How can I prevent bruising from Restylane or Juvederm?

All of the suggestions offered by the panel are very informative and helpful. Unfortunately, these instructions may not always be shared with the patient prior to the procedure so that they may take advantage of the advice.

As a few panel members mentioned, a slow, gentle technique goes a long way in helping to minimize the risk of bruising. I've found that taking the time to use extra stand-alone lighting aids in making the vascularity more visible. This is especially helpful when administering Botox around the eye area.

One thing not mentioned is the importance of educating the patient not to be overzealous in massaging areas that were treated. In fact, we almost always discourage any form of massaging. Delayed hematomas (bruises/swelling) from massaging and patient manipulation is possible when using fillers.

Unfortunately, there is no way to prevent bruising, as bruising is actually bleeding in the tissues under the skin and any time you place a needle into the skin, there is always a chance that a bruise can occur. However, with that said, there are ways to reduce the likelihood that you will bruise.

First, unless you have a medical condition that would make this necessary, you should stop taking aspirin, ibuprofen or other antinflammatory medications at least 5 days prior to your procedure.

The selection of your doctor is also very important as some doctors are much better at this than others. I typically take about an hour to treat an entire face, where many of my colleagues do this in 15-20 minutes. The faster the doctor injects, the more likely he or she will cause a bruise. I also inject very gently, making sure not to force the product into the skin while many, if not most, doctors force it into the skin; again, there is a greater likelihood of bruising with this technique.

Finally, if you use ice before, during and after your cosmetic injections, this can help minimize bruising.

While unsightly, bruises typically fade and do not cause any lasting trauma.

There are precautions you can take to help minimize bruising from procedures such as Botox and fillers, although never a guarantee.

Around the eyes, tear trough, near the nose, and corners of the mouth are a few zones more at risk for bruising due to the thinner properties of the skin. A careful injector will take his/her time in assessing your skin in good bright lighting for any visible vessels, so they may be avoided.

General tips:

1. Avoid anti-inflammatorys such as Aleve, Aspirin, and Motrin at least one week prior to injection date.
2. Avoid any herbal remedies such as St.John Worts, Gingko, Fish oil, Vitamin E.
3. Use cold packs to the area treated, during or immediately post-treatment. At Healing Waters we use a cooling machine called Synercool; this allows for less discomfort and helps decrease bruising. Cold therapy will constrict the blood vessels and thus allowing less seepage into the surrounding tissue so the bruise won’t be as large or as painful.
4. Pre-treat 3 days prior to injection date with Arnica tablets from health food stores.

Think ahead and plan your injection date at least 2 weeks prior to a big event. A green-based foundation with an anti-inflammatory mineral make-up on top (I really like the True make-up line) will help minimize the appearance of bruising and discoloration just in case there is bruising.

Unfortunately, there is no way to absolutely eliminate the possibility of bruising, so we ask our patients to not have big plans for a week after injections. They also avoid aspirin and motrin-type products for a week before injection and take arnica around the time of the treatment. With all these measures, bruising is usually minimal and short lived.

There are a few things that can be done to reduce the risk of bruising.

Plan your injectable 2 weeks ahead of time and 2 weeks before any major social event.

Most people already know the common medications and suppliments to avoid for 2 weeks before injectables. The list includes prescription and o.t.c. NSAIDS (Aspirin, Advil, Aleve etc), Vitamin E, herbal suppliments (Ginko,Ginseng, garlic pills, fish oil). Whereas all prescription blood thinners will increase your chance of bruising, they should not be stopped without consulting with your internist.

I do not stop coumadin for Botox injections. With concomittant cooling and extra care, I have been able to avoid bruising. In my office I use Zimmer chiller to cool the area for a few minutes before injecting and during injection. This causes vasoconstriction and reduces bruising and swelling considerably. It also provides cryo-anesthesia for injectables that do not require use of local anesthetics (Botox).

Arnica tablets and topical gel is anecdotally considered to reduce bruising. While I do not routinely recommend it for Botox, I do suggest it for injectable fillers - particularly to patients who have a tendency for easy bruising.

Although there are no guarantees on bruising, gentle technique goes a long way towards minimizing bruising and swelling!

Other ways to prevent bruising including the following:

• Avoid aspirin, Advil, Motrin, or other oral medications which encourage bruising for at least 7 days before your treatment

• Ask your physician for Arnica Montana. This herbal homeopathic remedy is used by many injectors to reduce post-treatment bruising and has few associated side-effects

• Ice following your treatment

• Avoid exercise for 24 hours following your treatment

• Keep your head up for the first few hours following your treatment

While these recommendations cannot guarantee a "bruise-less" experience, they can certainly improve your chances!

While there is no guarantee that when you get an injection you will not bruise, there are some things you can do to reduce the risk of bruising.

First, if you take any medications at all, even over-the-counter medicines, they can increase your risk of bruising so you may want to reduce them before your injection. Including:

• Aspirin
• Motrin
• Aleve
• Ibuprofen
• Vitamin E
• Flaxseed Oil
• Fish oil

All of these products thin the blood. If your blood is thin then you are more likely to bruise because your blood clots more slowly. I happen to be an easy bruiser so sometimes I get a little bruise if I get an injection.

There are some people who happen to bruise easily. They'll tell you, ”Heck yeah, I bump myself and I get a bruise every single time.” Well, they are definitely likely to be someone who gets a bruise with an injection. If you are one of these are people then you want to be very careful to not get multiple pokes when you are getting your injections. The medical practitioner should try to do one poke with multiple threads within that one poke with their filler. Statistics say that with less pokes you reduce the chances that you will get a bruise.

If you pre-treat for a couple of days by taking Arnica before your injection, it can help reduce the chance of bruising. There are tablets of Arnica that you can get at health food (and some grocery stores) and you place the tablet under your tongue. We also sell Arnica in our Calidora Skin Clinics. Additionally, you can use ice immediately before the treatment. An ice pack placed on your skin for 3-5 minutes will constrict the little vessels in the area you are going to treat. Using ice immediately after your treatment will also help reduce the risk of bruising. We also recommend icing throughout the rest of the day.

If you see any sign of bleeding beyond a little polka dot of blood that’s usually going to be a bruise. I recommend applying pressure and ice immediately and hold the ice on the spot. You should also limit your activity for the rest of the day so that you don't raise your blood pressure as that can increase the likelihood of a bruise. I also recommend taking Arnica after the treatment for a few days.

Of course make sure to consult your medical practitioner before your injections to let them know your concern.

To reduce the chance of bruising from a cosmetic injection such as BOTOX, Restylane, Radiesse, Sculptra, etcetera, steer clear of the following for 2 weeks before your treatment, and do let your injector know if you have taken any of the items below:

1. Prescription medicines to thin the blood such as Coumadin, Heparin, and Persantine. ALWAYS ask your doctor first prior to stopping these medications as they are preventing dangerous blood clots in your body. (You will only be allowed off of these for a few days, if at all).
2. Over the counter medicines that thin the blood such as aspirin or aspirin-like products (e.g. Advil, ibuprofen, Motrin). This includes medications that relieve pain due to headache, arthritis, and menstrual cramps. Tylenol (acetaminophen) or Extra Strength Tylenol by itself is okay, but be careful, as some Tylenol products are used in combination with blood-thinning medications, such as Tylenol Migraine or Tylenol Arthritis.
3. Herbal supplements and vitamins that thin the blood, such as Vitamin E, Gingko Biloba, Feverfew, Ginseng, Red Clover, Fish oil, and garlic supplements. If you dont want to take any chances, stop taking your multi-vitamin also if it contains more than 40 IU (units) of vitamin E.

To further decrease your chance of brusing, apply ice or cold compresses as soon as possible after (or during) your treatment; let your injector know of any obvious veins to watch out for, and go to a trusted and experienced injector who knows how to inject carefully and precisely, while avoiding as many blood vessels as possible.

Even if you follow all the advice above, it is still possible to bruise. If you have an important event or photos coming up, allow at least 2 weeks for recovery so you won't be disappointed.

• Don’t take aspirin, Motrin, Advil, or Aleve (ie NSAIDs) at least a week before and a week after injection, as these medications can lead to more bruising.
• Intermittent icing is recommended for about the first 6-12 hours after injection to help with swelling and possible bruising.
• Arnica Montana herbals have anecdotally been said to lessen the bruising related to procedures, but I do not typically recommend this to my patients getting Botox.