Thank you for your question. After reviewing your question, I understand you have a history of severe dry eyes due to Hashimoto’s Thyroiditis. You consulted three plastic surgeons who assured you that the placement of Restylane in the tear troughs would not aggravate your dry eye condition, but two days after you had the injection, you had considerable swelling and extreme dry eye symptoms.Just a bit of information about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. The Fellowship training I received also covers diseases and conditions affecting the eyelids, the orbit and the lacrimal system, the tear duct and tear gland system, so I can certainly help you with your concern.Hyaluronic acid fillers like Restylane do indeed have a low likelihood of causing allergies, and do not require skin testing prior to treatment. Earlier fillers such as Zyderm and Zyplast which was a bovine source required skin testing.Just to be clear, though the tear trough has the word “tear” in it, there is actually no direct relationship between the tear trough and the production of tears. Tears are produced by the lacrimal glands located in the conjunctiva (for your baseline tears) and in the orbit (for reactive tearing). While deep in the bone towards the nose in the tear trough area, there is a lacrimal duct that drains your tears. What you are experiencing may be due to sensitivity to the injection process or to Restylane itself, though this is difficult to determine without an actual photo of the swelling.Autoimmune diseases can be quite tricky because there’s a lot of individual variability and unpredictability in terms of how someone is going to respond. But as you probably already know, when it comes to your dry eye, you need to be very aggressive with topical lubricants and make sure you use something like an ointment or a gel at night to lubricate the eye when sleeping. If the area is very red, itchy, and/or inflamed from the placement of the filler, you can try to request for an anti-inflammatory, like a steroid, from your doctor to reduce inflammation. This might be reflective of other systemic inflammations occurring. Ultimately, just for your peace of mind, you could just have the filler dissolved.The tear trough can be a challenging area. In our practice, we sometimes combine hyaluronic acid filler with platelet-rich plasma (PRP), to improve skin quality, the color of the skin, and to improve the longevity of the filler at the same time. PRP, from my observation, has also been beneficial for inflammation and actual active inflammation, and so I wonder whether there is value in considering combining PRP with the filler in this area. This, however, is not something that you can do immediately. This is something that you do as part of an ongoing, long-term clinical relationship to see if it works.I suggest that you meet with your doctor as soon as possible — don’t wait. In my practice, I make it a point to tell my patients that I’m available for them 24 hours a day as a surgeon, and they can always reach me for any questions or concerns that they may have. I think most doctors with practices similar to my own share the same philosophy. So, meet with your doctor, tell them your concerns, and ask about dissolving the filler, anti-inflammatories to help manage the inflammation, and aggressive eye lubrication. At the very least, I can tell you that the injectable filler is not likely to have directly caused your eyes to become very dry. I hope that was helpful and I wish you the best of luck!
