In these highly transparent eras, if a brand dares to conceal unseemly matters, it will undoubtedly be exposed – if not outright exposed and criticized.
While this transparent ethos pervades nearly every industry in 2019, certain aesthetic treatments, as we've noticed, seem somewhat exempt. Reported side effects and complications might be voluntarily entered into a scarcely known FDA database or perhaps discussed by doctors at medical conferences; yet, on the whole, they tend to be downplayed to the public. So when we exit our lunchtime filler appointment, two days before our best friend's wedding, with a developing black eye or needle-induced mark, we can't help but feel blindsided.
Bruises following cosmetic injections come as a surprise, precisely because no one discusses them. Contusions might be covered in the consent forms you "sign and initial here, here and here" before treatment, but injectors seldom elaborate on the topic. And when black-and-blue marks do surface, patients go to great lengths to conceal them. All in all, our collective reluctance has made injectable bruises seem like an anomaly when, in reality, they’re “a common and often inevitable” part of the procedure, says Dr. Jeannette Graf, a dermatologist from Great Neck, New York.
Pause for reflection: a bruise after injections is hardly a reason to stop. Some might say it's the price we pay for beauty. And I understand that. I'm admittedly grateful to Botox for sparing me crow's feet, fine lines and forehead wrinkles; I appreciate the balance hyaluronic acid fillers bring to my aging face. But when expensive “no-downtime” procedures intended to make us look and feel more beautiful leave us swollen and bruised for days to weeks – well, it's a cruel paradox indeed.
Why filler bruising is more common than you think
Tens of millions of filler and neurotoxin shots are administered each year, and each of those needle pricks poses a risk of bruising. Why? Because the human face is an arterial maze, its complexities beautifully depicted in this frequently shared illustration commissioned by aesthetic nurse Connie Brennan from artist Kevin Cease.
Practitioners who navigate injectable treatments through vascular territory without leaving a mark either have extraordinary luck or some form of magic on their side. The truth is, “anyone can bruise, and it's not about Botox versus filler – it's related to the needle,” says Dr. Robert Anolik, a dermatologist in New York City. “If the needle happens to touch a slightly larger vessel, blood can seep into the surrounding skin, causing a bruise. A blunt-tipped cannula can be helpful in some cases, but if a cannula has to be pushed with significant force because it's not sharp enough to glide smoothly, that force can also trigger bruising.”
As Dr. Tina Alster, a dermatologist based in Washington, D.C., explains in a popular RealSelf Q&A, “No matter how skilled your physician is, it is very challenging to avoid bruising when having fillers injected. In fact, the likelihood of bruising after dermal filler treatments is high and it's one of the most common side effects – on average, 67% of patients bruise, based on 22 clinical studies with more than 2,700 patients. These FDA studies were conducted by some of the most expert injectors in the world, which further shows that bruising is common even among the most proficient practitioners.”
Related: Off-Label Is the New Black: The Strange New Ways Doctors Are Using Filler
Living proof: bruises occur to the most skilled injectors
On this point, I can personally confirm. Beauty editors, as you might have heard, are an incredibly fortunate group. The chief benefit of the job is unrestricted access to the world's most prominent (and generous) cosmetic dermatologists. I didn't fully exploit this privilege until several years ago, when my now 42-year-old face started to deflate and sag.
I had just turned 38 when I visited Dr. Graf for my first dose of filler – a single syringe of Voluma, divided between both cheeks, to subtly lift my midface and smooth my smile lines. Thoughtful, gentle and precise in all she does, Dr. Graf has impeccable technique – yet I still left her that day with a faint scattering of pinpoint bruises. In retrospect, they were minor and vanished after about a week; but at the time, I was extremely distraught – completely unprepared for this entirely normal reaction to having a needle pierce my skin.
In the years since that first injection, I've seen numerous dermatologists for filler injections. With the exception of one or two fortunate instances, I've consistently had bruising. During that period, I've also extensively reported on the potential drawbacks of injectables, familiarizing myself with even the rarest of risks – things far scarier than bruises, like blindness and skin death resulting from filler-blocked arteries. With these potential horrors firmly implanted in my mind, I now view every bruise as a potential crisis.
And yet… I keep going back.
In the summer of 2018, I met up with an old friend in New York City, and together we visited Dr. Anolik, an expert injector who injects Manhattan's elite on a daily basis. Toward the end of my session, he grazed a vessel near the top of my right cheekbone. The area swelled and darkened almost immediately as blood filled my tear trough and eventually developed into a full-fledged black eye. I overreacted in an equally dramatic way. Dr. Anolik still jokes about regretting giving me his cell number. (Just kidding – he called and texted regularly after my appointment.)
My black eye persisted for almost three weeks, and I did my best to cover it with concealer and oversized sunglasses – all the while refraining from posting selfies, because a) it wasn't attractive and b) I worried (unnecessarily) that sharing what happened might annoy my doctor. With an entirely unruffled ego, Dr. Anolik attributed it to bad luck and said he sees bruises of such severity “perhaps twice a year.”
This past June, I got an appointment with another renowned brilliant dermatologist, whom I've interviewed countless times (she requested anonymity here – something I offered to everyone). After evaluating my sagging face, she filled my hollow temples and then injected my chin, aiming to extend it back to a youthful position that would better balance my naturally strong cheekbones. As bruises began to surface on my temples, she treated them with her Vbeam laser.
It wasn't until hours later, when I was on a train back to Providence, that my chin completely reacted. I took some unflattering selfies in the Amtrak bathroom and texted them to my injector, who promptly reassured me that everything looked normal. By the time I got home that evening, my chin was swollen and marked with violet streaks. (Chin bruises tend to drain downward, leaving streaky trails.) My kind and understanding doctor prescribed prednisone (for the swelling) and a night without worry (a harder pill to swallow).
The next day, Dr. Caroline Chang, a dermatologist in nearby East Greenwich, Rhode Island, fortuitously reached out, inviting me to try the new blood vessel-targeting Aerolase Neo laser she happened to be testing. She treated my bruises, and a week later, they were nearly invisible.
Related: What It’s Really Like to Get Fillers Dissolved
Filler bruising: what to do if it happens to you
Being prone to bruising has taught me what helps speed up healing and what doesn't – for me, at least. I hope you can draw something useful from this, but keep in mind: your body might respond differently – what didn't work for me could very well help you. Here's what I've learned.
- Certain areas of the face – namely, the under-eye area, the crow's feet, the chin and the lips – are more likely to bruise. “But it can happen anywhere, at any time,” Dr. Anolik notes. To be on the safe side, don't schedule injectable appointments within two weeks of important events.
- “Some patients are inherently more prone to bruising – they tend to have thinner, more sun-damaged skin,” says Dr. Graf. (I'll try not to be offended.)
- The usual advice about avoiding blood thinners for one to two weeks before filler injections (and, some say, one to two days after) is quite reasonable. According to Dr. Anolik, staying away from “things that can increase bleeding, such as aspirin, ibuprofen, alcohol, fish oil and vitamin E, can help reduce bruising.” (For your information, along with the specific ones mentioned, there are many other common supplements that can raise the probability of bruising, including ginkgo, ginseng, St. John's Wort, and flaxseed oil. And it's also a good idea to avoid over-the-counter NSAIDs – Aleve, Motrin, naproxen – in general. Instead, stick with Tylenol.) Emphasize the word reduce. Abstaining hasn't always worked for me, but my most severe black-and-blue mark to date occurred after an Advil-treated migraine. Keep in mind that many prescription medications, such as Warfarin, can also increase the likelihood of bruising, so be sure to discuss that with your injector beforehand.
- Arnica montana – it can't do harm and might help. The majority of evidence supporting the herb's anti-bruise benefits is anecdotal. I've experimented with the homeopathic tablets, over-the-counter arnica gels and creams, doctor-prescribed rollerballs, even those OcuMend high-potency hydrogel patches that dermatologists are enthusiastic about – all to no avail. However, Dr. Heidi Waldorf from Nanuet, New York, calls the OcuMend pads “a game-changer for bruising.” The key, she says, “is applying them before you bruise, immediately after injections” – ideally, covering the entire face and not just the injection site, then leaving them on for six hours before replacing them with fresh pads for another six hours, and so on. “They won't prevent you from bruising if a vessel is hit, but they can reduce the slow, leaky bruising that tends to develop on the second day.”
- Icing: If your injector nicks a vessel, they should apply pressure to the treated area immediately and start icing as soon as possible. Ice acts as both an anesthetic and a vasoconstrictor, explains Dr. Waldorf, reducing pain and early blood seepage. She recommends icing for 10–20 minutes per hour for the first two days while awake. Personally, my bruises have appeared so rapidly and intensely that ice packs have been ineffective.
- Topical vitamin K oxidase I haven't tried yet, but Dr. Graf says “it breaks up hemosiderin – the hemoglobin pigment of bruising.” Apply it three times a day, starting right after injections. (You can find it in a product called Auriderm.)
- Lasers can significantly reduce healing time – in certain circumstances. When Dr. Anolik uses his pulsed dye laser on bruises in the days following injections, he often sees them “disappear in a matter of hours,” he says. One exception: if the bruising is widespread after a single needle prick or accompanied by underlying swelling, it might be too deep for the laser's energy to reach (such was the case with my black eye). Once it's partially healed and appears more purple (rather than black) and on the surface, then laser treatment might help fade it the rest of the way. Similarly, Dr. Chang has found that her Neo (a type of Nd:YAG laser) can halve the healing time. (It worked for me!)
More important than any of this advice is knowing when a bruise is not just a bruise but rather a sign of vascular occlusion (filler inside a vessel, blocking blood flow to the skin). If the area of discoloration has a dusky, net-like appearance and is extremely painful after treatment – as in searing, keeps-you-awake-at-night pain – call your injector immediately, says Dr. Waldorf, “because delaying diagnosis and treatment is extremely dangerous.”
How to cover bruises from injectable fillers
The right concealer is everything. Since I might very well be the world's worst makeup artist, I reached out to one of the world's best: Sandy Linter, who's concealed her fair share of filler bruises. “You'd be surprised how easy they are to hide – and without a lot of hassle,” she says. Her secret tools: This Kryolan Dermacolor Mini Concealer Palette – the formula “sticks to the skin immediately” – and a good concealer brush (she uses the Kevyn Aucoin). To build coverage, she explains, “many times I start with a deep pink – it seems to hide or lift the black. Then I'll add a darker skin-tone shade and touch up the top with a color closest to my skin tone [or the client's] before dusting on a bit of powder or applying foundation. The lightest applications work extremely well.”
The bottom line on filler bruising
Bruising after injectable fillers can be truly devastating (no exaggeration), but try not to panic. Ask your injector what they can do for you at the moment, or perhaps a few days later, to expedite healing. And consider seeking tips from your friends and colleagues – chances are, they've also had an unfavorable experience with a needle before and can help guide you out of the difficult situation.
