How can you limit bruising with Botox and cosmetic fillers?

How can you limit bruising with Botox and cosmetic fillers?

How can you limit bruising with Botox and cosmetic fillers?

Let me start by saying that even the best injectors in the country can give a patient a bruise with any of the cosmetic injectables. Sometimes these things just happen! The good news is that they tend to not be a big problem and let’s see if I can teach you a few tricks to help as much as possible.

The first thing to keep in mind is when you schedule your procedure, make sure you don’t have any important work or social events for about a week just to be safe.  If you bruise easily, you may need to plan for up to 2 weeks to completely heal. If your event is something more important, like a wedding or a reunion, I would recommend having fillers done at least 3 weeks before the big day.

What exactly is a bruise?

The bruises we are focusing on here occur as a result of traumatic injury with a sharp needle to the blood vessels near the surface of your skin.  Once the blood vessel wall is broken, the blood leaks to the surface and pools within the tissue there. As the blood sits, it becomes darker in color and can be seen under the skin as a black and blue discoloration.  In order for the bruise to resolve, the blood needs to be absorbed back into your body.

What can you do ahead of time to try to avoid getting a bruise?

Here are some things that you can actively do to help:

  • Apply and/or take orally (it dissolves under your tongue) homeopathic Arnica Montana for 2 days prior to your appointment.  You can find Arnica Montana at some pharmacies and natural food groceries (like Whole Foods, Vitamin Cottage and Natural Grocers).  Make sure to read the label and follow the instructions on the bottle or tube (if it is a gel).
  • Try eating pineapple 2-3 times a day for 2 days prior to injections.  Or take bromelain (a pineapple-based enzyme). But keep in mind with this, the evidence of helping is only anecdotal!  So if you don’t like pineapple, don’t worry about it.

Here are some oral medications, vitamins and supplements to AVOID for at least 10 days prior to your procedure:
Some of these medications and supplements may be needed for medical reasons, so check with your doctor first.  The reason to stop these is that they make your blood less likely to clot, which makes bruising more likely. If you are on warfarin (Coumadin) or Plavix, stay on it unless you get the okay from your doctor to discontinue.

So these are the biggies to AVOID:

Over-the-Counter Medications:

  • Aspirin
  • Ibuprofen (Advil, Motrin)
  • Naproxen Sodium (Aleve)
  • Midol, Excedrin, and some cold medicines (check the label for the above listed ingredients)


If you need something for pain it is no problem to take Tylenol (acetaminophen).

Another thing to avoid is drinking alcohol 1-2 days prior to your procedure.  Alcohol is a vasodilator, so drinking can increase your chances of bruising.

Oops…You bruised.  Now what?

Your bruise will last about 5-10 days and rarely longer.

How can I help my bruise go away more quickly?

  • Avoid drinking alcohol 24 hours after having your injections done.
  • None of the over-the-counter medicines, vitamins or supplements listed previously for 2 days post procedure.
  • Icing or cold compresses for 5-10 minutes every hour.
  • Arnica Montana orally and/or topically for 4 days
  • topical vitamin K cream can be applied to speed resolution.  We carry Auriderm (vitamin K cream) in our office for convenience.

I frequently do an IPL treatment on the bruise for patients 1 to 2 days after your procedure.  This is quick and easily done in about a 10 minute appointment in the office. If you are interested in this, just book it the day you are in for Botox or filler or call the office if you realize after your procedure that you may benefit from this.

Can I cover the bruise?

Sure!  This can be difficult at times, but some concealer can come in handy to hide those dark bruises. I have been told that one good technique is to put very thin layer of concealer on, then use a light layer of powder over to set it.  You can repeat it two to three times to build up more coverage. The last layer should be powder – but be careful so that it doesn’t look too cakey. If the bruise is on your lip, then lipstick should do the trick.

Good luck and know that a bruise is not harmful, it just can be an unsightly inconvenience for a while!

Injectables, Anything but Superficial. They can help you feel good too!

Injectables, Anything but Superficial. They can help you feel good too!

Injectables, Anything but Superficial. They can help you feel good too!

Could Botox and cosmetic dermal fillers help with depression?

These injectables are typically used to improve the appearance of facial wrinkles, but now studies have shown that Botox may be an effective treatment to help depression.  Why not get rid of wrinkles and improve your mood at the same time?!


Injectables are really anything injected into the body with a needle.  But in the derm world we are referring to dermal fillers (brands like Juvederm, Restylane and Radiesse) and “neurotoxins” (brands like Botox, Dysport and Xeomin).  Injectables like these are the number one cosmetic procedure in the US…and for good reason.  Not only can they make you look more youthful, they apparently can make you feel better about yourself too!


Botox has been investigated and found to ease symptoms of depression and elevate mood in actual scientific studies.

It was first reported in the Journal of Cosmetic Dermatology, 2009, by Michael Lewis, PhD and Patrick Bowler MB, BS, that non-depressed patients who received Botox injections above the eyes frowned less and felt better than those who did not receive the injection.  Dr. Lewis concluded that, “Smiling makes us feel happy whereas frowning makes us feel sad. People who have undergone chemical denervation (with Botox) of their frown muscles cannot frown. We have found that these people (possibly because they can no longer get the feedback from frowning) are happier than people who have had other forms of cosmetic treatment.”

Then in 2012, The Journal of Psychiatry Research reported a study done in Switzerland showing, “a single treatment of the glabellar region with botulinum toxin (Botox) may shortly accomplish a strong and sustained alleviation of depression in patients, who did not improve sufficiently on previous medication. It supports the concept, that the facial musculature not only expresses, but also regulates mood states.”  Translation…Botox treated depression in patients that did not respond to antidepressant meds.  Impressive!

More recently in a larger study in 2014, Eric Finzi, MD, PhD and Norman Rosenthal, MD (Clinical Professor of Psychiatry at Georgetown Medical School) showed groundbreaking evidence that there was a significant improvement in depression in the study group treated with Botox.  Dr. Eric Finzi even made the comment (in the New York Times) that, “This new research supports earlier facial feedback theory of Charles Darwin which suggests that facial expressions influence mood.”


Believe it or not, there is historical support for a connection between emotions and facial muscle activity.  Back in the Victorian era the “omega sign” was what they called the facial expression where you wrinkle between your eyebrows and nose because it resembles the Greek letter omega.  They believed the “omega sign” was diagnostic of a depressive disorder.

With all of this info, it seems possible that a more positive facial expression can make you feel better about the way you look and therefore improve social interaction, elevating your mood.  As you look in the mirror and see a face without negative expression it elevates your mood. If you look happy, you start to feel that positive, cheerful vibe!


Well, if Botox was found to create a more positive outlook in the patients that were studied, why not fillers?  Cosmetic dermal fillers have not been directly studied, but they also can create a happier looking face.  Fillers can literally turn that frown upside down!  This is done by injecting the marionette area (the lines that can develop from the corners of the mouth to the chin).  Fillers can be injected in lots of other areas to create a more positive, happy looking face too – like in the cheeks to help defy gravity, or between your eyebrows to get rid of that furrow.