Is this swelling, overfill, or Tyndall effect from Restylane (defyne or refyne) to tear trough 8 days ago? (photo)

Question

My doctor 1st used a cannula. He went in again on left eye with a little additional filler, but this time used a needle and said I would probably bruise. My left eye immediately swelled and I bruised. Day 2 my left eye had a lump and my right eye had a slight ridge which caused a double bag. Went back to my doctor yesterday and he told me it was swelling and to return in a week. He said if the lump is still there he can put a small amount of hyaluronidase.

Nima Shemirani, MD · Answer

Hi @Js0305! The filler was not placed in the proper tissue plane. 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. Another reason for the prolonged swelling can be due to the fact that too much facial filler product was used. 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. Best of luck, Dr. Nima!

Jonathan Kulbersh, MD · Answer

It's difficult to tell from your picture, but swelling and bruising can happen with tear trough injections. I recommend waiting 2 weeks before assessing your final results. I hope this helps.

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

Thank you for sharing your concerns and posting your photos. This soon after your treatment with Restylane it is too difficult to determine what the bulky area is due to. Wait another few days and follow up with your doctor. It could resolve without treatment.  Good luck,

Aldo Guerra, MD · Answer

I think it's too early to tell the cause of your symptoms, since it's only been a little over one week since your injection. Please follow up with your injector next week. Good luck, Dr. ALDO

Kenneth D. Steinsapir, MD · Answer

I personally to not think that most physicians understand Restylane Defyne and Refyne.  These products are softer and more runny than Restylane or Restylane Lyft. In someways they are designed to behavior more like intermediate fillers like the hylacross fillers made by Allergan (Juvederm and Voluma family).  That makes these fillers too runny for the under eye area in my opinion.  This is an area where you need a very firm filler with a high G prime.  The product that I think is best for this area is Restylane.  I suspect that you will need the filler you had removed with the enzyme, hyaluronidase.

Is this swelling, overfill, or Tyndall effect from Restylane (defyne or refyne) to tear trough 8 days ago? (photo)

Answers (5)