Lower Blepharoplasty After Restylane and Hyaluronidase? (photo)

Question

4 months ago I had Restylane injected to tear troughs, and since then have had a problem with recurrent swelling, an apparent immune response to the Resty. Lower eyes are now bumpy, saggy and uneven. Originally wanted lower bleph but doc talked me into Resty instead. Now it is advised that I dissolve it with hyaluronidase. Question: After dissolving it can I still have a lower bleph? How long should I wait?

James C. Marotta, MD · Answer

You can definitely have a lower blepharoplasty following Restylane and Hyaluronidase injection. You basically want to return the lower lids to their natural state before proceeding with blepharoplasty. That is all the Restylane should be dissolved and any swelling or bruising either from the Restylane or Hyaluronidase injection should be gone. This is usually 2 -7 days following Hyaluronidase.

Robert F. Centeno, MD, FACS · Answer

Thank you for your question and photo.  Hyaluronidase will be very helpful to reverse the filler and you should proceed at your earliest convenience.  You will be back to baseline in a day or two.  Resty usually performs well in the tear troughs in comparison to the other HA's. Your findings may  be technique related not product related.  You are still a candidate for a blepharoplasty.  Best wishes.

Mark Glasgold, MD, FACS · Answer

We have been seeing an increased frequency of intermittent swelling after restylane injections under the eyes, but this usually occurs 1 - 2 years after the initial injection. We find that the swelling resolves within a few weeks of injection with hyaluronidase and we usually do it about 2 weeks before surgery. It is important the some form of volume, probably fat transfer is part of your lower eyelid treatment. I would imagine your doctor would agree with this as he suggested volume replacement initially.

Michael I. Echavez, MD · Answer

Well, to answer your first question, it would be possible to have lower blepharoplasty surgery after having had Restylane and Hyaluronidase in your tear trough area. The answer to your second question is a little harder. There is not a specific amount of time I could give you to wait in between the hyaluronidase injection and the lower blepharoplasty procedure. Ideally, you would want to wait until all of the swelling and unevenness of your lower eyelid area has resolved. The amount of time for this to happen is the unknown factor.

Bennett Yang, MD · Answer

Hi,
	thanks for the post. Yes, you can have the restylane dissolved. i doubt this is an allergic reaction. 

	it does appear that perhaps too much restylane was used. this area typically needs a very small amount. since restylane is hydrophyllic it tends to swell and expand. 

	in regards to the surgery, you would need a face to face consultation. The lower bleph is a risky procedure if you have weakness in the muscle. If I do a snap test, and find the muscle to be even marginally weak, i will not do a lower bleph. instead, i would use the laser to tighten the skin. the main concern here is something called an ectropion. This is a downward pulling of the lower lid and is a disaster of a complication that can be difficult to correct. 

	best to you.

William Portuese, MD · Answer

It is best to have the Restylane removed with Hyaluronidase. It's important to make sure that all of the Restylane has been removed prior to embarking on an elective cosmetic eyelid surgery. A second shot of hyaluronidase may be required if all of the Restylane has not been dissipated. One month would be an acceptable time period to proceed with a blepharoplasty

Lower Blepharoplasty After Restylane and Hyaluronidase? (photo)

Answers (6)

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