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

I had Botox 4 days ago including under the eye area to "help open my eyes up." The injector stated there was no bruising but I found there was a bruise under my eye once I returned to my car. Area still purple & baggy & crepey. I've been using aloe Vera oil but not helping so any advice please? Also, Is ice recommended throughout procedure? No ice was used as my injector advised ice can cause bruising. Finally is Botox recommended under the eyes or are only fillers recommended in this area ?

Doctor Answers 15

Bruising under eye

Sometimes bruises appear after the injector injects, which he/she may not be able to see at the time of treatment. If a bruise occurs, it should resolve over the next 5-7 days. Bruises and swelling can be helped with ice, however I would not suggest pressing hard on the area as you do not want to move the Botox product. Botox is not recommended directly under the eye, however dermal fillers can help to treat under-eye “bags” or appearance of tiredness.

Columbus Physician
5.0 out of 5 stars 19 reviews

Bruising with Botox

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.

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 55 reviews

Bruising can occur after BOTOX(R) or other injections around the eyes

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.

James Nachbar, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 22 reviews

Bruise from undereye Botox

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.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Bruising after Botox around eye

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.

Byron A. Long, MD
Marietta Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Brushing after botox

Thank you for your question.

I am sorry you have bruising with your procedure. This can happen regardless of the experience of your injector but would be more common with the less experienced. The bruising should start to fade soon but for the color to totally resolve may take up to 2 weeks.  Some folks advocate laser or arnica.

I would not expect there to be much affect using ice this long after your injection. I personnaly like ice during and immediately after injection as the cold will constrict blood vessels and theoretically decrease the chance for injuring a blood vessel (which causes a bruise). Botox can be used with care under the eye for the purpose you stated. Fillers are used commonly as well but for volume restoration and blending the lid cheek junction.


Dr. L

Andre Levesque, MD
Austin Plastic Surgeon
4.7 out of 5 stars 3 reviews

Bruising after Botox?

Thanks for your question. I agree with the other physicians here in that bruising is a risk of any facial injections. To minimize bruising, I like to make sure patients aren't taking any medicines that increase their chance of bruising: NSAID's, Motrin, Advil, ibuprofen, aspirin, green tea supplements and/or fish oil. It is best to stop these prior to any treatments. I do advocate for icing PRIOR to and AFTER treatment to minimize bruising. Unfortunately, the area around the eyes has the highest chance of bruising. Once there is a bruise, I recommend: Arnica gel, V Beam treatments and patience...To answer the question of filler or Botox for under the eye--that depends on the patient. Patients with hollow under eyes require filler for volume and wrinkled skin requires Botox. I hope this helps and I wish you the best.

Sean T. Doherty, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 30 reviews

Botox around the eyes

From your description of the events, it seems that you were treated by a Nurse Injector.  In any event, bruising could occur under the eye or anywhere on the face where a needle is inserted.  Ice and or local firm pressure can help at the time of the injection, if the person injecting recognises that they have burst a blood vessel in the first place.  For now, rest head up for a few days, get 15 minutes of sun  a day and you can try some Arnica tablets to reduce the bruise.  It may last up to two weeks.  Fillers and or Botox are both used around the eyes depending on the indication. Do not massage around the eye area for the next 72 hours.  It may be more useful to see a specialist facial plastic surgeon for your next treatment.  Hope this is helpful.

Botox bruising

Botox like any other injection can cause bruising. Are there any other medications that you have injected around your eyes by an "injector" instead of a doctor? You cannot illiminate risk but can reduce it significantly when you have a prescriptive medical treatment such as Botox performed by a qualified and experienced DOCTOR who can also answer all your questions.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Bruising after botox

thank you for the question. I like to apply ice before injecting botox for a few reasons: to help numb the area and to constrict blood vessels, thereby decreasing the risk of bruising. fortunately, the bruising you are experiencing should resolve in a few days/week. icing after a procedure is most helpful to combat swelling. i generally do not like injecting botox under the eyes. fillers are great, however, for addressing tear troughs (so called "lunchtime blepharoplasty"). prior to any intervention, I recommend you visit a board certified facial plastic surgeon. hope this information helps!

Sahar Nadimi, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 3 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.