Dr. Gardner on Injection Bruising

Hi, Dr. Gardner again, and one of the things that happens during injections – and when I’m talking about injections, I’m talking about Botox, I’m talking about fillers like Juvederm – one of the things that can happen is bruising.

Nobody likes bruising, the doctors don’t like bruising, the patients hate bruising, but if you’re gonna take the step of doing injections of Botox or fillers, you have to accept that part of the procedure may result in a bruise.

What is a bruise? A bruise is nothing more than blood under the skin that causes a discoloration. It fades over time as the blood is absorbed, but that’s what a bruise is. It isn’t that the needle was stuck into a muscle or created some sort of trauma, it’s blood under the skin. Any time you take a needle which is required for an injection and you stick it into the skin, you’re going to get some bleeding.

If the blood gets out of the little hole the needle goes in, usually you don’t get a bruise, but if it gets trapped under that skin, you’re going to get a bruise. So what can you do to avoid bruising? Well from the patient’s perspective it’s very important, and we actually ask you at the time you make your appointment, to avoid anything like aspirin, ibuprofen, or any blood thinners for two weeks before your injectable appointment. At that point, the platelets have had a chance to recover and your chances of bruising, while a little bit increased, go down substantially. Particularly those who are on aspirin chronically and who take ibuprofen after a tennis match or anything like that.

So what do we as doctors do to try to avoid bruising? Well my protocol involves, particularly for Botox, laying the patient flat. When we lay the patient flat, all the blood vessels in the face, and there’s a lot of them, dilate up or get bigger so I can see them.

The other thing I do is I use special glasses called loupes. Loupes have magnifying lenses that allow me to see smaller vessels to avoid them while I’m injecting and the other thing we do is we apply ice directly on the area of injection right before we put the needle in. What that does is it causes the blood vessels to vasoconstrict, or shrink up, so that gives us a better chance of avoiding them, but what happens if you do get a bruise? We do offer an anti-bruising kit which consists of arnica it consists of bromelain and you can expect that over two or three days those bruises will subside.

So remember, if you’re going to get fillers or Botox, avoid any aspirin-containing products or ibuprofen or blood thinners two weeks before you have your appointment and that’ll give us the best chance of avoiding bruising. If you do get bruising, we get you on the bromelain and the arnica and we wait a few days and it usually goes away.

Thanks very much.