Alexander Z. Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who has focused his practice exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments in Southern California. He understands that no one relishes the thought of “going under the knife,” and believes modern medical technology can provide today's patients with superior alternatives to invasive, painful surgery that requires a long recovery time.

Tuesday, September 2, 2008

Discoloration Under the Eyes After Juvederm

Hi,

I had juvederm in sept07 for some dark circles. Dr. told me to fill the hollow and it would get rid of the shadow. One month later there was an imperfection on one undeye(dent) so she talked me into filling it with restalyne. She hit a blood vessel on the l eye and I had a black eye for 5 wks. When it cleared, there was still a very dark mark where the black yey had been It did not get lighter and she said it was a hemosidirin stain and lets try to laser it. She laser it 2x and it helped lighten the bottom but there is still a discoloration I never had before. The other eye strated to get a discoloration under it also. It became worse than the other side. It looks like 2 dark lines that where drawn from my eye to the side ofthe nose. They are MUCH more noticable than any dark circles I used to worry about. They are VERY distinct in photos and I look like an exhausted mug shot. I reviewed all my photos prior to the injections and you cannot see any darkness or distortions under my eye. I guess the dark circles bothered me in the mirror but they were nothing compared to what I am dealing with now. I look terrible in photos and it is quite noticable in person. There is a slight bump on the right side but I can live with bumps. Its the discoloration (darkbrownish) that has me terrified. I am afraid I ruined my face. All over a little dark circles. I would give anything to have my face back. Any ideas? The 2 syringes of juv were 9/07 and the resty on top of it was 11/07.

Thank you for your help!


hi
sorry - i was on vacation
the discoloration that you are describing is a rare but really disturbing side effect of injecting restylane or juvederm under the eyes. i'm not sure why it happens - probably the filler becomes visible through the skin (it is clear, but looks blue under the skin). did your doctor inject deep, next to the bone? if she injected too superficially, it is possible that the filler becomes visible like this.
the filler is still there, so i would dissolve it with hyaluronidase enzyme if i were you. if your doctor is injecting under the eyes, she should be familiar with the enzyme. it will remove the filler and your eyes should go back to normal.
cheers

2 Comments:

Anonymous Anonymous said...

From on the ground experience (I'm not doctor; just an experienced patient!) I have to say I disagree somewhat with Dr. Rivkin's analysis here. I had exactly the same thing happen to me: Had Restylane injections under eye about 10 months ago. Doctor hit vein(s) and I ended up with two horrible black eyes for about 10 days. After black eyes resolved, I was left with a darkish, brownish "stain" under each eye. Several docs concurred that this was not Restylane peeking through, rather the stains were hemosederin -- essentially iron deposits left over from the bleeding.

Hemosederin stains are deep under the dermis. Most people think cannot be adequately reached with most lasers.

It has been 10 months for me now, and most of the staining seems to have disappeared. (The process has been slow; it has taken almost a year.

In an admittedly bold move, I actually had another practitioner inject Juvederm under my eyes again yesterday! Having done about 500 of these types of under-eye injections, she inspired great confidence (unlike the plastic surgeon who did my eyes before). Lo and behold, this second time around has been great. No bruising whatsover. The hollowness under my eyes is filled in quite nicely.

September 27, 2008 10:53 AM

 
Blogger Dr. Alexander Rivkin said...

you are absolutley right - this is the other possible scenario and i should have mentioned it. hemosiderin deposition after bruising is a definite possibility. it is fairly rare, though.
most of the cases that sound like this are tyndall effect - i would have to see the situation to know for sure one way or another.
the other point is that, yes, there's not much that can be done for hemosiderin. it gets better over time, but its slow and one just has to wait.
this is why i am extremely careful about bruising and, fortunately, have not seen more than 1 or 2 cases in my practice.

September 27, 2008 3:07 PM

 

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