Injector too harsh? Hematoma, bruise spreading and swelling after Juvederm on lips. (photos)

Question

I have had my lips done with Juvederm twice, 0.5mL and 1.0mL by the same nurse. Everytime I bruise badly, especially on the top lip and the bruise would spread onto my upper lip. Swelling goes down on the 4th day and bruises take about 12 days to totally disappear. (see photos)I've taken arnica prior injections for 1 week and it still does not seem to make a difference. I'm not sure whether it is because the nurse that injects it was too harsh and I should find a new clinic.

Kurtis Martin, MD · Answer

Anytime a needle is used over a cannula the risk for bruising is greater. Each provider has their own technique to lips. Maybe try to find a provider who uses a cannula in the future if it continues to be a problem. Remember to avoid taking any blood thinning medication and to avoid drinking alcohol before your injections. They do thin your blood and can cause more bruising.

Jason Emer, MD · Answer

There can be bruising and/or swelling with lip augmentation injections. Injections with cannulas can limit bruising. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately any time that a needle is placed into the skin there is a risk of bruising to the tissues.  Though certainly technique and "gentleness" of the injector is important you may want to ask for the use of a cannula next time to reduce the risks.  If you are unhappy with your results then you may want to consider a change in provider.  Hope this helps.

Cheryl Perlis, MD, FACOG · Answer

There is a lot of filler placed in to your lip, which maybe the reason that you are having so much swelling. I would  suggest that you use another experienced injector, who may use another technique like the cannula, which may cause less bruising. Also using less product may help as well, more is not always better, and your body may not be able to tolerate too much product all at once. I would still continue your arnica. Also adding Quercetin- which is a supplement that can help with swelling. It can be purchased at whole foods.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question mwc520. I am sorry to hear about your
situation. Juvederm is a hyaluronic acid filler designed to enhance the
appearance of the face. Bruising and swelling may occur with any injection. I recommend that my patient be prepared for it. Swelling can be reduced by applying cold compresses and we treat bruises with a laser as early as the day after the treatment. Please consult with a doctor for specific recommendations. Good luck!

Reza Tirgari, MD · Answer

It is not uncommon to see bruising after injectables, especially in a very vascular area such as the lips.
Assuming you do not have any additional medical reasons for easy bruising (do you usually bruise easily?) and are also not on any blood-thinning medications, then I would first ensure that the practitioner is using ice on the area each and every time before injecting.  This is a very easy thing to do.
Also make sure they are putting pressure on the area after each injection.  We do this constantly and almost never see bruising such as yours.  Maybe see if other clients are experiencing the same results or whether this is happening only to you.  That will help you identify the cause more clearly.

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photos.  The lips are a sensitive area, and it's not uncommon to experience swelling and bruising after any filler injection in the area.  It's possible that your nurse injector's technique is contributing to your bruising, however some patients are just more prone bruising for a variety of factors (anatomy, genetic conditions, medications and supplements, etc).  I would recommend that you request that your injector use a blunt microcannula for future injections, as this can help minimize the risk of bruising.  Also, there are a number of lasers that can be used to help bruises fade faster - in my clinic, we offer this as a complimentary service after any cosmetic procedure.   Best of luck!

Laurene DiPasquale, MD · Answer

Thank you for your question.  Any time a needle is put through the skin, there is a chance of bruising.  Lips happen to be very vascular, which increases the chance of bruising and swelling.  A good concealer will help cover those bruises until they heal.  If the injector is inexperienced, that could increase the bruising and swelling.   Regards, Dr. DiPasquale

Leonard Grossman, MD · Answer

I don't believe your injector was too harsh as people simply bruise after being stuck with a needle. As long as you are happy with the results I would definitely stick with the same person for future treatments. Applying warm compresses after bruising will help you in terms of reducing them. Good luck from New York City

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  This can be due to your anatomy or poor technique or some combination thereof.  I recommend on your next injections to try a microcannula technique as this leads to much less bruising, if the bruising still occurs it may be time to find another board certified Dermatologist/PS to inject you.  For the bruises you have, they can easily be lasered off with a pulsed dye or Excel V laser and this is typically offered as a complimentary service. Once layered the bruises typically resolve within 24 hours.  Regards, Dr. Matt Elias

Injector too harsh? Hematoma, bruise spreading and swelling after Juvederm on lips. (photos)

Answers (12)

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