidase? What about Toplaise? I was previously VERY hollow.

Nelson Lee Novick, MD · Answer

This quite possibly is lymphatic obstruction/lymphedema, a condition that has been called under-eye "puffy pillows" that is believed to arise from an improper choice of HA filler for the under-eyes and/or too superficial placement of an appropriate filler. It can be a difficult problem to treat. However, I have had gratifying results using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps.

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