Discolored under eye after filler. What should I do to correct this? (Photo)

Question

I had radiesse injected under my eye well over two month ago, mainly the left eye since it was more hallow then the right eye. Now I am completely discolored under my left eye and I have no idea what to do. It looks as though I have a black eye, and I am afraid it is permanent. What should I do to correct this? I have tried eye creams with no effect at all.

Nelson Lee Novick, MD · Answer

I am sorry that you are experiencing this problem. Unfortunately, Radiesse is not recommended for under eye treatments. except when occasionally used in minute amounts along with hyaluronic acid to lighten dark circles. Belotero Balance, which I use in my Manhattan office, and Teosyal Redensity II, which I opt for in my Israeli satellite facility (where a far greater number of regulatory agency approved fillers are available), make better choices, since they possess little to no tendency to engender the unwanted, bluish Tyndall Effect when injected superficially into the delicate under eye tissues.  Since it has been two months already, your problem unlikely to be simple bruising, which is quite common when the infraorbital (under eye) region is treated. Deposits of blood breakdown products, such as hemosiderin, may be causing the discoloration, and this may take a prolonged period of time to be completely cleared. If this is indeed the case, intralesional injection of anti-inflammatory agents, such as triamcinolone, may be helpful, as may topical vitamin K, especially when combined with medical microneedling to physically break up the deposits. Going forward, make sure that you seek consultation and treatment by a board certified aesthetic physician with experience and expertise in the use of injectables for under eye rejuvenation. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Radiesse is an FDA-Approved filler that we use very frequently in our office to sculpt the contours of the face. Since we are a national center of excellence for filler reversal, we also encounter patients from other doctors' offices who wish to have Radiesse fillers removed for one reason or another. In our office, we employ a directed technique to visualize the filler material, if possible on ultrasound, and then use non-surgical methods to dissolve the filler or granuloma tissue using intralesional injections. There are many methods using a combination of enzymes, intralesional modulators of scar tissue, and Kenalog to help reduce volume and remaining filler. These techniques require meticulous attention to detail and can be performed at intervals of two to three weeks to achieve longterm effect.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hi Jessica. One question that would help us identify a common side effect is whether or not you had bruising after the treatment.  With medium and darker skinned patients, if they have profound bruising during injections or surgery, they can end up with a condition called hemosiderin staining.  If this is indeed what has happened in your case, we use q-switched lasers to break up the pigment.  An example and before and after photos can be found below.

Jason Emer, MD · Answer

I recommend following up with your injector. If necessary, this can be improved with venus legacy treatments and 5/FU steroids. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Melvin Elson, MD · Answer

Radiesse is not the best filler for this area, but now that it is done cortisone injections might help. See a a board certified and experienced dermatologist

Discolored under eye after filler. What should I do to correct this? (Photo)

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