I Have Already Had a Full Syringe of Restylane in the Tear Trough and Still Need More!

I still show an indentation (w/puffiness) on ONE side of my face, right above my cheek. I hesitate to put more--where is it all going? The filler was added on three separate occasions. What are my other options? I don't think I want to go through this every few months--especially if it does not fill in all the way--not to mention the cost. Any thoughts please? Could it be the technique used by this particular dermatologist?

Doctor Answers 7

Restylane - I Have Already Had a Full Syringe of Restylane in the Tear Trough and Still Need More!

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The amounts of Restylane needed to "correct" areas such as this can vary a lot from patient to patient.

Sometimes it's a question of trial and error, sometimes there are differences the way physicians address specific contour irregularities.  If you've had one syringe and the results are not adequate then it's certainly possible that you would need more than this in order to achieve the changes you're looking for.  I'm not sure if I'm reading this correctly but it seems like you had a total of 1 syringe over three occasions; if so, that's not the way I would normally address this.  The syringes are single-use and I don't save them from one visit (or patient!) to another.

I would advise that you consider some additional consultations or, if not that, then some additional filler if you wish to continue the treatments you're having.

I hope that this helps, and good luck,

Dr. E

Restylane in the tear troughs

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It's difficult to say for sure what may or may not be happening without seeing you.  It is NOT unusual to need more than one syringe for a tear trough correction.  That being said however, there is no magic number or amount that works for everyone.  One patient may need only half a syringe and another may need two. Correction for this area is very injector dependent and done incorrectly it can look terrible and accentuate the problem you are trying to correct.  It is definitely better from an injector stand point to under-correct and add more volume rather than over correct and then deal with dissolving product and starting again.  It's important to pick someone with good experience injecting this area. Once you have your desired result, it should last quite some time, as this is not an area that moves a great deal the product dissolves slowly. (most patients get at least 9 months before they need touch up and some even longer)

Good luck~

Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

Restylane is excellent for correcting tear trough deformities

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Restylane is my favorite product for the tear trough. Some need more than others to get optimal correction. There are several factors to consider- sometimes the product needs to be place in different layers to get the right amount of filling without puffiness and I also find that there are times when a little strategic placement of the product to the cheek  makes a very big difference. I find it best to do this over more than one session to see how the filler settles and to assess at 3-4 week intervals.

Doris Day, MD
New York Dermatologic Surgeon

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I Have Already Had a Full Syringe of Restylane in the Tear Trough and Still Need More!

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Very unusual to need a FULL syringe of Restylane for the tear trough deformity. A posted photo ALWAYS helps to address your issues. Sounds like you need more than just fillers. 

I agree with Dr. Campanelli

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If I understand correctly, you've had a total of one syringe of Restylane, which may or may not be adequate volume for your situation.  So many factors are involved - your age, bone structure, muscle movement, in addition to the talent of your injector.....I would suggest seeing a few physicians, including an oculoplastic specialist and a cosmetic dermatologist experienced in tear trough injections.  Good luck!

Laura E. Skellchock, MD (in memoriam)
Boca Raton Dermatologic Surgeon

Persistent Indentation in the Cheek after Filler Injection

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Your problem, most likely, is that the ligaments that connect the skin of the cheek to the underlying bone are too strong and are forcing the filler out of the corrected area.  This is not common, but when it happens, it is discouraging because it can not be corrected with more filler.  Ask if this is the case the next time you are seen. 

Joseph Campanelli, MD
Portland Facial Plastic Surgeon

Restylane in Tear Trough

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Your experience sounds unusual.  I tell patients that Restylane should last 9-12 months in the tear trough.  Most patients require at least 1cc of Restylane in this area, and many require more to get an adequate fill.  The syringes are single use, so I don't inject a syringe over several appointments.  I would need to evaluate you in person to comment on the indentation and puffiness.  

I think you should see an experienced injector for an evaluation.  Options may include:

1) Injection of more Restylane

2) Massage of the Restylane

3) Dissolving the Restylane (partially or totally) with hyaluronidase

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon

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