Input Please- MD Icing / Pressure Protocol When Veins Are Hit in Tear Troughs?

A vein was hit when Restylane was injected under my lower lids. My PS iced and applied pressure for one minute or less before continuing injecting. He did not ice at all before or after- but sent me home with an icepack. (No blood-thinning supplements factor in, and thorough home-care by me afterwards.) It seems that reasonable MD protocol would be to apply pressure and ice the area immediatley and longer to reduce bruising. What would you, as an MD, do?

Doctor Answers 10

Risks of Bruising with Injections around the Eyes

Injecting any of the hyaluronic acid fillers such as Restylane of Juvederm around the eyes, in my opinion, has the highest risk of bruising of anywhere on the face. Even with the correct injection technique there is always the chance of hitting a vein and causing a significant bruise in this area. All of my patients are warned of this possibility before any injections are done. So obviously luck unfortunately plays a role as well. If necessary, I will have the patient apply pressure for at least five to ten minutes to prevent the bruise from worsening. After that, it's "hands off".


South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Bleeding with fillers


The coagulation cascade can take up to 12 minutes to work, therefore I always recommend that gentle pressure be applied to the area for 10 minutes continously.  The use of ice for hemostasis(stopping bleeding) does not help.  The pressure must be gentle as I do not want you manipulating the filler that has just been placed in the area.  Rubbing or constant motion might cause the bleeding to start again, along with possible displacement of the filler.  Gentle pressure should diminish the size of the bruise.

Ernesto Hayn, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 2 reviews

Pressure not icing for veins hit during injections

You need to hold steady, firm pressure to the area for 10 minutes without lifting to see if the bleeding has stopped.  Ice does nothing at all.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Pressure for 5-10 minutes immediately after fillers can reduce bruising

Pressure for 5-10 minutes immediately after fillers can reduce the incidence and severity of bruising. I have found that 10 minutes works better than 5 minutes, and for the past couple of years have had my patients apply firm steady pressure to the treated area as soon as the needle comes out of the skin. Pressure is vastly more effective than ice after the injection.

If a patient gets a bruise in spite of this, they can return to see me in a couple of days and we can treat the bruise using LimeLight™ Intense Pulsed Light, at no charge, which will often greatly accelerate resolution of the bruise. I expect that other types of IPL machines could also be helpful, at appropriate parameters.

By the way, arnica or vitamin K creams and pills are completely worthless for the prevention and/or treatment of bruises. If the pills really did make the blood clot better, they would probably also increase the patient's risk of heart attack, thrombotic stroke an/or blood clots in the legs and pulmonary embolism. So ... good thing they don't work as advertised. The only thing they are good for in generating revenue for the pill-and-cream sellers.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon
4.7 out of 5 stars 4 reviews

Bruisestick ointment containing Arnica montana

Early application of Bruisestick ointment can help resolve the bruising underneath the skin. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Always a chance of bruising after injections

Greetings Lilliana~

Whenever someone undergoes injections, whether it be for cosmetic reasons, getting a vaccination or venipuncture, there is always the risk of a bruise, regardless of the skill of the injector or the care taken.  We always advise patients that they will very likely have bruising when we inject around the eye and tear trough area and therefore it is not wise to do before a big event or if they have plans the week following the procedure.  Though applying ice and pressure can be helpful, it is not part of any strict guideline or protocol for injecting that area.  Even after icing and slow, purposeful injections a bruise can result.  It is quite common.

Good luck~

Dr. Grant Stevens    

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 147 reviews

How to treat bruising with tear trough Restylane injections

All good feedback from the panel members. 

With regards to pressure being applied, we find that using more pin point pressure with a large swab or Q-tip is more effective.  In these situations, we do not rush the process and provide adquate time to stop the cascade of events.  Icing has helped with the swelling that wants to settle into this unforgiving area. 

In a situation wherein someone is experieincing bruising that is beyond a small area, the treatment is stopped, and the patient is invited to return when swelling/bruising is resolved so that a more accurate and complete treatment may be done. 

Being that you already experienced the bruising, the only other thing to offer as a side note is that the pulsed dye laser is an excellent option in cleaning/clearing the bruise if done while the bruise remains purple and/or blue in color.

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

Bruising after restylane injections

I don't find that ice helps at all in limiting bruising.  Ice may help reduce swelling.  If a vein is inadvertently injected, then I have my patient or assistant hold pressure.  Small capillaries only need several seconds but a vein can take several minutes.  If someone is taking aspirin, fish oil, vitamin E, Advil, Ibuprofen, Alleve, Motrin, and other blood thinners, then the time of pressure should be about ten minutes. The amount of bruising may be less with taking Arnica montana by mouth, using topical vitamin K, and limiting exericse after the treatment.  Vbeam laser has been shown to reduce the duration of the bruise by a couple of days.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Bruising after Restylane injection

One of the potential side effects on injection is bruising, especially under the eye. This is a very sensitive area with a lot of blood vessels. I always tell my patients the potential of bruising. Although bad bruising rarely happens, there can sometimes be extensive bruising, which depends on various factors including if you take any Omega-3, Aspirin, blood thinners, alcohol etc. Pressure is the most important thing that you can do. Holding it down for about 10 minutes is very important. Although ice may help, pressure is the most important thing. Take Arnica tablets and also eat pineapple. The bruise will go down, just takes time.

Ben Behnam, MD
Santa Monica Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Please lighten up on your plastic surgeon.


As I posted yesterday, bruises happen when you get poked with needles.  Even having your blood drawn can cause a nice bruise.  Doing filler is associated with a definite risk of bruising.  Yes it is helpful to be prepared by the injector that you can bruise.  Please see my post from yesterday. 

Any of us injecting a lower eyelid will immediately address an area that is trying to bruise at the time of injection with direct pressure.  I for one do not want my patients going home holding a lot of pressure on a bruised area.  First, after a short period of time, the bruise has mostly likely completely clotted off.  It is essentially a done deal.  No amount of icing or holding pressure at that point will change the presence of the bruise or how long it will take to clear.  I do think that it is possible to manipulate the area or through activity, make the bruise worse after the treatment.  For that reason, I do not want my patients pressing or messaging the treated area.  There is an actual risk that one could push filler out of the location it needs to be in.  I have had patients return with the "thumb print sign" in their treatment area from directly manipulating the area.  So we are clear, it actually takes a remarkable amount of force to do something like that.

How effective is icing to reduce swelling from a bruise.  Let's just say, somewhat effective.  Is icing essential: the reality is that no, it is not essential.  It sound like your surgeon did the right thing here.  Now you have a very tough job which is to be patient and let your bruise resolve and this could take weeks if it is a bad black eye and of course it is impossible to hide with cover-up.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.