Tear trough injections hard swelling, normal or poorly done? (photos)

Question

This is my second time restylane filler in my tear troughs. The first time there was swelling that lasted about 4 days it was "poofy" but not hard. This time where it is bruised and swollen it is hard. Is this normal? Or is it over injection/poorly done?

Robert M. Lowen, MD · Answer

When injections are done with a needle there is bound to be some injury to small blood vessels and variable bleeding under the skin and bruising. So this is a side effect of treatment. To avoid these kinds of problems, I do not use needles. Rather I use the TSK Steriglide cannulas. Through one or two distant points of injection that are anesthetized, the cannula glides through the tissue and filler can be precisely injected and distributed without causing any blood vessel injury, bleeding or bruising. It is also comfortable for the patient. Also, in the very vascular area under and around the eye, because it is not sharp, the cannula is much less likely to penetrate a blood vessel, and thus decreases the risk of injecting filler into a blood vessel which will cause an embolism.

Raffy Karamanoukian, MD, FACS · Answer

I would use Plato's Bruise Balm first followed by Hidef Hyaluronidase injections to reduce the material in the tear troughs. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

Yes, it's normal to have some swelling and firmness after under eye injections and it can last 1-2 weeks. You also have some bruising, which can happen in this area and cause firmness. I recommend using a cannula with injections to this area to reduce the risk of bruising. If you're concerned, you can have it reversed with hyaluronidase and try a different technique next time. Best, Dr. Emer

Miguel Mascaro, MD · Answer

Hannah, thank you for your pictures.  Sometimes when bruising develops the product itself absorbs more fluid and can become a little "harder".  that being said, it should soften up after a few days.  Tear troughs are particularly delicate due to the sensitive nature of the skin - therefore, I would suggest you visit your injector to see if there is anything that needs to be done as it may need to be dissolved with hyaluronidase.  Best of luck.

Hardik Soni, MD · Answer

Thank you for your question. The tear trough area is a very delicate area. It is normal to have some swelling, bruising and firmness in this area after injection. This can take up 2 weeks to resolve. It is best to use a cannula in this area to reduce the risk of bruising. If you are unhappy with your results you can have this dissolved with an enzyme called hyaluronidase. Best of Luck!

Jill C. Fichtel, MD · Answer

Many patients do experience mild swelling and/or bruising after getting Restylane to the tear troughs.  This should improve significantly over the next few days.  The tear troughs are a very sensitive area and are more prone to bruising than some other areas of the face.  Using a microcannula for future injection can help prevent bruising to some extent.

Richard Ort, MD · Answer

You should follow up with your injector if you have concerns about your results.  If you were injected with a needle, I would recommend that next time you have injections done using a blunt cannula.  This technique greatly reduces the risk for bruising, hardness, and swelling.  Regards,Dr. Ort

William Marshall Guy, MD · Answer

Hello Hannahleighhh,The tear trough area is a very delicate area.  Even being slightly off with the injection can lead to obvious irregularities.  It can take up to 2 weeks to get your final result, so if you are within that time period then probably nothing is needed.  The fact that it is hard where it is bruised and swollen likely means you have a little collection of blood under the skin, which can happen with tear trough fillers.  Since you are concerned, I would recommend you follow up with your injector for an evaluation, as an in person evaluation is the most effective way to determine what is needed.  If it is over injected, then hyaluronidase can be injected and dissolve the filler.  Given the delicate nature of the area, I would always recommend, especially for this area, that you only receive your injections from a core aesthetic physician injector (facial plastic surgeon, plastic surgeon, or dermatologist).I hope this helps and good luck.

Suneel Chilukuri, MD · Answer

Thank you for your question and sharing your photos.  It is normal to have some swelling for 2-3 weeks after hyaluronic acid (HA) fillers such as Restylane.  With significant bruising, it may feel "hard" to the touch.   There are a variety of methods to decrease swelling and bruising.  Please return to your physician for evaluation.  He or she may offer a laser or IPL to resolve the bruising within 24-48 hours.  You may also be a candidate for a low dose diuretic such as Lasix to rapidly resolve the swelling. In general, the tear troughs are a difficult area to treat.  I hope you are seeing a physician who is an expert and has significant experience injecting this delicate area. Best of luck,Suneel Chilukuri, M.D.Houston, Texas

Michele S. Green, MD · Answer

Restylane and Belotero are both great products for under eye injections.  You can definitely have some bruising or swelling after the injections.  If you are concerned about a hard area you should return to your treating physician for examination since this may need to be dissolved with Hyaluronidase.  Best, Dr. Green

Tear trough injections hard swelling, normal or poorly done? (photos)

Answers (10)

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