Thank you for your question!
You’re 22-years-old, you underwent injections of Restylane in the tear trough approximately
23 days prior to your submission and you submitted photos where you describe that the area actually
looks worse that you have greater amount of swelling in your eyes under the eyes and that
there is bruising and discoloration.
You initially described the situation as your doctor offering to use another half cc of
Restylane to further correct and you are also questioning whether or not there is a value
in doing surgery or can you have surgery to cure this.
Well I can certainly give my opinions.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon, practicing in Manhattan in Long Island for over 20 years.
The concerns that you have is reflective very much of large part of my practice which is
rejuvenation of the eyes whether it’s through cosmetic surgery as well as the use of injectable
fillers and new technologies for rejuvenation in the stem cell world such as use of platelet-rich
plasma (PRP).
So to begin with, I would then comment on the photos that you submitted.
If the fluid or the swelling that you described has occurred after the one half cc of Restylane
under your eyes, I’m a little bit concerned on whether or not additional Restylane would
be of necessary value.
This is not to second guess your doctor.
I think that when you choose a doctor based on your perception of the doctor’s ability
to do the treatment, the injection of Restylane in the tear trough area usually doesn’t
create profound swelling under the eyes so the question I would ask you is to look at
your photos before you had the injection.
Did you have the fluid that I see at the cheekbone that’s right below the orbital rim, below
the rim of the eye socket.
If that swelling was always there, than that’s more of a situation called malar edema.
If that swelling is subsequent to the injectable filler, then that’s a different story.
Usually injectable fillers such as Restylane can in certain cases causes more swelling
by the virtue of the fact that hyaluronic acid is very hydrophilic.
It pulls fluids in.
Now there is finesse in doing this.
It is routine for me and my practice to treat tear troughs with hyaluronic acid filler like
Restylane combine that with a regenerated technology using platelet-rich Plasma.
Platelet-rich plasma is derived from your own blood and it’s a concentration of growth
factors that stimulates collagen and blood supply and improves the color of the skin
under the eyes which is very difficult to do because of the intrinsic nature of the
delicate and thin quality of the under eye skin which is the thinnest skin in the body.
That being said, it is also part of my philosophy that I work with is that the patient who I
treat for this type of situation or any type of procedure, we have an ongoing relationship
where I’ll do the treatment I’ll see them two weeks later to re-evaluate how things
look.
With the nature of injectable fillers, there is often a transition period where it takes
time for things to settle down.
Now you’re 23 days after the injectables.
It would be interesting to understand your doctor’s thinking.
I have a feeling your doctor is focused on the hollow part and not necessarily the swelling.
The doctor may feel that the swelling is just par for the course and maybe something that
you’ll have to accept.
This is something that is of course personal choice but in my practice, on people with
your age who come in for injectables, I often try to talk them out of it mainly because
I feel like there is a different lifestyle in your 20’s compared to your 40’s.
In your 20’s, if you’re going to try to make this something sustainable you kind of
have to accept, with people who are in their 40’s, accept that you’re going to do this
on a regular basis.
You’re going to deal with some bruises and swelling and it does require ongoing maintenance.
I understand why you are asking about surgery but I would caution you about choosing surgery.
I don’t think surgery also is a good idea at this stage.
You don’t want to create more problems and surgical solutions for tear troughs are less
than perfect.
I think that injectable fillers have a lot of value in the treatment of tear trough but
you have to figure out what is right for you.
In scenarios like yours when someone has swelling whether it’s the tear trough area or anywhere
in the face, I will often use hyaluronidase just to dissolve the fillers if it’s hyaluronic
acid filler.
Hyaluronidase will actually dissolve the filler and then you can restore closer to your original
anatomy.
It does affect the hyaluronic acid that’s native in the area but at least there is some
potential benefit by getting rid of the factor or the element that is causing the swelling
to get worse.
I think you need to have a good discussion and spend some time with your doctor to go
over this and to understand the risk and benefits of the additional syringe as suggested and
think to yourself if doing this on an ongoing basis is worth it and is this the right thing
for you at this time of your life.
So I hope that was helpful, I wish you the best of luck and thank you for your question!