Juvederm and Restylane Nodules: Options for Treatment

Ms. DB presented to my office for a second opinion.  She had had Juvederm injected into her "tear troughs" to fill out the dark circles underneath her eyes.  Unfortunately, she developed a visible nodule beneath her lower eyelid.  To her, it looked worse than the original "dark circle."

On examination...

• The lump was below the lower eyelid.  ("Bags" develop when fat around the eyeball pushes out against the lower eyelid.  The cause can be age or fatigue.  This nodule is too low to be a bag.)
• The nodule was superficial.  (Juvederm is usually injected into the deep layers of the skin or just beneath it.  However, around the eyes, the Juvederm should in placed beneath the muscle that is right underneath the skin--there should be two layers on top of the Juvederm in order to obscure it.  This is the other doctor's mistake; he didn't know the nuances of periorbital Juvederm placement.)
• The lump has the soft, jelly-like consistency of Juvederm, Restylane, and Hydrelle.

There are three solutions, all of which are appropriate and none of which are mutually exclusive.

1. Patience:  Time will take care of such a nodule.  Juvederm typically lasts 6-12 months.  Therefore, we can all assume that the Juvederm will dissolve away on its own.
2. Massage:  I always recommend firm massage for 5 minutes, 5 times per day.  Include up-down, side-side, and circular motions.
3. Hyaluronidase:  Hyaluronidase is an enzyme that specifically dissolves hyaluronic acid products, such as Juvederm, Restylane, and Hydrelle.  It is simple to inject, but may require multiple treatments (to avoid over-dissolving the natural hyaluronic acid in the cheek area).  It usually (but not always) makes a significant improvement.

Ms. DB chose to undergo hyaluronidase immediately after her consultation.  She then massaged patiently for a month.  Fortunately, she had full resolution!

Comments

[Plastic Surgery]

To avoid these kind of mistakes, patients can discuss about the procedure with the surgeon for better understanding.

[Chrissiann]

Nono you do not know what you are talking about. This lump is likely very close to the same size, if not the same size, as it was 9 mos ago. There is mistaken belief that the product just dissolves away. This is true for some areas of the face (high movement areas), but the eyes it lasts MUCH logner. I have had juve under my eyes nearly 2 years ago and it is still there. I also had a little vitrase added to take it down a notch. but what i did not have removed is still under my eyes.
So to look at my eyes now, you would be sorely mistaken to say "wow those bags musta REALLY been big 2 years ago!!" No, they are the same size.