I suggest seeing an expert, it appears you need a formal consultation to determine what is best. Dr. Emer
Lumps and bumps after filler can occur. Seeing an expert injector is the best way to avoid unnecessary complications; however, even the best injectors can have complications occur. Most commonly, lumps and bumps are related to injection technique; too much filler, too superficial filler, wrong filler type, or bolus injection can cause lumps and bumps that appear within a few days after injection. Red or inflamed bumps that appear after about 10-14 days can be related to infection but thankfully are rare. Then, there are bumps that appear later and are potentially tissue reaction creating a granuloma or inflammatory nodule. It is difficult to tell from a photograph what has transpired; however, most likely it is superficial filler place in the thin skin of the lower lid. A second trial with hyaluronidase by an expert injector would be warranted.
Thank you for your question. Was this your first injection of filler under the eye? If not, it is possible that you could have had another type of filler (not hyaluronic acid) placed under the eye that did not manifest as a bump until months to years later.
Restylane is a hyaluronic acid filler that should dissolve with vitrase. It could take several vitrase injections depending on how much is injected and how large the bump is.
The bump could also be a foreign body reaction to the filler meaning your immune system is attacking that part of the filler resulting in a bump. However, a biopsy would be needed to prove this. The treatment for this would be either a kenalog injection alone or a combination of 5-fluorouracil and kenalog.
Also, sometimes your lymphatics can be obstructed by filler resulting in a delayed bump even up to a year after filler injection. However, this is more common in the mid cheek and not as common under the eye. The vitrase injections should help with this.
I recommend going back to your board certified dermatologist or plastic surgeon for further evaluation and treatment.
It is very unusual for this to be present 10 months after injection and if Vitrase did not work it may be that it is not Restylane but either s a cyst that was formed or perhaps you were injected with a more permanent filler--check with your injector to be sure you received what you thought and be sure you are seeing a board certified dermatologist or plastic surgeon
Yes it is possible that you need more Vitrase injected into the bump. Please contact an experienced injector for the best cosmetic results. Best, Dr. Green