What to Do About Restylane Bruising?

Question

I had Restylane injected under my eyes, just above my cheeks. I developed severe bruising that lasted for almost 6 weeks. It has been 6 months since the procedure, and I still have what looks like lingering bruises where the Restylane was injected. Also, the doctor who did this over-filled the right side and you can clearly still see the filler bulging out in a line under my eye where he injected it.

	Will the bruising and bulging go away? What can I do about it? Do I need to have other treatments? I don't want to have any injections to dissolve it at this point because of the bruising.

Harold J. Kaplan, MD · Answer

If you still have bruising or discoloration 6 months after injections, it's possible that you have a condition called hemosiderin staining. We use q-switched lasers to resolve the dark discoloration.

	It's also possible that you are experiencing the Tyndall Effect, which is caused by injecting dermal fillers too superficially (too close to the surface of the skin). In this case, it's possible to resolve with hyaluronidase. If you're worried about additional bruising you may want to find a different injector that has experience with reversing Restylane injections to decrease the risk of additional bruising.

Jed H. Horowitz, MD, FACS · Answer

In the future, the best way to minimize bruising
- especially for sensitive areas like lips or under the eyes, is to avoid
medications such as aspirin, Ibuprofen ( Motrin and Advil) and non-steroidal
anti-inflammatories such as Alleve or Naprosyn that might be taken for sports
injuries .Other culprits of bleeding and bruising tendencies are green tea,
flax seed oil, Omega -3s and alcohol or caffeine intake  the day before
your treatment!
Arnica oral tablets are an easy remedy to reduce
the degree and length of time of bruising and can be taken 3 -5 days following
the treatment.#Restylaneinjections  #bruisingwithinjections  #undereyebruising

Richard J. Bruneteau, MD · Answer

It’s unusual for patients to develop bruising following the
use of injectable fillers. Never the
less, this complication may occasionally occur following these injections.Bleeding and bruising aren’t usually related
to the filler material, but instead are related to the injection technique and
the patients clotting mechanism.Six
months after Restylane injection lower eyelid discoloration is probably not
related to bruising. Although, in rare
situations hemosiderin deposits may cause this type problem, this is unlikely
as well.This
discoloration is most likely secondary to superficial deposits of
Restylane. This phenomena can cause a
bluish discoloration which can mimic bruising.Under these circumstances, Restylane can be removed by perforating the
skin with a needle and manually extracting the material.It can also be treated with the enzyme
hyaluronidase which dissolves hyaluronic acid.In
someone who’s afraid of needles and is unwilling to utilize these treatment
options, the only alternative is the passage of time.With time, Restylane will eventually resorb.It’s
therefore important to discuss your situation with your provider.Hopefully your provider can formulate an
alternative plan that addresses needle sticks and pain management so this
problem can be brought to a quick resolution.

Raffy Karamanoukian, MD, FACS · Answer

Bruising can occur after cosmetic fillers such as Juvederm, Restylane, Radiesse, and Perlane. If you are prone to bruising, I would suggest over the counter medications such as Bruise Stick or Bruise Pak to reduce swelling and bruising after these procedures.

Michael A. Persky, MD · Answer

Hi Curious,

	Your question is best evaluated in person where it can be determined exactly what is going on.

	That having been said, to minimize bruising from Restylane or other fillers, it is best to not take any blood thinning products for about 2 weeks before your treatment. You may take oral Arnica Montana for a few days before the injections. At the time of the treatment, have your injector place ice over the skin immediately prior to the injection. Physicians need to note any bleeding immediately and apply continuous pressure for a few minutes. Avoid exercising, bending over, or lifting for about 36 hours.

	You may be able to have carefully placed Restylane camouflage the areas that are bothering you.

	Lastly, choose your injecting physician carefully, preferably someone who is trained and board certified in one of the cosmetic oriented specialties such as facial plastic surgery, ENT, plastic surgery, dermatology, or opthalmoplastic surgery.

	Be well.

	Dr. P

David Shafer, MD, FACS · Answer

First of all, please be very cautious before having anyone inject anything around your eyes.  The skin around your eyes is much thinner than elsewhere on your face and body.  Therefore, having injections in this area has a higher incidence of visible material and side-effects from the injections - such as bruising.  The discoloration you are describing may be bruising which should resolve over time.  However, the discoloration may actually be the injected material as well.  If the injectate is too superficial or in too large of droplets, then the light hitting your skin may refract differently causing a bluish hue which may be confused with bruising.  As the material is metabolized and disappears, then the discoloration should go away as well.  You are correct to not have any further injections - especially until your current problem is resolved.
I hope this is helpful.
David Shafer, MD
Manhattan

Steven H. Williams, MD · Answer

Even though most of the injectable fillers show significant resorption at 6 months some patients can experience lasting effects beyond that.
Try gentle massage and give it another 3 months.  The bruising should resolve within this period of time.  You are right to not consider additional treatments at this time.  
I hope this helps.

Dmitriy Schwarzburg, MD · Answer

Bruising, swelling, sometimes discoloration, lumps, and bumps are normal side effects but they should be gone in a matter of days. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Imjustcurious. I understand your concern. Fillers are used to restore lost volume in and enhance the appearance of the face.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles. However, I hope the information provided here is useful.Bruising is a risk with any injection. To prevent the risk of bruising I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours after a treatment because these activities bring blood to the skin and can increase the risk of bruising. I also recommend that they avoid medications that thin the blood such as aspirin as well as natural blood thinners like turmeric, ginger, cinnamon, cayenne peppers, and vitamin E for a few days before and after and injectable treatment. Tell your doctor if you are taking prescription-strength blood thinners such as coumadin or Plavix. I recommend that my patients avoid injectable treatments within two weeks of special events where they want to look their best.

After fillers we apply the Cearna OccuMend pad. The Cearna OccuMend pad is a new and innovative technology that is simple to use and significantly reduces the risk of bruising after injectable treatments and after surgery. It also makes bruises resolve more quickly and reduces swelling in the skin. The patch is clear and sticks to the skin. For most treatments two patches are used, one per side of the face. They are applied on the skin immediately after a treatment and left on for six hours. Then the patches are removed and replaced with another set of patches for another six hours; this can be done at bedtime and left on overnight while asleep. Ensure that the skin is clean and dry when applying the patches because any dirt or products on the skin will decrease the anti-bruising effects.
  
The Cearna OccuMend pad contains very high doses of arnica and ledum, natural ingredients that have been used for years. These ingredients reduce swelling, bruising, pain, and inflammation. Arnica is available over-the-counter in both topical and oral forms. However, the concentration of arnica in the anti-bruise patch is 50 times stronger than that available over-the-counter. Each pair of pads comes in a sterile sleeve that can be kept at room temperature without the need for refrigeration.
  
We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution.
  For some people, especially those with dark skin types, there is the risk for post-inflammatory hyperpigmentation (PIH). This is darkening of the skin after an injection or other treatment. This can be treated with topical creams such as hydroquinone. This can last weeks to months after a treatment. If I had a patient with the concern described here I would suspect this may be what is happening. It would be much easier to diagnose with before and after photographs.
Please consult with a doctor for specific recommendations. Good luck!

Suzanne Kilmer, MD · Answer

The “bruising" that you see may
actually be the filler if it has a bluish tinge and is still bulging….you may
need hyaluronidase to dissolve it and it typically does NOT bruise much if you
are off blood thinners.

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What to Do About Restylane Bruising?

Answers (18)

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