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

Question

I had 20 units of botox (frown lines @9am) Ive had botox in the past with no bruising/swelling My derm said after the first injection "I was bleeding a lot, had I used aspirin?" I had not, but I had Motrin the day prior. Almost w/in 5 minutes of the injections my left side above eyebrow looked bruised at both injection sites. It has continued to darken, is swollen and sore! Will these blood vessels return to normal? Could there be complications? Why is the swelling worse now,12 hours later?

George Yang, MD · Answer

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		Since botox needles are very thin, normally when the needle is withdrawn, the platelets will seal the point of entry and prevent excess leakage of blood which will cause a bruise.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

Jerome Edelstein, MD · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

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

Richard Baxter, MD · Answer

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.

Sam Naficy, MD, FACS · Answer

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.

Monika Soni, MD · Answer

Thank you for your question! Bruising after Botox can occur. Most of the time it is visible the same day or the very next day. In some cases, however, it may become visible several days later. A bruise occurs when blood leaks out of a traumatized blood vessel. It could be that with strenuous activity or rubbing or due to blood thinners that an injured blood vessel dislodges a clot and causes some blood to leak into the tissue and thus cause a visible bruise. The bruise typically dissipates within a week or two. Swelling, redness, discomfort and possibly bruising during the first few days following the injection is common. Most of this settles down within 3 days. Occasionally, the swelling can last up to one week, as well as bruising. As long as the swelling has stopped and there are no signs of increasing pain, redness, or visual difficulty, then your bruise will resolve. In some cases this may take as long as 3-4 weeks but typically by 7-10 days 95% have resolved. Best of luck!

Matheson A. Harris, MD · Answer

Botox injections can cause bruising if the needle hits a blood vessel on the way in. Often, it is impossible to see these vessels beforehand. The initial bump that forms is from the blood pooling in the skin and muscle. Once the bleeding stops, the body has to work to get rid of it. An inflammatory reaction will develop to breakdown the blood and carry it away. This is why the swelling gets worse after a few hours. It will all resolve with time, but may take a week or two.

Ramona Behshad, MD · Answer

Bruising after any injection is very common and always temporary. That being said, sunscreen is a must. Sunlight on a bruise can cause the iron in your bruise to stay around in your skin longer. Also, avoid herbals, aspirin, and NSAIDS (ibuprofen, alleve, naproxen). These medications predispose you to bruising. Sunscreen, concealer, and a tincture of time are the best treatments for bruises.

Darryl J. Blinski, MD · Answer

ANYTIME you have needle injection there is ALWAYS a risk of bruising! This usually resolves over a few days. And YES the Motrin could be associated but bruising can still occur in the best hands.

Jacque P. LeBeau, MD · Answer

Although it is not common to have significant bruising with Botox due to the small caliber of the needle typically used, it can happen.  You had a greater propensity towards bruising with the recent use of Motrin but you should see resolution of the bruising over the next 4-6 days and you will have no long term sequelae.

	Best Regards,
	Jacque P. LeBeau, MD

	LeBeau Clinic

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