Still Have Dark Circles After Restalyne? (photo)

I have seen this with Restylane in thin areas of skin. Most likely due to PIH and hemosiderin. I would use Retin A and #Melarase cream for 6 weeks, followed by a Melapeel and/or laser. Raffy Karamanoukian Los Angeles

This likely is an issue with pigmentation and would best benefit seeing a dermatologist, he/she can prescribe you proper products to use to help lighten the area. 

Photos are seldom ideal. What I do see, however, appears to be more in the way of darkened tear troughs and the beginnings of bag formation under the eyes. A problem with discoloration on the cheeks is less obvious in the photo.

That having been said, for the sake of completeness, there are some general comments that can be made about the treatment of pigmentary irregularities of the cheeks and elslewhere. Dark spots on the skin, including under the eyes, can result from the presence of prior inflammation, such as acne or eczema (postinflammatory hyperpigmentation aka PIH), genetics, sun damage, pregnancy and hormone treatments, such as birth control pills. The dark circles on the cheeks should therefore be evaluated by a board certified dermatologist and the appropriate treatment instituted. For post inflammatory hyperpigmentation, this would mean eliminating the cause or suppressing the active condition and then instituting, if necessaryan at-home and in-office regimen of skin lightening agents and peels.

If the dark "circles" on the cheeks are more triangular in shape and in the mid-cheek area, these may be caused by loss of volume below, and the shadowing effect on the surface that is often seen as a consequence. For this, volumizing fillers, such as Perlane L, which have a greater lift than Restylane (which is really best reserved for treating fine, shallower lines and wrinkles) or a combination of Perlane L and Radiesse, may work quite well.

Under the eyes, the dark circles, like tear troughs and bags, may also be rooted in a loss of volume. However, the delicate skin here requires treatment with fillers, such as Belotero Balance, which do are unlikely to cause the Tyndall effect, a light scattering problem that imparts a bluish tinge to the skin when hyaluronic acid fillers, such as Restylane, are injected too superficially or into very thin skin. If volume loss is the underpinning to the dark circles, I typically combine the Belotero with a very tiny amount of Radiesse (which is whitish in color) in order to help lighten the overlying skin without concern for inadvertently darkening it via the Tyndall effect.

Consultation with a board certified dermatologist with extensive experience in treating these various problems is a must.

 

Dear mff70,


If the skin is pigmented, then Restylane will not help that much with the dark circles

If the dark circles are from hollows under the eyes, then Restylane would help

If you would like an expert opinion near you, visit the Glasgold Group in Highland Park, NJ, which is about 30-45 minutes away from you

Some patients are better candidates for surgery rather than injections, so an exam would be great to tell you more information


Best regards,

Nima Shemirani

If Restylane was used for the cheek area (to build cheekbones), and not the tear trough, then you will likely still have under eye volume loss. The pigmentation may be augmented by the volume loss but could be due in part to the highly vascular nature of the thin skin and the vessels showing underneath. Restylane is not permanent. If filling the cheeks made the tear trough area more noticeable, you may require additional product. It is hard to say because your cheek area is not very visible in the picture.

Restylane is a filler; this does not mean that it will correct pigmentation issues under the eyes.  Sometimes, what a patient classifies as a dark circle is the representation that the fat pads under the eyes have deteriorated with aging.  In other circumstances, they are talking about other issues.  Two syringes of Restylane could not have failed to produce any improvement whatsoever.  I recommend that you return to your plastic surgeon or dermatologist and compare your current appearance to your pre-procedure photo before engaging in a candid discussion with the physician.