Restylane - Gone in 5 Months?

Had Restylane for tear trough area (dark circles, volume loss)and minor nasolabial folds and Xeomin for "9s" in June and loved the results. All but gone now. Always had dark circles & volume loss due to aging is making them worse. My Dr admits she was conservative when injecting as this was my first experience with any cosmetic procedure. She suggested a permanent filler (Sculptra?) for next time but this concerns me. Will probably have facelift in next 2 years - can this cause issues?

Doctor Answers 13

Restylane is ideal for the area under the eyes

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.

New York Dermatologist
5.0 out of 5 stars 76 reviews

Tear Trough and NLF Fillers?

    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.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

No harm in being conservative with Restylane or Juvederm under eye fillers.

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

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Restylane duration in the tear trough

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. 

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 50 reviews

Radiesse Combined With Belotero Balance Works Well For Hollows and Dark Circles Under the Eyes

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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Fillers Often Used in Combination

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!

Robert F. Centeno, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 77 reviews

Longer lasting fillers

Radiesse has been shown to be a better, longer lasting filler for the nasolabial folds in most instances so I would recommend this for your next treatment. I also routinely use Radiesse for treatment of the tear troughs with excellent, longer lasting results but many physicians are not comfortable injecting Radiesse in this area. You would need to find someone who is very experienced and comfortable injecting this area. BTW, Sculptra is not a "permanent filler". It is longer lasting than the others but does not work as well as Radiesse for the tear troughs or nasolabial folds.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Restylane at 5 months

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Restylane gone in five months

There are several reasons why the Restylane might have disappeared quickly. One is that you are a fast metabolizer of this and it lasts less time in you. Another is that it might have been injected too deeply. I believe that that affects the time that it lasts. I might try Restylan again if you loved it but if you were my patient and loved Restylane but not how long it lasted I would try some Radiesse. I might still use Restylane in tear troughs. Some doctors use small touch up type syringes so you do not have to always buy a separate whole syringe for tear troughs. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Restylane gone in five months

Please remember that when we give lengths for how long fillers last, this is based on averages given by the company. If the company says it lasts 6-8 months, that means there will be some people it lasts less time for, and some people over it. Thus, it's an average. So, you may be on the shorter end for lasting effects of HA fillers. Or you may have needed more to begin with. The issue is that you said you loved how it looked. Which means that adding more may not be the best idea! It will be more, in those areas, which you said you loved as they were. So, it's hard to say to add more simply to have it last longer. You may just be on the shorter end for how long it lasts, period.

I would absolutely not do Sculptra under the eyes, and even in the NLFs I've seen bad things. It's not as soft as HA fillers. Also, it's a procedure that builds on itself over time, meaning you won't see the results as immediately as you do with HA fillers. And usually, you have to do Sculptra, and then an HA filler over it, simply because people want to see something immediately. As the HA filler goes away, the underlying Sculptra starts working.

Regardless of if you decided to do more HA fillers or have Sculptra (please don't do this in the regions you specified though), either are fine with a facelift in the coming years.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 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.