Why Does Restylane Cause Little Bumps Under the Skin?

A lot of people say that after their restylane injections, they can feel bumps under their skin for a long time.  Why does this happen to some people and not others?  What causes the bumps, and more importantly, how can I make sure that I don't get them?

Doctor Answers 28

It even has a NAME

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Bumps close to the skin after a Restylane injection is caused by the injector pushing on the plunger as the needle is being withdrawn.  It causes bumps that will sometimes have a bluish hue to them.  This is called the Tindall effect.  It is seen whenever the product gets too close to the skin or the skin is especially thin (i.e. around the eyes).  Other lumps that are deep but not blueish should be gently massaged smooth at the time of the injection.  To prevent the Tindall effect:

  • In areas where the skin is thin, Restylane needs to go deep, below muscle and on the bone
  • Slow down and don't press the plunger when withdrawing the needle 

What to do if you have it

  • If it's early, be patient and it will likely fade
  • If it's been there a while, you can dissolve spots with Hyaluronidase

Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 90 reviews

Restylane does not cause bumps under the skin...

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Restylane does not cause bumps under the skin unless:

  1. It is injected too superficially
  2. It is injected unevenly

Skin reactions or prolonged inflammation related to the injection of Restylane are extremely rare (I, personally, have never seen it). Areas where the skin is thicker, such as the nasolabial folds, are much less likely to end up with bumps, compared with areas where the skin is very thin, such as the tear troughs below the medial lower eyelids.

I recommend that patients do nothing other than gently apply ice to areas injected with fillers, including Restylane, for the first 3 days following their treatment. This allows for most of the initial swelling to resolve.

After the 3rd day and before the 7th day post-injection, I recommend massaging any area with a visible bump, excess fullness, or asymmetry, several times a day, until it smooths out. This massage can be performed with a fingertip or the tip of a Q-tip.

Patients should recognize that injected fillers may be palpable for several months, however, only visible lumps or bumps are of concern. It would certainly be a mistake to massage an injected filler out of the area that it was meant to fill.

The good news, in case of a Restylane or Juvederm bump that fails to resolve in a timely fashion, is that these materials (hyaluronic acid gels) can easily be dissolved with the injection of hyaluronidase (Amphadase or Vitrase).

Bumps composed of other injectables, such as Radiesse or Artefill, are more difficult to treat. Injection of steroids along with vigorous massage would be a good first step. Surgical excision is rarely, but sometimes required as a last resort.

John M. Roesler, MD
Los Angeles Facial Plastic Surgeon

Bumps under the skin are probably Restylane

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Bumps that appear under the skin after treatment with any hyaluronic acid filler like Restylane, Perlane, or Juvederm are most likely due to deposition of the filler too close to the surface of the skin.  This can happen in a few ways.  First, the injector may simply have injected it too superficially in that area.  Second, the injector may have been withdrawing the needle or cannula while injecting allowing some of the filler to wind up too close to the surface.  Third, when a needle is used for injection as opposed to a blunt cannula, multiple punctures are made in the skin and this creates a greater likelihood of filler "back tracking" along the needle marks causing the bumps you refer to.  This is one reason why I personally favor the use of a blunt cannula for most of my injections.  there is only one entry point and no repeated insertion and removal of a needle to allow this kind of back tracking.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

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How to get smooth results from Restylane

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Properly done, Restylane and Juvederm should not leave lumps. There are several techniques that are used for dermal fillers, and the original one is called "serial puncture" in which a series of injections are done along the wrinkle.

This is more likely to leave bumps in my opinion, and I more commonly do "linear threading" in which the product is layered along the wrinkle being filled. There are several variations on each of these, but lumpiness should be avoidable.

Bumps caused by injection technique...

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It’s not unusual for small bumps to occur following Restylane injections. These bumps occur at the site of the injection and are related to the injection technique. When Restylane is injected closer to the surface of the skin these bumps commonly occur. They can be prevented by avoiding superficial injections. Once they occur, they can be treated with massage. In most cases, a response is generated within a week of this maneuver.
The best way to avoid this complication is to consult a specialist with training and certification in this area. It’s also important that this specialist have experience with injectable fillers.
If you’re concerned about this problem, it should be discussed with your provider. Your provider should be able to address your concerns.

Good filler placement should not leave obvious bumps

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Experienced injectors should not leave visible bumps when injecting at all, and should leave few if any bumps that you can feel. The trick to quality placement of Restylane or any filler is for it to FEEL as natural as possible and also LOOK as natural as possible.

Small translucent or blueish bumps, if noticed right away, can be easily repaired before the filler starts to cause collagen building and longer term settling into the skin. Do not be afraid to ask your doctor about any bumps or clear blue areas you see.

Help to minimize Restylane bumps

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Thank you for your question.

Injection technique is primarily responsible for bumps after treatment. While this is injector-dependent, you can also do things to reduce bumps. The main post-injection practices that you can do are gentle and repeated massage, and ice application to minimize swelling. You only have a 1-2 day window of massaging to move the Restylane around and minimize the bumps.

If you notice a "blue bump" in the skin that does not improve after massaging, that may represent restylane injected too high in the skin. To correct this, your physician can inject a little hyaluronidase or make a little nick in the skin to remove the Restylane. Otherwise, you might have to wait approximately 8 months or longer for it to be resorbed.

Hope this helps!

Don Mehrabi, MD
Beverly Hills Dermatologist

Restylane side effects prevention

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skin lumps after the injections, is related to the depth of it.

areas like under the eyes or in the upper/lower lip are the most prone for lump formation.

to treat those areas, injections are done very superficially what makes lumps noticeable early after the injections.

the thin skin under the eye reveal the injected materials under it.

to prevent it, injection should be done in deeper layer. the patient should expect in those cases of less than optimal results.

using products specialized for those areas, help diminishing that risk

Jacques Haddad, MD
Montreal Plastic Surgeon

Restylane and Bumps Under the Skin

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Thank you for the question. Bumps that you can feel, or irregularities (in color or surface) that can be seen, are generally the result of the injection technique.  If Restylane (or any other hyaluronic acid filler) is placed too close to the skin surface, these issues can result. Particularly in the lower eyelid region, a gentle touch and a clear understanding of the anatomy are keys to a smooth, natural-appearing result.

Restylane and bumps

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Restylane if injected very superficially can cause bumps.  The best way to avoid this is by injecting deeper. In addition, if lumps are felt, they can be massaged to soften them.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.