Should I have botched Restalyne under eyes fixed by same doctor or get a second opinion?

Hi @betterlivingthroughchemistry. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

The lower eyelid skin is among the thinnest skin on your body.  Injections there can be challenging and lead to issues like you have experienced.   Of course, there can be very inexperienced injectors or injectors without a delicate touch or an eye for precision.  However, even the best and most proficient injector can have issues such as yours arise.  The key is your level of trust and confidence in your surgeon.  

Injecting in and around the eyes is one of the toughest things to do in cosmetic filler injections. Bruising and swelling in this area are notorious, and occasionally the Tyndall effect (blue hue), or lumps and bumps may develop. Thankfully most of these things resolve within 2 weeks. However, occasionally they don't, and thankfully hyaluronidase is a great antidote/enzyme to break down the hyaluronic acid filler (e.g. restylane, juvederm). I would go back to your treating doctor assuming they are highly qualified and have experience with hyaluronidase as they know exactly what they did and where they put it, and likely wouldn't charge you for the antidote whereas other doctors would.

Restylane is a great filler but there are always potential side effects, especially in the delicate area under the eye.  Bruising or swelling can develop, especially if you forgot to discontinue a blood thinner, vitamin, or fish oil, before the injection.  If you feel comfortable I would return to your dermatologist for Hyaluronidase injections to allow them to fix the problem for you.  Perhaps Belotero would be a better choice in the future since it is such a fine injection especially for the area under the eyes.

There is never a 100% guarantee that you won't get an over-reaction to a filler. The big positive is that any hyaluronic gel filler can be dissolved. Your physician's suggestion is what any other doctor would recommend. I would give him an opportunity to smooth out the area.As expert as many of us can get in any procedure, every patient will have an individual response to a treatment. It is dismaying to us as doctors when any patient has an adverse outcome. But it is, in all honesty, not something we have complete control over. The vast majority of patients who get under eye fillers do extremely well, but when you are the one of few who has an unexpected reaction, then it feels like the procedure was "botched". Patients don't always know if they will react strongly to fillers, but once you know that, then it's a good plan to alert your doctor if you have any future injections so the filler amounts can be adjusted.The following is in NO way meant to suggest you are responsible for unexpected swelling, but it does provide some guiding recommendations for anyone contemplating fillers.Prior to filler injections, we always recommend that our patients stop taking any supplements that cause thinning of the blood and also refrain from over the counter anti inflammatory medications like ibuprofen or similar pain killers (Tylenol is okay)Don't drink alcohol the day before, of or the day after fillersStay out of the jacuzzi, sauna or gym the same day - you want to keep your body temperature normalIcing after injections can help if you tend to swell or bruiseBromelain or Arnica helps resolve bruisingDon't massage filled areas unless instructed to do soSee us as soon as possible if you see any red lumps or have extended swellingThe skin beneath the eye is very thin and also tender. Try not to press on the area while you are waiting to see your doctor. But do see him and let him treat you. The guiding standard for removing hyaluronic gels is hyaluronidase. Restylane will dissolve in a day or two.