How Do I Treat Bruising After Lip Augmentation with Restalyn?

I had Restalyn injected in my lips yesterday. I made it clear to my practitioner that i wanted the results to be very subtle, that I was starting a new senior job next week and did not want to deal with any bruising or freakish swelling. They assured me that it would be fine and that I could even go out that same night. They also promised to be very restrained in how much they used - saying that i could always inject more later. Well, going anywhere is not a possibility and I'm really worried about my first week at work.

The biggest problem is the duck like appearance, an imbalance between my top and bottom lip and, most importantly, severe bruising which has turned the left side of my bottom lip black. Oddly enough my top lip is totally fine ( although they did do more injections on the bottom) I'm icing all the time, taking Benadryl and Arnica, and sleeping upright. I think the swelling will probably be gone by Tuesday ( start day) but I'm worried about the black bruising. It's even on my skin next to my lip. is there anything at all I can do to make the blackness dissipate? I can't even cover it with concealer. Does anyone know of any make-up that can cover black and blue lips? It almost looks like they're bleeding black and blue

Doctor Answers 29

You are doing everything you should be doing

Dear Black and Blue,

Keep doing what you are doing. Unfortunately you were not given the proper information. There is always a possibility of bruising and swelling and you should have been informed so you would have been prepared for the outcome. The bruising and swelling should subside over the next few days.

Los Angeles Plastic Surgeon
3.0 out of 5 stars 3 reviews

Dermablend or CoverMark are good coverup makeups

You are doing everything you can at this point. I would recommend not taking any alcohol drinks or aspirin nor advil for at least 5 days before your next injection session. Don't blame the restylane or the physician for the bruising. It happens regardless to the best of us physicians from time to time.

It doesn't mean that it will happen next time so don't give up on fillers for your lips unless you want to go to the permanent (but reversible) implants that look and feel very natural. They run about $1500-2000 per lip but saves you alot of money and painful injections in the long run.

A good makeup is either CoverMark or Dermablend.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.8 out of 5 stars 37 reviews

Bruising following lip injections.

To start with if a patient tells me they have a big event or new job the next week, I usually always tell them to plan to have bruising. Its unpredictable sometimes, and the swelling can very from patient to patient. So I like to encourage patient's to plan a couple of days just in case this should occur. I also feel that using a Cannula to fill the lips has decreased bruising on lips because the cannula has a dull tip and does not shear the blood vessels in the lip. It also does not cause as much discomfort to do lips. Swelling often occurs because of the lidocaine, or multiple needle sticks. Using the cannula again because I only need to make 2 needle sticks, one on either side of the lips. From this same incision I can fill the top and bottom lip on one side and then from the other incision I fill the other half of the lip. Less trauma medermaans less bruising. I think wearing dark lip stick for bruises on the lip and then coverup like dermablend works well but putting powder over it, helps it stay in place. 

Cheryl Perlis, MD, FACOG
Lake Bluff OB/GYN
5.0 out of 5 stars 5 reviews

Time should resolve bruising after Restylane lip injections

Bruising following Restylane injections to the lips are very common, and often don't become evident until this next day. The lips are highly vascular, and the inadvertant injury to a small vessel is the norm rather than the exception. To minimize the risk of excessive bruising I suggest you ice your lips both before and after the procedure.

I do not feel that Arnica is beneficial in this scenario, and am not aware of any studies demonstrating its efficacy. Benedryl probably would not be helpful, because this is unlikely to be an allergic type reaction.

Time will usually resolve the bruising issue. If excessive fullness is noted once the bruising has resolved, then Hyaluronidase can be injected into the lip, which will remove the Restylane.

Wilfred Brown, MD
New York Plastic Surgeon
4.7 out of 5 stars 13 reviews

Bruising After filler injection

Thanks for the question. It is such a problem and we all have issues with bruising and fillers. The key is trying to prevent it. I've recently wrote an editorial discussing research into this area. Perhaps it would be of help?

I go over alot of information so hopefully it helps in the future!

James P. Bonaparte, MD, MSc, FRCSC
Head and Neck Surgery
practicing in Facial Plastic and Reconstructive Surgery
Assistant Professor, University of Ottawa
Ottawa, Ontario, Canada

James Bonaparte, MD, MSc, FRCSC
Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Facial Fillers and Bruising: Arnica, BruisKare, Sinecch, Massage

There are two things to do if you experience bruising with facial fillers or other injectables:

1. Speed up the rate of recovery from bruising by employing the following treatments:

  • Arnica tablets: BruiseKare; Sinecch, Homeopathic arnica montana
  • Arnica ointment: BruiseStick ointment
  • Massage

2. Prevent future bruising by speaking to your physician prior to performing your next treatment about the above-mentioned pre-procedural treatments:

  • Arnica tablets: BruiseKare, Sinecch, Homeopathic Arnica montana
  • Arnica ointment: BruiseStick ointment
  • Avoid aspirin, ibuprofen, Motrin, Advil, or any other blood thinners
  • Use ice after the injection
  • Massage early
  • Hold pressure immediately after the injection

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Allow for bruising

Careful technique can minimize bruising, of course. Also Juvederm may be a better choice for patients who experience bruising and swelling with Restylane. As hyaluronic acid fillers have become longer lasting and thicker, the complications from injections have increased.

In all patients who need to be "camera ready", we recommend 48 hours-72 hours of down time, "just in case".

Also, for a patient's first injection, we often recommend Prevelle, which does not last as long but has much lower comlication rates. Very sensitive patients who are sensitive even to Prevelle should probably not have Restylane injections.

For swelling that is already present, ice, elevation, reduction in activities, perhaps arnica cream, perhaps motrin, and perhaps even a Medrol dosepack for very large swelling are all things you should discuss with your doctor. For very severe prolonged cases, hyaluronidase injections to dissolve the Restylane can be considered.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 136 reviews

Bruising will subside with time

Bruising is a commong problem when injecting the lips. Over the years I have found that it is very important to avoid aspirin, ibuprofen, alleve and other anti-inflammatories for at least a week before your treatment. Alcohol, vitamin E supplements and gingko can also make you bruise more easily.

Regardless of the technique, bruising is common and you are doing the right thing to ice and take benadryl for the swelling. The swelling seen with Restylane will subside over the first two days.

Try to find a color stain lipstick such as Revlon's colorstay that stains the lip and hides the bruising then apply a gloss on top. Hope you look great!

Brenda Dintiman, MD
Fairfax Dermatologic Surgeon

Bruising and swelling after filler injection of the lips

Whenever a needle is involved with a procedure, a bruise and swelling is possible.  The lips are very vascular (lots of blood vessels) so bruising is common.  And hyaluronic acid filler absorbs fluid so swelling can also happen.  While most patients don't get as swollen as you described, some do.  Rarely patients may even require oral steroids after lip filler to control swelling.  

There are ways to reduce the amount of bruising and swelling expected.  Reducing the number of injections, injecting through the skin above the red lip, adding lidocaine with epinephrine to the filler or utilizing a cannula instead of a needle are all options.  The science for arnica isn't great but patients do feel it helps so oral arnica and bromelain (or eating pineapple which contains bromelain) is an option. Icing afterward reduces swelling.  However, no one can guarantee a bruise free, swelling free result.  For patients who tend to bruise, I recommend they plan injections when they have nothing critical at work or socially the following week. I also suggest having the treatment at a time when they can return two or three days later for a VBeam pulsed dye laser treatment.  Treating a bruise with a pulsed dye laser once the bruise comes out will make it immediately darker (more purple) but by the next day the bruise is broken up -- more red and yellow than purple. 

We give patients a sample of Kat Von D tattoo concealer which Ive found is one of the more helpful for covering bruises.  I suggest you put on your usual makeup and then tap on the extra concealer.  It is available online and at Sephora.  

Finally, my strong suggestion is that you reach out to your physician about your concerns.  

I hope this answer was helpful.  Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 9 reviews

Bruising after lip augmentation with Restylane

I am very sorry to hear about your experience.  While we can anticipate how the majority of patients will respond once having fillers injected, we cannot fully determine the degree to which patients will bruise and swell. It is important for you to share what medications you have taken and any lifestyle choices that could attribute to more bruising and swelling.   It is important that your injector sets realistic expectations, including addressing all possible side-effects, so that you are informed enough to decide if you should proceed with fillers or reschedule your appointment. 

You are doing everything you can do to help the healing process.  Continue to refrain from any medications and such that could thin the blood.  I typically recommend Jane Iredale Corrective Colors Kit to patients who need to cover deep bruising.  You could also look into an department store brand like DermaBlend to help conceal the bruising. 

Vu Ho, MD
Plano Facial Plastic Surgeon
4.7 out of 5 stars 38 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.