Will I Return to Normal After Restylane is Dissolved?

Question

About 4 weeks ago, I had Restylane injected in the trough of my eyes. Later on, I developed lumps on the area, with bluish-tinge under my eyes. Will I return to how I looked like before the injections if I have the Restylane dissolved?

David Shafer, MD, FACS · Answer

Dogeez,
Restylane can last for months. If your doctor is experienced in injecting hylauronidase, it may be useful to dissolve the hylauronic acid in the Restylane. However, whenever you have injections around the eyes, you have to be very, very careful. This tissue is very thin and very unforgiving.

Harold J. Kaplan, MD · Answer

If the bluish tint under the eye is caused by superficial injections (The Tyndall effect caused by injecting too close to the surface) then this will most likely go away as the product degrades normally over a 6-9 month period. 
Alternatively, ask your practitioner about Hyaluronidase injections. Hyaluronidase is an enzyme that is used to dissolve the Restylane and may be able to solve your problem much more quickly. The lumps can also be resolved fairly immediately with Hyaluronidase.
If the bluish tint is related to bruising, then we would look for a local practitioner who uses Pulsed dye lasers as these can be used to resolve bruising in less than 72 hours.

Mark Berkowitz, MD · Answer

I am sorry to learn of the difficulty that you are experiencing. Perlane, Juvederm, Restylane or Elevess are all Hyaluronic Acids (HA). The beauty of them is that they are soft and work well to fill in lines and wrinkles around the face. Side effects from these fillers and dissatisfaction is rare. When these occasions do occur the wonderful thing about this group of fillers is that we can offer Wydase or Hyaluronidase to reduce or dissolve them. As an Ocular Plastic surgeon, in the suburbs of Detroit, I utlize Wydase all of the time as part of my freezing solution for eyelid surgery. Side effects from this substance are rare with the most common being an allergic reaction ( which I personally have never encountered with over 3000 procedures, Knock wood:)) You should speak to your Cosmetic Surgeon about using Hyaluronidase to hasten the effect of the filler.

Michael A. Persky, MD · Answer

Hi Dog,
Sorry to hear about your complication with under the eye lid filler.  The bluish tint is either caused from the Tindall Effect, where the filler is too superficial, or from some residual bruising. In either case, time is the best antidote.
Once the Restylane that was placed under your eyes completely dissolves, your eye lid area should return to the way it was before.  Unfortunately it takes a while for the Restylane to disappear from this area.  
Some physicians inject hyaluronidase to help dissolve the excess product, but as you have probably read here on RealSelf, there have been patients who have had continued problems.  If it is not too bad, then it is probably best to leave it alone and be patient.
Good luck and be well.
Dr. P

Scott Tucker, MD · Answer

The skin below the eyes is very thin and injections in this area need to be very deep right along the bone. After the Resylane resorbs you should go back to normal. In the mean time you can massage the are to get the product to disperse a little quicker. This could take a while in the range of several months to occur.

Jessica J. Krant, MD, MPH · Answer

I am sorry to say that if you see blue lumps under your eyes, the Restylane will hopefully dissolve away eventually, but for sure it will take longer than the 6 to 12 months you might be hoping for in this situation. In some cases, the tissue reacts around the filler and forms inflammation and scarlike areas, and the lumps never fully go away. I recommend seeing your injector immediately for careful tips on how to begin to get this resolved. The earlier you start working on it, the safer and better your outcome is likely to be. If your injector was not a board-certified dermatologist or plastic surgeon, then I recommend immediately seeing one to help.

Pat Pazmino, MD, FACS · Answer

Restylane is a powerful and effective dermal filler that usually lasts approximately 6 months. Once it results, patients almost always return to their initial baseline. If you are unsatisfied with your current results, rest assured that they are temporary and with the tincture of time you should return back to your pretreatment appearance.

Steven Wallach, MD · Answer

The bluish hue is form injections too superficial as ar ethe lumps. These will go away with time or you can have hyaluronidase injected to eliminate it quicker.

Stella Desyatnikova, MD · Answer

Restylane injection in the undereye area is an off-label indication. It means that the company has not studied this product in this particular area. In fact, the only indication for Restylane currently, is its use for nasolabial folds correction. Several other indications are coming soon. So, its use in the lips, cheeks, etc. is all off label. Despite that, it has been used extensively and safely in all of these and other areas.
Restylane injections under the eyes can make a dramatic improvement in their appearance. Unfortunately, if done incorrectly, they can make the appearance worse. One of the best things about it, however, is the fact that it is temporary and reversible. Yes, you will return to normal after the Restylane is dissolved. It might take several months, and if you can't wait for this to happen, Vitrase injections are a safe method to reverse it.  Keep in mind that using any products around the eyes should only be done by an experienced physician.

Peyman Solieman, MD · Answer

Dear Dogeez,
I hope you don't mind if we use your question to expound about this problem. I think if you read it you will find we answer most of your questions. 
A few months back, we posted a blog specifically asking:
Why is there so much promotion for off label usage of Fillers for the the Treatment of Hollowing and Under Eye Circles? 
In the blog we ruminated that this treatment is off label and that few studies have been done to check for its safety and efficacy  in this setting. A few things we noted included the lumpiness some patients had encountered as well as some patients complaining about a blue hue after being injected. This blue hue arises due to the Tyndall effect which is the blue light we notice when light is scattered by a colloidal particle.  The same phenomenon explains why the sky is blue and why our veins appear blue even though we all know our blood is red.
As to problems with lumpiness,  we noted that due to the thinner skin overlying the eyelids patients were much more prone to have problems with fillers under the eyes as opposed to in the nasolabial folds and cheeks, especially in the hands of less experienced injectors.
So we lamented that unfortunately the number of people who read our blog would be far less than those who read the NY Times article, which touted this procedure.
Thankfully we noted that a few weeks back Ms Natasha Singer posted a new article  - Questions on Using Fillers Near Eyes. In the article she not only expounds on the off label nature of this procedure but the growing number of patients having problems with these injections.
We want to be clear that doctors use medicine off label all the time. Most antibiotics get approved to treat one problem- say sinus infections- and then get used for other needs. So off label by itself is not the problem. We believe that the skin around the eyes by its very nature is more fragile and thinner and as a result, in less experienced hands injections can cause problems like lumpiness. We believe that doctors should be more clear in the potential problems. However, the quote by a doctor saying any injection can cause blindness is also unfair. It is technically true, but its like saying anyone crossing the street can be hit by a car.
As to your specific question, restylane and juvederm do break down with time. We would recommend you not have other procedures, such as hyaluronidase under the eyes to break down the restylane, because here too we have seen problems. In general, our advice to patients who present with this problem, is be patient and most of this will go away. If the hollowing or dark circles return, consider having someone do micro fat injections which were the original source for this procedure because the fat will last longer and not have the same propensity to cause the blue hue.
I hope this answers all of your questions. Should you have other questions, please feel free to call or email us so we can address your unique situation.
All the best.

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