I have purple slightly raised area under my eyes a few years after getting filler. Is this tyndall? (Photos)

Question

I have purple slightly raised area under my eyes a few years after getting filler. I also have sinus pain the last few years - not sure if they are related. injector placed 1ml of Restalyn lift under each eye. I have spoken to him a few times over the years about potentially having it removed but he claims it’s in my imagination. I did seek a second opinion of which they said they can definitely still see it there and that he placed too much but that he is best to disolve. Thoughts?

Brandon Richland, MD · Answer

Hello, and thank you for your question. Under eye filler is a very sensitive area to place filler, and if overdone, can cause/worsen under eye bags or create a Tyndall effect. If you feel this can be dissolved, especially since you had another provider tell you to dissolve this, then I would go ahead and dissolve. Yes, sinuses can affect several areas of the face and may cause swelling in unwanted areas. However, a ball of filler can also result due to placement of product, amount of product, or migration of product. I would recommended seeing a provider who can dissolve the product and potentially refill by a new provider or seek alternative methods to help with your under eye concerns. Hope this helps!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

There is a suggestion of a Tyndall Effect in the photos, but the overall puffiness actually suggests the possibilituy 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 either the case of Tyndall Effect or lymphedema due to an HA filler, the use of hyaluronidase would be the first logical choice of treatment. This usually works well for the Tyndall Effect, but 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.

Kenneth D. Steinsapir, MD · Answer

Please understand that Tyndall has become a nonspecific term that is used to describe any unwanted skin color change after filler. Is this Tyndall? Absolutely. Restylane Lyft is a poor filler choice for this area. It is very challenging to place this stiff filler as smoothly as necessary to achieve a satisfactory result. This product should be removed with hyaluronidase enzyme. Standard Restylane (lower G prime than Lyft) is the best choice but still requires skill to get a great result. Hope that information is helpful.

I have purple slightly raised area under my eyes a few years after getting filler. Is this tyndall? (Photos)

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