Why isn't Hyanluronidase working to dissolve my restylane fillers under my eyes? (photos)

You doctor has not used enough hyaluronidase.  This has left you with partially broken down product in the lower eyelids.  Unfortunately there is no book out there to tell doctors how much enzyme to use.  If you have not had at least 150 Units of hyaluronidase, you need more enzyme.  Gone is gone and if you are still having a reaction after 4 weeks, there is still likely product in the eyelid.

Hyaluronidase tends to be particularly effective in dissolving Restylane, as opposed to dissolving more robust fillers, such as Voluma or even Juvederm. The fact that three treatments with it so far have not been successful suggests that what you are experiencing now may simply be the residual swelling from so many treatment sessions. If so, the swelling should eventually completely dissipate over the course of usually the next two to four weeks. It is also possible that your injector did not inject sufficient hyaluronidase or sufficiently cover the entire treatment area, or used too low a concentration or all of the foregoing. A second issue is that Restylane was chosen as the under eye filler. Even prior to the introduction of more appropriate fillers for under eye use, such as Belotero Balance, or Restylane Silk, ordinary Restylane, in order to minimize potential complications, was very often diluted when used for injection in the regions immediately below the eyes. And finally, close examination of your photos suggests that while you no doubt have a problem under the eyes, the major aesthetic problems that relate directly to your under eye issues appear to stem from lack of cheek volume in the cheekbone region (zygomatic region) as well as in the area under your eyes closer to your nose (inferomedial cheek)--areas that provide the support and scaffolding to the infraorbital regions.  In my Upper East Side Manhattan office, I would choose Voluma XC for the cheekbones and Belotero Balance for the upper inner cheeks. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizing fillers are available, I would opt for Stylage XXL and Teosyal Redensity II, respectively, for these problems.  For now, you might be wise to seek a second opinion from a board certified aesthetic physician to help you with your current problem. And going forward, when vetting potential aesthetic providers, be sure to seek consultation with a board certified aesthetic, core physician and make certain to ask to see his/her before and after pictures for the treatment of all these problems. Best of luck to you. 

It appears you have under eye bags, which are actual orbital fat prolapse. See following video and link. You may be candidate for lower blepharoplasty instead. See an oculoplastic surgeon.

This is probably a combination of swelling from injections and filler. It can take a series of treatments to dissolve Restylane and it will take 1-2 weeks for the swelling to resolve. I recommend cannulas with injections to minimize swelling. Best, Dr. Emer

I agree with the previous sentiments.  Anti-inflammatories and lymphatic massage can help mobilize the residual swelling.  You have to remember that in that area, the naso-malar ligament functions like a hammock - it retains excess fluid for quite some time.  Its the reason boxers get those black eyes that last for much longer than a traditional bruise.  Sorry to hear you had a reaction to the restylane.  I hope some of this helps!

Thanks for posting. You may have some degree of underlying orbital fat prolapse which requires a surgical procedure to correct. The filler will cause swelling, but this should settle down rather quickly. Also, the volume I see in the photos seems like more than a syringe of filler would provide. Best of luck, Dr. M

This is likely a combination of residual swelling and not using enough of the enzyme. More often than not, it takes multiple hyaluronidase injections to get it right as determining the amount needed to fully dissolve the filler is not a perfect science. I would not worry, you are definitely not stuck looking this way forever - it can and will be fixed. If your current doctor does not know what else to do, then I would advise finding another one who does.

In all likelihood the hyaluronidase die work but you are left with residual swelling which is not unusual in this area after having procedures done now 4 times.  This should resolve on its own but you might try antihistamines or other anti-inflammatory drugs

I would be recommending ice and anti-inflammatories at this point.  There is also the possibility that lymphatic massage could help gently move the residual fluid out of this area.