What to Do when Restylane Won't Dissolve?

Question

I had Restylane injected under my eye area a year and a half ago. It has not dissolved on its own.
It seems to have caused some extreme heaviness in my cheek area that has cause my mouth to look like its pointing downward. The left cheek is much bigger and both sides look different. Also, when I smile the cheek pushes up so high into the eye area and causes so many lines under my eyes it looks terrible.
Can I use something to remove it?

David Shafer, MD, FACS · Answer

Michelle,
The Restylane should be completely gone by now.  You really need to either go back to your original injector or seek out someone who specializes in injections and periorbital surgery.  It sounds like you may need some type of intervention, but you need a complete evaluation prior to rushing into anything.
David Shafer, MD

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Depending on what product was used, you might be able to have it dissolved. See and experienced doctor for your treatments. Good luck!

Harold J. Kaplan, MD · Answer

While it's possible that Restylane may be still present in your cheeks 18 months after injection, it's unlikely. It sounds like there is something else going on. Before suggesting what it might be, it's best to visit your practitioner for an evaluation. If it is still Restylane, Hyaluronidase can be used to break down and dissolve the Restylane. First step is to back to your physician or be seen by another.

Otto Joseph Placik, MD · Answer

Hyaluronidase is a naturally occuring enzyme that is produced by bacteria to help them dissolve the hyaluronic that exists in normal tissues. This can be used to help dissipate the restlyane if that is the cause of your problem. Other possiblities include a hematoma with fibrosis.

Ron Shelton, MD · Answer

It does sound that the heaviness more than one year after the Restylane could be caused by multiple reasons, which may not be Restylane.
You should see your physician for evaluation as most of the REstylane probably has dissolved by now. If it is the Restylane it would be an exceptionally rare situation that deserves an in-office examination.

Joel Schlessinger, MD · Answer

Restylane is a great product in that it is very easily dissolved if it is not doing what you want it to do, but my concern is that you didn't receive the real thing.  There are many other fillers out there, some of which are very scary as they don't go away after 6 to 12 months and can even be permanent and cause permanent scarring.
The most concerning of these fillers is silicone, but there are others like Radiesse, Sculptra and Artefill that may be what was used here.  I agree with the other doctors that you probably won't benefit by surgery and may end up worse.  While hyaluronidase is an option, with this being close to the eye that may be a problem.
This case shows the utmost importance of choosing your surgeon wisely.  There are many people who are getting into this field that have little or no experience or qualifications and many who have a good name but farm their fillers and botox out to nurses or PAs/NPs.  So be careful in the future and good luck with this issue.

Pat Pazmino, MD, FACS · Answer

Restylane is a powerful and effective dermal filler that usually lasts approximately 6 months. It sounds on your case your Restylane has lasted much longer than that. This may be due to some leftover Restylane in your tissue or it may be due to swelling or a small amount of scar tissue in your skin around the original Restylane injection. At this time, scheduled a consult with a board-certified plastic surgeon who will be able to determine the cause for this firm tissue. If you have Restylane left over in this area, they may recommend an injection with a hyaluronidase solution to help break up the leftover Restylane.

Peter A. Aldea, MD · Answer

I would go back to your Restylane injector and have him / her dissolve your Restylane with Hyaluronidase; An enzyme which literally breaks up hyaluronic acid, the active ingredient in Restylane, Perlane and Juvederm.
Dr. P. Aldea

Jeffrey Zwiren, MD · Answer

Restylane rarely lasts more than 12 months. If your Restylane was injected only in the lower eyelid area I would not expect it to spread out and cause other problems. If you have some lumpiness in the lower lid area then this could be attributed to your injections. I would agree that an evaluation is required.

Stephen A. Goldstein, MD · Answer

Restylane is comprised of hyaluronic acid which typically lasts between six to nine months.  After a year and a half, I seriously doubt that the changes you described are totally attributed to Restylane.  There could be other things going on. 
I suggest that you go back to the physician who performed the injections and confirm that this was the product that was utilized.  I hope that pre-injection photographs were taken in order that you can diligently study and compare them to recent ones. 
It is my hunch, that the changes described are due to the horrible "a" word...aging!
Stephen A. Goldstein, MD

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What to Do when Restylane Won't Dissolve?

Answers (15)

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