Bruising and Swelling After Juvederm Under Eyes

I had Juvederm injected into the tear troughs under my eyes on Friday. She injected more into the right side (seemed like a lot more!). Today is Sunday, and the swelling has gone down a little bit, but the right eye is still extremely puffy. My eye recedes behind the puff! Help! I have an important event in 2 weeks and had no idea there was going to be such a recovery period. Doctor told me about a week for bruising. Should I go ahead and have the enzyme injected to reduce the amount under the right eye?

Doctor Answers 11

Special skills required for Juvederm tear trough injections

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I believe that injections of Juvederm into the tear trough requires special skills to avoid complications. It is possible that the Juvederm was injected into the peri-septal space of your right eye, creating the swelling under your eye.

I would start with a 6 day course of methylprednisolone to treat the swelling. If there is still significant swelling one week after your Juvederm injection, I would recommend a dilute injection of hyaluronidase into the right side bag.

Swelling and bruising normal after Juvederm injections

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Thanks for your question.

It is normal to have swelling and bruising after Juvederm for the tear troughs, and that swelling plus the volume effect of the Juvederm itself can be quite dramatic appearing.

For the swelling, I recommend taking Ibuprofen 400mg 3x/daily (if you have no contraindications), plus icing the area. It will still take time, however. Ibuprofen can also cause slight bleeding immediately after a procedure, but you are far enough removed from the procedure that that is not a worry to me now. In addition, for future procedures, you may wish to take Arnica Montana to help limit the degree of bruising from injections. Anecdotally, patients have reported that this really does help prevent dramatic bruising for Restylane and Juvederm procedures.

Give it a week or so and evaluate your appearance then. I wouldn't jump to do hyaluronidase yet. See where these measures get you and re-evaluate your results this Friday with your physician.

Good luck!

Don Mehrabi, MD
Beverly Hills Dermatologist

Bruising related to injection technique, and should resolve soon...

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It’s unusual for patients to develop significant bruising and swelling following the use of injectable fillers. Never the less, this complication may occasionally occur following these injections. Bleeding, bruising and swelling aren’t usually related to the filler material, but instead are related to the injection technique and the patients clotting mechanism.
When this situation arises, bruising and swelling usually resolve in 7 to 10 days but may take as long as three weeks to completely resolve. With an important social engagement on the horizon this may not be enough time for this problem to resolve. Under these circumstances, anything that minimizes the inflammatory response might speed the process. Ice and steroid treatments might be helpful for this reason.
It’s important to discuss this issue with your plastic surgeon. It’s also important to understand that the odds are still in your favor and that with appropriate intervention your social plans won’t be disrupted.

Swelling after Juvederm

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Typically, swelling caused by Juvederm should resolve in seven days. In rare instances especially when bruising has occurred the swelling could take 4-6 weeks to completely resolve. A small amount of puffiness or mild swelling for a day or two is normal. If the patient experience swelling at the injection site, an ice pack may be applied for a brief period. The patient should see an immediate improvement in the treatment areas. However, the filler can be dissolved with the hyaluronidase enzyme, which I would recommend for you to do.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Restylane for Tear Troughs

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We agree with Dr. Reichner that this is a very technique dependent procedure. There is more than one technique used for tear troughs and it sounds like you may have been injected "over the muscle". When tear trough injections are performed "over the muscle" they can lead to much trauma, including bruising and swelling. We inject under the muscle and rarely have bruising in our patients (less than 5% of the time).

It sounds like Hyaluronidase may be an option for you at this point to get rid of the puffiness. Bruising may also not be resolved in 1 week, but pulsed dye laser treatments can clear this problem in 2-3 days if your practitioner has this laser or someone else around your area.

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

Bruising and swelling

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The timing of your injections is somewhat unfortunate. Sounds like you may have had too much filler to the right eye area - you will have a better idea of this 1 week after the initial injection. Excess filler can be extruded from that area, or hyaluronidase can be used. Please discuss this issue in person with your physician/injector, the sooner the better.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist


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The area under the eyes is delicate, and generally swelling and puffiness can last a little longer than other areas. Give it a good two weeks before you judge your results. 

Injections under the Eyes

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I love injecting the under eye area since it gives very nice subtle results to treat the tear trough area. Juvederm is too thick for the under eye area.  I much prefer Restylane or Belotero under the eyes for the tear trough area.  These finer injections are better suited for the delicate under eye area.  You should return to your physician to have them dissolve these injections.  For the best results please consult a board certified dermatologist with a great deal of experience with injecting this delicate area.

Bruising after Juvederm injections

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Our office recommends Arnica ointments with Bruisestick being the first choice for bruising after injectables such as Juvederm. 

Bruising and Swelling after Juvederm

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Unfortunately a vessel can be nicked or penetrated during the injection of any under eye filler. As blood collects under the skin, it can cause swelling and bruising. The only recommendations I have are to avoid aspirin, alcohol, and straining, and to try taking Arnica Montana, an herbal supplement proven to reduce bruising. Intermittent ice may reduce the swelling as well. Before your presentation, cover the area with a yellow or green tinted concealer. Best of luck! 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

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.