5 days post op Restylane- Swelling, Tyndall effect, what is this bubble lump post tear trough filler? (photos)

Question

It has been exactly 5 days since I had tear trough filler injected (Restylane). It looked perfect when I left. A few hours later I noticed a little swelling in the one area below the left eye. The next two or three days my eyes were very swollen so I didn’t notice the bubble. The swelling is subsiding and now I’m left with a bubble/lump on one side. Should I wait it out? Massage? Return to injector? I’m freaking out...

Kenneth D. Steinsapir, MD · Answer

This is not going to get better on its own.  Have your injector fix this. If they are unable to, please find and injector who knows what they are doing.  This can be rolled but I suspect you need the product modified with hyaluronidase enzyme.  These are fussy services that are not well performed by many injectors.

Nima Shemirani, MD · Answer

Hi @csper821. The filler was likely not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Another reason for the prolonged swelling can be due to the fact that too much facial filler product was used. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections. Best of luck, Dr. Nima!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. The bump could be superficial filler, too much filler, swelling or a small bruise. Try applying pressure/ massaging it over a few days. If it is not better in a week, then see your injector.

Kian Karimi, MD, FACS · Answer

Thank you for sharing your question and photo. Based on the photo you have provided, it appears your filler was injected too superficially and will likely need to be dissolved. I strongly recommend following up with your injector to discuss your concerns at your earliest convenience. He/she can inject an enzyme called hyaluronidase, which will dissolve the filler within 24 hours. While this is a common problem with injections, please be sure you are seeing a board-certified specialist for any tear trough injections. Injections into this area require a skilled injector with extensive experience. If you are unsure if your injector is qualified, please seek a second opinion. Best of luck,
Dr. Kian

Jonathan Kulbersh, MD · Answer

I recommend following up with your injector. The lump can be dissolved with hyaluronidase. It can take up to 2 weeks for final results after tear trough injections. Hope this helps.

Aldo Guerra, MD · Answer

Swelling and bruising is what you have. I don't believe you have the Tyndall effect, but you should see your injector for a diagnosis and treatment plan. Perhaps a short course of steroids might help.Best.

Jose Barrera, MD · Answer

The Tyndall effect is caused by the hyaluronic acid being injected too superficial in the tear trough area. The HA can be removed with Hyaluronidase. Hyaluronidase is the enzyme that breaks down hyaluronic acid. Although there are different types of hyaluronidase, generically its the same compound. Commercially it is available as Vitrase or Hyalase. There are different unit amounts per preparation. An experienced injector will be able to judge how much of hyaluronidase should be injected depending on the condition. It usually starts working right away.

Shaun Patel, MD · Answer

I would return to your injector for followup. If the filler is placed too superficially, it can result in lumps and prolonged swelling. In these cases, the filler usually needs to be reversed using hyaluronidase.

Melvin Elson, MD · Answer

Tyndall effect is a bluish discoloration and you do not have that/ the swelling that you have is unusual in only the degree and will subside but the lump is probably uneven injection of the material and you should return to your doctor for an evaluation

5 days post op Restylane- Swelling, Tyndall effect, what is this bubble lump post tear trough filler? (photos)

Answers (9)

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