What is Hemosiderin Staining and How Long Does It Last?

Hemosiderin is a pigment that is a byproduct of hemoglobin that has spread into the tissues following injury with bleeding and bruising of the tissues. It contains iron pgiment and may take along time (years) for the body to metaoblize the iron and pigment that has spread into the tissues.

 Hemosiderin staining refers to a process where iron from the blood can stain the skin.   In the process of some surgical procedures particularly light liposuction leading can happen.   If this blood sits around there is the potential for the breakdown products of this blood to cause a staining of the skin directly over it.   Although theoretically it can happen with any surgery that creates bleeding. In my own  practice I have only seen in associated with liposuction, particularly liposuction done in a very superficial layer.   Once the blood has oozed out into the tissues the body will go through a process of resorbing.  As the blood cells are broken down iron pigment may be spilled into the surrounding tissues, and if it is close enough to the skin could get into it causing hemosiderin staining.  By contrast, hyper pigmentation refers to the process where the melanocytes and the skin proliferating creating dark patches. again in a general sense the most common type of hyper pigmentation one could argue is a suntan.  Here the UV energy from the sun causes the melanocytes in the skin to proliferate.  Melanocytes are protective cells that absorb UV energy to protect the underlying skin from injury caused by this form of radiating energy.  In the case of hyper pigmentation areas of inflammation which are results of trauma and/or surgery are more susceptible to the UV energy.  And as a result when one is exposed to sunlight these areas tend to get darker than other areas of the body, and we called these areas hyper pigmentation.  For areas of hyper pigmentation treatment including the use of hydroquinone can very easily be done as a cream that is applied on a nightly basis.  Typically within 2-3 month he will see significant improvement.  The concentration of hydroquinone can vary depending on skin type, degree of hyper pigmentation, and amount of area treated.    Alternatively IPL and other  medical lasers can be very effective. Hemosiderin staining on the other hand is a lot more difficult to treat.    Although it may resolve some with time, most patients that end up with this are looking for a more expeditious way to improving. Typically there is no cream they can readily remove the iron out of the skin.  Treatment for this is better suited by laser therapy.  Specifically, the Q switch laser can be very effective.  But this may take multiple treatments to get complete clearance.

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
Great question — bruising is a completely normal part of the healing process after both liposuction and a mommy makeover, especially when combining procedures like tummy tuck, breast surgery, and body contouring.

Pigmentation changes after liposuction or other body contouring procedures can be quite normal. While term hemosiderin staining sounds very serious, it is not. Hemosiderin staining is simply the result of body's local cells cleaning up small amounts of bleeding in an area of trauma - in this case, where you had your liposuction.   The cells in the area chew the byproducts of the blood and can change color. This is usually temporary, but can sometimes be a long-term situation.In your case, I feel that you have what is called "post inflammatory hyperpigmentation." Particularly because it happened some time after your procedure, this is less likely hemosiderin staining, and more likely the response of your skin to local inflammation/trauma/surgery. This is quite common after surgical procedures.What is the best way to treat this? In most cases, time will feel this. Some patients choose to use such as hydroquinone. Micro needling with PRP can be an effective treatment with zero downtime. Also, some may choose laser therapy. In your case, laser therapy may be a little bit of a challenge because of darker skin. I recommend discussing the matter closely with your surgeon and perhaps involve a dermatologist.I wish you the best,Dr. Gabbay

Bruising from surgery or any other cause generally resolves in about three weeks. On the face, this can be concealed with makeup usually at about 1-1/2 weeks. In some cases, discoloration may last longer than 3 weeks. Along an incision, like for breast augmentation, this discoloration often represents a transient increase in skin pigmentation from an increase in the activity of melanocytes (pigment producing cells). This hyperpigmentation is more noticeable in patients with darker skin types. Hydroquinone cream can help this but takes a few weeks to work. Hyperpigmentation usually takes a few months to resolve. Another cause of discoloration is hyperemia (increased blood flow). Most incisional scars will have this to some degree for several months after surgery. If you press on your scar and it turns lighter for a couple seconds, then gets more red or darker again as blood flow returns, then you have hyperemia. It is part of normal scar maturation, the last part of healing. Silicone gel sheeting, scar massage, and moisturization may help. Hyperemia is also common in the skin over areas treated with liposuction. Again, it generally takes a few months to resolve.The least common cause of prolonged discoloration after surgery is hemosiderin staining. From a health standpoint, there is nothing harmful about this. Bruising is caused by extravasated blood, blood that leaks out of the blood vessels. When the hemoglobin (the protein that carries oxygen and makes blood red) breaks down, the main breakdown product is hemosiderin, which is then taken up and carried away by cells called macrophages. Sometimes hemosiderin may persist in the tissues. This causes discoloration. Generally this improves, but like hyperpigmentation and hyperemia, it also takes months to do so, and staining can occasionally be permanent. Certain types of lasers may help. Hydroquinone has been used. Green tea and other healthy foods rich in antioxidants and vitamin C may help also. Discuss options with your surgeon.Lastly, for lower eyelid surgery (blepharoplasty), some patients may still notice persistent mild dark circles under their eyes after surgery. The lower eyelid skin is thin and delicate and in most patients actually shows the color of the orbicularis oculi muscle (the squinting muscle) through the skin. Surgery can beautifully smooth and eliminate lower eyelid bags and shadowing, but the reddish tint of the muscle may still show through the skin. This can be confused with hemosiderin staining. Thanks for your question.

Given the fact that your hyperpigmentation was established so long ago, it probably is completely stable and will not go away on its own. You should check with your plastic surgeon regarding hydroquinone, a product which may help decrease the pigmentation, and laser therapy.

Thank you for your question.  Hope your happy with your result, other than the bruising.  Hemosiderin is the breakdown product of heme (blood).  Your body will naturally continue to break this down until it resolves.  Depending on the amount of bruising/bleeding that occurred from the initial procedure will dictate the length of time it takes to resolve.  It will all resolve in due time.  Bruising can last several weeks to months at times, but in your case it should resolve without permanent discoloration to the skin.  Hope that helps!

Hello, this darker skin color or hyperpigmentation is likely inflammatory after liposuction. It seems to be more common on the darker skin individuals. It generally resolves on its own but can take a long time. Hydroquinone may be of help. Thanks.

Hemosiderosis is an iron overload disorder resulting in the accumulation of a pigment called hemosiderin. The pigment can be imbedded into tissues after a bleeding episode, causing bruising and in most cases resolves as the healing continues. It usually goes away in a few weeks. The pigment may remain in some conditions such as stasis dermatitis. Options for improvement in these cases can include bleaching cream, IPL laser, steroid creams and massage to increase flow through these areas of stasis. A qualified, board certified dermatologist can help.

I agree with my colleagues. I do not think the pigmentation shown in the photo is hemosiderin staining, but it is possible. If so, it can take some time to go away.  Some patients opt for laser treatments to break up the hemosiderin pigment sooner.  From my observation, I believe it is likely post-inflammatory hyperpigmentation (adjacent to the incisions) which is quite common and which can be treated with "bleaching creams" such as hydroquinone (Triluma is a common prescription cream that contains hydroquinone) as well. If it does not go away after some time period, I would also recommend getting some input from a dermatologist as well as your plastic surgeon. Good luck! 

Sometimes this condition occurs but is rare following liposuction. It's the pigment of the blood that sticks around and can last a very long time and might not go away. You could possibly visit a laser center and see if a few treatments might decrease the appearance of the pigmentation or try medicated creams with bleaching components. Our practice has these kinds of products made by obagi and ZO- might be worth checking with your physician about these options as well. Best of Luck.