Swelling and Discoloration 3 Weeks Post Juvederm

Question

I had bruising after injection that went away. Now it looks lumpy and I have reddish bluish areas going down at the inner corners of my mouth. This is my third time using juvederm.No problems before.

Richard H. Tholen, MD, FACS · Answer

Filler injections (regardless of which ones) into the lips can inadvertently hit tiny arterioles or veins that can bleed somewhat more than the "usual" needle stick. Since multiple sticks are utilized for the usual filler session, there is always the possibility that a vessel might be hit and bleed a bit more than "average," causing a small bruise (or slightly larger one) that can turn into scar tissue or just harmlessly reabsorb.

	Avoiding ANY aspirin or ibuprofen (Advil, Nuprin, etc.) 2 weeks before filler (or Botox) injection can help to reduce the severity of any bruise or bleed from that random vessel hit!

	The reddish discoloration is simply breakdown products from the blood that caused your bruise. Gentle massage can help to soften the firm areas (lumps), or steroid injections can be done to help the scar tissue soften and diminish. Any experienced plastic surgeon, facial plastic surgeon, or dermatologist can help you with persistent lumps due to scar tissue.

	Realize that this is not the "fault" of the injector, nor the type of filler chosen. Just random bad luck that can (and does) to anyone doing injections in the face or lips!

Jerome Edelstein, MD · Answer

Lumps and bruising usually resolve on their own, once the filler starts to get incorporated with your own skin tissue and you recover from your treatment. It would be best if you book a follow up appointment with your injector in 1-2 weeks, and he/she can massage any residual lumps or bumps at that time.

Ron Shelton, MD · Answer

The Tyndall effect involves the way light reflects off surfaces and can create a bluish coloration when the Juvederm or Restylane is injected close near the surface. I have seen this near the corners of the lips. It can be expressed by the doctor, or dissolved with hyaluronidase.

Monika Soni, MD · Answer

Thank you for your question. Anytime a needle is used it can cause bruising. However, at 3 weeks post treatment this should be resolved. I suggest being evaluated by your injector to make sure this is just bruising and not vascular compromise. If it is just bruising, it will eventually resolve on its own. Best of Luck!

Ken Landow, MD · Answer

glad the bruising went away...now the question is how to get the reddish/blue lumps to take a hike...they most likely represent an excessive amount of product deposited too superficially in the skin...that's the typical color...treatment...have the doctor poke right into the area with a needle and squeeze the tissue and the material almost magically extrudes out...a more expensive but okay solution is to inject the area with hyaluronidase to dissolve the material...it also works well and fast...just an issue of personal preference...problem is not likely to be anything else...certainly not vascular compromise or bleeding...so an easy solution to an unfortunate glitch...good luck

Jacqueline Calkin, MD · Answer

If the persisten discoloration is from the bruising you developed, there are lasers such as the Vbeam and other pulsed dye lasers, as well as some good IPL systems that can help to clear the hemosiderin (pigments from blood). Check with your physician to see if he/she offers those treatments. Also be sure the blue color is not the Juvederm placed too superficially in the skin as this can be easily treated with injections of hyaluronidase.

Travis L. Shaw, MD · Answer

Ingrid

	Although bruising after an injectable treatment is not uncommon, it sounds as if you have discoloration that has persisted longer than normal. I would make an appointment to see the physician who did the injections and discuss the issue with them. You would want to make sure you are not having a reaction to the product. 

	Lumps are not uncommon, though can usually be avoided by careful injection technique to avoid placing product too superficially in the skin. If the lumps persist you can have injections of a medicine called Hyaluronidase which can help to break down the material in Juvederm. 

	I hope this helps

	TS

Emily Altman, MD · Answer

It is possible for the bruise to develop or continue developing for several days after an injection, especially if any blood thinner was taken within 10 days of injection.  If you are on any blood thinners on the advice of your physician, you should not discontinue any of them without consulting with your prescribing physician first.  Discontinuing prescription blood thinners can be dangerous.

	Over the counter bBlood thinners include aspirin, NSAIDs like ibuprofen or naproxen, gingko, ginseng, fish oil and vitamin E.

	Reddish-bluish discolorations may be a resolving bruise.  That should go away within the next 7-10 days.  If there is any swelling, heat or pain with these, you need an evaluation immediately.  If not, try applying a warm (not hot) compress twice a day for 5 minutes to help speed up the resolution of the bruise.

Jo Herzog, MD · Answer

I agree with all of the above but would like to add one more comment. If Juvederm is injected too superficially, especially in areas with thin skin like under eyes, you can see it , or it can reflect light, through the skin(tyndall effect). this might be the BLUE.

Eugene Mandrea, MD (retired) · Answer

It is possible that you may have had persistent  slow bleeding causing thebluish discoloration. As the blood is absorbed, it also degrades chemically, causing a purple, then blue then yellow discoloration After 3 weeks, if this was persistent bleeding, I would expect also a little yellowish color. There may even be a slight leakage of the color downwards.

	As to blood thinners, they are  often  prescribed  to patients in the age group that  seeks Juvederm injections. We discuss this with all our potential patients,young or old. For self prescribed blood thinners, we advise patients to  discontinue them for 2 weeks before and one week after the injections.

	It is also possible that  the Juvederm was injected too superficially, causing a Tyndall effect with bluish discoloration.

	In this case, removing the Juvederm with Hyaluronidase in the bluish areas  would be quite effective.

	Always make sure that you are treated by a Board Certified Dermatologist or Plastic Surgeon.

Swelling and Discoloration 3 Weeks Post Juvederm

Answers (12)

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