What is this grey dark line on my face? I've had Restylane Refine placed in my marionette lines. (Photos)

Question

Hi! I'm 28 & had Restylane Refine placed in my marionette lines for loss of volume. I also have filler in my cheeks. Two different RN/Aestheticians said they don't think I need more filler. If there is bright light it's hard to see. I can still see it with makeup in certain lighting from the side. I think there was some darkness in this spot before but am not sure if it's worse after filler. The RN said it could be a vein or filler. It's not brown but more grey. Other side isn't as bad, thanks!

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  It is difficult to see what may be taking place in your pictures as this could be a small bruise or a vein that is close to the skin surface.  I would discuss with your injectors' physician for the best advice.

Aldo Guerra, MD · Answer

Thanks for your question. It's difficult to identify the cause to your problem by looking at these photos. I suggest a personal examination with a physician might be better for an appropriate diagnosis. Good luck, Dr. ALDO

Abdulla Fakhro, MD, FACS · Answer

Hello, anikaxo 
Sorry to see you are not entirely content with your soft tissue filler. I cannot tell what the line you are referring to is from, I also agree with the other answers, it can very well be a small bruise from an angry vein or vessel in the area (there are a few vessels that encircle your lips) or if it just a matter of light reflecting through the thin skin and creating a blue hue. 
a bruise will settle and improve with time and patience, but the Tyndall effect only gets better by either allowing the body to remove the filler over time or by assisting the removal by applying some enzyme in the area (Sometimes this excess filler sits higher on the skin because it was injected superficially (the most common reason is while you are pulling out of the tissue and injecting while you pull the needle out) 
take some new photos, in full lighting so that no shadow is cast on your face, it also helps if you have direct views. not just an oblique or profile view. 
hope this helps!

Blue Medi Spa - Sherman Oaks - Account Suspended · Answer

Thank you for posting the photos. However, it is still very hard to determine exactly what the line is due to. I agree with the RN stating that its either a vein or filler. If it is filler, it may be causing a blueish hue called the Tyndall affect. With that said, this usually happens with thicker fillers or if the filler has been injected very superficially. A device that we have at our facility called accuvein, can show the veins under the skin and that is one way to determine if it is just a vein that has been pushed to the surface, or it truly is filler.
Thank you, Melody

Steven F. Weiner, MD · Answer

I can't fully appreciate your gray line but this is most likely a Tyndal effect from the filler. This can be remedied with hyaluronidase. I still see marionette lines and these can often be corrected with placement of filler in the preauricular area and along/beneath the jawline. I'm a huge fan of using Refyne/Defyne in the perioral oral and it is great for this area. However, you must not over fill the marionette area because it gives a wide and abnormal looking lower face.

Justin Harper, MD - Account Suspended · Answer

HI anikaxo, You are right - the bluish line you are worried about is difficult to see. The RN is also correct when she said it could be a bruise or a filler. Bruises when treated with Laser or IPL will diminish or be gone totally. If it's dermal filler, you could be talking about the Tyndall effect, a phenomenon that occurs when when the fillers are injected too superficially. In any case, your doctor can check whether you are a candidate for laser/IPL or for hyaluronidase to dissolve fillers. Personally, you may just wait it and do nothing at this point.I agree that you probably don't need fillers. But you may consider a PDO threadlift to  lift the area adjacent to the side of the mouth.All the best,Justin Harper, M.D.

What is this grey dark line on my face? I've had Restylane Refine placed in my marionette lines. (Photos)

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