Belotero tear trough bruising. Is this permanent? Should I be patient? (Photo)

Question

Hi I am very concerned now because the bruises are still the same 11 days after filler. The skin looks purplish/dark pink pigmented appearance and I haven't noticed one bit of change from when they first appeared. I know 2 opinions said it will get better but I am really panicking now as I've seen no signs of improvement or color changes in the bruises. Is this permanent? Should I be patient or is there a great laser treatment? Please advise & thank you for taking the time to respond.

Peter Lee, MD, FACS · Answer

The tear trough region can be densely populated with small  blood vessels, and the skin here is very thin, so this combination of factors puts patients at risk for visible bruising following injection of fillers.  The risk of bruising is increased if a patient has been taking aspirin, NSAIDs, fish oil, and a variety of other homeopathic medications.  Preinjection with anesthetic containing epinephrine and use of a blunt cannula for injection can reduce the risk of bruising, but nothing, except good luck, can entirely prevent it.If you see bruising following injection of the tear trough region with filler, arnica montana and bromolein are two homeopathic medications that can accelerate its resolution.  It is also very important that you keep this region out of direct sunlight while the bruising is resolving, in order to prevent long term hyper pigmentation of the skin here. It can take several weeks before the bruising completely disappears, and patience with this is definitely in order.  Light stimulation treatments can also help speed resolution of the swelling and bruising.In rare cases, patients can develop hemosiderin staining from deposition of iron ions released from the hemoglobin of ruptured blood cells in the deeper layers of the skin.  Hemosiderin staining also usually resolves completely, but this can take many months, instead of the weeks that garden variety bruising takes to resolve.  In cases of hemosiderin staining, chelating agents and treatments with alexandrite lasers can speed the resolution of this condition.  However, in your case, since you are only eleven days out from treatment, you would be best served by waiting two to three more weeks, and then returning to your physician to reevaluate your progress.

Jason Emer, MD · Answer

bruising can take 2-3 weeks to improve sometimes longer, i suggest laser treatments to speed it up and arnika pills.  Best, Dr. Emer.

Jon Kurkjian, MD · Answer

Thank you for your question.
Swelling and bruising is not uncommon with tear trough injections. Using cold paks, Arnica, and bromalain can all help reduce the swelling and get rid of the bruising quicker. Swelling can last up to 2 weeks. I encourage you to remain patient and not judge any results untl after the 2 week mark. At which point I would follow up with your injector to see if any massage or touch up is necessary. 
Good Luck

Shehla Ebrahim, MD · Answer

Dr. Ebrahim explains that bruising is common after tear trough injections. The area is very vascular and thin.  It will not be permanent and usually takes approximately 2 - 3 weeks to resolve. Patience is the key!

Hratch Karamanoukian, MD, FACS · Answer

The bruising can be resobed faster with the application of Bruise Balm. 
Apply Bruise Balm from Plato's Medicinals to reduce inflammation in the area. See link.
More permanent hyperpigmentation can be reduced with the use of Sclerovase and Scleroquin plus creams from VenaSmart.
If it persists, ask them to dissolve this product with hyaluronidase. 
H Karamanoukian MD FACS

Shaun Patel, MD · Answer

This looks like typical bruising after undereye filler injection. Bruising in this area can take 2-4 weeks to completely resolve. Hang in there; this is not permanent.

Keith Denkler, MD · Answer

The bruising under you eyes could last a total of perhaps three to four weeks.It will slowly get better over time.

Qais Wahidi, MD · Answer

One of the things I have found is that if your doctor uses blunt end cannula, there is less bruising.  I would ask next time if your doctor is using them.  The blunt end of cannula push around blood vessels and not cut through them

John R. Burroughs, MD · Answer

This can happen, but sorry it has happened to you.  I mostly use cannulas under the eyes to minimize bruising and to make the injections as safe as possible.  To minimize bruising, patients should avoid any items that can thin their blood to include alcohol, aspirin, NSAIDS (motrin etc), and many herbal supplements (Fish oil, COQ10) for 1-2 weeks prior to injections whenever safely possible.  Once bruising occurs it almost always will clear with time, but can take a month or more sometimes.  I think warm compresses are helpful once they are fully developed.  We in our office offer complimentary IPL (intense pulse light) treatments to our cosmetic patients to help the bruises dissolve more quickly.   Their are lasers that can help as well.  Topical arnica montana gel has mixed results but is not harmful.  You don't want to massage the area firmly (especially with Belotero) as this can mess up your filler placement and result.  Speak to your injector about options.  Best regards.

Belotero tear trough bruising. Is this permanent? Should I be patient? (Photo)

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