What Are the Symptoms or Artery Blockage/Damage from Restylane?

Your symptoms are typical of infraorbital nerve irritation, inflammation, or needle injury. This should heal and resolve, and the rapidity of return to normal will be dependent on the exact type and severity of whichever of the above was the cause of your numbness. The fact that it is better and intermittent is good and reassuring.

Blockage of an artery requires an artery big enough to suffer (an unfortunate) direct hit with the HA needle, and injection which causes the blood flow in this vessel to be blocked. The tissue that obtains its circulation from this vessel will become pale, dusky, gray, or purple, and if the loss of circulation is severe enough and uncompensated by adjacent other circulation, skin can die. Since you are at least 11 days out from this, you are already past the "danger period" for this concern.

Your injector was injecting deep (properly) and was just unlucky enough to hit or get quite close to the nerve. This should heal and be fine. I don't think hyaluronidase (Wydase) is needed, and another needle is just another (rare) chance to hit the nerve!

Rest easy, be well, and stop worrying about this!

Thank you for your question. It is difficult to give you advice without examining you in person. However, if necessary you can have the filler dissolved with hyaluronidase. I recommend having a follow up with your injector for an evaluation. Best of Luck!

Dear Freakingout,

Blood vessel occlusion due to Restylane injection can present in several ways, including:

1) Immediate blindness in one eye

2) Pain in the injected area followed by reddish / purplish blotchy skin discoloration

3) The color changes described above with minimal pain

It does not sound like you have occlusion of a blood vessel.  You need to see your injector for follow up.

 

In my last post, I suggested that you be aware that blood vessel blockage is also a possibility with ongoing facial pain or numbness after filler treatment. The most significant signs of this would be a color change over the area affected by the artery, such as "duskiness" (purplish or blueish bruise-looking area) or paleness. This would mean there is lack of normal blood flow to the area affected. Sometimes intermittent pain/numbness could be a factor if an artery is spasming (clenching) and then releasing.

However, it does sound like nerve damage is a possible factor in your case, as well. Please do not take the word of distant doctors on a website for your answer. Please go directly back to the physician that injected you, past his or her nurse, and right into the exam room to be checked, just to be sure.

The most common symptoms of a vascular blockage are when patches of the skin turn pale/white (arterial blockage) or purple/deep red (venous blockage).  Of the two, the arterial blockage generally has much higher risks.

Fortunately, most of what appear to be blockages of the vessels are actually external compression of the vessel in question and dissipate fairly quickly and, hopefully, without any significant permanent effects.  That is not always the case, however, and some of the most severe complications of filler injections are due precisely to this phenomenon or, at its extreme, direct injections into the vessel.  These events are, fortunately, extremely rare.

More likely is that you have a nerve injury.  That, too, is most commonly due to compression of the nerve (in your case the infraorbital nerve, coming out just below the orbital bones around your eye).  Rarely, it can be due to direct injury of the nerve.  Assuming it's external compression then it, too, should settle down on its own over a period of several weeks to months (possibly).  In the unlikely even that it's a direct nerve injury the recovery may be more prolonged and potentially less complete.

Either way, you should speak with your physician about this and make sure that he/she is aware of what's happening.  In the early stages, and depending on the mechanism and extent of the problem, hyaluronidase may be useful to "dissolve" the hyaluronic acid.

I hope that this helps, and good luck,

Dr. E

If an artery was blocked, you would see marhed blanching at first and an area of sloughing later. Also, you would  feel pain at first and numbness later. An arterial spasm would cause a temporary blanching and pain.

It is quite unlikely that an artery was blocked.

Most likely, you had a nerve squeezed. Apparently the peoblem is subsiding .

If numbness persists,  a hyaluronidase injected in the area of the  infraorbital nerve exit from the bone may prove beneficial.

When your tear troughs were treated, the infraorbital nerve [which exits from bone in that area] might have either been hit with the needle, or compressed if Restylane® was accidentally injected into the infraorbital foramen. Either scenario could account for the numbness you are describing.

At this point it sounds as though you are getting better on your own. If necessary, hyaluronidase could be injected in the general area of the infraorbital foramen [hyaluronidase diffuses quite far from where it is injected, so there is it can be injected a safe distance -- say, 1 cm -- from the infraorbital foramen and still get to any Restylane® which might be compressing the nerve [or less likely, compressing the vein and/or artery in that area].