Fillers Suddenly Looking Bad. What are my options? (Photo)

Question

I had fillers done exactly three months ago, trying to hide sagging eyes and cheeks. This time was Restayline, but after it was done, the doctor noted a bump in the tear trough left by a Radiesse injection from 1 1/2 years prior. The latest fillers looked good for 8 weeks but now I look worse than before, and that bump is turning into a festoon. I'm not sure if I should do more filler (had only one syringe this time) or something else. RF suggested but don't wanna lose facial fat.

Hung William Song, MD · Answer

Hello thanks for asking this question. I would advise against getting any more filler under the eyes at this point. The newly developed festoon is most likely due to the Restylane you had injected recently rather than the Radiesse you had a year and a half ago. Restylane is a hyaluronic acid filler that attracts water and is what is probably causing the fluid retention and puffiness under your eye. You can wait for it to resolve on it's own, but this can take a couple of years, or you can have it dissolved with hyaluronidase. After the fillers are dissolved, you may be left with wrinkly skin. This is where the radio frequency treatment will come in handy. By the way, hyaluronidase will not dissolve the Radiesse, but it sounds like the nodule was not visible, so you can just leave that alone. For the future I would advise PRP or PRF for the under eye area. Autologous fat transfer is also a good option, but it should be done only by a very experienced doctor.

Brian Bassiri-Tehrani, MD · Answer

This is a good question. The simplest option would be to dissolve it right away, presuming it was a dissolvable HA (hyaluronic acid) filler. After dissolved, you can have the area injected again to feather out any indents or volume loss. If you do not want to deal with the hassle of going through this ordeal again, you do not have to have a repeat HA injection. The under eye area and festoon is a challenging area to place filler and often the lymphatics become affected, leading to swelling after injection and unpredictability. Hope this helps!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Eric M. Joseph, MD · Answer

If you never had a festoon before, and if the puffiness along your right cheek is new after your Restylane injection, please visit your doctor to see if this can be dissolved with the enzyme. In general, when somebody has a problem after injectable fillers, adding more filler rarely solves the problem. I hope this is helpful! Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

I'm really sorry that you are experiencing this. Of course, an in-person examination would allow for a more accurate assessment of the problem. However, one reason for this kind of puffiness under the eyes following HA filler treatment in the region has come to be known as under-eye "puffy pillows."  The causes for this problem include an inappropriate choice of HA filler for the infraorbital region and/or too superficial placement of the filler within the very delicate tissues of the under-eye regions; the underlying issue is believed to be due to lymphatic obstruction (lymphedema). If this indeed the issue here, this can be a very difficult problem to treat. However, I have personally treated patients who were treated elsewhere who have come to me with this condition, and I have had success using a combination of intralesional hyaluronidase combined with an algorithm of varying combinations, concentrations and amounts of certain anti-inflammatory agents. You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist, and best of luck.

Camille Cash, MD · Answer

From the submitted photos it is not advisable to add more filler as it could worsen the look that already concerns you.  You can consider having the product dissolved with hyaluronidase or all it to metabolize naturally over time.  Lasers or Morpheus8 treatments may give you some improvement.

Shana Kalaria, MD · Answer

I would recommend having your filler dissolved with hyaluronidase.  Hyaluronidase is injected to the area with previous filler and dissolves the filler almost immediately. You can expect bruising and swelling in the area for around one week. Good luck!

Leonard Grossman, MD · Answer

I have been saying this for over 27 years, no hyaluronic acid filler should be placed into the lower eyelid or the tear trough. The reason for this is quite simple. The skin in the lower eyelid is extremely thin. Also, the orbicularis muscle acts as a sphincter and squeezes the gelatinous hyaluronic acid towards the nose in most patients, creating a baggie like appearance. The Tyndall effect which is blue hue, and daylight or bright indoor lighting. What you need to do is have the hyaluronic acid filler dissolved with the use of hyaluronidase. And then, once everything looks the way it used to, you can have fat grafting done to the area. Fat grafting should correct your issues once and for all as long as it’s done by Plastic surgeon with a great deal of experiencing fat grafting techniques. I hope this helps and good luck from New York City plastic surgery

Fillers Suddenly Looking Bad. What are my options? (Photo)

Answers (8)

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