Restylane Questions (50) answered by Dr. Steve Weiner, Facial Plastic Surgeon
A: Both Belotero and Restylane can be used for the tear troughs…Restylane will last longer I suspect
A: Studies have shown that Restylane is safe to store at least 9 months after it was used initially
A: Looks like you have been overfilled in the tear trough area with Restylane
Steve Weiner, MD, Facial Plastic Surgery, Destin, Florida.
A: Lumpy lips and blue tint 4 years after Restylane – Try hyaluronidase
A: To correct lips which you are not happy with use hyaluronidase to dissolve
A: Under eye injections should be done with blunt cannulas and expert injector
A: Using Restylane in the glabella and a vein was hit, now with prominent vein – you must go back to Doc
It looks like the vein in your forehead is more prominent than it was before the procedure. This means that there is more pressure in the vein either from being occluded or from external pressure. This needs to be addressed by your doctor soon. I think it probably needs to be dissolved with hyaluronidase. This area is particularly prone to vascular problems and should only be injected by the most experienced physician. Steve Weiner, MD, Facial Plastic Surgeon, between Destin and Panama City Beach, FL
A: Both Juvederm and Restylane are equally safe
Both are safe. My overwhelming preference is for Restylane. Restylane has a higher G prime which will lead to more lifting ability. It also is much better for tear trough area because it is less hydrophilic (less water absorption). It also gives more structure to lips that are small and lack definition. Juvederm tends to spread as well leading to correction in a general area and not exactly where it’s placed. I do use Juvederm in the temples placed superficially. Overall there are more applications in my opinion for Resty.
A: Uneven Restylane results could be result of asymmetry unrecognized before the treatment
Most often, the asymmetry which is seen after filler is something that was pre-existing. That’s why photos are very important. The patient often looks at the area treated much more critically than prior to the treatment. If indeed it is due to the filler, that all has to be negotiated with the office. Since you are one month out, the swelling should have already subsided, but if you were only a few days out, I’d tell you to wait 2 weeks before we re-inject. Steve Weiner, MD, Facial Plastic Surgeon, Panama City Beach, Florida.
A: Restylane will help for acne scars, but don’t expect great results
I have been only mild impressed with fillers for acne scars. The problem is often the skin is tethered down and the filler doesn’t lift the depressed area well. For a quick fix, its the only thing available. Besides lasers, there is TCA cross and radiofrequency devices such as the INFINI by Lutronic. See my blog about acne scars. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Skin necrosis on bridge of nose can occur from dermal fillers. Need to be evaluated ASAP
The nose is particularly prone to skin necrosis, especially if you had previous rhinoplasty or any scarring. The vascularity can be compromised with filler by compression of vessels or by direct intraluminal (inside) injection. The first signs are blanching, which occurs almost immediately. Later signs are a blue reticular pattern that can occur in areas far from the actual injection point. Late signs are dying of the skin which is dark or black. You must catch things early in order to avoid necrosis so its best to see someone right now for evaluation. No one can tell what’s going on without seeing you. I don’t inject the nose anymore after seeing at meetings the number of complications in this area. Steve Weiner, MD, Facial Plastic Surgery, Destin and Panama City Beach, Florida.
A: After hyaluronidase to remove poorly injected filler, wait about a week to re-inject.
Hyaluronidase works very quickly. Sometimes you will see improvements before leaving the office. You could probably get filled in a couple days, but waiting a week is definitely safe. Good luck. Steve Weiner, MD, Facial Plastic Surgeon, Panama City, Florida.
A: Restylane for lips, minimal swelling after 1/2 syringe, that’s good not bad. Blunt cannulas are great for the lips.
Most patients will have some swelling after their Restylane injection in their lips because the product is hydrophilic, loves water, and therefore pulls in water and swells a little. If you had blunt cannula technique and only a small amount of filler, the swelling should be minimal. Some of my patients go right out to lunch or dinner. Please see the attached links and videos. Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.
A: Restylane can be injected in lips if you’re under 21
The reason Restylane stated that you needed to be 21 was because their FDA trials were done on people 21 years and older. So that’s what they got approval for. It can be used off label for people under 21 in their lips, and anywhere else, as long as its within the standard of care. Hope you have a doctor who uses cannulas because there is much less bruising, swelling, and discomfort doing it this way. See my blog below!! Steve Weiner, MD, Destin, Florida.
A: Volumizing a face can be done with fillers other than Sculptra, like Radiesse, Restylane, see video
Sculptra is an ideal volumizer because it is long lasting. The problems with autoimmune disease were that on retrospective review, with the old dilution, that people who got granulomas had a higher frequency of having autoimmune disease. I don’t believe that celiac disease was one of those found. You can probably have Sculptra, but Radiesse is a great volumizer, along with Restylane or Belotero. It will cost more to use fillers other than Sculptra, and results won’t last on long, but you can do it. I have a video attached which shows a “Liquid Facelift” using Belotero and Radiesse. Steve Weiner, MD, Sculptra Trainer, near Destin, Florida.
A: Swelling and lumpy filler around the eyes should gradually resolve.
I tend not to like Juvederm around the eyes because of its characteristic to draw in water which can lead to prolonged swelling. It should get better, but if not, hyaluronidase will help dissolve it. Bruising can take up to 14 days to improve. I like to use blunt cannulas which leads to less swelling and bruising. Sometimes some mild massage in the lumpy areas can help out uneveness.
A: Long term use of dermal fillers is actually good for the health of your skin and maybe for you in general
At the most recent Multispecialty Cosmetic Symposium in Las Vegas, several Plastic Surgeons noted that the skin was much more youthful appearing when they were doing facelifts in patients who did filler. I think that doing filler with needles around the tear troughs is not the state of the art and only cannulas should be used there. This will decrease the bruising and swelling after the procedure. I have written a blog recently discussing that HA fillers might actually help with cancer prevention and increase your longevity. Please read it. Steve Weiner, MD
A: I agree that after about 2 weeks from lip filler is your final result.
Restylane typical has some mild swelling after injection particularly around the eyes and lips. This is due to the product absorbing water and from the “trauma” of the injection. This usually takes 2 weeks to completely settle down. Sleeping more upright helps to relieve some swelling. The total volume from one syringe of filler is 1 cc. This is one fifth of a teaspoon, which isn’t much. You might want another syringe in your lips. It’s my practice to wait two weeks before reinjecting after filler so I know where I’m starting at again (the new baseline). Keep in mind that it is impossible to go from someone which has no lips to real full lips in one session without looking strange.
A: After 10 days, lumps from bruising around the eye should be almost gone and most likely is the Restylane.
It’s very hard to tell from the pictures anything about the “lump” you describe. However, if it were due to bruising, it should be almost gone by 10 days and shouldn’t be just appearing. It most likely is related to a clump of filler which could be dissolved with hyaluronidase. Around the eyes is a difficult injection and should be done with the most skilled injectors using blunt cannulas.
A: Severe swelling that you have after Restylane looks like a rare side effect called angioedema
Angioedema is a rare rapid excessive swelling that some people get after any type of manipulation on the face (dental, trauma, injections). It most often occurs, in my experience, in people which are taking “ACE inhibitors” for their blood pressure but occurs with other medications or for unknown reasons too. There is a hereditary form of this condition too. It will respond to high doses of steroids and antihistamines. Will this happen again? Not always, but to help prevent it from happening again, you should take steroids before and after any procedure you have on the face or dental area. You should see an internist to look for the root cause of the problem and switch medications if possible.
A: No problem with mixing fillers like Restylane and Voluma
The current trend is to use multiple different fillers in the same patient. There is absolutely so problem with having different fillers in the same or nearby areas. Each filler has its unique qualities which make them better in certain applications/areas. The more robust fillers for lifting and filling are: Radiesse, Perlane, Voluma, and to a lesser extent Restylane. Juvederm and Belotero, are softer, more diffusing fillers. Sculptra is unique in that it volumizes and thickens the skin. More of a global fill. By the way Voluma is not widely available in the US at this point.
A: Swelling around eyes after fillers
My guess is that you got Juvederm in the tear troughs, which in my opinion is a mistake because it leads to prolonged edema. Other thoughts are that too much was placed in the area. My guess is that is will improve but not resolve and should probably be dissolved. The biggest area of complaints on RealSelf.com is related to filler around the eye. I can’t stress this enough..you need to go to an experienced physician in this area and shouldn’t use Juvederm. Also, blunt cannulas should be used. Steve Weiner, MD, Santa Rose Beach, FL
A: Touch up with Restylane can certainly be done at 2 week follow up for your lips
Touching up with Restylane in the lips should be no problem at the 2 week mark. I usually like to wait that amount of time because if there is any swelling or bruising, it is gone by then. If you have remaining Restylane from your previous procedure, its up to the doctor whether there is an injection fee or if it is complimentary. I use blunt cannulas for the lips..less swelling, less bruising.
A: I would recommend filling your eye hallows (tear troughs) with Restylane
By the looks of your picture, it appears to me that you would greatly benefit from tear trough and upper cheek filling with Restylane. I would use blunt cannulas in this area to avoid bruising and vascular risks. It should give you about 9-12 months worth of improvements. I would start with about 1 syringe per side. You might need more but that can be evaluated after about 3 weeks. See my video please.
A: Lumps around eyes after Restylane are usually related to poor injection technique
From your photo, it looks like too much Restylane was placed in too small an area. This can be dissolved with hyaluronidase. It is of upmost importance that the undereye injection be done by an experienced physician. This is the number one area for people’s dissatisfaction on RealSelf.com. I can’t stress this enough. Also, using blunt cannulas is the best way to treat this area for less swelling, less bruising, and less risk.
A: Are you a candidate for Restylane under the eye..YES
You have pseudoherniation of fat in your lower eyelid. This is caused by a combination of factors. For you and your age, my recommendations are blunt cannula augmentation of the upper cheek and tear trough. This will improve your situation with minimal downtime, cost, and discomfort. I would start at 1 syringe on each side with Restylane. Add more if needed after 2-3 weeks. I have never had the blueish Tyndall effect with cannulas because I inject below the muscle. It takes only a couple minutes per side and bruising is rare. Please see my video. Steve Weiner, MD, Santa Rosa Beach, Florida.
A: Tear troughs are a great place for Restylane or Belotero from experienced injector
It looks like you have a fairly deep tear trough. Fillers are great to improve this area. I would make several recommendations:
- Go to someone that does this often. There are too many people with bad outcomes in this area because of poor injection technique
- Use only Restylane or Belotero. Other fillers will lead to nodules, or swelling.
- The injector should use blunt cannulas to minimize bruising and risk.
- Don’t overfill. It’s better to get two treatments because it was underfilled the first time.
- Stop all blood thinners 3-4 days before, aspirin – 10 days. Although I inject people on aspirin and even Plavix, if the injector is using a needle, you must decrease the chances for bruising.
- Avoid strenuous activity for the rest of the day you are injected.
A: Filler for nasolabial fold in 18 year old is fine
There is no problem with getting fillers at age 18. I would make sure that it’s not a problem with your cheeks needing filler before filling the nasolabial folds. Its not a permanent solution, so if you don’t like it or can’t afford further treatments you will go back to baseline in about 9 – 12 months.
A: After Restylane in lips, bruising is fairly common but less with cannulas
The lips tend to bruise with dermal fillers but when the injection is done with cannulas, there is much less chance. Necrosis is a rare complication with fillers, and again, the blunt cannula technique will reduce this chance even further because an intra-vessel injection is almost impossible. I don’t see any evidence of necrosis in your picture. Warning signs are immediate blanching of the area and area around the injection. It then turns mottled, with bluish hues within several hours.
A: Bruising from Restylane under the eye can be minimized with blunt cannulas
Addressing your exact question is tough without seeing you in person. If the problem is a shadow from loss of volume, more Restylane will help. Restylane won’t help dark circles from pigmentation. Also, sometimes residual pigmentation from a prior bruise can take a long time to resolve. I always use blunt cannulas in this area and rarely get a bruise. It’s also a lot safer too.
A: Uneven lips after Restylane will usually even itself out after about a week.
Sometimes after lips are injected with filler, they appear uneven. This is possible for a number of reasons. First, they weren’t even to start with. Second, there is assymetric swelling or bruising. Third, there was an uneven amount of Restylane or Juvederm placed. The best thing is to wait about a week before doing any modifications. Sometimes adding a little to the less filled side will be sufficient. Sometimes you need to dissolve a lump with hyaluronidase. But, most of the time, nothing needs to be done, and it all looks OK after a week. It’s important to have the doctor take good before pictures so that pre-existing assymeties can be evaluated.
A: Fraxel Dual or re:store (or any other laser) has no effect on your dermal fillers such as Restylane and Juvederm
It is quite alright to get filler now and then get Fraxel Dual a few months later. There will be no change in the results of the filler and it will not adversely affect the Fraxel. There are a number to studies to support this.
A: Restylane injected around the eye is extremely safe with blunt tipped cannulas
Restylane is my choice of dermal filler for injecting around the eye. I can not confirm or deny the 2 cases you state of blindness from injecting Restylane around the eye, I just don’t know. This horrible complication has occurred with other dermal fillers and has been discussed at several meetings I’ve been too. It has nothing to do with the brand of filler injected and can occur with any of them. It has to do with an intravascular injection that travels retrograde from a vessel around the eye back to the retinal area. It would occur rather quickly (ie, in the office). HOWEVER, this complication is near impossible or impossible if blunt tipped cannulas are used. There is practically no way to enter a vessel with a blunt tipped cannula so injecting filler inside a vessel is extremely difficult. I also am constantly moving the cannula so as not to put too much product in one place or more than a minute amount if I’m near a vessel.
A: Swelling after Restylane in lips could be a small collection of blood, of product, or related to the injector
Technique is so important when injecting lips with dermal filler. It is the most unforgiving area because a little issue can be very obvious, unlike the marionette or nasolabial area. I feel that the less trauma you cause when injecting, the less downtime the patient has and the happier they are. In my hands, that means using blunt cannulas. There is less bruising and swelling when injecting with the cannulas. In your particular instance, you need to see you doctor so he can look and feel your lips to see if there is an accumulation of Restylane or a small hematoma (blood collection). If there is a “bunching” of the Restylane, hyaluronidase will solve the problem rather quickly. In very rare instances, a condition called “Angioedema” can occur with is marked swelling that is rapidly progressive. In cases of AE, one needs to be treated quickly so the swelling does not progress, with high doses of steroids and antihistamines. Please see my video too.
A: Swelling after Restylane under eye is minimized with Blunt Cannula technique
Your picture shows moderate to severe swelling after your injection in the tear troughs. I’m not sure if this is related to the manipulation or the injection itself, but it should improve gradually. I highly recommend the blunt cannulas for this area because you get minimal or no swelling in this area. If the swelling persists, hyaluronidase might be needed to decrease the amount of Restylane in this area.
A: Restylane injection under the eye is very safe to correct tear troughs and hallows with blunt cannulas.
Restylane is a great filler to improve the under eye hallows and tear troughs. It is extremely safe. Using blunt cannulas, this is even safer because the vessels around the eye will be even more difficult to enter. Blunt cannulas also lead to less bleeding, less swelling, and less bruising in this area. I have been doing this procedure since early 2011 with the blunt cannulas and urge you to get a doctor that is experienced with this technique for your treatment. Most questions and problems with fillers on Realself.com stem from injections around the eye so you need to do your research. Please see the attached video to see how quickly this is done.
A: Restylane around eyes can lead to bruising, but much less chance if blunt cannulas are used
As a long time Realself.com physician, I must say that the eye area gives the most questions regarding fillers. Unfortunately, several people have had lumpiness, blueness, swelling, and bruising in this area. You, the patient, must go to the most qualified physicians to get good results with filler around the eye. You must have Restylane and not Juverderm, Sculptra, or Radiesse. I have been using blunt cannula’s for about 1.5 years in this area and the bruising has been minimal. It looks to me that the filler was place too superficially and should be removed with hyaluronidase. Without actually seeing you, it is possible that this is residual from a bruise, which can unfortunately take a very long time to resolve because the hemosiderin (pigment in blood) can sometimes persist even after the initial bruise is gone.
A: Restylane comes in 0.4, 1.0, and 2.0 ml syringes
There are actually 3 different sizes of Restylane. As stated above there are 0.4, 1, and 2 cc syringes. Keep in mind that a teaspoon is 5cc, so 1cc is actually 1/5th of a teaspoon. Any other sizes are not from the company in the US and are either made up by the physician or purchased outside of the US. The size which most people feel is standard is the 1 ml syringe.
A: Certification for Restylane injection by Physician not needed
As far as I know, any physician can inject Restylane. However, certain malpractice carriers, hospitals, or group practices might set their own set of rules. This makes it so important to go to the physician that is recommended to you by your friends, or has the credentials behind him. If you just go to the lowest priced physician, you might not get the result you were hoping for. Keep in mind, the lowest priced Restylane might be the least busiest doctor, and he/she is using pricing to bring in patients.
A: Reaction 18 months after Restylane
One possible explaination is a smoldering infection that was quiet for a long time but got activated for some reason. This could be the result of bacteria being “dragged in” with the injection, or bacteria in the blood stream that got caught in the Restylane. Antibiotics would help is this was the problem. See the doc who placed the Restylane for more advice.
A: New appearance of purple splotches is a concern after dermal filler
I would go to your physician and have him look at this. It’s hard to advise you without a photo but what you can possibly have is occlusion of the vessels around the nose. This can lead to the overlying skin dying from poor circulation. It can usually be improved if recognized early by Hyaluronidase, heat, blood thinners and nitro paste.
A: Restylane is great for under eye and cheek rejuvenation
Restylane is my preferred filler for the under eye and upper cheek filler. It can help fill in the hallows and replace mid cheek flatness that occurs with age. My preference is to be conservative in this area and reinject after 4 weeks if needed rather than inject too much at the initial treatment. I’ve seen too many unhappy patients which have been over injected. Bruising is slightly higher in this area vs. other areas.
A: Restylane increase collagen in area of treatment
Restylane does help in stimulating collagen in the treated area. One frequent finding is that fillers tend to last longer the more you use them, and this is mostly due to the collagen production. The same can be said for all fillers too.
A: Q-Med has licensed the filler to Medicis in the US
Q-Med makes several different fillers and does license the rights to Restylane and Perlane to Medicis in the US. I agree with all the comments below concerning safety and outcomes. My favorite saying is “The results don’t depend on the filler, but the filler (injector).”
A: One study says opened Restylane lasts 9 months
There has been a study on the sterility of opened Restylane. The study concluded that an opened Restylane syringe stays sterile for at least 9 months.
A: The physician is more important than the dermal filler brand
I agree with Dr. Persky. Either is a good choice. My preferences are:
- Eyes – Restylane
- Lips – Juvederm
- Nasolabial and Marionette – Either, but I lean towards Juvederm.
Remember, it’s the Doc that’s most important. A physician trainer for other physicians is a good choice, but not necessarily a requirement. Steve Weiner, MD Facial Plastic Surgeon.
A: My style is to not wait until it is completely gone
This is more of a question about doctor’s style. There is no right answer. My style is to touch up the previous injection when the correction appears to be waning. It makes more sense to me to walk around with a full or near full correction most of the time then to have swings from full correction to no correction. There is no problem with putting a different filler on top or using the same filler. In some areas, like the lips, sometimes a mild enhancement is done initially. Then, before it is gone, I will enhance the lips further than the original results if the client desires large, full lips. This avoids the “coming out” with real big lips, dividing it up over time.
A: Severe Swelling can be Angioedema
There have been cases of angioedema after injections with dermal fillers. This is an abnormal swelling, not just the usual minor swelling one gets after HA dermal fillers. The cause is usually unknow, but frequently it’s related to someone taking an ACE inhibitor antihypertensive (usually the medication name ends in -ace). It doesn’t always happen to a person who has had it before and it only very rarely will occur in someone taking ACE inhibitors. It can also run in families. There are measures you can take to help prevent it in the future like taking steroids before and after.
To have an actual allergy to HAs is extremely rare.
If you suspect angioedema is the problem, this should be worked up by your internist.
A: A granuloma is not an allergy
Granulomas are when the body reacts to a substance and considers it foreign material. The is an intense inflammatory response, but not an allergy. This creates redness and swelling. Steroids are usually given to reduce the swelling. Sometimes, dissolving the filler with hyaluronidase will resolve the problem too.
You can form granulomas with any filler. Also, it doesn’t happen every time you get the same filler.
Interesting, I was told that Radiesse forms the least amount of granulomas of the fillers, but I can’t substantiate that. Radiesse does form more nodules than other fillers, which is bumps that are not swollen and do not hurt.
I don’t have any personal experience with the granulomas, but have been to several meetings where they were discussed.