Tear trough filler edema - will hyaluronidase fix this? (Photo)

Question

In Nov 2021, I had a total of 2 cc (1 cc on each side) of Restylane-L injected into my tear troughs. On most days I just dislike how it looks b/c I just feel that the natural contours of my eyes are distorted. Then about once a month I develop edema under my right eye that doesn’t respond to cold compresses or antihistamines. There are no identifiable inciting events (no cold or flu like symptoms), I just wake up like this. It is slightly tender to the touch. Will hyaluronidase fix this? Help!

Nelson Lee Novick, MD · Answer

The overall puffiness actually suggests the possibility of infraorbital "puffy pillows" (i.e. lymphedema or lymphatic obstruction) due to the filler.  Puffy Pillows generally result from an improper choice of filler for the under eye area and/or too superficial placement of the filler leading to compression or obstruction of the lymphatics in this delicate region. In the case of lymphedema due to an HA filler, the use of hyaluronidase would be the first logical choice of treatment. In my experience, alone however, This  generally has little effect on Puffy Pillows. For this problem, I have personally combined an appropriate concentration of hyaluronidase with varying concentrations and amounts of an intralesional anti-inflammatory agent with gratifying results.  Make sure to consult with a board certified cosmetic dermatologist to discuss these possibilities. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

The edema and excess filler should be reversed if that is your preference. I do this all of the time in my office but use a HIDEF approach that gradually reduces volume in order to exact the results.

Best,
Dr. Karamanoukian
Reaself100 Surgeon

Bryan G. Forley, MD · Answer

The amount, depth, and type of hyaluronic acid injectable filler placed in the lid-cheek junction or tear trough can result in the appearance of swelling or excessive fullness. This appearance of edema can be intermittent or constant and in some cases doesn't appear until months or years later. Fortunately, it can usually be successfully treated with hyaluronidase which is an enzyme that selectively dissolves the filler.

Leonard Grossman, MD · Answer

This is not edema but way too much filler. I would most definitely have the filler dissolved with hyaluronidase and do fat transfer which should provide you with much better results as well as permanency. I hope this helps and good luck from your city plastic surgery

Tear trough filler edema - will hyaluronidase fix this? (Photo)

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