Severely concerned, please help! Necrosis or bad hematoma after Juvederm in tear trough? (photos)

Question

Went to a med spa to get filler and when the nurse placed the needle she immediately took it out because there was blood and a sac thing and then it started turning dark! It appears my whole right side is a dark dark color. Mind you my eye is a little red from washing it. I did take a tablespoon of ginger, had a big glass of wine and took Motrin yesterday completely forgetting the fact I was getting filler today. Does this look like hematoma or necrosis I'm so scared and don't know what to do!!

Kevin Mosca, DO · Answer

From the history you have provided of drinking wine, taking NSAIDs, and ginger...this most likely represents a hematoma and you should not be worried about necrosis at this time. Keep your head elevated and it should resolve over a week or two. This is very common in that area and the skin around the eyes is rather thin an will show any bit of blood very easily.

Roberto E. Garcia, MD, FACS · Answer

I would not worry too much about necrosis.  This is a very uncommon area to get tissue necrosis as there is a tremendous amount of blood flow there. You do however have a good bruise that will more than likely get worse before it gets better.  The pictures are limited so my analysis does have limitations, but this is what it looks like.  Arnica Cream and if you can tolerate it, use some Vicks vapor rub to the area.Best of luck

Jason Emer, MD · Answer

It's difficult to tell from your pictures, if this is a hematoma, but some bruising can occur after injections. This can be improved with icing, arnica and VBeam treatments. I recommend following up with your Doctor for a formal evaluation. I recommend injections with cannulas to limit bruising. See an expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your filler experience.  Based on your narrative it sounds as if your nurse injector struck either a vein or artery when piercing the skin resulting in the "sac" you described.  Luckily it sounds that they did not inject the filler as a result.  Based on your pictures alone your darkened tissue is more likely bruising rather than necrosis.  You may have a small hematoma as well.  This should clear with time but you can take some adjunct measures to try and accelerate its absorption - use cold compresses to your cheek for 2 days then switch to warm compresses, sleep with your head elevated at night with a couple of extra pillows behind your back.  You may want to also consider using Arnica Montana and bromelain as supplements, while eating dark leafy green vegetables.  Hope this helps.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question khiggins08. I understand your concern. Juvederm is a hyaluronic acid filler designed to enhance the
appearance of the face. Bruising is possible after a treatment and is more common under the eyes where there are a lot of vessels. I recommend that my patients avoid blood thinners and alcohol before and after a treatment to reduce the risk of bruising. Bruises typically resolve on their own in 1-2 weeks. In our office we treat bruises with a laser as early as the next day. This makes them resolve faster. Please consult with a doctor for specific recommendations. Good luck!

Steven Wallach, MD · Answer

It is difficult to tell from the photo for sure. If it is bruising, it is a very common area  to get bruised after injection. If it is bruising it will often get better within about a week.

Sean Doherty, MD, FACS · Answer

It is hard to tell from the photo if this is a hematoma but bruising is common. Especially under the eyes. Ice the area. Try taking arnica. And if things don't improve then see a board certified plastic surgeon for an in person evaluation.

Christian N. Ford, MD · Answer

Thank you for your question and for sharing your photographs.  Sorry to hear about your experience.  I do not recommend placement of Juvederm in the tear trough.  Based on your photos, you appear to have bruising and likely a small hematoma.  Icing may be beneficial for up to 48 hours after the procedure.  Arnica is also helpful for minimizing bruising and swelling.  If you continue to have concerns, I would suggest seeing an expert injector for an in-person reevaluation in order to determine the best treatment plan.  Hope this helps and best wishes!

Richard O. Gregory, MD · Answer

This is likely a hematoma which will reabsorb and not a slough. Arnrica, warm compresses and massage are usually recommended.  There can be residual scar and pigmentation.You are fortunate that no occlusive injection was done in that blindness can result from intravascular injection.  The question of the qualification of the spa injector should be made.

Severely concerned, please help! Necrosis or bad hematoma after Juvederm in tear trough? (photos)

Answers (9)

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