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Restylane Injection Hit Blood Vessel in Eye Lid. I Wonder if I Should Look for Another PS?

An experienced PS injected Restylane in my lower lids, and hit a blood vessel. I COMPLETELY understand that this happens to the best of them, but I have a truly black eye that mocks makeup coverage going strong still 10 days later. PS let me know he hit a vein, iced it and applied pressure for MAYBE a minute before continuing injecting. He did not ice at all before or after- but sent me home with an icepack. (No blood-thinning supplements factor in, and thorough home-care by me afterwards.)

Doctor Answers (16)

Preparation for the expected black eye is essential.

+3

If you were not prepared for the possibility of getting a black eye with your undereye filler treatment, then I seriously question how "experienced" your plastic surgeon really is.  This service cannot be done without causing lower eyelid bruising in a percentage of all patient's treated even if they stop taking their Tibetian yak liver supplements or whatever.  Simply the treatment has to be placed behind and in the lower eyelid orbicularis oculi muscle which is quite vascular.  I have one of the largest practices of lower eyelid filler treatment in Los Angeles. In assessing the total experience, 30% of individuals have some type of lower eyelid bruise and 2% get a black eye.  A small bruise at the point the needle was injected might easily hid under coverup.  A big black eye that looks to the world like you were slugged by your domestic partner (and that is what the world will think) is just never going to hide except behind an oversized pair of Gucci sunglasses.  Oh, and this bruise can take 3 weeks to disappear so forget the party you were hoping to look fabulous for this weekend.  No experienced injector would do this treatment without preparing you for this possibility.  I tell my patients that the results are better than surgery but this service is very much like surgery in a syringe.  You get a fantastic result that rivals or is better than surgery without going to the operating room and it is basically painless and it is all done in the office.  The down side is yes, you can bruise and the treatment may need adjustment once it has settled.

Should you throw in the towel on your "experienced" plastic surgeon.  Hey this was a big detail to leave out.  As you say, anyone can cause a bruise.  It is the lack of preparation that is at issue here.  I recommend that you let the dust settle which will be about 10 days after all of the bruise has disappeared.  If the result is great, perhaps you can forgive.  If there are issues with the treatment, then it might be a sign to move on.


Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Bruising is not necessarily operator dependent

+2

Bruising can happen to any patient when any physician is injecting, especially in the eye area. I do think that patients should be warned of this  possibility but short of that it is going to happen to someone if you do this enough. I do ice before and after and am not sure that  that would do a whole lot if/when I nicked a little vessel. If you like this doctors work, stick with him. The bruise will pass and you will enjoy your filler-just don't have it done before an important event.

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 12 reviews

Risks of Bruising with Injections around the Eyes

+2

Injecting any of the hyaluronic acid fillers such as Restylane of Juvederm around the eyes, in my opinion, has the highest risk of bruising of anywhere on the face. Even with the correct injection technique there is always the chance of hitting a vein and causing a significant bruise in this area. All of my patients are warned of this possibility before any injections are done. So obviously luck unfortunately plays a role as well. If necessary, I will have the patient apply pressure for at least five to ten minutes to prevent the bruise from worsening. I don't think icing the area will help at all. After that, it's "hands off".

 

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

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Black eye after lower lid filler

+2

You can but IMHO, anyone that's using a sharp needle to inject fillers into thin skin filled with blood vessels, as the lower eyelids are...at some point is likely to create a bruise.  You may want to try having the Restylane placed through the inside of the lower eyelid, but you may still get a significant bruise.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Black eye after Restylane

+2

The majority of patients do not have bruising with injections.  However, areas around the eyes and lips have the highest incidence of bruising.  Even the most experienced injectors cannot guarantee no bruising.  I always warn patients that there is a possibility of bruising and tell them not to have injections if they have an important event coming up in the next week.  That said, there are some treatments that can help reduce the incidence of bruising such as pre and post treatment with Arnica Montana, icing of the area and injection techniques to reduce bruising such as using a blunt micro cannula to inject the produce instead of the sharp needle with comes with the kit.  I hope this is helpful.

 

Good Luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 54 reviews

10% of patients may develop a "shiner" after a lower eyelid Injectable Filler treatment.

+2

I read your concern. The lower eyelid skin is very thin and unforgiving if a vein is encountered during an Injectable Filler procedure. Your bruise should completely resolve in around 2 weeks.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 268 reviews

Restylane Injection Hit Blood Vessel in Eye Lid. I Wonder if I Should Look for Another PS?

+2

Dear Lilliana:

I understand your frustration, but it can happen to everyone. If you have used him before and you like the results you get from his skill injecting Restylane, and this untoward event is not the norm, I would stick with him. Going somewhere else does not assure you that the next person may not hit a vein again.

I explain to my patients that some veins are underneath the skin and they can not be seen when the injection is taking place. Sometimes this events cannot be prevented.

 

Michel SIegel, MD

 

 

 

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.5 out of 5 stars 69 reviews

Bruising after Restylane injected under eyes

+1

In our practice, we see probably 1-2 out of 10 patients with bruising under the eye after Restylane injection to this area.  Usually it doesn't start until 1-2 days later though it can begin immediately.  The results in this area with Restylane are phenomenal if done correctly but we do caution our patients that the area under the eye can bruise more easily than any other part of the face (second to the corner of the lips) so we always ask if they have any big plans in the coming days before injecting.  Since this complication can occur in the most able hands, if you like your PS and he's done a good job for you in the past, stick with him.  Those pesky veins are just hard to avoid sometimes.

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Black eye and restylane in lower eyelid

+1

the risk of bruising is usually discussed with patients prior to injecting the lower eyelids (and other facial areas, but especially the eyelids since the skin is so thin and more vascular there), but ice prior to and even after does not  minimize bruising (it may make the injection more comfortable and may decrease post injection swelling). Your makeup may not hide it well but there are many coverup makeups and experts to help you.  Warm compresses, V-beam laser, topical vitamin K such as Auriderm, and Arnica by mouth, may help quicken the resolution of your bruise, but you should check with your PS.
 

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Bruising after Restylane injection in the lower lid happens

+1
Bruising after an injection into the lower eyelids is an event that happens. I do ice before and after this procedure and make sure that my patients are not taking any known blood thinners i.e. aspirin, aspirin conatining products, medications known tom thin the blood, herbal remedies and vitamins. With this said when a vein in injected and a small bleed occurs you will have bruising. I always inform my patients not to have this treatment prior to an event they are attending and let them know that they could have bruising for an extended period. If you are comfortable with your surgeon this old not be an indicated reason to leave as it could happen to any of us. Best regards and quick healing!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 122 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.