LAM FACIAL PLASTICS

Hi Dr. Lam,

Today I went and saw a board certified plastic surgeon (highly recommended to me by a clinic) to get restylane done under my eyes in the tear trough area. It is now about 6 hours post injection and I have two enourmous racoon looking dark purple circles under my eyes with lots of lumps. What is with the lump anyway, I expected the bruises. I asked him to use a blunt canula (what I read you use) and he said, HUH??? Anyway, he used a needle and although my under eyes look better, I have these problems with lumps and bruises. Is that normal?? My skin under my eyes is extremely paper thin like a 90 year old woman's would be, and he said he got a blood vessel. What are your thoughts if you don't mind sharing. I am in my late twenties. Thanks, my first time getting this done.

sorry to hear that. this is why i use cannulas. yes, i know 99.999% do not know how to do that. my bruising under the eyes are usually close to zero. also, my results are very smooth. i can't promise you that the lumps are not Restylane lumps but only swelling since I did not do it. worst case scenario, the lumps can be dissolved with Vitrase. again, sorry to hear of your situation. fortunately, everything is reversible if need be. but hopefully not needed.

I absolutely love the results as I look so much younger and less tired. However, it is lumpy and I would like to smooth it out. There is tons of blood leaking in different places under my eye and is spreading to wierd areas. He really hit a blood vessel because it is dark purple and really dark red. I hope the bruising goes away, but I am not concerned about that is much as the lumps. I wore my sunglasses all day at work. I don't want to dissolve the restylane because I like the effect, just not the lumps. So, lumps are normal and they do go away? One is really big and I don't know if it is the product or not. When I push down on it, it moves around. It is like a clump of the product. I wish it were smoother and more natural looking. However , this is only on the left side of my face, the right side looks awesome but that is where the bad bruising is.

One more thing I forgot to mention in my last post. The plastic surgeon did not massage after he injected restylane with a very fine needle, rather he pushed down after each injection. He said he doesn't believe in massaging with restylane under the eyes. Is that technique similiar to yours besides the difference you using blunt canulas. Would it help if I pushed down on the three lumps under my left eye. I think the swelling is over by now, it has been more then 24 hours now. I think this is permanent, so if me pushing down on the lumps doesn't work, I guess my next visit will be to go get the product dissolved. What a waist!

The same thing happened to me. I had restylane injected in my Tear trough area as well. Bad bruising would be an understatment. The right eyes is fine, but the left side there is a huge bubble in my tear trough area with two smaller lumps. The bubble is filled with the product because I can move it around. Dr. Lam, is it possible that I ONLY got this bubble area dissolved with an enzyme of some sort because the other area around my left eyes lid is okay. I dont want to dissolve all the product, just the obvious bubble, is that possible?

hi ladies,
1. yes, you can target a very specific area with a very specific amount of Vitrase to dissolve the area that you want more precisely to dissolve. however, there is always a risk of over and underdissolving the product since Vitrase is not an absolutely precise dissolver. in most cases, i err on the side of being conservative since i can see the dissolution within a day or sometimes less.
2. pushing down probably will not help and can even worsen it. it could also help. you need to go see your PS to have him judge the situation. when i use cannulas, i almost never have to do any massage or pushing in the tear trough because it is precisely placed in the right plane in the right amounts.

interestingly, i had a lady from seattle last week who had an injection around the eyes in LA last year (?) by a VERY experienced injector who created huge unsightly lumps, a huge bizarre looking tear trough and bruising that lasted 3 weeks. she flew in to me to fix it (after the product had gone away) and i was able to fill her up including areas in my opinion much more aesthetically important like the anterior cheek, buccal transition zones, and prejowl) all without real bruising or any discomfort. If you are reading this now, perhaps you can help comment on your experience with me compared with the other "experienced" injector. Obviously, do not mention any names please.

best of luck with all that,
sml

do all PS's have the enzyme to dissolve the restylane if needed in their offices or are you the only one who can do that?

no, a lot don't. the only word i have for that is shocking. I THINK ANYONE AND EVERYONE DOING HYALURONIC ACID (RESTYLANE, PERLANE, JUVEDERM) REALLY SHOULD HAVE IT STOCKED ALL THE TIME. I always have it on hand so that if there ever is a problem (with what I do or another physician's) I can get rid of the problem within 24 hours. Another risk that is 1:10,000 cases is arterial or venous problems that can arise with injections. Another reason to have it handy. Fortunately, I don't use needles so my risk of arterial and venous issues are practically (but not entirely) zero. Another question a patient should ask every injector is do they carry nitropaste on hand. I ALWAYS HAVE NITROPASTE AVAILABLE. Again, for that one in 10,000 complication of arterial or venous occlusion issues. I used it the other day on a woman who had an infected nasal implant that I had to remove (not one that I put in) who was a smoker. Her nose was literally saved by nitropaste available. I admitted her to the hospital for around the clock nitropaste and her nose is now almost 95% okay compared to having potentially lost the entire upper part of her nose. This is such a rare case but I am glad that I had nitropaste. I am not trying to scare the pants off you but just to let you know what safety things should be with every physician injecting any product.

Here is an update on my condtion. If you read my posts above, you will know that I had restylane injected in my tear troughs 2 days ago and found three lumps in my left tear trough area. The largest lump was like granula or whatever they are called, it was huge. It was like a balloon filled with the product. I tried moving it around and massaging it but couldn't get a grip on it to do that. Well, today I pushed the lump against my orbital bone and massaged so it would stay in place and to my utter shock, I massaged it and it is now gone and spread out. I have had many Physicians tell me to massage lumps and then I have had others say not to, well, this did work, so I hope I did something okay and not dreadful for future purposes. I was worried because it looked like this huge bag under my eye. I am glad that restylane can be manuevered around.

Dr. Lam, I do have a question about this blunt canula. If it is not a needle, then how does it go into the skin, I just can't picture this in my mind too well, but I am very curious. I just wish you could teach other physicians on how to use them, could it be that hard to teach, it woud be a lifesaver here in California and other places as well,

i use a needle only to go through the skin. then the rest is cannula. i used to teach it but the physicians i taught scared the pants off me so i have stopped doing that 2 years ago. it is a much more advanced technique that most physicians out there do not know how to use.