Is this Tyndall effect that can be solved with hyaluronidase? (Photo)

Question

Hello: Is this Tyndall effect? I have already visited different doctors (not only because of this, I have taken other procedures) and got different opinions: 2 of them are sure that is Tyndall effect (one proposed to inject hyaluronidase and the other recommended just wait, the other 3 thought it is genetics( 1 recommended nanofat). Is there a "scientific" way to check it Tyndall is the main cause of the dark circles? Regards, J.

Raffy Karamanoukian, MD, FACS · Answer

Hyaluronidase enzyme continues to be an excellent option for patients with fillers that need to be dissolved. Fillers can swell and migrate unpredictably, especially when a filler with a high-edema quotient is used in thin areas. Our office uses disciplined approaches to help patients with acute or chronic issues related to hyaluronic acid fillers. We begin by assessing for any tissue compromise and advocate early treatment to avoid complications with vascular occlusion. In chronic issues, it is important to gradually break up and dissolve filler so there is no further migration of loose filler substrate. Conservative staged dilution may also help avoid volume loss. If the filler is not dissolving, we may consider stronger concentrations or surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Leonard Grossman, MD · Answer

Tyndall effect is an observation when a hyaluronic acid filler is injected under very thin skin creating a bluish hue under direct light. Your picture does not show that effect, however you do have an overfill effect from hyaluronic acid filler. You will benefit from hyaluronidase Administration as long as it’s done by a plastic surgeon with experience. I hope this answers your question and good luck from New York City plastic surgery

Jo Herzog, MD · Answer

Tyndall effect usually has a more purple and less gray tinge to it but this might be difficult to judge from your photos. Did you have darkness under eyes before the procedure? 
Sometimes adding volume can change the way that you see natural dark circles because they are no longer sunken in. If that is the case, not tyndall. If you had no darkness before, might be tyndall. Also consider which filler you used as some more common to see tyndall. If it were me I would definitely not use fat and probable would not dissolve. Try a cream that helps with darkness;Skin Better has a good one. You might also think about putting filler in cheeks(difficult to see from this photo but it gives a hint) to change election of light and accent different part of your face.

Robert T. Buchanan, MD (retired) · Answer

Without a careful exam and more history, it is impossible to know for sure. However, you appear to have a two part orbital ligament (that is congenital) with the medial part traversing from the medial cantonal area down and across the molar area and the lateral part more closely attached to the orbital rim. The coloration you see is shadow and highlight from that and probably not a Tyndall effect. If this is the case, what you need is fill of the area by an expert using a heavy filler like Juvederm Voluma deep on the bone or muscle below the different components of the ligament pushing the tissues up. Unfortunately, the vast majority of injectors do not totally understand the anatomy or concepts of injecting this area so be very careful who you choose

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