Thank you for your question!
You stated in your question that you have a history of severe dry eyes due to hashimoto’s
thyroiditis and you had, prior to undergoing Restylane injection in the tear trough area,
consulted three plastic surgeons who stated that there would be no issue with the dry
eye with the placement of Restylane in the tear trough.
Further in your history, you described that you had the injection performed and you had
significant swelling but you didn’t have dry eye initially.
But then two days later, you have considerable swelling and extreme dry eye symptoms and
you just wanted to know what’s going on and that you are very concerned.
Well, I can certainly assist you with this question.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon.
As an oculofacial plastic and reconstructive surgeon, the fellowship training is in diseases
and conditions affecting the eyelids, the orbit and the lacrimal system, the tear duct
and tear gland system.
So I can certainly provide you with my perception from my experience in the treatment of lacrimal
diseases.
So there is certainly a lot of validity to the choice of going with Restylane to fill
the tear trough area.
Certainly, the hyaluronic acid fillers do not require any skin testing prior to treatment
because of the low likelihood of an allergy to the filler.
Back in the day before the Restylane or any other hyaluronic acid filler had come out,
we were using Zyderm and Zyplast and that was a bovine source and therefore we needed
to do skin testing before using that as an injectable.
Now, the tear trough is an anatomic area that has the word tear in it but honestly, there
is no actual direct relationship with the production of tears.
Tears are produced by the lacrimal glands that are in the conjunctiva for your baseline
tears and there is the lacrimal gland and the orbit for reactive tearing.
And deep in the bone towards the nose in the tear trough is the lacrimal duct and that’s
what drains your tears.
So there may be some issue related to sensitivity to the injection process and the fact that
there’s a possibility that you may have a sensitivity to Restylane because in the
absence of a photo, it’s hard to tell how swollen you are.
Because when someone describes swelling, it’s very subjective.
Now, with that being said, the management of your dry eye, I’m sure you’re already
familiar with.
You have 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.
It’s very tricky when it comes to the autoimmune diseases to predict how someone’s going
to respond.
I have treated patients with your condition as well as lupus and a variety of diseases
that are in the autoimmune spectrum and certainly, there is going to be individual variability.
Now a solution for you might be, just for peace of mind, is to dissolve the filler.
That might be a way to at least for you to know that there is no more filler in that
area.
You know, it’s interesting.
The tear trough area is very challenging sometimes.
In our practice, we combine the use of hyaluronic acid filler like Restylane with platelet-rich
plasma to improve skin quality and to improve the color of the skin and to improve the longevity
of the filler at the same time.
That’s been something that we’ve observed.
Because I also use PRP or platelet-rich plasma for people with acne scars and people who
have had inflammation and actual active inflammation and I’ve seen benefit with that.
I would even wonder whether there may have been some value in considering combining PRP
with the filler in this area but this is not something you do immediately.
This is something in a clinical relationship you do as part of an ongoing relationship
to see if something works.
You know, that’s the art of medicine, the art of patient care in an ongoing long-term
basis rather than in an episodic basic which unfortunately with the commoditization tendencies
of various types of fillers and injectables, people sometimes do.
I’m not saying that’s your case at all.
Your doctor may also try putting you on some anti-inflammatory like a steroid or something
like that try to reduce the inflammation.
This might be reflective of other systemic inflammations occurring but if the area is
very red or very itchy or basically inflamed from the placement of the filler, then the
solution might be the best option for you.
Meet with your doctor again.
Talk about your concerns.
Don’t wait to see your doctor.
I tell my patients I’m available for them 24 hours a day as a surgeon and even my filler
patients or my hair loss patients, they can always reach me and I always want patients
to come in with any questions or concerns and I think most doctors share the same philosophy
who really have a practice that’s similar to my own.
So again, I think meeting with your doctor, asking about dissolving the filler, asking
about anti-inflammatories to help managing the inflammation and of course, aggressive
eye lubrication.
What I can at least probably help you understand is that the injectable filler is not likely
to have caused the eyes to become very dry directly.
So I hope that was helpful, I wish you the best of luck and thank you for your question!