Lump of Restylane filler under eye not dissolving. Can I have hyaluronidase third time in a year and just refill area? (Photo)

Hi @leanneohara19! 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!

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hyaluronidase will have best effects for over-treated areas when applied within a couple months post-HA filler injection. You can have Hyaluronidase injected again. Patients who have been over-injected often fear that all of their filler will be removed after having Hyaluronidase or that they will appear diveted and depleted. This is not necessarily true if injecting with an experienced injector who can evenly spread hyaluronidase in targeted areas. Some providers will actually dispense hyaluronidase injections in very small amounts to target certain areas without depleting all hyaluronic acid. 
I recommend that you seek in-person consultation with an experienced injector.
Best, 
Dr. Anil Shah

Hi, looking at the photo, it does look like you should have the filler removed. Be aware that hyaluronidase can dissolve your natural hyaluronic acid as well, so the removal should be done very carefully in multiple sessions if necessary. The area can be refilled with filler but you should wait at least a month since the hyaluronidase can dissolve the new filler. Finally, the tear trough area is very tricky. Only injectors with extensive experience should attempt to fill this area as it is very common to see lumpiness and a blueish discoloration if it is not done perfectly. PRP or fat injections are another option but again, should be performed by experts only.

One of the issues with Hyaluronidase is that can remove your own natural hyaluronic acid as well so an overfilled area will be underfilled. Resolving it again and refill it after 3 to 4 weeks is an option. Fat transfer could cause the same problem there is no guarantee that you do not get lumpy. Nanofat which is basically work like PRP the volume effect is short term, fat preparations that has some live fat cell in them will have more long lasting effect, but some area of fat may become permanent and some areas not, which again could cause lumpiness, and it is difficult to remove the fat lumpiness and may requires surgery.

Hello there,
      I was actually reading a clinical study the other day about this exact problem. For some patients, surgery is recommended to correct the issue that caused the need for injection. This would, of course, eliminate the need for further treatment until years down the road. For other patients that prefer non-invasive treatments, reversal and CORRECT re-injection typically corrects the problem. I would recommend consulting with someone who is in an expert in this area. Hope this helps.
Sarah RN BSN 

It is most unfortunate what has happened to you, but it is not unusual when people use hyaluronic acid fillers in the lower eyelid region. Even though you may be someone happy with your left eye but I still think it looks like you have a lower eyelid bag. For those very same reasons I recommend that patients undergo autologous fat grafting. With fat grafting one performed by a plastic surgeon who's extremely experienced in fat grafting techniques, the results are extremely natural and permanent. I would recommend having all of the fillers dissolve completely and undergo fat grafting. I hope this helps and good luck from New York City plastic surgery