Tear trough and bruising with restylane, is this normal? (photo)

Bruising can occur no matter how skilled the injector is but you could stop taking Ibuprofen, Aspirin, Fish oil and green tea for two weeks before treatment to help eliminate the risk.

I have been using fillers and volumizers to treat tear troughs and hollows under the eyes for well over twenty years, dating back to the use of the original Zyderm I collagen filler. One thing you can say for certain is that bruising is a real possibility following injectable filler treatments in this very delicate region. There are, however, a number of tips and techniques that can help to reduce this very unwanted consequence. If possible, i.e. if there is no medical reason not to, all aspirin or aspirin-containing products, which thin the blood, should be stopped about ten to fourteen days before treatment. NSAIDs, such as naproxyn or ibuprofen, should likewise be stopped about a week beforehand. It is also advisable to disontinue certain other food supplements that are known to thin the blood and increase the likelihood of bruising, specifically omega 3 fatty acids, gingo, garlic and ginseng. Finally, alcohol should be avoided for twenty-four hours beforehand  A word of caution: Blood thinners, such as coumadin and Plavix should not be stopped without medical advice. There are certain techniques that injectors may use to reduce bruising. The slower the injection, the less likely to cause damage to blood vessels under the skin (the cause of bruises). The use of blunt tipped catheters, instead of sharp needles, is another method of minimizing tissue damage and bleeding as is adding a small amount of epineprhine to the injectable filler to promote blood vessel constriction. Lastly, although not guaranteed to work in my experience, applying ice, taking sublingual arnica along with bromelain pills (a pineapple derivative) and applying arnica and vitamin K creams all have their proponents. It should go without saying that consultation and treatment by a board certified core aesthetic physician with extensive experience in injecting the delicate under eye area is strong advised.

Bruising like this is uncommon but does occur. The eyelid skin is so thin that if it is going to happen anywhere, it is going to happen in the tear troughs. Next time stop all blood thinners (aspirin, advil, fish oil, etc) 2 weeks prior to your injection, take Arnica pills starting the day before the injection, and use Arnica cream and ice immediately after the injection. Most importantly, make sure your injector knows about your previous issue prior to the injection. Going slowly and putting direct pressure for several minutes on any bleeding sites during the injection can make all the difference in the world. This extra attention takes longer, but makes a big difference. An injector that is not in a hurry is often the best medicine we have to prevent bruising. Good luck.