Severe hematoma from Botox remains after 8 weeks

I decided to have my first Botox procedure done after diligent research, and I chose a Board-certified plastic surgeon to administer the Botox injection for my under eye creping. The doctor said he hit an artery/nerve, which most likely caused immediate swelling and hematoma on the area. I did everything I can--ice, elevation, topical and oral arnica, applied heat, massaged it lightly, and put vitamin gels--but 8 weeks later, the bruising and swelling are still there. Will this ever go away, and what should I do now?

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11 answers to “Severe hematoma from Botox remains...”

A: Time is really the only cure for severe bruising

By S. Randolph Waldman, MD - Lexington Facial Plastic Surgeon

I would have to wonder if you might have some underlying reason for such severe bruising (taking medications that might lead to "thinnning" of the blood like Aspirin, Ibuprofen, Plavix, Vitamin E, Green Tea, etc). In my 16 year experience with Botox, I have not seen this extent of bruising or... more

A: Botox bruising

By Steven H. Williams, MD - Bay Area Plastic Surgeon

Thanks for the question. As the other physicians have noted, any injection can injure an artery, which can lead to bruising and a hematoma (a collection of blood). The anatomy of the tear trough area can make the hematoma appear worse. The skin of that area can be very thin and show uneven injections or... more

A: Uncommon but well known problem

By Jordana S. Gilman, MD - Manhattan Dermatologic surgeon

Any injection has the potential to injure a blood vessel. The larger the vessel is the more bruising there will be. Because you have had the bruise for a long time, it sounds like it may be located in the tissue in such a way that it is harder for the healing elements to reach it. Think of it as if... more

A: Just wait and let the natural healing of your body resolve the bruise.

By Michael McNeel, M.D. - Atlanta Plastic Surgeon

Your result is not typical but is a known risk of an injection of any type. The area around the eye is very vascular and therefor blood vessels can be at risk from injections and result in bruising. Many physiicians require patients to be off any medications that might increase the risk of bruising for... more

A: There may be a bright side.

By Kenneth R. Francis, MD - Manhattan Plastic Surgeon

It's unfortunate that you have experienced one of the adverse effects of injectable cosmetic medicine, especially on your first treatment. However, for the reasons previously cited, most importantly possible underlying bleeding disorders, it may be a fortunate complication. I hope it... more

A: Blood in the preseptal recess

By Robert M. Freund, MD - New York City Plastic Surgeon

The eyelid has a septum that holds the eye structures and fat inside the orbit. The septum pass over the orbital rim and leaves a small hidden recess in exactly the position where you have the 8 week old bruise. This small recess can fill up with blood and it will take much longer to resolve than other areas... more

A: Not very common

By Steven Wallach, MD - Manhattan Plastic Surgeon

Injections in and around the eye can cause bruising. However, it is not very common to get significant bruising from Botox injections. It will most likely resolve on its own, but the cause should be investigated. SOmetimes a hematology work-up is necessary to rule out strange blood clotting... more

A: Don't Just Cover Up! Investigate the Cause...

By Athleo Louis Cambre, MD - Los Angeles Plastic Surgeon

Occasional bruises are the bane of injectables, including Botox and fillers. Usually, they are small and inconspicuous, and fade within a few days. Certainly bruising is more common and easier to see around the eyelids, where the skin is thin and the network of small blood vessels is rich... more

A: There is really no procedure that is completely risk free.

By George J. Beraka, MD - Manhattan Plastic Surgeon

Injuring a blood vessel is a very rare but recognized complication when puncturing the tissues with a needle. You must feel terrible; unfortunately there is not too much to do right now other than use camouflage make up and wait. This will almost certainly clear up in another month or two. You may... more

A: Very Rare Botox Complication

By David Shafer, MD - Manhattan Plastic Surgeon

MasonGirl, I am sorry to see that you had such an experience with Botox. Certainly this is a very rare complication - I personally I have not seen this happen with Botox injections. However, regardless of what is being injected, if a superficial artery or vein is punctured, this is a possible outcome. 8... more

More answers to Severe hematoma from Botox remains after 8 weeks
Seattle - Certainly this is very unusual

Comments

John Tang, M.D.
7 posts
4 Feb 2009

In the eye area, there tends to be a higher chance for bruising because of the richer blood supply. In that particular area, there is a collecting area where the blood can collect. In general, you would want to wait for the bruise to be slowly cleared by the body. After 2 weeks most bruising will go away. However, the ones that remain become annoying and that point, patients just want them gone! I have found success uing IPL laser to help speed up the process. It is thought that the light energy helps break down the hematoma so that the body can clear up faster. You will need several treatments. I have found that it speeds up the clearance by at least 2 fold, meaning it would take half the time to clear it then if you just let it heal on its own. I think it is well worth it if you have an important function coming up. Remember, injections in this area are subject to bruising. In the future, there are ways to decrease the risk of bruising. I have written about this in some questions I have answered. Here is a summary. 1. Pick your injectionist wisely. Experience is key. Experienced injectionists will need less injections and massaging which will decrease the likelihood of bruising. 2. Ice immediately. Compression if necessary. 3. Avoid aspirin, anti-inflammatories 1 week before 4.Avoid vitamins such as omega 3's several days prior 5. Avoid certain herbal medicines such as gingko 6. Arnica gel, arnica tablets - homeopathic medicine - one is OTC, the other is prescription 7. Auriderm gel - has a special form of Vitamin K - can reduce bruising by half 8. Bromelain - get at your local store

DrFardad
12 posts
19 Nov 2008

The face and especially around the eyes has a very rich blood suppy. There is a good chance he may truamatized a small blood vessel which cuased the hematoma or the blood collection in the area. The hematoma and the swelling usually do go away. However if there is breakdown of the blood products and absorbtion of it by the surrounding tissue has caused the staining, may take a long time. The tissue staining needs to be treated with laser at a later date.

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