Restylane injection - black eye. The surgeon did not use a cannula. Should she have?

Question

I got restalyne injected under my eyes and ended up with a black eye and swelling underneath only one eye. The surgeon did not use a canulla, but should she have? I'm really frustrated because, while I knew there was a risk of swelling, I didn't think it'd look like I got sucked punched. Did the doctor make a mistake? And could this have been avoided by using a canulla? Is there any good reason not to use a canulla?

Sheila S. Nazarian, MD · Answer

There is always the risk of bruising after dermal filler injections but these things may help:1. Ice during and after the proceure2. No aspirin, alcohol, high-dose vitamins, herbal medications or teas a week before the procedure3. Arnica??? (not proven)And I prefer needles.Hope that helps!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for the good question. Unfortunately, bruising is not unusual with placement of fillers near the eyes whether a needle or cannula is used. Every doctor who has treated many patients has caused bruising. Make sure an experienced eyelid expert is the physician performing the placement of the filler in this risky location. The bruise will resolve within 10 days without treatment. Good luck.

Brian S. Biesman, MD · Answer

I am sorry to learn about your bruising.  It is not uncommon for bruises to appear on one side and not the other.  There is no scientific proof that cannulas are safer or cause less bruising than needles.  It sounds as if the treatment you received was entirely appropriate.  Lasers can be used in many cases to help clear up bruising which occurs following injection, trauma, or surgery.  The laser treatments are safe and tend to be highly effective.  You may wish to discuss this option with your physician.

Harold J. Kaplan, MD · Answer

Hi Carter.  We use needles exclusively for under eye injections because it allows us to be more exacting for where the filler is placed.  Because the needle goes through the dermis rather than injecting into it (we inject under the muscle), we very rarely have bruising with this type of injection.To see examples of a under eye injections using needles and Restylane for our Los Angeles patients, click on the link below.

Jason Emer, MD · Answer

I only use cannulas to tear trough to prevent bruising and swelling but with any injections you can get bruising.  It is common to use needles and expect bruising there.  I suggest seeing someone in the future who only uses cannulas if you are concerned.  Best, Dr. Emer.

Michael A. Zadeh, MD, FACS · Answer

Using a needle versus a microcannula for filler injections is really a physician's choice. Not using a microcannula would not be considered a mistake. I use both microcannulas and needles for my filler injections, the choice of which one I use varies for each individual patient. I almost always use microcannulas when I treat underneath the eyes. Although the risk of bruising is not zero with microcannulas it is greatly minimized. The good news is that the bruising will completely resolve in time.

Mehryar (Ray) Taban, MD, FACS · Answer

Either cannula or needle can cause bruising after filler injection, especially around the eyes as the skin is thinner and there is more finer blood vessels.

Soheila Rostami, MD, FAAO, FAACS · Answer

Cannulas are the safest way to inject the lower eyelids or near the eyes. In my opinion, using needle near the eye put s the patient at other risks that are not necessary. I only inject fillers near the eye with cannulas. The change of getting any bruising or hematoma is much less and other more serious complication can't happen with cannula.

Richard Ort, MD · Answer

In general, I prefer to use cannulas around the eyes.  There is no question that using a cannula will decrease the risk of getting a bruise.  It does not guarantee that you will not bruise, but the risk is lower.  With a needle, there will be bruising a certain percentage of time because some of the veins are not visible and cannot be avoided completely.  The other reason I generally prefer a cannula around the eyes is that the risk of intravascular injection (injection directly into a blood vessel) is likely lower than with a needle.  This is a rare but serious complication and cannulas likely reduce the risk.  There are times when I do use a needle around the eyes.  Because it is shorter, a needle can be more precise.  Sometimes if a patient needs an injection in a specific area, I will use a needle to be more precise.So to summarize, cannulas do have advantages and usually I prefer to use a cannula around the eyes, but it is not a mistake to use a needle and I do use needles around the eyes when necessary.

Gerald Searle, DO · Answer

I recently attended a seminar for physicians.  The doctor doing the presentation asked by show of hands how many of the physicians used a cannula and how many used a needle for injections around the eyes.  It was pretty evenly divided.If you ask your doctor, it really comes down to his or her preference.  Significant bruising in this area is very common and sometimes unavoidable - and cannulas can cause bruising just like needles.Hope this helps.

Restylane injection - black eye. The surgeon did not use a cannula. Should she have?

Answers (13)

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