Is it common to have bruise patches all over the nose and upper cheek after a Juvederm injection?

Question

I have received 1 syringe Juvederm injection into my nasolabial folds, right after the injection circular bruise patches appeared all over my nose and upper cheek. I have previously done Restylane and didn't have similar reaction, I had bruise at the spot of injection but never on my nose; does this have to do with the product or with the way of injection, and should such discoloration on my nose be a concern? is there a way to decrease this. Thank you.

Brian S. Biesman, MD · Answer

If you are having a problem with skin discoloration following filler injection you should contact the physician who performed your injections immediately.  This could be something as simple as bruising or something more serious that requires immediate intervention..

Christopher Khorsandi, MD · Answer

It sounds unusual to have this type of reaction.  There is a network of arteries in the area and the filler may have been injected into the artery mistakenly.  The filler can then travel and cause blockage of smaller arteries downstream.   When this happens, tissue is deprived of blood supply and can become dark in color.  Seek the help of a board certified plastic surgeon in your area immediately.

Martin Jugenburg, MD · Answer

Thank you for your question. It is important that you contact and visit your injecting physician immediately to be assessed. All the best,

Jason Emer, MD · Answer

This picture is a emergency and needs to be treated immediately so you do not lose any of your skin and get scarring.  I suggest calling your physician, taking an aspirin and ibuprofen right now, and using warm compresses on the areas.  You likely will get injections of an enzyme to break apart the filler but require other medical treatments such as nitropaste to help blood dilation in the tissue, and oral viagra to help increase blood flow.  Best, Dr. Emer.

Michael A. Persky, MD · Answer

Hi Dana,You must see an expert injecting physician immediately for evaluation and probable dissolving of the filler that was recently injected.  Good luck and be well.Dr. P

Michael I. Echavez, MD · Answer

It is possible that the Juvederm injection you had into your nasolabial folds had some effect on the blood vessel that supplies the nose and upper cheek.  This could have been due to direct injection into the vessel or due to some compression on the vessel.  In most cases, this issue should resolve by itself over time, but I would contact the physician who treated you to alert him or her to your problem.  Your doctor may want to examine you to check on the extent of the issue.

Todd C. Miller, MD · Answer

Hi Dana, the pattern that you are describing does not sound like a typical bruising pattern that could occur following an injection with Juvederm. It's possible that some of the product got into the blood vessels and disrupted the blood supply to the nose. I would consult with your injector or an experienced facial plastic surgeon immediately to have it further evaluated.

Michele S. Green, MD · Answer

Juvederm is a great product for injections around the nasolabial and oral commissures.  Bruising is a potential side effect but extensive bruising in one particular area usually means a blood vessel was injected.  I recommend you consulting your treating physician to verify.  In the future technique and cannulas can avoid such bruising.  I also recommend you initiate Arnica Forte for two days before Juvederm injections.  For the best cosmetic results please consult a board certified dermatologist with experience with cosmetic injections.

Stephen Weber MD, FACS · Answer

This is definitely not normal and not a bruise. This likely resulted from injection of filler into a blood vessel ... it happens. This needs to be treated immediately with hyaluronidase, nitropaste, aspirin, warm compresses etc. If your injector does not pay immediate attention to this find a plastic surgeon or dermatologist injector who will. This is an emergency and needs to be dealt with today. I'm not trying to scare you. This should heal well if it's handled immediately. Best.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Steven F. Weiner, MD · Answer

This is an emergency that needs immediate attention.  When something happens at an area that wasn't injected, it probably means that Juvederm was injected inside a blood vessel and is causing poor circulation to the nose and cheek.  Hyaluronidase, warm compresses, blood thinners need to be administered.  Using cannulas decreases this risk significantly and that is all I use for this area.

Is it common to have bruise patches all over the nose and upper cheek after a Juvederm injection?

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