Under eye bruising after filler still visible 6 weeks later, is this normal? (Photos)

Question

6 weeks ago I had filler injected under my eyes. The bruising has definitely gotten better (I looked like a football player immediately after the procedure) but the dark spots are still there. I've been using Arnica gel topically on the bruises for about a week now. I have not noticed a difference. I'm concerned. It's very unfortunate as the discoloration still comes through even with very strong cover up. It defeats the purpose of me even getting the injections to begin with. Please help!!

Anna Petropoulos, MD, FRCS · Answer

Hello lindsaylu, and thank you for your question! I'm sorry you are dealing with this tricky issue. Based on the image, it looks like there’s been good healing under one eye, but some discoloration remains on the other. There also seems to be less filler on the left (pigmented) side when compared to the one-week post-procedure photo. This might be due to the Tyndall effect, which happens if filler is placed too close to the skin surface, creating a bluish hue. If it’s a hyaluronic acid (HA) filler, it may need to be dissolved. I suggest having your injector assess the area to determine the cause & offer a solution. Usually, bruising fades and turns yellow before disappearing completely, but sometimes, particularly in the under eye area, it can take 6-8 weeks for the skin to fully recover. I hope this helps! Best, Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Boston and Danvers, MA

Onir Spiegel, DDS, PhD · Answer

Bruising under the eyes is common with HA fillers in the tear tough area. 6 weeks is a long time.   But,  not unheard of. The area is very vascular which can result in bruising.  This will eventually go away and probably very soon.   In the future I recommend Arnica pills prior to and right after injecting.   Lots of icing right after injecting and avoid any NSAIDS, fish oils and other blood thinners for at least a week prior to future procedures.   I also strongly recommend seeing your doctor to see what they suggest.  They know your medical history and what was injected and how much.  I hope this is helpful to you.  Regards,  Dr. Onir

Maurice M. Vick, Jr., MD · Answer

Bruises ,especially under the eye can occasionally take several weeks even a few months to resolve. Your after pictures suggest that some of the darkness could come from superficial capillaries or possibly shadowing from incomplete filling of your tear troughs. Go let your treating physician examine you. Best Wishes, Maurice Vick MD

B. Edward O`Dell, MD · Answer

Thanks for your question and photo.  From your pics it looks like you have had good resolution in the left under eye area.  There is still some discoloration and it looks as if there is loss of filler in that area on the left compared to your one week pic. It possibly could be the Tyndell effect if some filler is too close to the skin.  This is where blue light is trapped by the density of the filler.  It would need to be reversed if it is and HA filler.  I would let your injector see it and examine it to determine that.  Most bruising will turn yellow with time and then disappear.  I have had one patient in which it did take abouit 6-8 weeks for full normal skin to return.  Hope this helps.
Dr. ODell

Marek Kacki, MD · Answer

Most of the bruising resolved within 2 weeks. On occasion it may take longer if there was a significant amount of blood in tissue and the "cleaning" process is impaired. As we all experience from time to time, normal bruise undergoes many changes of color from red to purple, brown, yellow and green. This is related to degradation of hemoglobin contained in our red cells. One of the steps is creation of hamosiderine  with iron in the middle. The iron is poorly accessible to the metabolic process so the degradation process takes time. Eventually, the changes will resolve without any residual discoloration. 
Other options: post inflammatory hyper-pigmentation or filler related light refraction (Tyndall effect). Your injector should be of great help in advising you the next step. Good luck!

Karen Leong, MD · Answer

I'm sorry your experience has been prolonged by bruising. The skin under the lower lid is very thin and any changes to the underlying tissue can show through. Bruising may be from injury to small blood vessels during injection - while 6 weeks is a long time, some people form deposits of hemosiderin (break down products of blood) in the fat pockets of the lower eyelid that stain the fat and show up as bruises. Vbeam or similar lasers may help, or even irrigating out with sterile saline. Tyndall effect, as my colleague mentioned, comes from the filler itself. Certain types of filler reflect light and appear blue to the naked eye. If this is the cause then you would have to have the filler melted away. Have you been back to see your injector? Otherwise, make sure you find a physician who understands the anatomy of the lower eyelid and is able to treat you appropriately! I hope this helps. - Dr. Leong

Tyler Rogers, MD · Answer

So sorry you had this complication.  Under eye bruising after filler is not unusual.  However, yours is more significant than typical.  At 6 weeks out from the procedure I would certainly recommend you have a consult with your physician to evaluate.  
There are several potential explanations and ways to improve the outcome!  There may have been some filler implanted too superficial resulting in the discoloration.  This often can be dissolved and corrected.  There could be some calcification of the bruising.  Sometimes we can improve this with laser treatments to the area, targeting the blood.

Alex Roher, MD · Answer

This is the number one area patients tend to bruise after getting a minimally invasive cosmetic procedure.  The reason being, it's a highly vascular area with very thin overlying skin.  The vascularity increases the likelihood of bruising because the practitioner is more likely to hit a vessel and cause blood to collect under the skin.  The thin skin makes that collection of blood more noticeable from the surface.  
To help prevent this, I only fill tear troughs with a blunt tip cannula.  The blunt tip takes the path of least resistance, meaning it will push vessels out of the way instead of piercing them.  Ice before, during, and after the procedure can also help.
Now that you have a bruise, however, I would recommend continuing the arnica gel and switching the ice to heat.  You can also use certain lasers to duration and appearance of the bruise. I think the best laser for this purpose is the Cutera Excel V.  It specifically targets the hemoglobin molecule, the molecule responsible for the discoloration.
I hope this helps.  Lingering bruises can be very frustrating. Even though it is clearing up very slowly, rest assured it will clear up.

Shaun Patel, MD · Answer

Thanks for sharing your question and photos and sorry to hear about your experience. I would expect the bruise to have resolved at this point after the treatment. It looks like you may have a lump of filler which has been placed to superficially which is resulting in swelling and discoloration. The discoloration may represent Tyndall. You may need to have the filler reversed and reinjected deeper. My preferred filler for the undereyes is Restylane and I inject it using a microcannula to minimize swelling and bruising. I don't recommend Juvederm under the eyes because of its propensity to swell.

Jean M. Casello, MD · Answer

It is not unusual to have bruising under the eyes after fillers. Usually it will fade over time.  If the bruise was very deep or large there may be prolonged healing.  Sometimes using laser/IPL/topical preparations  to break up the pigment will help speed the process. You should discuss this with your provider who can advise you.  This should resolve eventually.

Under eye bruising after filler still visible 6 weeks later, is this normal? (Photos)

Answers (10)

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