What can I do to prevent the puffy face after under eye fillers?

Question

Hi! I had one syringe of Restylane a few months back and I noticed that my face actually looks older because of the puffiness in the cheek area. I went back for a follow up and the nurse said it was water retention. Is there anything I can do to reduce the puffiness in my face or should I dissolve?

Nima Shemirani, MD · Answer

Hi @thsawhew! I'm sorry you are having prolonged swelling after receiving tear trough fillers. There are a few reasons for this swelling. One being that 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 that 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.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Raffy Karamanoukian, MD, FACS · Answer

There is no question that you may be a candidate for filler reversal in order to mitigate the swelling of the lower eyelids.

Dr. Karamanoukian
Realself100 Surgeon

Nadir Qazi, DO · Answer

Firstly, it's important to note that some degree of swelling is normal after any type of filler injection. However, if you're experiencing excessive swelling or puffiness in the cheek area after under eye fillers, there are a few things you can do to help reduce it:
Apply ice packs: Applying ice packs to the treated area can help to reduce swelling and inflammation. Be sure to wrap the ice pack in a cloth or towel to prevent direct contact with the skin.
Avoid strenuous exercise: Avoid any strenuous exercise or activities that may cause you to sweat excessively for at least 24 hours after the treatment.
Sleep with your head elevated: Sleeping with your head elevated can help to reduce fluid accumulation and prevent puffiness.
Massage the area: Gently massaging the treated area can help to distribute the filler evenly and reduce any lumps or bumps that may be contributing to the puffiness.
Stay hydrated: Drinking plenty of water can help to flush out any excess fluid and reduce puffiness.
If these methods do not work, you may want to consider talking to your injector about dissolving the filler. Dissolving the filler with an enzyme called hyaluronidase can be an effective way to address overfilled or uneven areas.
Overall, it's important to work with a trained and experienced injector who can help to minimize the risk of complications and provide guidance on post-treatment care. Be sure to follow any specific instructions given by your injector and don't hesitate to reach out if you have any concerns.

H2T Skin and Laser Center - Foxboro · Answer

Hello! The puffiness can be from either swelling after needle trauma, the fact that many fillers are hydrophilic (attract water), or both. I would suggest trying a less hydrophilic cheek filler, such as Juvederm Voluma next time if this temporary side effect bothers you. Hope that helps!

Camille Cash, MD · Answer

One syringe of fillers under the eyes should not create puffiness throughout the cheeks.  You can try watching sodium intake to see if there is an improvement.  Could it be related to allergies? If you are confident it is related to the filler and cannot find resolution you can elect to have the product dissolved.

What can I do to prevent the puffy face after under eye fillers?

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