Thank you for your question.
You submitted a single photo and you state that you got over filled with Restylane on
one tear trough.
You don’t want to do hyaluronidase to dissolve it but you want to see if you can massage
it and can you get it to absorb more quickly.
And in addition, you also state at the end of your question about maybe adding some more
Restylane in some areas to further improve the cosmetic result.
So I can certainly give you some guidance from my perspective.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon.
I’ve been practicing in Manhattan and Long Island for over 20 years.
Helping people around the eyes with the fillers such as Restylane is something I do every
day in my practice and I can share with you with a little guiding philosophy I have when
it comes to the tear trough area.
Well, first of all I would also ask in this question how long since your injection photo
was taken.
You see, when you do a correction any area with injectables, there is a certain amount
of reactive swelling.
There is a certain amount of swelling from the injectable itself in terms of its absorption
of water and so the timing of the evaluation does make an impact.
In my practice, I tell my patients to come back after 2 weeks for reevaluation because
during that time, a lot of things settle out and balance to a level where I think that
they are going to be stable for certain amount of time.
Now, Restylane is one of the softest of the hyaluronic acid fillers in terms of the spectrum
of hyaluronic acid fillers.
There are different levels of fillers that have different types of viscosity based on
the cross linking of hyaluronic acid.
With that also comes a certain longevity.
However, as far as the absorption of Restylane in the tear trough area, there is a certain
amount of unpredictability there.
The way it is placed, it’s placed under the skin in a minimum.
And in general, I would say it is placed deeper.
In other words, it’s placed under the muscle.
Now in that scenario, I have seen Restylane present or hyaluronic acid fillers in this
area for that matter to be present for years and I think that to a point, the body can
sometimes form some type of capsule that can make the material last a bit longer.
So to answer the question, how to make it absorb faster, I don’t think there is a
good answer to that but there is a way of course to try to sculpt it and that is with
massage but I wouldn’t say that there is any value and necessary being overly aggressive
to try to get to break up or to absorb faster.
So the I think you have to do a little observation.
Now, to answer the areas of volume that may benefit, I think you are certainly on the
same track.
I always tell people when they look at themselves and they look at under eye hollows, very often
they overlook the fact that there are actually hollows in their cheeks.
And so when I look at people, I don’t just think of the tear trough or the eyelid, I
think of the eyelid and cheek as one aesthetic unit.
So it is not unusual for me to not only fill the tear trough and just think about it and
maybe something in your situation.
When you do just the tear trough area, someone with relatively shallow cheekbone, it’s
almost creating a ledge or a shelf and that ledge just hanging by itself.
So I think you are recognizing that a little bit of volume in the cheek area will also
be of value.
There is an area right in the area of the cheek junction typically needs volume, that’s
called the V deformity and it is a routine for me to add volume in that area.
A lot of my patients especially women who are 40 – 45 years old who are very fit and
have very relatively thin faces, they actually benefit from cheek lifting using a filler
such as Juvederm but placed in a deeper level, at a structural level so that the eye is framed
by the cheek.
I think of injectables in some many ways like in the art of surgery and that there is really
a lot of ways to look at certain areas.
A lot of people tend to be more regiment in the way they do things.
If you come with the tear trough complaint, they will fill the tear trough.
If they come for the nasolabial fold complaints, they will fill the nasolabial fold.
For my perspective, these are all more parts of a larger issue where volume loss, bone,
muscle, fat actually can be more artfully managed by more definitive, more global procedures.
So we do a procedure wherein we do structural volumizing, where a person may come for just
the nasolabial folds.
When they see the restoration of the cheekbone and the jaw angle, they don’t even think
of the nasolabial folds because the nasolabial folds is actually not the issue in the first
place, it’s the volume surrounding it but I think you are in the right track.
That’s not just the tear trough, it’s also the cheek with the tear trough and under
eye area.
So again I think that you should communicate with your doctor.
Look what your options are in terms of the realistic potential for improvement.
I think a lot of times, you just have to wait it out and let it absorb and let it blend
over time but if necessary, hyaluronidase can be of value in your situation as well.
So I hope that was helpful, I wish you the best of luck and thank you for your question!