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Severe Hematoma from Botox

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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13 Doctor Answers | Asked by XSmartGirl in NJ

Doctor Answers (13)
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Very Rare Botox Complication

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 weeks later is a long time for the bruising to still be present. It sounds like you are doing everything right. Talk with your doctor about possible referral for further interventions... more

Blood in the preseptal recess

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 around the eye or in the face. It looks to me like there is some blood in the recess and it will take months to go away. Rest comfortably- it will go away! A great cover-up is Shu... more

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

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. Prolonged bleeding or bruising may indicate that you have some underlying bleeding or clotting disorder. If you tend to bruise easily in other circumstances as well, you should consider seeing your... more

There is really no procedure that is completely risk free.

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 be left with some pigmentation in the skin which can later be treated with lasers.

Certainly this is very unusual

There is a rich vascular network around the eyes and it is possible to inadvertently hit a blood vessel during an injection session. Bruising and swelling will subside always but some staining of the skin may linger as the iron in the blood remains and needs to be mopped up by the body. I don't know when the picture of you was taken, ie recent or early after the injection. You might consider having an ultrasound study done of the area to see if there was a specific fluid collection of... more

Botox bruising

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 hematomas more easily and for a longer period. I know you've given it 8 months, but additional time is your best bet. Try gentle massage in the meantime. A good concealer can... more

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

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 2-4 weeks prior to injections. An example of these products are aspirin type medications or anti-inflammatories like Motrin. At this point, I would just wait and allow the body to heal.... more

There may be a bright side.

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 turns out to be simply a bruise for you, which will eventually disappear in time. Keep out of the sun, as it will prolong the discoloration. Good luck!

Not very common

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 anomalies. Of course the first thing to find out is if you took aspirin or nonsteroidal antiinflammatory agents in the recent past prior to yoru injections. Also some foods can cause thinning such as... more

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Severe Hematoma from Botox

There are some rare complications from any injectable and a hematoma is one of those complications. If the needle punctures an artery then there can be a significant hematoma. Sometimes it takes longer than other times to resolve. If it is liquid then your surgeon can aspirate it to speed up the resolution of the hematoma.

Pulsed Dye Laser Treatment for Botox bruising

One not so well know solution for resolution of bruising from injection procedures is the pulsed dye laser. We use it in our own practice if a patient gets bruised and we often resolve bruises for patients like yourself that have been injected at another practice. There are options besides waiting and you should seek out a physician in your area that has a pulsed dye laser and is familiar with this type of treatment.

Harold J. Kaplan, MD

4 reviews

Los Angeles Facial Plastic Surgeon

www.celibre.com

Time is really the only cure for severe bruising

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 swelling after Botox injections. Still, at this point, nothing but time will make much of a difference. It may take another 4-8 weeks before this becomes less apparent.

Uncommon but well known problem

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 the bruise is hidden between 2 walls and it takes a while to break the wall down. To speed up the clearance of the bruise you may need pulsed dye laser treatments to "break up"... more