Botulinum Toxin and Filler Revisions
This patient had tear trough filler injections performed by another injector. She developed painless firm nodules in the areas where filler was injected that caused associated skin discoloration. The patient was referred to Dr. Mettu for further management. She was told by the original injector that the filler injected was a naturally occurring substance that was not permanent. From this description, one would infer that this patient was injected with a hyaluronic acid based filler. Review of records revealed that the patient was actually injected with a permanent filler made of an acrylic plastic in a collagen gel. Based upon the history and evaluation, the patient was diagnosed with filler granulomas. A series of injections containing steroid and 5-fluorouracil was planned. The patient underwent 3 injections. Another injection of steroid and 5-fluorouracil was planned but deferred by the patient as she was pleased with her improvement.
Are you unhappy with your Botulinum toxin or filler injections done by another provider? Given his detailed knowledge of facial anatomy and his experience with cosmetic injectables, Dr. Mettu may be able to help.
Botulinum Toxin
Sometimes a droopy eyelid can occur after injections. This can be problematic as it can affect vision and is generally bothersome cosmetically to most people. As an ophthalmology trained plastic surgeon, Dr. Mettu can perform an evaluation to see if a prescription eye drop may provide temporary relief.
A 'Spock eyebrow' appearance can occur if one is injected with botulinum toxin in the forehead with poor technique. This can be improved by injecting additional botulinum toxin in specific areas to achieve a natural eyebrow contour.
Other suboptimal results from botulinum toxin are due to unbalanced injections which may only be noticeable with facial expression. Injecting more botulinum toxin to target certain areas may help in these situations.
Filler
Undesirable results from filler may present in a variety of ways. For areas that are under treated, more filler can be added. For areas that are overfilled leading to poor cosmetic appearance and/or impending vascular compromise, hyaluronic acid (HA) fillers can be dissolved with hyaluronidase.
Rarely, filler granulomas (firm, hard, painless masses) can develop. These are more common with permanent fillers than with HA fillers. Granulomas can be successfully treated with a series of injections containing anti-inflammatory and anti-metabolite medications. Filler granulomas can also be surgically removed. The need for surgical removal of granulomas is uncommon and is typically only pursued if injections fail.