Minor bruising is one of the most common adverse events of injectables like botulinum toxins and dermal fillers. Although it's impossible to prevent bruising completely, there are ways to minimize the risk and manage them.
What is a bruise
A bruise is an area of skin discoloration. A bruise occurs when small blood vessels get punctured and leak their contents into the soft tissue beneath the skin. A bruise is also called hematoma. The bruise which occurs after injectables is subcutaneous (beneath the skin). Under normal circumstances, the vessel repairs itself quickly and the bruising will be minor.
Bruising is more commonly seen in patients who received larger volumes of filler and those whose injections were delivered in less time indicating that both rate of injection and volume are independent risk factors for bruising.
Position during procedure
Patients undergoing a cosmetic injection procedure should be positioned properly. They should sit in a chair that is reclined 30° with the head firmly rested against a solid headrest. The hands of the physician should be braced against the patient, thus preventing any unnecessary trauma if the patient were to unexpectedly move. Blood vessels should be avoided by careful inspection of the injection site. The skin of the patient should be clean, so makeup or other material should not cover or camouflage the vessels. The room and patient should be well lit and some providers recommend a sidelight on the patient to highlight blue vessels. The use of magnifying loops is helpful in looking for small vessels within the injection site.
Cool down the skin
Cold compresses can also be applied prior to the treatment to encourage vasoconstriction and reduce the risk of bruising.
Lidocaine
Lidocaine is one of the common kinds of anesthetic. Though licodaine patches, and topical sprays and gels, are available, it is most widely used as an injectable anesthetic in a 2% or 1% strength solution, both with or without epinephrine (adrenaline), a vasoconstrictor.
Contrary to popular belief, lidocaine use does not increase bruising during a procedure — if anything, especially with the use of epinephrine, one of the good side-effects of this product is that it can reduce post-operative bruising (reference). Some injectable fillers contain lidocaine for increase comfort.
The use of blood thinners
There are a few reasons why this repair (coagulation) might take longer, for example when blood thinning substances or medication is used prior to the injection. This increases the risk for developing bruises and impact the severity. It is important to inform your physician if you take blood thinning medication like painkillers. If aspirin is not medically necessary, it should be held for one week prior to any injectable procedure. Avoid (if possible) the use of non-steroid anti-inflammatory medications (NSAID's like ibuprofen) for five days prior to any procedure. Alcohol slows down the coagulation and therewith increases the risk of bruising. Many herbal supplements and vitamins have the potential to increase the risk of bruising, in particular high-dose vitamin E, ginkgo biloba, and garlic. Most physicians recommend to stop taking those particular substances two weeks prior to the treatment.
Using micro cannula instead of needle
A cannula has a blunt tip and decrease damage to tissue and vessels and thus bruises versus use of traditional needles. Read more: benefit of blunt tip micro cannula vs sharp needle.
Fanning technique
Using a fanning technique increases the risk of bruising when compared to single puncture threading technique or multiple puncture technique.
Aftercare
- Pressure on injection site: Immediately after the injection, pressure should be applied to the injection site for a few minutes. However, in a later stage, post procedure pressure on the face can best be avoided.
Cold compresses can also be applied to encourage vasoconstriction (shrinking) of the vessels and reduce bruising.
Food: When you think about food, a relative vasoconstriction of the skin vessels occurs as blood is shunted to the gastric system in anticipation of eating. This relative cutaneous vasoconstriction may minimize slight bruising and bleeding.
Heat: Don't go to the sauna after your treatment or take hot baths to avoid bacteria and vasodilatation (expansion) of the vessels. - Sunlight: Protecting your skin from the sun is always important, but after treatment, excessive sunlight and UV lamp exposure should be avoided.
Sports: Try to avoid heavy lifting and extreme sports immediately after the procedure. Sports increase the blood pressure and circulation.
Rubbing: It's recommendable not to rub the injection site after botulinum toxin or filler injections. However, massaging the injection site after some injectable fillers, for example Sculptra is recommended. - Napping: Some physicians recommend not to lay down the first few hours after the procedure and take an extra pillow to elevate the head the first night.
What to do if you bruise
Even when you've taken all precautions to prevent bruising, and you were treated by a highly skilled and experience physician, you can get bruises. There are some data that indicate that topical application of arnica, bromelain, and/or high-dose vitamin K can reduce the formation of ecchymosis and increase the rate of resorption. Pulsed-dye lasers and focused IPL treatments seem to work well to expedite the resolution of bruising when used within approximately 48 hours after the injections. The laser energy allows your own body to reabsorb it more quickly. Lycogel offers a special full coverage breathable foundation and concealer to use after aesthetic procedures with healing ingredients, but you can also use regular color corrector or concealer to cover up bruises. Usually the bruise will turn to a more yellow color within 72 hours and disappear completely within 14 days, depending on the severity.
Anne-Marie van Geloven
Anne-Marie is the founder and managing partner of LICW®; a global quality alliance for non-invasive aesthetic procedures, specifically injectables (botulinum toxins & dermal fillers) and owner of Lily Leading Instant Eye Lift; a medical grade non invasive eye lift strip. Before that she held senior management positions within several pharmaceutical companies operating in the field of dermatology and aesthetics. Her objective is to improve satisfaction, outcome and safety of non-invasive aesthetic treatments.
Related information
- 9 things to consider before getting botulinum toxin injections (or injectable fillers)
- Reference: Minimize bruising after fillers and other cosmetic injectables
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