Gary Goldenberg, MD

It's normal to experience swelling, bruising and redness after a filler injections. In this case I do not recommend massaging the skin, because that can break down the product. So she won't get as much benefit from the injection. Icing the areas is a much better idea.

It's hard to tell from this picture because it doesn't show your entire facial structure. But based on the photo, you could use more botox around the eyes (it's possible to not see these wrinkles at all). You may need filler, like Juvederm, into the tear troughs, but you may also need something in your cheeks to rebuild your facial structure. So you need to be evaluated not in a piecemeal way, but in a holistic way.

From your picture, it looks like perhaps you could use a touch more on the left side. But remember, it's NORMAL to be asymmetric. In fact, you would not look natural if you had perfect symmetry. The bruise will go away.

It is pretty much impossible that the product is gone. Likely what you were initially seeing was edema (swelling). After the swelling goes down, the results always look less dramatic. Compare to the before picture and see if there is much of a difference. It may be that you simply need more product.

Most patients are able to continue with their day after having dysport or botox. I always warn patients that they may get a bruise or some redness. But it's nothing that make up can't cover (this is true for men also). I ask my patients not to drink alcohol, exercise vigorously or go shoe shopping (bend down) immediately after the injection - all increase the chance of bruising.