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Worried About Bruising After Your Injectable Cosmetic Treatment?

adapted from CMAC (Complications in Medical Aesthetics Collaborative)

What are the risks?

Whenever a needle is used to pierce the skin, there is a risk it will injure a blood vessel which can bleed into the skin causing a bruise.  For this reason, bruising is recognized as a known risk and a common one.

Patients will often be most concerned about the risk of bruising on their face and will ask the practitioner to predict the level of risk.  It is not just possible  to predict as there are so many factors involved and so few within the control of the practitioner.

This is a risk (amongst others) explained and disclosed as part of the consent process, and you will be asked to sign a consent form which acknowledges your understanding and acceptance of that risk.

If the risk of bruising (or any of the risks disclosed in the consent form) is unacceptable to you, you must decline to have the treatment or defer until a time a bruise would be acceptable.

What can be done to reduce the risk?

How old are you?  There are some things that are known to increase the risk of bruising.

The older you are, the more fragile your skin and blood vessels tend to be, making you more prone and sometimes slower to heal (a bruise may be slower to fade away).

Do you drink alcohol or take supplements or pain killers?  There are some over the counter medicines and dietary supplements that slow the time your blood takes to clot and therefore make bruising more likely, these include: Alcohol, Vitamins A, C and E, Fish oils, Garlic, St. John's Wort, Ibuprofen and aspirin (this list is not exhaustive). Your practitioner will advise and possibly recommend you avoid taking them for 7 days before the procedure.  Alcohol should should be avoided the day before and after the procedure.

What medical conditions do you suffer from?  There are a number of medical conditions and medicines prescribed associated with an increased risk of bruising, so it is very important your practitioner takes a medical history and that you do not withhold any information.  It is for your practitioner to assess the risk, not you.

Be cool.  In hot weather, or a hot room, you are more likely to bleed or bruise.  Ice or cool packs can sometimes be applied to chill the skin and constrict blood vessels.

Follow any aftercare advise provided.  Aftercare advice is given to help ensure optimum results with minimal downtime, it's important you follow it.  You are advised to avoid extremes of heat or vigorous exercise, saunas and sun bathing/sun beds for 48 hours or more (until bruising and any swelling has settled) after the treatment.  Also to avoid alcohol, aspirin and ibuprofen for 48 hours.

What Can The Practitioner Do To Manage The Risk?

In the safest hands, you can reasonably expect your practitioner to know where important blood vessels are and do their best to avoid them, but they do not have X-ray vision and everyone's anatomy can have slight variations.

A slow and steady approach can minimize trauma and if you bleed after a needle insertion, the practitioner can stop and apply gentle pressure to minimize bleeding into the skin.

Some practitioners may elect to use a cannula for certain treatments, cannulas have a blunt tip and can minimize the risk of bruising, but not completely protect against it as a needle must be used to make and entry point for the cannula.

What Can I Do If I get A Bruise?

  • Be prepared.  Schedule your treatment with the potential for bruising in mind.

  • Remember we do get bruises in life for all sorts of reasons and they always heal away, usually within 10 days.

  • Most (but not all) bruises can be covered by makeup.

  • Prepare a good, but not very interesting story for your bruise (if you do not want to discuss your injectables!).

  • After 48 hours, applying a warm compress two or three times a day, may help to promote blood flow to clear the bruise in less time.

  • There are some herbal and homeopathic remedies that claim to help relieve the pain, swelling, or discoloration of bruises.  These treatments have not been proven to be effective by scientific testing, but patients report them to be helpful.

    • arnica in gel, cream or tablet​

    • vitamin K cream

    • bromelain cream or eating pineapple

  • If you are worried the bruise is extensive or it is associated with heat, extreme swelling or pain (beyond the usual associated with bruises you may have experienced in the past).  It is worth going to see your practitioner for advice.

  • If your bruising is associated with a paleness or looks mottled in any way, contact your practitioner, who will arrange to see you to assess.

At Consultation

Be honest about your medical history and current medicines, or supplements you take.

Tell the clinician if you have any important events scheduled.

Read the consent form carefully , ask any questions and discuss concerns BEFORE scheduling treatment.

5 Days Before Treatment

Stop taking any dietary supplements your clinician has advised that may increase the risk of bruising.

You should not stop taking medicines prescribed by your primary care practitioner unless advised you may do so.

On The Day Of Treatment

Begin taking arnica if choosing the tablets.

Following Treatment

You may apply creams such as arnica, vitamin K or bromelain to help clear bruising and settle swelling.

You may apply cold packs or compresses to reduce swelling.  DO NOT apply ice directly to the skin and only apply to chill the skin - no more than 10 minutes at a time.

You may take acetaminophen (Tylenol) for any discomfort.

For 12 Hours

Do not apply makeup.

For 48 Hours

Avoid vigorous exercise, saunas, sunbeds, getting hot.

Expect some tenderness with swelling and bruising, but you should not be in pain.  Bruising can appear worse before it gets better, but usually resolves within 10-14 days.

If your skin appears pale or mottled or you have any concerns, please contact your clinician who will need to see you to assess and advise.