I Had Severe Bruise After Tear Trough, After 4 Weeks I Can Still See Brown Mark, Is It Permanent? (photo)

This is likely a by product of red blood cell breakdown. Though bruising usually resolves within a few weeks, sometimes it by product staining [iron based] can last a few weeks up to a few months.

This usually improves with time, so I recommend patience for now. There is photofacial therapy [IPL] that can help if you are not satisfied with the progress.

Bruising usually resolves but in some patients the iron cannot be reabsorbed from the area, leaving brown staining.  If you do not protect the area with #30 or above sunscreen, some patients get over stimulation of the melanocytes from the inflammatory  effects of the bruising.  This results in brown hyper-pigmentation that may take months of topical lightening agents to remove.  It is sometimes permanent.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Thank you for posting your photo. This is a very delicate area. I always tell my patients about the possibility of bruising in this area that could persist for long amount of time. The most important thing is to make sure that what you are thinking it is a bruise is not the actual filler being seen through thin skin, which is cold Tyndal effect. Based on the photo you provided this does not seem to be the case. If this was the case the filler would need to be dissolved. Bruce's in this area usually respond well to Arnica gel application 3-4 times a day. 1 it is a long-standing bruise I sometimes use laser treatments to help breakdown the pigment and allow for faster resolution. Some patients may develop hemosiderin (iron) deposited in the deep tissues which makes the whole process more chronic and difficult to resolve.  Some patients would also go on to develop a postinflammatory response which needs long-term treatment with topical creams to control melanin deposition. In my experience these all get better with time but he does require a lot of patience. I hope this was helpful. Good luck!