Poor injection technique (or too much) Restylane in N/L folds? Do I dissolve or balance out with filler to lift cheeks? (Photo)

40yo. 5 wks ago had 1 syr Resty to NL & marionette lines, plus tiny amt in lips, and a dent between eyebrows. I returned to Dr 2.5 weeks later, bc NL lines still there. On my right side, I felt I could see a "stripe" of Rest lateral to NL that exacerbated NL. I thought she might dissolve but instead she added 1 syringe Rest Silk to NL and lips. Am I now overfilled? Stripe on right now worse, there's lump left corner of mouth & I can still see lines! Do I dissolve or add volume to cheek to lift?

Doctor Answers 4

Using these fillers differently will help correct your problem

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My first comment is that I would have preferred to inject your filler where you lost your medial fat pad(mid cheek) to raise your nasolabial folds instead of injecting into them. This would have corrected the problem at the source. You need mid-face volume. I would get someone experienced to do this for you. I bet that you would not have to dissolve anything but if need be that could be done. 

Forget Chasing Smile Lines With Fillers; Instead, Think Nonsurgical Facial Volume Repletion, Recontouring & Reshaping

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The way sophisticated aesthetic physicians use fillers has undergone a revolution in the past ten to fifteen years. Nowadays, it's no longer about simply chasing after and filling in lines and folds, like the laugh lines (nasolabial lines) and marionette lines, but instead involves non-surgically re-volumizing and re-contouring the face in three dimensions to recreate, restore and reestablish the lift, contours, and projection of youth. Parenthetically, it is also no longer a "pay by the syringe" Tupperware party-like affair. More experienced physicians charge by the entire job, the way surgeons charge by the operation, no matter what it takes to get the job done, and not by the number of packages of suture material or gauze pads used. 

From the photos, it appears that you are experiencing a well described, unacceptable result arising from the direct placement of the filler within the smile furrow line or to the side of it. Since there is obvious volume loss in the mid-face cheek area above, a mid-face rejuvenation with a volumizing filler would very likely have been the much more appropriate approach. Volumization of the cheeks would not only have given them a better, more youthful contour, but would, by providing lift and projection, have likely taken care of the smile line problems without any need for directly treating them at all, which would have avoided the current problem entirely.

At this stage, you can either wait until all the injected material is spontaneously metabolized (which can take upwards of a year) or the material can be dissolved with hyaluronidase, after which the appropriate treatment, as described above may be performed, if so desired.

Be sure to consult with a board certified aesthetic physician and make certain to ask to see his/her before and after photos before proceeding. Best of luck.

Restylane Can be corrected.

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I think a lot of your problems can be corrected. Before and afters will be great, as this will give us an accurate assessment. Regardless, if you are worried about the lump, that's easily dissolved (if filler was placed there in the first place). As for the uneven appearance a good injector can correct. You also asked about the area between the nose and cheek- this should be done by an experienced injector as you have the Angular artery there. Yes, that can be treated, but filler has to be placed on bone- not for the inexperienced. 

So, yes, there are solutions, all the best
Dr Davin Lim
Laser and aesthetic dermatologist
Brisbane, Australia. 

Filler in Nasolabial Fold

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I think it would best to add Voluma to cheeks to lift away from the nasolabial folds. It is difficult to say with 100 percent certainty from the photos.  Please consult an expert.  Best, Dr. Green

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.