Recurrent swelling 4 months after Restylane to rear troughs? (Photos)

Question

2 months after Restylane, I started experiencing recurring swelling under eyes. Each episode leaves area lumpy & bruised. I've read horror stories about hyaluronidase making matters worse. I'd like to wait it out, but I’ve read fillers under eyes can last for years. Doc wants to dissolve, but I'm wary. I’ve read accounts of the swelling recurring even after hylase. Would love to hear from doctors who've seen this phenomenon & successfully treated it.

Sam Naficy, MD, FACS · Answer

Based on your photo's I would highly recommend you give your provider the opportunity to remove the product and treat that area. You can read horror stories about virtually anything and everything on any website, however, the horror stories don't always provide all of the information and don't apply to everyone.

Kenneth Hughes, MD · Answer

Based on the photos provided it looks like you may have an allergic reaction, not to Restylane but other facial products you may be using on a daily basis. I suggest having a follow-up consult with your medical provider

Jonathan Kulbersh, MD · Answer

Hello, and sorry to hear about the issues you are experiencing following your treatment with Restylane. It is possible the swelling can be a result of something else, as it is abnormal to have swelling appear randomly at 2 months. Were you swollen at all 1-2 weeks following the injections? When used properly by an experienced physician, hyaluronidase can have a fantastic outcome and successfully eliminate any filler that is present. And you are correct, filler can last longer than usual in the tear trough. Do you trust your doctor and his experience? If so, hyaluronidase may not be a bad option for you. In general, the side effects of Restyane may include:

	1) Swelling
	2) Light bruising
	3) Irregularities
	4) Lumps or bumps

	I would recommend following up with your provider. Go over your routine with him or her, and communicate any changes in your habits that may have led to swelling in this area to rule out any other causes. I hope this helps, and I wish you the best of luck.

Kenneth D. Steinsapir, MD · Answer

The enzyme is highly effective at helping situations like yours. It is improbable that this represents and allergic reaction to the hylauronic acid filler. However, clearly you are holding too much water in association with the product. The enzyme can be very effectively used to help this. The reason why you hear horror stories about the enzyme it that using this product well requires significant experience.

Marc DuPéré, MD · Answer

Thank you for your answers.  I agree it could be an allergic reaction: perhaps new creams, new soaps, etc.  However, I have seen this with people who have festoons.  Festoons are genetic swelling in the lower part of the lower lids into the cheek region that some people develop.  Perhaps your mom or father have that too.  It is thin skin with chronic swelling.  A mild inflammatory process, made worse with fluid retention, spices, allergies, hormonal changes, etc.  If fillers were injected into the festoon, it could worsen a pre-existing festoon.  We normally try to inject around the festoons, not into them.  So best to revisit your injector.  Medications exist to dissolve the restylane if the restylane was injected into the festoon.

	Best, Dr. Marc DuPere, Plastic Surgeon Toronto

Nima Shemirani, MD · Answer

Dear Sallify,

	
		Did you not have any swelling until 2 months out from your treatment?
	
		Your eyes look like they are having an allergic reaction, but I don't think it is from Restylane or else it would have presented much earlier
	
		You should see a specialist so that we can get a detailed history and exam to see exactly what is going on
	
		The other question is...are you sure that it was Restylane that was injected? Did you see it taken out of the box?


	Best regards,

	Nima Shemirani

Heidi A. Waldorf, MD · Answer

If you haven't already done so, please see the physician who performed your injections.  If you have already and he or she wasn't able to help you then see a core cosmetic physician known to be an expert injector.  It is not known why some people absorb more fluid with hyaluronic acid gel fillers -- increases in pressure (such as crying or vomiting) or  some interaction with characteristics of your fat, lymphatics or sensitivity to electrolyte imbalance (for example women who complain of lower lid, fingers and feet swelling after eating a salty meal) or other characteristics that make your restylane filler recurrently absorb fluid.  Regardless of the trigger, if it is due to the Restylane that was injected, injection with hyaluronidase should dissolve the filler and fix the problem.  It may take more than one session, but there is no reason you have to 'wait it out'. I hope this answer was helpful.  Wishing you the best of luck.

Martie Gidon, MD, FRCPC, FAAD · Answer

If your doctor is an experienced injector, you should consider his recommendation of hyaluronidase to dissolve the Restylane.

Steven Wallach, MD · Answer

Based upon your photos, it sounds like a good idea to try some hyaluronidase. Yes, it will cause more swelling initially but that is usually temporary. Good luck.

Richard Ort, MD · Answer

I would try a small amount of hyaluronidase to see if it helps. If you see improvement, you could repeat hyaluronidase again. I think that the swelling is likely related to the Restylane which was injected not very long ago. Make sure that you are going to an experienced injector.

Recurrent swelling 4 months after Restylane to rear troughs? (Photos)

Answers (10)

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