In these gloriously transparent times, if a brand dares to harbor dirty laundry, it will most certainly be aired—if not used to hang them out to dry.
While this open-book ethos pervades nearly every industry in 2019, certain aesthetic treatments, we’ve noticed, seem somehow exempt. Reported side effects and complications may be voluntarily logged into a little-known FDA database or, perhaps, discussed by doctors at medical conferences; but on the whole, they tend to be downplayed to the public. So when we leave our lunchtime filler appointment, two days before our best friend’s wedding, with a burgeoning black eye or needle-inflicted hickey, we can’t help but feel blindsided.
Bruises after cosmetic injections take us by surprise, precisely because nobody talks about them. Contusions may be covered in the consent forms you “sign and initial here, here and here” prior to treatment, but injectors rarely dwell on the topic. And when black-and-blues do rise up, patients go to great lengths to hide them. All told, our collective reticence has made injectable bruises seem like an anomaly when, really, they’re “a common and often unavoidable” part of the procedure, says Great Neck, New York, dermatologist Dr. Jeannette Graf.
Pause for perspective: a bruise after injections is hardly cause for boycott. It’s the price we pay for beauty, some might say. And I get that. I am admittedly grateful to Botox for sparing me crow’s-feet and fine lines and forehead grooves; I appreciate the balance hyaluronic acid fillers bring to my aging face. But when expensive “no-downtime” procedures undertaken to make us look and feel more beautiful render us swollen and bruised for days to weeks—well, it’s a cruel irony indeed.
Why filler bruising is more common than you think
Tens of millions of filler and neurotoxin shots are administered each year, and every one of those needle pokes poses a risk for bruising. Why? Because the human face is an arterial minefield, its intricacies beautifully detailed in this frequently regrammed illustration commissioned by aesthetic nurse Connie Brennan from artist Kevin Cease.
Practitioners who navigate injectable treatments through vascular terrain without leaving a mark have either uncanny luck or some kind of sorcery on their side. The reality is, “anyone can bruise, and it’s not about Botox versus filler—it’s associated with the needle,” says Dr. Robert Anolik, a dermatologist in New York City. “If the needle happens to touch a slightly larger vessel, blood can be released into the surrounding skin, leaving a bruise. A blunt-tipped cannula can be helpful in some scenarios, but if a cannula has to be pushed with great strength because it’s not sharp enough to glide easily, that force can also trigger bruising.”
As Washington, D.C.–based dermatologist Dr. Tina Alster explains in a popular RealSelf Q&A, “No matter how skilled your physician is, it is very difficult to avoid bruising when having fillers injected. In fact, the chances of bruising after dermal filler treatments are high and it’s one of the most common side effects—on average, 67% of patients bruise, based on 22 clinical studies with more than 2,700 patients. These FDA studies were completed by some of the most expert injectors in the world, which further demonstrates that bruising is common among even the most skilled practitioners.”
Related: Off-Label Is the New Black: The Weird New Ways Doctors Are Using Filler
Living proof: bruises happen to the very best injectors
To this point, I can personally attest. Beauty editors, you may have heard, are an absurdly fortunate bunch. Chief among the perks of the job is open access to the world’s most preeminent (and generous) cosmetic dermatologists. I didn’t begin to fully explore this privilege until several years ago, when my now 42-year-old face started to deflate and sink.
I had just turned 38 when I visited Dr. Graf for my first dose of filler—a single syringe of Voluma, split between both cheeks, to subtly hike my midface and smooth my smile lines. Thoughtful, gentle and precise in all she does, Dr. Graf has flawless technique—yet I still left her that day with a faint smattering of pinpoint bruises. In hindsight, they were minor and disappeared after a week or so; but at the time, I was nothing short of distraught—wholly unprepared for this perfectly normal response to having a needle pierce my skin.
In the years since that first stick, I’ve seen a number of dermatologists for filler injections. Save for one or two lucky shots, I’ve bruised fairly consistently. During that stretch, I’ve also reported extensively on the potential pitfalls of injectables, familiarizing myself with even the rarest of risks—stuff way scarier than bruises, like blindness and skin death resulting from filler-blocked arteries. With these could-be horrors forever embedded in my brain, I now view every bruise as a potential emergency.
And yet… I go back.
In the summer of 2018, I met up with an old friend in New York City, and together we paid a visit to Dr. Anolik, an expert injector who injects Manhattan’s elite on a daily basis. Toward the end of my session, he grazed a vessel near the top of my right cheekbone. The area swelled and darkened almost instantly as blood filled my tear trough and eventually bloomed into a full-on shiner. I overreacted in equally dramatic fashion. Dr. Anolik still regrets giving me his cell number. (J/k—he called and texted regularly following my appointment.)
My black eye lingered for almost three weeks, and I did my best to veil it with concealer and oversize shades—all the while refraining from posting selfies, because a) not pretty and b) I worried (needlessly) that sharing what had happened might irk my doctor. With an utterly unbruised ego, Dr. Anolik chalked it up to bad luck and said he sees bruises of such severity “maybe twice a year.”
This past June, I scored an appointment with another famously brilliant dermatologist, who I’ve interviewed countless times (she requested anonymity here—something I offered to everyone). After assessing my sinking face, she filled my hollow temples and then injected my chin, aiming to protract it back to a youthful position that would better balance my naturally strong cheekbones. As bruises began to surface on my temples, she zapped them with her Vbeam laser.
It wasn’t until hours later, when I was on a train back to Providence, that my chin fully freaked out. I snapped some unflattering selfies in the Amtrak bathroom and texted them to my injector, who quickly reassured me that all looked normal. By the time I got home that evening, my chin was bloated and stained with violet streaks. (Chin bruises tend to drain downward, leaving drippy trails.) My kind and understanding doctor prescribed prednisone (for the swelling) and a night without worrying (a harder pill to swallow).
The next day, Dr. Caroline Chang, a dermatologist in nearby East Greenwich, Rhode Island, fortuitously reached out, inviting me in to try the new blood vessel-targeting Aerolase Neo laser she happened to be road testing. She treated my bruises, and a week later, they were nearly invisible.
Related: What It’s Really Like to Get Fillers Dissolved
Filler bruising: what to do if it happens to you
Being a “bruiser” has taught me what works to speed healing and what doesn’t—for me, anyway. I’m hoping you can extrapolate something useful here, but keep in mind: your body may respond differently—what failed me could very well save you. Here’s what I’ve come to know.
- Certain parts of the face—namely, the under-eye area, the crow’s feet, the chin and the lips—are more apt to bruise. “But it can happen anywhere, anytime,” Dr. Anolik notes. To be safe, don’t schedule injectable appointments within two weeks of important events.
- “Some patients are naturally more prone to bruising—they tend to have thinner, more sun-damaged skin,” says Dr. Graf. (I’ll try not to take offense.)
- The usual spiel about avoiding blood thinners for one to two weeks before filler injections (and, some say, one to two days after) is pretty sound. According to Dr. Anolik, steering clear of “things that can encourage bleeding, such as aspirin, ibuprofen, alcohol, fish oil and vitamin E, can help limit bruising.” (FYI, along with the specific ones mentioned, there are many other common supplements that can increase the likelihood of bruising, including ginkgo, ginseng, st. john’s wort, and flaxseed oil. And it’s also a good idea to avoid over-the-counter NSAIDS—Aleve, Motrin, naproxen—in general. Instead, stick with Tylenol.) Emphasis on the word limit. Abstinence hasn’t always worked for me, but my most gruesome black-and-blue to date did occur on the heels of an Advil-medicated migraine. Keep in mind that many prescription medications, such as Warfarin, can also increase the likelihood of bruising, so make sure to discuss that with your injector ahead of time.
- Arnica montana—can’t hurt, might help. The bulk of evidence supporting the herb’s anti-bruise benefits is anecdotal. I’ve experimented with the homeopathic tablets, over-the-counter arnica gels and creams, doctor-dispensed rollerballs, even those OcuMend high-potency hydrogel patches that derms are wild about—all to no avail. However, Nanuet, New York–based dermatologist Dr. Heidi Waldorf calls the OcuMend pads “a game changer for bruising.” The key, she says, “is slapping them on before you bruise, immediately after injections”—ideally, covering the whole face and not just the injection site, then leaving them on for six hours before replacing them with fresh pads for six more hours, and so on. “They won’t keep you from bruising if a vessel was hit, but they can reduce the slow, leaky bruising that tends to develop on day two.”
- Icing: If your injector nicks a vessel, they should put pressure on the treated area right away and begin icing ASAP. Ice acts as both an anesthetic and a vasoconstrictor, explains Dr. Waldorf, cutting down on pain and early blood seepage. She recommends icing for 10–20 minutes per hour, for the first two days, while awake. Personally, my bruises have come on so fast and furious that ice packs were no match.
- Topical vitamin K oxidase I have not yet tried, but Dr. Graf says “it breaks up hemosiderin—the hemoglobin pigment of bruising.” Apply it three times daily, starting right after injections. (You can find it in a product called Auriderm.)
- Lasers can slash healing time—in certain situations. When Dr. Anolik zaps bruises with his pulsed dye laser in the days following injections, he often sees them “vanish in a matter of hours,” he says. One exception: if the bruising is widespread after an isolated needle stick or accompanied by underlying swelling, it may be too deep for the laser’s energy to reach (such was the case with my black eye). Once it’s partially healed and appears more purple (versus black) and surface-level, then lasering may help fade it the rest of the way. Likewise, Dr. Chang has found that her Neo (a type of Nd:YAG laser) can cut healing time in half. (Worked for me!)
More crucial than any of this advice is knowing when a bruise is not just a bruise but rather a sign of vascular occlusion (filler inside a vessel, blocking blood flow to the skin). If the area of discoloration has a dusky, netlike appearance and is exquisitely painful post-treatment—as in searing, keeps-you-up-at-night pain—call your injector right away, says Dr. Waldorf, “because delaying diagnosis and treatment is most dangerous.”
How to cover bruises from injectable fillers
The right concealer is everything. Since I very well may be the world’s worst makeup artist, I reached out to one of the world’s best: Sandy Linter, who’s camouflaged her share of filler bruises. “You’d be surprised how easy they are to hide—and without a lot of fussing,” she says. Her secret weapons: This Kryolan Dermacolor Mini Concealer Palette—the formulation “adheres to skin immediately”—and a good concealer brush (she uses the Kevyn Aucoin). To build coverage, she explains, “many times I start with a deep pink—it seems to disguise or lift the black. Then I’ll add a deeper skin-tone shade and touch up the top with a color closest to my skin tone [or the client’s] before dusting on a bit of powder or applying foundation. The lightest touches work really well.”
The bottom line on filler bruising
Bruising after injectable fillers can be downright devastating (no exaggeration), but try not to panic. Ask your injector what they can do for you in the moment, or perhaps a few days later, to fast-track healing. And consider mining your friends and coworkers for tips—odds are, they’ve been on the losing end of a needle before too and can help guide you out of the darkness.
