Necrosis, is This Possible in the Tear Trough Area?

Question

It has been 7 hours after the restylane injections and i have developed swelling and bruises under both eyes. What worries me is during the injection of the filler I have developed a hematoma under one eye which quickly spread half the size of a penny. And now it seems like there is an area of blanching. I am freaking out right now and I am extremely worried that this is an impending necrosis. Please advice!

Kenneth D. Steinsapir, MD · Answer

I have not seen one example of necrosis in this area. It is the glabellar area that experiences necrosis. That does not mean you can't bruise and the bruise can be nasty. I advise my patents to think of these services as surgery in a syringe. The incidence of a black eye in my practice is about 2 out of 100 treatment. However that black eye is memorable. I recommend that you call your injector and let them assess what is going on. The black eye can last 3 to 4 weeks and it is embarrassing. People think you are the victim of domestic violence and these bruises are very hard to cover up. Hang in there and do repost and let us know how things went.

Sam Naficy, MD, FACS · Answer

It is not uncommon to have bruising that can last up to 2 weeks (or longer) in the tear trough area, and you will be swollen for the first several days after treatment. However, I wouldn't hesitate to contact the provider/injector and have an assessment right away to help alleviate your fears of necrosis. While it's not likely, it's best to have a person trained and experienced to assess this, rather than wait and worry.

Jonathan Kulbersh, MD · Answer

It is possible to develop a hematoma following Restylane injections.  Necrosis is typically caused by a lack of blood flow to a given area, and is very rarely caused by filler injections to the tear trough.

	 

	In general, if there is necrosis present, you may experience:

	1) Severe burning and pain
	2) Skin turning black in the affected area

	If you are concerned that you are experiencing necrosis, I would go to the ER or find the doctor on call ASAP and see a professional.

	 

	The typical side effects of Restylane may include:
	
	1) Minor bruising and swelling
	2) Infection
	3) Hematoma
	4) Redness
	5) Irregularities due to poor technique

	Thanks, and I hope this helps!

Rebecca Baxt, MD · Answer

It sounds like you have a bad bruising situation, but call your doctor and go in for an evaluation asap if you are not sure. Any good injector will see you quickly if you are worried about a side effect.

F. Victor Rueckl, MD (in memoriam) · Answer

First, please don't freak out. Swelling and bruising are normal with any fillers, especially in the tear trough area. Second, blanching can be the result of the hematoma, or the lidocaine that was used with your filler (either in addition to the filler, or the one that comes in the Restylane). If you are this nervous and upset, I would recommend you contact the office that injected you so you can be seen and evaluated. Technically you can get necrosis anywhere, but it's less likely to occur around the eyes. Remain calm. Use ice. And do not press on or move the filler around. Even if it is necrosis it can be fixed.

Necrosis, is This Possible in the Tear Trough Area?

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