Bruising and Swelling After Juvederm Under Eyes

Question

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?

Daniel Reichner, MD, FACS · Answer

Kimber,
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.

Larry S. Nichter, MD, MS, FACS · Answer

In the future, the best way to minimize bruising
- especially for sensitive areas like lips or under the eyes, is to avoid
medications such as aspirin, Ibuprofen ( Motrin and Advil) and non-steroidal
anti-inflammatories such as Alleve or Naprosyn  . Other causes  of bleeding and bruising tendencies are green tea,
flax seed oil, Omega -3s and alcohol or caffeine intake  the day before
your treatment!
Arnica oral tablets are an easy remedy to reduce
the degree and length of time of bruising and can be taken 3 -5 days following
the treatment.#bruisingafterinjections   #juvedermRestylanebruising   #avoidbruising

Richard J. Bruneteau, MD · Answer

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.

Michael Constantin Gartner, DO · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

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

Sanusi Umar, MD · Answer

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.

Harold J. Kaplan, MD · Answer

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.

Monika Soni, MD · Answer

Thank you for your question. Juvederm is not the correct filler to be used in the tear trough area as it attracts a lot water and causes edema. The best filler for this area is Restylane as it is a thinner filler and attracts less water. Typically, I use cannulas for this area for safety and less bruising. I recommend following up with your injector as he/she may want to dissolve the filler with hyaluronidase. Best of Luck!

Michele S. Green, MD · Answer

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.

Cameron Rokhsar, MD, FAAD · Answer

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!

Bruising and Swelling After Juvederm Under Eyes

Answers (12)