Received half a Syringe of Restylane (0.4cc) to treat both tear trough areas...Not sure if it was enough

Question

Abt 11 days ago I had 0.4cc syringe of Restylane injected into both of my tear trough areas (0.2ccs on each side). For the few days afterwards my eyes looked great! But then I noticed that the areas are somewhat hollow again and I'm not sure if this is normal b/c it has now settled or if I should have gotten a full syringe (1/2 syringe on both sides) to treat the areas. Should I go back to my doctor and get another 0.4cc syringe injected into both areas (0.2ccs on each side) ?

Harold J. Kaplan, MD · Answer

Hi Delilah.  We typically use between 1-2 CC's for this procedure so .4 is a very small amount.  What you were seeing was probably swelling.  Was the treatment done with a technique called "under the muscle"?  If not, I would be concerned about getting more injected as this is a very technique dependent area.  If your injector is placing the product deep in the skin under the muscle, then by all means go back for more.  If you only get .4 CC's you may not see value past a few months.  We inject 1-2 CC's to get patients 6-12 months duration.  Good luck.

Kenneth Hughes, MD · Answer

It sounds like you were under-dosed and it was mostly swelling that you saw the first few weeks, I do suggest you have another syringe to see full result

Jason Emer, MD · Answer

0.4cc is a very small amount to the tear troughs.  I typically use cannula injection or depot on the bone in this area and get good results, but use much more than 0.2cc per side.  You may also consider a different filler such as Voluma which gives a little more lift if you are truly "hollow."  Without photos it is very difficult to give a great opinion.  However, I do agree with the other responses that an expert injector, someone with a lot of experience and significant background, is required for treating this area.  I wish you the best of luck, Dr. Emer.

Nissan Pilest, MD · Answer

It is
possible that you had swelling under your eyes and that is why you thought it
looked great for the “first few days” but .2cc is a very small and does not
give very much improvement.

In my office
I typically start off by injecting 1 cc of Restylane .5 and .5 into each tear
trough. 2 weeks later I have my patient come back in for a follow up and we
decide if they want or need additional filler at that time.

It is best
to consult with a Board Certified Dermatologist with plenty of experience
injecting under eye hollows.

Michele S. Green, MD · Answer

Restylane for tear troughs is a wonderful tool.  It sounds like you just need a little bit more Restylane injected into the area for a full result.  I would suggest you return to your treating physician to correct the tear trough area.

Robert L. Kraft, MD, FACS · Answer

0.4 cc of Restylane is a very small amount and insufficient to treat both tear troughs.  You probably demonstrated improvement based on post-procedure swelling.  I think that you will find that a full cc would be necessary to establish a sufficient and longer lasting improvement. I am personally not a fan of the smaller syringes as they are less cost effective than the 1 cc dose.  Many physicians offer them as a "come on" because the price seems so much lower or use them for touchups.  Remember that whatever product is not used can be stored for your personal use at a later date.

Sheryl D. Clark, MD, FAAD · Answer

We don't have the advantage of pictures, but it is always good to start with less filler and add more. This makes it less likely that you would bruise or have puffiness under the eyes.  So if you to,erated it well it is probably time to have a little more.Medicis used to produce Restylane in 0.4 cc syringes (as well as 1 cc syringes) but now provides 0.5 cc, 1cc, and 2 cc syringes.

Chase Lay, MD · Answer

it's always a good idea to do less especially if your first starting out with these types of treatment.  If you feel like it is not quite enough then you can always add more.  There is no cookbook or guide for this sort of thing.  This should be tailored and customized to each patient.

Anne Marie McNeill, MD, PhD · Answer

I agree with that approach.  It's always best to start with a small amount of Restylane under the eyes.  Often, the 0.5cc vial (the smallest vial) is enough under the eyes.  But everyone's different.  I usually start with 0.5cc in the tear troughs, and see the patient back in 2 weeks to decide if that's enough.  It's very likely that you just need a little more, so I do think it's best to go back and discuss that option with your doctor.  Best, Dr McNeill

Eric Desman, MD · Answer

Without pictures, it is difficult to assess, but it does sound like you may just need more product. I would recommend returning to your doctor and considering more. This is one of the nice things about hyaluronic acid fillers in general - you can layer product on without having to overdo it.

Received half a Syringe of Restylane (0.4cc) to treat both tear trough areas...Not sure if it was enough

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