How Can I Prevent Bruising from Restylane or Juvederm?

whats the secret to minimizing bruises from wrinkle injections like juvederm or restylane? Should I apply ice to the area of injection? 

Doctor Answers 121

To reduce the chance of bruising from a cosmetic...

To reduce the chance of bruising from a cosmetic injection such as BOTOX, Restylane, Radiesse, Sculptra, etcetera, steer clear of the following for 2 weeks before your treatment, and do let your injector know if you have taken any of the items below:

  1. Prescription medicines to thin the blood such as Coumadin, Heparin, and Persantine. ALWAYS ask your doctor first prior to stopping these medications as they are preventing dangerous blood clots in your body. (You will only be allowed off of these for a few days, if at all).
  2. Over the counter medicines that thin the blood such as aspirin or aspirin-like products (e.g. Advil, ibuprofen, Motrin). This includes medications that relieve pain due to headache, arthritis, and menstrual cramps. Tylenol (acetaminophen) or Extra Strength Tylenol by itself is okay, but be careful, as some Tylenol products are used in combination with blood-thinning medications, such as Tylenol Migraine or Tylenol Arthritis.
  3. Herbal supplements and vitamins that thin the blood, such as Vitamin E, Gingko Biloba, Feverfew, Ginseng, Red Clover, Fish oil, and garlic supplements. If you dont want to take any chances, stop taking your multi-vitamin also if it contains more than 40 IU (units) of vitamin E.

To further decrease your chance of brusing, apply ice or cold compresses as soon as possible after (or during) your treatment; let your injector know of any obvious veins to watch out for, and go to a trusted and experienced injector who knows how to inject carefully and precisely, while avoiding as many blood vessels as possible.

Even if you follow all the advice above, it is still possible to bruise. If you have an important event or photos coming up, allow at least 2 weeks for recovery so you won't be disappointed.

Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 40 reviews

To minimize bruising use Ocumend or another strong arnica montana containing product

To minimize bruising use Ocumend or another strong arnica montana containing product.  We like Ocumend patches, which are hydrogel patches containing a very high concentration of arnica.  They release higher concentrations directly where needed rather than a small amount throughout your entire body as oral versions do.  We also recommend icing the area and avoiding products that can "thin" your blood, such as aspirin, anti-inflammatory meds, coumadin, vitamin E and fish oil capsules.

Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
4.9 out of 5 stars 216 reviews

Choose a gentle injector!

Although there are no guarantees on bruising, gentle technique goes a long way towards minimizing bruising and swelling!

Other ways to prevent bruising including the following:

  • Avoid aspirin, Advil, Motrin, or other oral medications which encourage bruising for at least 7 days before your treatment
  • Ask your physician for Arnica Montana. This herbal homeopathic remedy is used by many injectors to reduce post-treatment bruising and has few associated side-effects
  • Ice following your treatment
  • Avoid exercise for 24 hours following your treatment
  • Keep your head up for the first few hours following your treatment

While these recommendations cannot guarantee a "bruise-less" experience, they can certainly improve your chances!

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
4.9 out of 5 stars 42 reviews

How to Avoid Bruising from Juvederm and Restylane

The short answer is that bruising can be a random and unpredictable event. However, there are a few things that you can do  as a patient to minimize the risk. With the consent of your doctor, avoid medications and herbal supplements that are known to cause bleeding. Most doctors are happy to provide you with a list of common medications and supplements that should be avoided for 5-7 days prior to injection. If its warm outside, cool down or apply ice to the area prior to injection. A blunt tip cannula can reduce the risk of bruising, but small needles often allow greater control over placement of the product. Careful and slow injection is most important factor in preventing bleeding. We apply pressure and ice afterwards and advise our patients to avoid exercise and alcohol for 24 hours. We treat any bruise that develops with a special laser (pulsed-dye laser - Vbeam), which dramatically reduces the time it takes for the bruise to resolve. 

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 118 reviews

A Laser solution for injection bruising

The answers here offer excellent information about how to avoid injection bruising. We give our patients much of the same information before their treatments but in some cases, bruising is unavoidable either because the patient cannot stop their medications or because they are more prone to bruising.

In these cases, we have an excellent post injection bruising removal technique. Pulsed dye lasers are designed to treat vascular conditions like Rosacea and port wine stains so the target for this laser is the hemoglobin in the blood. We have found that using this laser the day after an injection procedure causes a bruise will generally resolve the bruising within 48 hours. When left untreated some bruises have lasted up to 14 days. While this is not a preventative solution, it is a great way to fix the problem once a bruise has occurred.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Juvederm Ultra, Restylane, and bruising


Thanks for the question. While it is impossible to predict the likelihood of bruising when undergoing injectable filler procedures with products such as Juvederm Ultra or Restylane, in general, we recommend patients refrain from drinking alcohol, and abstain from medications such as NSAIDS( ibuprofen), aspirin, Vitamin E, and any other medication which predispose to "thinning" the blood, prior the procedure. Additionally, I like to ice the area of injection prior to the procedure and then immediately after. Having said this, again, bruising is variable. Areas that tend to bruise more, in my experience, include the periorbita (around the eye), and the lips, whereas the nasolabial folds tend not to bruise as frequently.

Hope this helps.

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 31 reviews

Minimize Bruising with Facial Injections

Any cosmetic surgery, procedure, or product has the potential to result in bruising, and skin discoloration. Luckily, most of this bruising is temporary and fades away in a few days or weeks. More extensive procedures may take longer to recover. What can one do to proactively minimize the bruising after cosmetic plastic surgery? To help have the best outcomes after plastic surgery, follow the basic guidelines below, whether you're having a lunchtime cosmetic Botox injection, face lift, or a cosmetic rhinoplasty.

Avoid Blood Thinners
Makes sense, correct? But we are sometimes unaware that normal medications or herbs may cause bruising. Stop all aspirin and aspirin-like products such as ibuprofen for at least 2 weeks prior to your procedure. Avoid any herbal teas or medications which have blood thinning qualities such as St. John's wort, ginkgo, ginger, garlic, ginseng, kava, vitamin C, and vitamin E. Your plastic surgeon will let you know when it's ok to resume taking these products.

Elevate Your Head
Avoid lying flat or prone. Positioning your head on top of a few pillows, or elevated mattress top, will help reduce bruising, swelling, and pooling of blood in the area. Let gravity play a role in the healing process.

Crushed ice or cool compress help constrict the blood vessels and help prevent a bruise from spreading. Ice should not be directly on the skin. Use a soft cloth to help distribute the cooling effects of the ice to the skin. Ice and cool compresses are especially important within the first 2 days after cosmetic surgery.

No Strenuous Activity
Any activity which elevates your blood pressure or causes Valsalva effect may exacerbate and cause bruising, at worst even frank bleeding. Strenuous activities to avoid include, but are not limited to running, exercise, weight lifting, pilates, aerobics, cycling, climbing, and sex. Yoga should be avoided too. Patients should even avoid straining on the toilet! Your plastic surgeon will inform you when you can resume normal activity.

Arnica Montana
A homeopathic or alternative medicine approach to bruising, Arnica is available without prescription. Arnica helps alleviate dark, swollen bruises by apply a gel containing arnica every few hours over the affected area. Arnica has traditionally has been used for muscle aches, sprains, and bruises. Some may have a reaction to arnica. Discontinue use if the treated skin becomes red, itchy, or inflamed. Speak to your plastic surgeon before starting arnica, as it is not allowed at all for some cosmetic procedures.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Prevent bruising

Three things     1) hold pessure on the injection site immediately for 5 minutes      2) use ice over the area for 10 minutes afterward        3) make sure the surgeon uses a 30-gauge, sharp injection needle so as to cause as little trauma to the tissues as possible

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

How To Minimize Bruising Following Cosmetic Injections

Unfortunately, there is no way to prevent bruising, as bruising is actually bleeding in the tissues under the skin and any time you place a needle into the skin, there is always a chance that a bruise can occur. However, with that said, there are ways to reduce the likelihood that you will bruise.

First, unless you have a medical condition that would make this necessary, you should stop taking aspirin, ibuprofen or other antinflammatory medications at least 5 days prior to your procedure.

The selection of your doctor is also very important as some doctors are much better at this than others. I typically take about an hour to treat an entire face, where many of my colleagues do this in 15-20 minutes. The faster the doctor injects, the more likely he or she will cause a bruise. I also inject very gently, making sure not to force the product into the skin while many, if not most, doctors force it into the skin; again, there is a greater likelihood of bruising with this technique.

Finally, if you use ice before, during and after your cosmetic injections, this can help minimize bruising.

While unsightly, bruises typically fade and do not cause any lasting trauma.

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon
4.8 out of 5 stars 5 reviews

Minimize Bruising with Injectables

Bruising can occur with any procedure, but there are techniques that can minimize the odds. First of all, if you are taking aspirin, extra vitamin e, ginkgo, or other exotic supplements, stop them at least 1 week before the visit. Stop all other NSAIDS 2-3 days before your visit. Use of ice on the area to be injected is sometimes helpful prior to and immediately after injection. Lastly, use of arnica montana after treatment can also help fend off bruising.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.