Bruising under eye after Botox and should ice be used before and after injecting Botox?

Some physicians may prefer to use ice before and/or after a Botox injection and others may not.  For my patients, I do prefer to ice the area prior to treating as I feel this can help to decrease bruising by constricting the blood vessels in the area.  Some patients and physicians prefer to ice the area after injection and others do not.  In regards to Botox or fillers under the eyes, I think fillers work better under the eyes and Botox works better on the sides of the eyes for crow's feet.    

Bruising with Botox injection can usually (but not always) be avoided by slow and careful injection technique by an experienced injector using a tiny (31 G or smaller) needle. A small dose of Botox (usually 1 unit per eye) can be injected under the eyes to help improve lines associated with contraction of the inferior orbicularis muscle. In this case it will also subtly open up the eyes. This should only be done in patients with a strong orbicarulis muscle (usually determined by a snap test). Any bruising from the injection will usually resolve on its own but its resolution can be expedited using a vascular laser and possibly arnica.

It is important to recognize the limitations of BOTOX or other products injected around the eyes.  I often hear of injectors, especially non-physician ones, telling patients that BOTOX will "lift" or "open" the eyes.  However, BOTOX can never do anything other than temporarily weaken or paralyze the muscle it is used to treat.  The only way it can cause lifting anything is by weakening a muscle that is pulling that thing downward.  In very limited circumstances, therefore, a little elevation is possible, but it will be limited.  Similarly, the only way BOTOX could cause the eyes to "open up" is if the muscle it is used to treat is constantly closing them.  There certainly is a muscle, the orbicularis oculi, which contracts to close the eyes, but I would be skeptical about BOTOX treatment making the eyes noticeably more open.Bruising is unusual with BOTOX treatment, but it certainly can happen, especially around the eyes, where the skin is thin and there are often a number of small veins that can be hard to see.  A bruise is caused by bleeding under the skin, and resolves as the body absorbs the blood.  Although I generally do not use ice, some surgeons do. If the vessels are constricted by the ice, it might make them more difficult to see and might increase the risk of bruising, but I am not convinced that that would be a major factor.Unfortunately (or fortunately), there is nothing other than time that will generally resolve a bruise, and while arnica and bromelain have long been recommended, the evidence that they are helpful is weak.Presumably you wouldn't have used the word "injector" if the injector had been a surgeon, or even a physician.  Depending on the state, generally non-physician injectors are supposed to be supervised by a physician, who is responsible for the treatment, and who should be available to help with any problems.  My best advice would be for you to talk with that physician about your concerns.  Otherwise, my advice would be to see a surgeon who can review all of the options available to you.

Botox is used in this area to improve wrinkles associated with hypertrophy of the obicularis oculi muscle. It sometimes forms a roll and wrinkles under the eye and Botox will help. It can't be used in people with laxity in the lower eyelid or they will get ectropian. A snap test is needed prior to test for this. If there is volume loss, filler must be done as well. Ice helps to control bruising for the first couple hours. Bruising should not occur in most cases during this injection with either Botox or fillers if the injector is an experienced one. To expedite resolution of the bruising, I use an Excel V laser and arnica patches.

We do have patients put ice on the area to be injected followed by immediate pressure for 5 minutes around the eye area. If you already have a bruise you can apply iced compresses to the are for 20min/h for the first 48h. I like arnica cream applied to the area of bruising also. People who tend to bruise can take arnica orally a few days before the injections also.