Restylane Under Eyes - Known Risks and Complications?

Question

I have very fair skin and hollow ridges under my eyes that I was born with.  I'm researching treatment, and became interested in Restylane, but it is so expensive for something that only lasts 6 months to 2 years. Can I get permanent pigmentation under the eyes from a bruising at the time of injection? If you can, how is it treated?  How often do lumps occur, and are they visible? Any better options?

Brent Moelleken, MD · Answer

All fillers can cause chronic swelling reactions around the eyes.  All experienced injectors know this.  While the incidence is low, it is not zero, even in the best of hands.  Experienced injectors are prepared if necessary to recommend hyaluronidase.  Some fillers are better (Prevelle, Restylane), some worse (Juvederm).  The exact location of the injection is important.  With patients from every major news network in our practice, this is especially important since a swollen lid can mean an (expensive) week off work, a lost modeling contract,  a missed audition, business meeting, or red carpet appearance.  Or just an embarrasing evening filled with stories of moutain biking accidents.  A conservative attitude is best for these reasons.  We do not recommend periorbital injections just prior to major events. 
That being said, if patients allow enough time for healing to occur and anticipate the potential for swelling, and stick to experienced physicians with conservative attitudes, the overwhelming majority of patients get very predicatable, excellent results from injections around the eye.

Kenneth D. Steinsapir, MD · Answer

Dear Mothers Glow
My father taught me that when the butcher tells you that the meat is bad, you should listen.  If a doctor tells you that a treatment is a problem, it generally means that it is a problem in their hands.  Translation, don't have service with them for that issue and don't make them do a treatment they are not comfortable with.
Think about it.  If you can get a result with under eye Restylane that is better than what can be accomplished with surgery and there is very little down time, any post-procedures issues can easily be addressed with an enzyme that can be used to modify the treatment at anytime until the material disappears, and treatment lasts well over a year, what is that worth?  But before you answer you have to know that lower eyelid surgery and even laser resurfacing are commonly associated with a lifetime of surgical complications, healing is more involved, does not produce as natural results as the filler, the procedure are more expensive than filler service and the results may only last a few years anyway.
For many of my discerning West Los Angeles clientele, they understand the value and predictability of the under eye Restylane treatment and swear by it.  Some do eventually have surgery to address issues that simply can't be dealt with by the fillers.  However, the filler service represents a tremendous value.  Yes these are expensive services but you are kidding yourself if you think you will save money having surgery.
The key is finding the right doctor to do the service.  I suggest you look at the liquidfacelift.com website.  This is a registry for the leading filler botox practices.  These are physicians and surgeons who treat the patients themselves and are prescreened by the website.  WIth any luck one of these doctors will be convenient for your location.
By the way, if you do bruise, this will resolve on its own.  Tissue staining from a bruise is not that common and certainly if it is going to happen it could also occur with surgery as well.

S. Randolph Waldman, MD · Answer

There is no question that fillers under the eyes can result in the problems that you mentioned as well as prolonged swelling and edema (months!).  We very rarely advise fillers in this area and if we do we insist on a very conservative treatment with only partial correction of the problem.  You must make sure that the person injecting is a doctor with lots of experience with not only injectable fillers but also with surgical blepharoplasty!

Brooke R. Seckel, MD, FACS (retired) · Answer

I have seen patients with permanent discoloration and lumps following filler injections under eyes. Since you have thin skin you are especially prone to complications of fillers under your eyes.
The staining caused by bruising is usually permanent and cannot be removed.
See before and after pictures of transconjunctival arcus marginalis release and open composite fat grafting.

Restylane Under Eyes - Known Risks and Complications?

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Answer: Open fat grafting and arcus release for hollow eye circles in thin skin

Answer: Open fat grafting and arcus release for hollow eye circles in thin skin

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Restylane Under Eyes - Known Risks and Complications?

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Answer: Open fat grafting and arcus release for hollow eye circles in thin skin

Answer: Open fat grafting and arcus release for hollow eye circles in thin skin

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