Is two syringes too much?

Question

I had deep tear troughs. When I met with my Doctor yesterday, she told that I needed two syringes of Restylane, since they were so deep. After the injection, she said she hit a vien. Now, under my eyes and my cheeks are completely swollen, and it looks like I had cheek implants. Now, I'm concerned that she used too much or that maybe she injected my cheeks. My cheeks were fine. My face looks horrible. I look like a completely different person. Is two syringes too much?

Nima Shemirani, MD · Answer

Hi @teresa71! I always recommend starting with 1 syringe to correct the tear trough deformity.  After two weeks, I have the patient return to see if further corrections need to be made. Always seek treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

Harold J. Kaplan, MD · Answer

Hi Teresa.  Two syringes of Restylane is not out of the ordinary for this area and can sometimes produce profound swelling.  If the issue becomes problematic for you, there is a way to reverse the injections using Hyaluronidase, an enzyme that dissolves products like Restylane, Juvederm and Perlane.  To read more about Hyaluronidase injections, click the link below.

Jason Emer, MD · Answer

The amount of filler needed is independent to the individual patient.  Sometimes more is needed and sometimes less.  I suggest seeking a physician with experience in filler injections particularly cannulas in the tear trough area.  Best, Dr. Emer.

Michael I. Echavez, MD · Answer

While two syringes of Restylane for the tear troughs may be more than that needed in most people, it would not be out of the question.  Different people need different amounts to give the best results.   At this point, you will need to wait more time for your swelling to resolve before you can judge the final results.  I would wait at least two weeks and if you still are concerned you should return to the physician who treated you to be evaluated.

Michael H. Gold, MD · Answer

Thanks for your question and sorry that you are having problems after your Restylane injections. If you have any concerns following the injections, we recommend that you connect with your provider, share your concerns, and see them if necessary. While each person is different when it comes to injecting the tear trough areas as to how much filler is needed, most of us would usually use as little filler as needed in this area to start, usually in the half of a syringe per area, but sometimes more is needed. Swelling after the procedure is not uncommon, and if a vein was hit during the procedure, more bruising may be possible. You should always consult with a board-certified dermatologist or plastic surgeon as we are the true experts in the use of these products and understand the underlying anatomy the best and therefore use the amount of filler that is only needed in each area. If there is too much filler causing the filler, then hyaluronidase will help reverse this. Contact your provider and see what is going on and take care of the concern. And now there is a new filler, called Restylane Silk, which may be perfect in this area moving forward. It is technique dependent and the injector needs to be trained in its proper use but can give great results in this area.

Burr von Maur, MD · Answer

Hi Theresa. It's common to see more swelling the first day or two after Restylane injection because of the actual injection itself and the hydrophyllic nature of the filler. If you are patient and apply cool packs, you will see the swelling go down.Two syringes is not uncommon to achieve proper filling,especially with deep tear troughs. If necessary, the Restylane can easily be dissolved. Good luck!

Benjamin Barankin, MD, FRCPC · Answer

I start with most patients at half a syringe per side and most are quite happy with it. That said, some people just have deeper tear troughs, whether due to age or genetics or weight loss, and do require 1 full syringe per side. This area swells a fair bit in general, and if a vessel is hit, there will be even more bruising and swelling, so I advise not doing the treatment if you have any major function within 1 week of the treatment. If after 2 weeks things don't look great, your dermatologist can always dissolve some or all of the filler with hyaluronidase, the antidote.

F. Victor Rueckl, MD (in memoriam) · Answer

You are most likely swollen from the physician hitting the vein more than the filler itself. While filler injections do cause swelling, hitting a vein there would cause the swelling to be much worse. Two syringes is absolutely not out of the norm. A syringe of filler has about 1 teaspoon of actual material so injecting two syringes really isn't that much material to that location.

Is two syringes too much?

Answers (8)