Should I dissolve or surgically remove overfilled Restylane after 6 months? (photo)

Hi BlueBosch, If your right eyebag was larger than your left eyebag prior to injection of filler, then more dissolving will not work. If the eyebags were  even then most likely even with a couple of dissolving sessions there may still be a small pocket of filler that was missed. Why might the filler be missed during dissolving?  A lot of filler was used so, it makes sense that more dissolved and more sessions may be needed to get it all “washed out.”  5 syringes of filler, is a lot of filler for lower eyelid filling to either fill in hollowing or trying to camouflage the eyebags.  In general, most patients only require 1-2 syringes and the most I’ve used on one patient was 4 syringes. With all of those injections, there is a membrane around the eyebag which holds the lower eyelid fat, called the orbital septum. When filling the lower eyelid hollow under the eyebag, we fill under the muscle (orbicularis oculi) but do not want to get any filler under the orbital septum, because that would make the eyebag larger.  How do I guide the filler under the muscle but not under the orbital septum?  I prefer using a microcannula, which is a specialized needle used for injecting filler which has a blunt rounded tip, this helps me feel which layer the tip of the cannula is located.Before I used microcannulas (prior to 2012), I would use the needles provided with the syringe of filler.   The technique is to place the tip of the needle onto the surface of the bone and inject small amount on the surface of the bone like a mini implant.   Thinking back, this technique would definitely ensure that the filler is under the orbicularis muscle, and if the needle tip is below the eyebag that should keep the filler outside of the orbital septum.  With larger eyebags, filler on the bone doesn’t seem to hide the eyebags well enough, and you can still see the eyebag above the filler.   If they use the needle and move upwards to try to further fill the remaining groove, going down with the needle, they may actually be inside of the lower edge of the eyebag and under the orbital septum, and any filler inside the orbital septum would actually make th eyebag larger. For this particular reason and many others, I prefer using a microcannula for filling the lower eyelid hollowing and camouflaging eyebags.  In future responses I will give to other questions, I will try to go into more detail the benefits of using a microcannula  If your injector did use a microcannula, it is still possible to get a little bit of filler through the orbital septum, but less likely. Why? The blunt tip requires some additional pressure to pop through the orbital septum, and the injector should be able to feel that pop.  The dissolver (hyaluronidase) can be directed under the orbital septum to intentionally using this technique to make sure the dissolved is in the same compartment as the possible residual filler. If  not the orbital septum will actually act as a wall and protect the filler from dissolving. Hope that makes sense. Best,Dr. YangP.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.
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Hi @BlueBosch! The filler can be dissolved with Hyaluronidase. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck to you, Dr. Nima!

I'm sorry you aren't happy with your results. The good news is you can have the filler reversed with hyaluronidase. Hope this helps.

If you're unhappy with your final results, you can have it reversed with hyaluronidase and try a different technique next time. See an expert. Best, Dr. Emer

Perhaps the most difficult and unforgiving places to inject filler is the lower eyelids.  You have had what I would consider an enormous amount of filler injected into the lower eyelids.  From the photos that you have provided it really looks like psuedo fat herniation of the lower eyelids.  I would absolutely not inject dissolver into these fat pockets as they are behind the orbital septum and that is no place for blind manipulation.  The idea that someone injected into this space is a little concerning.  You have two options from what I see in your photos.  You can have normal lower eyelid injections with Restylane and the use of canulas to fill out the orbital hollow.  You are also a candidate for a transconjunctival surgical blepharoplasty.  Consult with an experienced facial surgeon who is also experienced in eyelid injections so that you can get the best options available to you.

Whoever injected you has, in their enthusiasm, injected you in the planes just behind the orbital septum. They often do not understand this when it comes to enzyme the service. Also doctors tend not to use enough enzyme. I recommend getting the enzyme service you need. Read my patient reviews and you will see that I have done this for people who were subject to surgery to do this issue and they still need the enzyme. Do yourself a favor and get the care you need and stop messing around with amateurs.

Thank you for your pictures and I'm sorry you are experiencing this.  There is no need for surgery and simple couple of treatment with an enzyme to dissolve restylane will help you remove the bags, maybe even a short course of steroids.  I suggest you follow up with your injector to discuss this.  There is no need for surgery at all, unfortunately you just need patience and it will get better. Hope this helps. Best, Dr.Avaliani

If the under eye bags werent there prior to the procedure, this is most likely an allergic type reaction to the filler. The filler should be dissolved with hyaluronidase, which is safe and effective. There is no reason to have surgery. 

Thank you for your pictures and I'm sorry you are experiencing this.  There is no need for surgery and simple couple of treatment with an enzyme to dissolve restylane will help you remove the bags, maybe even a short course of steroids.  I suggest you follow up with your injector to discuss this.  There is no need for surgery at all, unfortunately you just need patience and it will get better.

That is a very large volume of Restylane to put under the eyelids.  If you have fullness under the lids, it is usually caused by excess fat and having a lower blepharoplasty to remove or reposition the fat is a more appropriate solution.   See a board certified Plastic Surgeon or an oculoplastic surgeon.   Injecting filler under eyes is an off label and potentially hazardous practice.   There have been reports of filler clogging vessels in the eyelid.