Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Restylane 
Q. I had one syringe of Restylane injected two weeks ago into nasolabial folds. Right after, I could feel hard bumps under the skin, but were not visible unless I pulled the skin taught. The smile lines looked erased. The bumps started decreasing over the next few days. Now two weeks later, the lines are back and only minimal improvement seen. Is this “settling” effect normal? Or is this an issue with the doctor’s technique and skill?
A. Sorry for your concerns. Your description of the changes following Restylane (one of many hyaluronic acid gel fillers) injection is spot on. Thanks for sharing your photos. To my eye, you have a very good result.
It doesn’t sound like your concern is either the filler nor the injector or his/her technique. Restylane is a perfect intradermal filler for the nasolabial folds. It takes about 2 days to settle into place and can form small beads or a “spaghetti-like” string depending on the injectors technique for this injection site.
Following any puncture or injury of the skin, inflammation will create swelling and many times bruising. It takes 2 to 3 weeks for this to resolve.
During the first few days, HA gels come to “equilibrium” with the surrounding tissue by attracting and holding onto water molecules. During this dynamic period of change, you can expect more filling / swelling than desired and then the inflammation edema and the injected material slowly change toward more smoothness and softness with improvement of the line/wrinkle/fold injected.
Your photos note a nice improvement. Your photos note a nice improvement. I can only fault the lack of volume, ie only 1 cc of filler is not enough for a very large area to fill.
I would recommend you return to your injector and consider more filler to achieve the volume and fold enhancement you seek.
All the best!
This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.
