During an injection, whether it is Botox or filler, there is soft tissue trauma. As a result, there is a risk for bleeding and a subsequent bruise. Ideally, we try to optimize the circumstance so as to prevent this unwanted outcome. Outside of practitioner technique, there are multiple elements that can promote bruising. With regard to medications, there are required medications and elective medications. Required medications include Plavix, Heparin, Warfarin, Lovenox, etc. These medications are prescribed under a doctor’s care for a medical condition and are given to prevent blood clots. Unfortunately a side effect is the significant increase in the risk of bruising. Other medications include conventional (Aspirin, Ibuprofen, etc.) and holistic (ginger, gingko, feverfew, fish oil, flax seed, etc.) over-the-counter remedies. Each of these “elective” medications and supplements are well known to increase the risks of bruising as well. In order to optimize your desire to minimize bruising it is recommended that you refrain from elective medications for a period of two weeks prior to your procedure. A complete review of you medications with your physician is recommended. When in doubt for an ache or pain – Tylenol (or generic) is fine. Be healthy and be well, James M. Ridgway, MD, FACS