Treatment for Superficial Necrosis Due to Restylane?

I had Restylane injected too shallow between my eyes (below the glabella). It caused necrosis where several skin layers were lost, and peeled away to reveal a tender, red new skin with telangestecias.

How can I help recovery of this wounded skin? It reminds me of a deep chemical peel!

Doctor Answers 4

Skin slough after filler injection

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If the skin has sloughed after restylane injection and has healed or is slightly raw, I would put bacitracin or neospoorin on it provided you do not have an allergy.  Then I would recommend sun screen once it has healed to minimize the risk of sun exposure causing hyperpigmentation.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Treatment of superficial necrosis from Restylane

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Restylane is a very popular and effective hyaluronic acid-base dermal filler. It has been used widely throughout the face for the correction of deep lines and wrinkles. If Restylane is injected to superficially, there is the risk of skin breakdown. If this is a small area, your doctor may recommend local wound care and allowing the skin to heal itself. If it is a large areas, or it appears that you continue to have a great deal of Restylane just under the surface, you may benefit from a debridement of the Restylane. Keep in mind that this is a very difficult and tricky problem. Your best bet is to work closely with a board-certified plastic surgeon, who is experienced in facial rejuvenation, blepharoplasty and wound care. Such a specialist will be able to assess your skin and determine which combination of treatments will help you heal with the least amount of scarring.

Proper wound care is key to decreasing wound and scar formation

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The best is to see a dermatologist as soon as possible. Necrosis is apparent when it does occur as blanching becomes noticeable first. Nitropaste can be administered first to prevent further progression of the problem. If necrosis has occurred, it is prudent to take care of the wound with proper hydration (emollients, etc) I'm a big fan of BIAFIN which can be used on wounds to aid in healing and decrease scar formation. As for the telangectasias, those can be treated with pulse dye lasers when healing has occurred fully.

Hassan Galadari, MD
Dubai Dermatologist

Necrosis after Restylane

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At this stage, if there is still an open wound, I would apply a bland ointment such as Aquaphor and keep it covered most of the time. Once the epidermal layer of skin has regenerated (when it is no longer an open wound), application of silicone gel sheeting can be useful. After wound healing is complete (approx 1 month), the final appearance of the scar and telangiectasias can be treated with a vascular laser such as the pulsed dye laser.

I hope that when all is said and done, you are left with minimal scarring.

Bryan K. Chen, MD
San Diego Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.