Bruising that won't go away after Juvederm injection. Will this ever go away?

Question

I had my lips injected with juvederm 4 weeks ago. The area above my upper lip bruised badly. The bruise subsided but I still have a gray discoloration. Will this ever go away?

Harold J. Kaplan, MD · Answer

Hi Anne.  Sorry to hear about your situation.  It seems that you may have one of two side effects occurring.  The first is the Tyndall effect which occurs when the placement of the product can be too superficial.  When this happens a blue/gray color can appear in the area of the injection.  This happens when the light is refracting or reflecting off the product and because it is so near the surface of the skin, it causes a bluish or grayish color.  In this case, you would want to dissolve the product with Vitrase or another Hyaluronidase product.Alternatively this might be hemosiderin staining.  This side effect occurs after heavy bruising and in many cases with patients that have medium or darker skin types.  There is a brown residue of melanin left after the bruising resolves.For this issue we use q-switched lasers and you can see an example of a recent Redondo Beach, CA patient that underwent hemosiderin staining reversal in our Torrance offices at the link below.

Jonathan Kulbersh, MD · Answer

Thank you for your question. At this point, residual bruising should have subsided. I recommend scheduling a follow-up with your injector to determine the cause of the discoloration and treatments that might be used to address it.

Jason Emer, MD · Answer

Please get this looked at and consider reversing the filler as this may be due to a multitude of things.  A formal evaluation is needed.  I have seen hemosiderin deposits, which is iron from blood that leeks into the skin after bruising.  But most liklely this is filler that needs to be removed. In the future use cannulas to limit complications.  Best, Dr. Emer.

Nelson Castillo, MD · Answer

Thank you for your question, and I am sorry to hear about your bruising after Juvederm.  At 4 weeks any skin pigmentation should have fully resolved, so I would recommend you see your Juvederm injector for an examination to try and diagnose the cause of the gray color.  It may require something as simple as warm compresses to bring additional blood flow to help clear the discoloration, or if it is due to something called the tyndall effect as a result of superficial placement of the filler, then hyaluronidase can be used to help clear it from the skin.  Hope that this helps.

Sheryl D. Clark, MD, FAAD · Answer

You may have some hemosiderin deposition or post inflammatory hyperpigmentation from the bruise. Your doctor should be able to tell what it is and recommend something to help it resolve more quickly. It will eventually resolve on its own as well.

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