Bruising & Swelling from Botox, Possible Hemotoma? (photo)

Hi Rachel,

The series of events can be explained.  From the other responses from the other doctors, you now know that the Motrin will thin your blood as much as the Aspirin (which is why your doctor asked if you took aspirin.)

Here is the sequence of events:


You took Motrin the day prior.

Your platelets in your blood become less "sticky" and thus thins your blood.  If your blood vessel is penetrated or cut, the "sticky" platelets will help to seal off the blood vessel and prevent it from leaking excess blood out.

You had your botox injections and one or two of the injections on the left side hit a blood vessel (probably a vein.)

Since botox needles are very thin, normally when the needle is withdrawn, the platelets will seal the point of entry and prevent excess leakage of blood which will cause a bruise.  However, because of the Motrin, the platelets were not working as well as they normally do, and thus your bruise increased.  It is possible the same thing happened in the past, but you did not take any blood thinners so you did not notice any bruising and swelling.

After the blood leaked out of the small needle penetration of the blood vessel, the blood itself causes some fullness purely from the volume of blood in the area (like a filler) and secondarily it will cause some inflammation and swelling in order to remove the red blood cells which should not be in the tissues and should only be inside of the blood vessels.

The swelling can be worse in the first 24-48 hours before it begins to dissipate on its own.  


I hope that makes sense, and your question will help future Botox and filler users to avoid Aspirin and Aspirin-like medications as well as herbal supplements and fish oil which also thin the blood.

Best,

Dr. Yang

It looks like the Motrin may have increased your rate of bruising. Swelling, redness, discomfort and bruising are common and settles down within 3 days or so. Rest assured, the bruising will subside over the next week or so. Follow your injector's post-care instructions to facilitate healing.

Bruising and swelling after Botox may occur. Our office recommends Bruisestick ointment that contains Arnica and Bromelain. 

Even experienced injectors occasionally have a patient who gets a bruise. Since Botox is injected into a muscle and all muscles have blood vessels, it cannot be avoided completely but usually it fades within a few days. Ibuprofen within the previous 24 hours can increase the chances of bruising.

It is not uncommon for you to have bruising after a Botox injection. From what your pictures show, these will settle down within a few days. If you regularly take any type of blood thinning OTC supplement, NSAID's on a regular basis (or prior to injections), and/or any other prescribed blood thinners, you have a greater risk of bleeding/bruising.