Restylane in tear troughs NOT dissolving years later. Any suggestions? (photos)

Hi Productjunkie27,It looks like you still have some residual filler which was not fully dissolved from the dissolver (hyaluronidase) injection.  More often than not, the filler may need more than one, if not several injections to completely wash out the remaining filler. The reason is that not all of the filler is injected in the same pocket. Imagine multiple "bubbles" of filler and when injecting the dissolver some of the dissolver was injected into some of those bubbles, while other bubbles of filler did not receive any dissolver. Sometimes trying to get the dissolver exactly into a bubble of filler under the skin is tricker than it would seem. If the dissolver is injected above or below the bubble, there can be rim (think orange rind) of collagen protecting the filler from dissolving.  So the injection needs to be precise or a little extra pin cushion maneuvers can be used to make sure the bubble get pierced. Since it looks blue, there is a likely a Tyndall effect and is probably superficial (close to the surface) and above the muscle (orbicularis oculi). If the filler is injected under the muscle, there should not be any Tyndall effect, because directly under the skin is the muscle which doesn't show as blue. When filler is injected between the skin and muscle it has a much higher chance of creating the Tyndall effect. I hope that makes sense. I also appreciate your question, because it highlights that even temporary filler such as Restylane can last much longer and may even appear not to be going away at all even though it is a "temporary" filler.   I use this observation an advantage, when filling to try to make the filler last longer. Best,Dr. Yang

Thank you for your question and I am sorry to hear about your experience. From your photo it appears that you have residual filler in your tear trough area. Sometime it requires more than 1 treatment of hyaluronidase to fully dissolve filler. I recommend having another treatment of hyaluronidase to dissolve your filler. Please remember to always see an expert injector. Best of Luck!

Thank you for your question and I am sorry to hear about your experience. From your photo it appears that you have residual filler in your tear trough area. Sometime it requires more than 1 treatment of hyaluronidase to fully dissolve filler. I recommend having another treatment of hyaluronidase to dissolve your filler. Please remember to always see an expert injector. Best of Luck!

Restylane in the tear trough areas such as yours need to be dissolved with Vitrase.  I am sorry for your problems but I believe that your problem will be resolved.  Best, Dr. Green

Dear productjunkie27,

Thank you for your clinical post and
photograph. From the photograph it is
evident you do have a kidney bean shaped swelling in the outer aspect of your
eye which is typically not the tear trough, but may well have been injected
with Restylane at the time of your intervention. Restylane and most HAs do not last years
although there are certain reports of Restylane stimulating a host collagen
response and the swelling you experience may not be the Hyaluronic acid gel
anymore, but rather your collagenous hypertrophy around the previous location
of the product. A bluish discolouration
is generally attributed to the Tyndall effect of an HA when injected
superficial or in large quantities, however, the HA has disappeared the bluish
discolouration may be simple venous engorgement. It does appear you have other veins under the
lower lid, which may contribute to the bluish discolouration over the
swelling. At this point an aggressive
injection regime of both Hyaluronidase diluted with a mild steroid can often
reduce the swelling. Other percutaneous
techniques using small laser fibre radio frequency probe can reduce swelling
due to fibrous enlargement and camouflage techniques with other fillers can
help hide the bulge. A bulge in this
location is occasionally the upper reaches of a festoon or lymphatic collection
and there are some percutaneous thermal techniques that help eliminate this. Fibrous reactions to soft tissue
fillers that don’t resolve and that are located in this area of the orbit can
sometimes be removed as a last option through a lower lid blepharoplasty
incision.

I think you have a lot of options to
try and improve this area of aesthetic concern and visiting a very experienced
and certified plastic surgeon or facial plastic surgeon that has experience
with soft tissue fillers with the complications of soft tissue fillers and also
performs blepharoplasty and surgical procedures if necessary will give you the
full breadth of options to improve or eliminate this aesthetic concern.

I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto