Ridge and discolouration under eye 1 month after Restylane injection to tear troughs. What's your opinion? (Photo)

Question

Followup apt 2 wks later to determine if this was due to the Tyndall effect, as the swelling and discoloration were still prevalent. Doc assured me that it was not the Tyndall effect, but a hematoma. I Am darker under both eyes now, along the line of unjections. Could this still be bruising 42 days later? Or a hemosiderin stain? Also, there is a distinctive column of fluid under my left eye, slightly raised, and quite pigmented. What is your opinion of this? How do I rid myself of a hematoma?

Harold J. Kaplan, MD · Answer

Hi Ally.   Hemosiderin staining is typical in patients that have type IV skin (Asians, Hispanics and Middle Eastern patients) and in situations where there was profound bruising after the injection treatment (under eyes, legs for spider veins, etc).  If it's 42 days out and you still have darkening under the eyes that was left behind after bruising, then it is likely to be hemosiderin staining.  Hemosiderin staining is differentiated from the Tyndall effect because the Tyndall effect is normally bluish or even dull grey whereas hemosiderin staining appears more like a brownish color.In our Los Angeles and Orange County based practice, we treat Hemosiderin staining with gentle q-switched Nd:Yg laser treatments.  The heating effect of this laser (which is designed for dark lesions like tattoos, sun spots and birthmarks) coaxes the dark pigment out over a short period of time (2-3 treatments).

Jason Emer, MD · Answer

This is a complication common of poor injection technique.  I suggest going to a cosmetic physician for a second opinion, and having them reverse the filler which can easily be done with an enzyme injection.  Best, Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

It looks like it is both Tyndall effect and hemosiderin deposit. Consider getting hyaluronidaze injection to get rid of some or all of the filler.

Sam Goldberger, MD · Answer

It certainly doesn't look normal.  From the photo, it looks like it could be Tyndall effect.  See another physician for a second opinion and be ready to receive Hyaluronidase to dissolve the Restylane.

Michele S. Green, MD · Answer

It appears from your photos that the product was injected too superficially.  Please consult a board certified dermatologist with experience in cosmetic facial injections to have the product dissolved.  I suggest waiting a few weeks and then have the tear trough area re-injected properly with either Belotero or Restylane.

Ridge and discolouration under eye 1 month after Restylane injection to tear troughs. What's your opinion? (Photo)

Answers (5)