Swelling and bruising after restylane on tear troughs and marionette lines. Should I worry? (Photo)

First let me say that I am sorry that you are worried. The good news is that bruising and swelling, if and when they occur following treatment with injectable fillers, are temporary--typically lasting only a few days--and do not effect the final aesthetic result. Icing, the use of oral and/or topical arnica,  oral bromelain and of course concealers are the usual remedies recommended to manage these problems,  but typically in my experience they resolve just about as quickly when simply left to their own devices.Going forward, however, before future treatments, it would be wise to abstain for at least a week prior to anticipated tretment--if medically permitted to do so, of course---from the use of aspirin or aspirin-containing products, NSAIDs, vitamin E, supplements, such as garlic, ginseng, and ginko biloba, since all of these prolong bleeding ("thin the blood"), which in turn increases the likelihood of bruising. Heavy alcohol consumption within twenty-four hours of treatment may likewise do so and should be avoided.Regarding the physician's end, you should be sure that the physician injector you choose has experience and expertise in injecting fillers, particularly in the tricky and delicate area under the eyes that is more prone to bruising owing to the abundance of capillaries in the area. The use of blunt cannulas for injection that require only one injection point to cover large areas can also reduce the likelihood (not eliminate) of bruising. And as an additional benefit, fewer skin pricks generally translates into less bruising and swelling and less pain.

Bruising and swelling are the most common side effects following the injection of cosmetic fillers.  The area below the lower eyelid has thin skin with many small capillaries, making it a high risk area for bruising and swelling following Restylane injections.  Icing, Arnica (topical or oral) and avoiding all aspirin or aspirin based products for the next couple of days should help, but understand that this swelling and bruising may last you a couple weeks so be patient.  Should you feel uncomfortable or uneasy, you should schedule a follow up appointment with your physician.

HA products such as Restylane are hydrophilic (water loving) and absorb water during the first 48 hours so there is often an appearance of tissue swelling, which is actually the product taking in water.  Using Bendryl at night for the first 2 nights can sometimes help diminish this effect a bit but it will go away within several days and bruising usually resolves within a week.  Make sure not to expose bruised skin to sun though as you might get staining of the skin with products from the blood cells.  Call your doctor if it is not significantly improved in a weeks time.

One of the potential side effects of Restylane injections are bruising and swelling locally at the site of injection.  These side effects should minimize and disappear in about a week.  Continue to ice and take Arnica and it will hopefully go away sooner. Some patients have told me that eating pineapple has helped heal the bruising faster.

I tell patients that if they do not bruise with tear trough injections that is and exception rather than the rule.  Best of luck.