Latent Bruising or Tyndall Effect Following Restylane Under Eyes?

Question

I had restylane injected under my eyes by an oculoplastic surgeon two weeks ago to correct hollowness. I had swelling for a week, but little/no bruising. After the swelling had resolved I noticed dark circles under my eyes & even darker lines from the corner of my eyes to cheek. The discoloration is strongest at my inner eye and spreads up to inner corner of upper eyelid. It changes color depending on the light. The hollows are not over-corrected. Is this evidence of the Tyndall effect? Can bruising appear later on? Is vitrase effective if the area is not overfilled?

Lorrie Klein, MD · Answer

Any clear HA filler, such as Restylane or Juvederm can look blue if placed close to the surface of the skin in thin skinned areas such as under the eyes. This is similar to clear water looking blue in a swimming pool.  This can occur with poor injection technique commonly but can occasionally with good technique also if the skin and muscle are both very thin in this area.  I would recommend waiting 2 more weeks, just in case it is latent bruising, then have your doctor dissolve it with hyaluronidase and re-treat the area. Sometimes Radiesse can be used if either the skin or muscle and subcutaneous tissue are thick enough to handle it.  If your doctor is not very experienced with fillers under the eyes, have someone who is re-treat you.

Marc DuPéré, MD · Answer

Thank your your question.  It would be useful to see your before pictures as a darker skin discoloration is often present pre-treatment (very common) of the #tearthroughs but then get 'pushed' to the surface and become more obvious after treatment of the hollows with dermal #filler injection.  Tyndall effect is also possible but hard to assess from your picture.  Tyndall effect is a bluish discolouration due to either filler injected too superficially, too much of a too thick filler (as you know, fillers come in different 'molecular sizes') or filler positioned properly but the overlying muscle and skin being too thin.  Time can help or perhaps, a dissolving enzyme.  Wait another 2 weeks and visit your injector.  Best of luck.  Dr Marc DuPere, Board-Certified Toronto Plastic Surgeon

Kenneth D. Steinsapir, MD · Answer

However what I see in this images is too much volume at the transition from the lower eyelid to the cheek skin. The treatment is a small modification of the treatment with Vitrase (hyaluronidase) to soften this ridge.  You may not see it as over fill but it is visually read as overfill.

Steven Wallach, MD · Answer

It is most likely the tyndall effect from the product being too superficial.  This can be treated with hyaluronidase to "melt" the product or will eventually go away over time.

Darryl J. Blinski, MD · Answer

Your description is classic Tyndall effect. The "bluish" hue is the effect of light refraction through the skin layers hitting the injected product. Yes, Vitrase will help. I recommend against the "nick and squeeze" technique because of you will have a small scar, more swelling and ecchymosis. Time will also help improve.

	From MIAMI Dr. B

Latent Bruising or Tyndall Effect Following Restylane Under Eyes?

Answers (8)

Answer: Tyndall Effect

Answer: Tyndall Effect

Answer: Tyndall effect following Restylane under eyes

Answer: Tyndall effect following Restylane under eyes

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Latent Bruising or Tyndall Effect Following Restylane Under Eyes?

Answers (8)

Answer: Tyndall Effect

Answer: Tyndall Effect

Answer: Tyndall effect following Restylane under eyes

Answer: Tyndall effect following Restylane under eyes

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Everything you need to know about Restylane

Our mission is to create a world where every investment in modern beauty is Worth It.