Does this look like necrosis or normal bruising? (Photo)

Vascular necrosis with filler injections is a true medical emergency that needs immediate medical attention in order to prevent tissue death, tissue loss and even blindness. Vascular necrosis occurs when, unbeknownst to the injector, the filler fills a vessel instead of the soft tissue, preventing delivery of blood to the surrounding soft tissue.  The symptoms include severe pain usually starting at the time of injection, but may sometimes not manifest until hours after the injection. Blanching or whitening of the skin is another symptom. The location of blanching depends on the area fed by the vessel blocked and may not always be at the site of injection or bruising. Another symptom is blisters that look like herpes infection developing in 24 hours. This is an early sign of tissue death. Any type of complication that is progressing for the worse instead of better needs an immediate phone call and an immediate visit by an expert injector. Many times the phone staff is unaware of how to triage or differentiate a person calling with a normal bruise from a person with a vascular accident who will lose their face in the impending hours. Because this a very rare complication.This diagnosis cannot and should not be made with just a photograph. A thorough examination by an expert is necessary if you think your complications resemble what I have described.

Hello, and thanks for your question and photo. Looks most like bruising from the photo, but I recommend following up with your physician to be certain. Best of luck, Dr. Frucht.