As we all know, “An ounce of prevention is worth a pound of cure” is a very true aphorism. This is especially true when it comes to preventing, or at least minimizing, bruising and swelling following Botox® or facial filler injections.
You might ask, “Why do I get bruising? Why can’t you always prevent it?” The reality is there are hundreds of minute blood vessels, called capillaries, supplying oxygen to the face. Although we know how to avoid the larger vessels by having an intimate knowledge of facial anatomy, the very small vessels form a plexus and we cannot possibly know where each and every vessel may be, as the pattern is unique for each person. If the needle is inadvertently inserted into a vessel, a small bleed can occur, creating a hematoma, or collection of blood. This causes swelling and a bruise. As the body resorbs the hematoma over several days, its original blue colour becomes green, then yellow and then disappears. Gravity often causes the bruise to become more visible as it drifts down the face.
However, certain factors predispose to bruising, and knowing them can help minimize bruising. First and foremost, smoking affects blood vessel dilation, and should be stopped two weeks before and after injections or surgery. Certain drugs such as aspirin, Cortisone, or any medication decreasing platelet activity necessary for the clotting mechanism, should be stopped 10 days before injections unless advised otherwise. Some women may bleed more during their period. It is recognized that some redheads tend to bleed a little more than others.
Immediately before treatment cool compresses can constrict blood vessels in the areas to be injected, and topical anaesthetics such as Emla or Numb-it “freeze” the area, allowing quicker completion of the injections and earlier compression to decrease bruising. Local infiltration of Xylocaine anaesthetic as used in dental offices has an even better numbing effect and adrenaline in the “local” decreases bruising. Once the injections are complete in one area, manual compression for two or three minutes, or at least longer than the patient’s bleeding time, will allow the blood to coagulate or clot, preventing any further bleeding. And cool compresses help to constrict the vessels even further.
If bruising does occur, warm compresses can be started three or four days afterwards to help break down the pigment causing bruising and hasten resolution.
Finally, many of our Toronto patients find that Arnica Montana (tradename, Sinecch) can be helpful to minimize bruising. It is a homeopathic medication taken orally, beginning at the time of injection or just before, for a few days.