Restylane Injection Hit Blood Vessel in Eye Lid. I Wonder if I Should Look for Another PS?

If you were not prepared for the possibility of getting a black eye with your undereye filler treatment, then I seriously question how "experienced" your plastic surgeon really is.  This service cannot be done without causing lower eyelid bruising in a percentage of all patient's treated even if they stop taking their Tibetian yak liver supplements or whatever.  Simply the treatment has to be placed behind and in the lower eyelid orbicularis oculi muscle which is quite vascular.  I have one of the largest practices of lower eyelid filler treatment in Los Angeles. In assessing the total experience, 30% of individuals have some type of lower eyelid bruise and 2% get a black eye.  A small bruise at the point the needle was injected might easily hid under coverup.  A big black eye that looks to the world like you were slugged by your domestic partner (and that is what the world will think) is just never going to hide except behind an oversized pair of Gucci sunglasses.  Oh, and this bruise can take 3 weeks to disappear so forget the party you were hoping to look fabulous for this weekend.  No experienced injector would do this treatment without preparing you for this possibility.  I tell my patients that the results are better than surgery but this service is very much like surgery in a syringe.  You get a fantastic result that rivals or is better than surgery without going to the operating room and it is basically painless and it is all done in the office.  The down side is yes, you can bruise and the treatment may need adjustment once it has settled.

Should you throw in the towel on your "experienced" plastic surgeon.  Hey this was a big detail to leave out.  As you say, anyone can cause a bruise.  It is the lack of preparation that is at issue here.  I recommend that you let the dust settle which will be about 10 days after all of the bruise has disappeared.  If the result is great, perhaps you can forgive.  If there are issues with the treatment, then it might be a sign to move on.

In our practice, we see probably 1-2 out of 10 patients with bruising under the eye after Restylane injection to this area.  Usually it doesn't start until 1-2 days later though it can begin immediately.  The results in this area with Restylane are phenomenal if done correctly but we do caution our patients that the area under the eye can bruise more easily than any other part of the face (second to the corner of the lips) so we always ask if they have any big plans in the coming days before injecting.  Since this complication can occur in the most able hands, if you like your PS and he's done a good job for you in the past, stick with him.  Those pesky veins are just hard to avoid sometimes.

the risk of bruising is usually discussed with patients prior to injecting the lower eyelids (and other facial areas, but especially the eyelids since the skin is so thin and more vascular there), but ice prior to and even after does not  minimize bruising (it may make the injection more comfortable and may decrease post injection swelling). Your makeup may not hide it well but there are many coverup makeups and experts to help you.  Warm compresses, V-beam laser, topical vitamin K such as Auriderm, and Arnica by mouth, may help quicken the resolution of your bruise, but you should check with your PS.
 

Hi Lilianna.  The question of whether you should look for another injector is only one you can answer.  If you trust your injector and are comfortable with the possibility that this sometimes happens then you should stay.  If you are not comfortable any more, then look for someone new.

Outside of this, we do have some other observations.  Regarding the blood vessel issues.  If an injector uses a retrograde motion (moving backward during the injection), it is much less likely that puncturing a blood vessel will occur.  Is your practitioner injecting in this way?

Secondly about the aftermath.  At our practice, we use pulsed dye lasers for those patients that get bruised during injections (our patients or other practices).  The pulsed dye laser can usually resolve even deep problematic bruising within 48 hours when used within 48 hours of the original injection.  Once the bruise turns yellowish, it will no longer respond to pulsed dye treatments.  Hope this helps.

Bruising is possible with filler injection to any area, even with the most experienced injector. If you are otherwise happy with your results I would not switch providers. There are ways to minimize risks of bruising, such as icing, stopping any blood thinning agents (including common herbals), using Arnica Montana and Bromelain before treatment, and holding gentle pressure. Even with these measures, there is no guarantee a bruise will not develop. The undereye area and lips are at higher risk for bleeding compared to other locations such as nasolabial folds, marionette lines, or cheeks. Try a thicker cover-up products to help camoflouge the bruising in the meantime (more dense coverage than your every-day type makeup).

The majority of patients do not have bruising with injections.  However, areas around the eyes and lips have the highest incidence of bruising.  Even the most experienced injectors cannot guarantee no bruising.  I always warn patients that there is a possibility of bruising and tell them not to have injections if they have an important event coming up in the next week.  That said, there are some treatments that can help reduce the incidence of bruising such as pre and post treatment with Arnica Montana, icing of the area and injection techniques to reduce bruising such as using a blunt micro cannula to inject the produce instead of the sharp needle with comes with the kit.  I hope this is helpful.

 

Good Luck.