Restylane Effects Gone 2 Weeks After the Procedure. What Happened?

If Restylane is injected into the mid to deep subcutaneous compartment underneath the dermis, it might be resorbed much more quickly than if it were injected into the superficial fatty layer immediately underneath the dermis. It might be worth another try, somewhat more superficially, or try the thicker and deeper counterpart of Restylane, Perlane.

Post-dermal filler injections, most patients observe transient swelling. As the swelling resolves over the course of 2-3 weeks, you have a more realistic representation of your end-result.  Without seeing your photos or in person, it is difficult for me to say exactly what happened, but perhaps you need an additional syringe to achieve optimal correction.  In most cases I recommend 1 syringe for each nasolabial fold to achieve a nice aesthetic result that will last.   Best to follow up with your injector for evaluation and next steps to ensure you are pleased with your result.

Restylane is a hyaluronic acid dermal filler that’s
frequently used for lip augmentation.It’s associated with excellent clinical results and high levels of
patient satisfaction.Your
history suggest that your swelling may have been a significant contributor to
your initial result.Resolution of your
swelling has resulted in a significant decrease in the fullness of the injected
area.This doesn’t mean that anything
has been done wrong or that you’ve had an unfavorable reaction to the
filler.It just means that you need
additional Restylane.When this type of
scenario arises, an additional syringe can easily be administered to correct
the problem.It’s
important to understand that most surgeons charge by the syringe for the volume
given at the time of treatment.It’s
safe to say, that with additional volume you should have an excellent result.

It sounds like one of two things are going on:

It could be that the initial satisfaction you had was related to swelling and now that this has subsided, there may not be enough product to fill the area in question.
It could also be that the product was injected incorrectly which will cause premature degrading.

Either way, 2 weeks is much too short a time for the product results to disappear. We suggest as a starting point to go back to your injector for a checkup to further explore what's going on. If that does not work out well for you, get a second opinion with another injector. Good luck.

Generally the nasolabial folds are deep structures that benefit from significant volume.
It was likely injected on the deeper side which can hide some of the fullness but if you inject it too superficially it may be too visible.
One syringe is probably not enough for you and you may likely require two or three syringes. Obviously that presents a financial burden for you.
The alternatives are to undergo other fillers such as Radiesse which pack more product into each syringe or to contemplate autologous fat injections which cost more upfront but may provide you with a longer term result.

Restyland consists of hyaluronic acid, a natural substance. Because of factors such as the crosslinking, thickness, free hyaluronic acid, etc. hyaluronic acid products cause swelling. After injection, a single syringe of Restylane may "act" as 2 or even 3 syringes, depending on the body's swelling response. When that swelling subsides after about a week, patients have the impression that the Restylane has gone away, when in fact only the acute swelling has gone away.
There are differences in the metabolism of hyaluronic acid, from different areas of the face, differences between athletic patients and sedentary patients. However these differences are noticeable on the order of months, not a week later. There are also differences between different types of fillers. Many patients have less swelling with Juvederm, and therefore see a more realistic "final result" earlier than with a filler that, with their physiology, swells more.
The most likely explanation for your problem is that acute swelling has subsided. Some patients may wish to have their injections "staggered" so once some of the swelling has subsided, they have another injection. This of course does not solve the issue of how to completely "fix" the nasolabial folds with a single syringe of Restylane, which may in fact be insufficient.

Restylane is a great product. One drawback that may be working in your situation is that it loves to draw water into itself soon after injection. Over the course of a few weeks it lets go of the water leaving behind product. Because of this peculiarity many who inject Restylane will underfill to avoid the "bee stung" look that is out of vogue now. You may just need to go back to your injectionist for a reevaluation.
The other thing that may be going on is that the injection was placed too deep ( deep dermal or into the subcutaneous fat). If that was the case, it would get processed very quickly and lose its effect. Restylane is very stiff. In experienced hands it is not difficult to feel it. Your injectionist should be able to tell you whether it is there (conservative initial fill) or not (too deep, all gone).
The reality is that there are better fillers for the nasolabial fold: Radiesse, Evolence, Sculptra, etc. You should investigate these for yourself. Good luck.
Dr. Shah
www.drmanishshah.com

I tell people who do restylane or other fillers to be careful not to get too excited initially as that is mainly swelling. Additionally, I give my patients a mirror initially to look at the results and tell them it may get better after a few hours, but not to believe that these are the final results.
If you liked this result, you probably need more. Additionally, it may be that the area to inject is actually the cheekbone area rather than the fold as that can sometimes lift the area significantly.
Hope it works out next time.

Hi Jen RN,
Restylane needs to be injected in the proper level of the skin to be effective. If it is injected too deep, then once the initial swelling is gone, the fold may again be apparent. Some injectors may not be using the whole syringe. Restylane lasts from 6 to 9 months, will not disappear in two weeks unless it is injected with hyaluronidase.
Another common occurence is that a patient may really need more than one syringe for adequate correction of the fold, but for economic reasons do not have enough injected for complete correction of the fold. Both Restylane and Juviderm are both offering specials for complete correction where once you pay for one cc, the second cc is half price.
You should return to your physician and voice your concerns. Perhaps a second syringe will do the trick. It is important to choose your physician carefully and trust your physician with your face. Be well.
Dr. P

Jen,
Most of the effect that you saw was probably due to the swelling. If the doctor took pictures before the injection, you should be able to compare them to what you look like now. Without more information, it is hard to tell if anything went "wrong." However, the Restylane is not metabolized within two weeks. The doctor may have under-treated, which is to your benefit. If they over-treated the area, you would have strange lumps and lines after the the swelling resolved. In all likelihood, you needed more than one syringe injected. When treating the nasolabial fold and crease, you often also need injections into your midface to help fill the missing volume which, if not treated, leads to the midface folding over the nasolabial crease and causing a persistent fold despite treatment of the crease. Have them inject half a syringe of Radiesse into each cheek, fanning out from the nasolabial crease. I think you will see nice results.
David Shafer, MD
Shafer Plastic Surgery
New York City