Restylane Effects Gone 2 Weeks After the Procedure

I had 1 syringe of Restylane injected into my left nasolabial fold about 3 weeks ago. I was immediately impressed with the results. However, after about 2 weeks, the wrinkle was fully evident again. Did the doctor do something wrong, or did my body reject it? What happened? I don't have that kind of money to waste. Thanks.

Doctor Answers 21

Restylane lasts months, even a year or more.

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Swelling may occur with fillers that can last in a rare case up to 2 weeks (usually only a day or two). It sounds like you were happy with the volume achieved from the swelling after your procedure. What you need is more volume from the Restylane, that means another syringe.  The biggest problem with first time filler users is that they do not have enough volume (trying to get a result without using the proper number of syringes).

Paradise Valley Dermatologic Surgeon
4.6 out of 5 stars 36 reviews

The bottom line is: go back and discuss your results with your treating physician/injector.

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We live in a mobile society and the rave associated with soft tissue fillers is getting a great cosmetic ‘fix’ with a fast recovery. Restylane fits this bill. In general, downtime with Restylane and soft tissue fillers are minimal.

For several days following an injection of Restylane, there may be mild degree of swelling which can be confusing giving the appearance of a more complete fill.

If at three weeks you feel that you have lost the filler, then I would go back to the physician/injector to discuss your results. Hopefully, pre-injection photographs were taken so that true comparison photographs can be studied.

One of two scenarios will most likely present: the first is that you do have more clinical improvement than you appreciated, but simply need more filler material.

The second condition is exactly what you stated whereby you truly show little to no improvement and the nasolabial fold is completely back. This is probably indicative of Restylane being placed in the wrong area, and completely missing the deep dermis.

The bottom line is: go back and discuss your results with your treating physician/injector.

Thanks for your question.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Restylane resolved quickly

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

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2 weeks is too short for Restylane effects to disappear

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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.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Nasolabial furrows often require several treatments

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One syringe of Restylane may not be nearly enough for the correction of deep naso-labial furrows. It sounds as if your early satisfaction may have also been due to the immediate post-injection edema that is often present in the first week or so. Deep nasolabial furrows may require multiple treatments over several weeks, and we prefer Perlane, Juvederm Ultra Plus, or Radiesse for this area in most cases, since they are all a bit thicker. This area can even require some type of surgical approach but this is a subject for a different thread.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Restylane for smile lines: think about 2 or 3 vials

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

The hyaluronic acid is still there, but not the swelling

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Restylane Gone Gone Gone

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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

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Much of the effect you saw was probably from the swelling

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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

I would see your doctor

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What is likely happening is that you initially saw swelling as a result of the injections and were pleased with the result. Once the swelling subsided, you may be realizing that you need more filler to completely fill the wrinkles. I would recommend you visit with your doctor to see if you need another syringe or a different product to better suit your needs. Best of luck. 

David P. Rapaport, MD, FACS
Manhattan Plastic Surgeon
4.7 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.