Restylane - Gone in 5 Months?

    If you are going to have a facelift in two years, you can just stick with the Restylane in the tear trough area.  You should consider fat grafting to the all of those areas at the time of facelift.

Combining Belotero Balance With A Little Radiesse Works Well For tear troughs, hollows, and dark circles under the eyes. It has been my experience that Radiesse, owing to its whitish color and more robust nature, can help to lighten dark circles and enhance the durability of the response--i.e. duration of the clinical results. While I routinely tell patients that the benefits may last about a year, I have had quite a few patients that have gone for several years before requiring a touch up, particularly when I combined a small amount of Radiesse with Perlane. 

Tear troughs, hollows, and dark circles are common problems of the lower lids. It has become standard practice to treat this region with lighter fillers, like Juvederm or Restylane, to lift, straighten, and contour this region. These relative "light weights" tend not to last as long as their counterparts, Juvederm Ultra Plus and Perlane, respectively, or Radiesse, which is calcium based.

Occasionally, if hyaluronic acid fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero, a new hyaluronic acid product, has been manufactured to avoid this.  As has been pointed out, Sculptra is not a permanent filler, and I would not recommend permanent fillers, such as silicone or Artefill, be used in this very delicate, visibly prominent, and cosmetically unforgiving region. Only an experienced, board certified aesthetic dermatologic or plastic surgeon injector should be sought to treat this region.

Volume restoration of the face for facial rejuvenation is now commonly accepted. Fillers are now commonly used to rejuvenate all areas of the face.  The most commonly used classes of fillers in the US include hyaluronic acids (HA's-Restylane, Juviders, etc), Radiesse, Sculptra.  There are many more that are used abroad and a few new ones that are slowly gaining acceptance.  Each of them performs slightly differently and work well in certain areas of the face.  The HA's work well in the lips and around the eyes where the tissues are thin and lumpiness can be a problem.  They also are easily reversed. Radiesse is a good sculptural filler and works well in the cheeks and nasolabial folds.  Sculptra is a good choice for those who want a gradual improvement over a longer period of time.  These fillers all last for 9-12 months in the face except in the lips where the HA's tend to go away in about 5 months.   The HA's also tend to last longer around the eyes.  If your fillers were gone in 5 months, it is probably as a result of undercorrection.  It is atypical for these fillers to resorb within 5 months around the eyes.  If you have had an excellent result and were pleased, it is reasonable to continue.  Their use should not have any future effect on plans for a surgical procedure such as a facelift.  Best of Luck!

You could try additional HA filler, like Restylane - alternatively, when you haveyour facelift done in a couple f years, consider fat grafting to the mid facial regions for a more permanant solution. I don't advocate the use of Sculptra in the midface because of prolonged edema/swelling issues I've witnessed in that region.

I'm not sure exactly what your question is, but I would say that it is unusual that the Restylane would be gone under your eyes after five months.  Normally, it lasts longer in that location.  It would not be so unusual for the Restylane to be gone in the nasolabial folds after five months.  You mentioned your injector was conservative and it is possible that using more next time could help your results last longer.  In regards to Sculptra, it is not a permanent filler.  Normally the results can last two to four years.  I would not recommend using Sculptra under the eyes, as due to the thin skin there, problems can arise.  Having fillers injected into your face should not affect your ability to have a facelift in the future.  

If you're asking about issues based on fillers and having a face lift in the next two years, unless you're having fat transfer additionally I don't think there is anything to be concerned about. It's all really dependent on what you want and what you're willing to pay and/or live with while you prepare for the lift.

The tear troughs are an extremely sensitive area.  I would definitely do Restylane again.  It typically lasts about six months.  I would much prefer my injector be conservative and have good results then over-inject and leave me swollen, bruised, and puffy.  Scuptra is not a great injection under the eyes and will leave you with alot of bruising.

Beach Girl in Memphis,

You say your first experience with injectable hyaluronic acid filler for under eye dark circles and hollows was a good one, and that you are disappointed the results are gone in 5 months. I say, rejoice! You got great results you liked, had no long term bad effects, and may be ready for a small touchup to enhance a bit of filler I would bet is still in place. In the first month or two, there can sometimes be lingering edema or swelling, especially under the eyes, and there is no harm in conservatively adding a bit more to "top off" the initial conservative (as you say) injections your doctor performed. Be glad it wasn't too much or too visible through the skin. Your problem is a good problem, as they say. I recommend sticking with what you know worked, seeing your doctor again for a bit more of the same, and seeing how long it lasts this time--rather than going more extreme to a completely different filler you haven't used yet. But that's just me. Conservative as well. Good luck!

--Dr. Krant

I generally find that most hyaluronic acid based fillers such as restylane, perlane and juvederm last about 1 year or even more in the tear trough since it is an area of low movement (e.g. compared to the lips). Radiesse is another option that can be used by very experienced injectors since there is no antidote like there is for hyaluronic acid based fillers (e.g. hyaluronidase). It may be that you lost more weight and that's why it seems to have disappeared earlier, or that too little was injected to begin with. 

Restylane lasts about six months in most areas.  So you probably need more if you were happy with the Restylane. You can use a longer lasting product. Sculptra is not a permanent product.