Healing Aids

Protocols to minimize bruising and swelling following laser treatments and injectables.
Healing Aids

A recent American Society for Aesthetic Plastic Surgery (ASAPS) study on injectables showed that bruising occurs in 19% to 24% of all procedures, while other sources report a 68% likelihood that a patient will bruise. Additionally, laser- and light-based procedures can cause redness and edema that linger anywhere from 24 hours to one week following treatment.

In an industry that prides itself on creating both optimal results and an optimal patient experience, finding ways to reduce postprocedure downtime can set your practice apart from the competition and increase patient satisfaction and word of mouth.

Pretreatment Protocols

Post-injectable bruising is more commonly seen in patients who receive larger volumes of filler delivered in less amounts of time—indicating that both rate of injection and volume injected are significant risk factors. But there are steps you can take to decrease the risk of swelling and bruising before the procedure even begins.

Houtan Chaboki, MD, a facial plastic and reconstructive surgeon at Potomac Plastic Surgery in Washington, D.C., has clients cease taking anti-inflammatory medications known to increase bleeding, such as aspirin and ibuprofen, two weeks prior to treatment. “Tylenol is still safe,” he says. “Under the guidance of a cardiologist, I also have them go off blood thinners such as Coumadin or Plavix.”

Before any procedure, he also has patients stop taking most supplements, aside from daily multivitamins. “Herbals that can increase bleeding include but are not limited to vitamin E, garlic, ginger, ginkgo biloba, ginseng, kava and St. John’s Wort,” he says. “Even herbal teas could increase bleeding and thus, bruising.” Weight loss medications, smoking and alcohol also affect healing. Dr. Chaboki asks patients to steer clear of alcohol and caffeine the day prior to a procedure, enjoy a light dinner, and refrain from any food or drink—water included—after midnight. He also requests that clients arrive free of makeup, which can camouflage blood vessels at risk of being punctured.

H.L. Greenberg, MD, of Las Vegas Dermatology counsels patients to stop tanning at least two weeks prior to treatment. “This decreases the risk of burns, especially when lasers are involved,” he says. “When I do fillers, I also get patients’ cold sore history to better pretreat at-risk areas with Valtrex. A lot of times I’ll go ahead and use some around the lips, just to be safe.”

To further reduce bruising from fillers around the lips, Dr. Greenberg typically performs a ring block: “I inject in a circle around the mouth’s oral cavity, thereby numbing the nerves inside the lip,” he says.

He advises patients to schedule their procedures a week or two before any special events. “Emphasize that they could be extremely bruised for that wedding or awards banquet,” advises Dr. Greenberg. “Be very clear—patients will not look well for at least a week, and if that is a problem for their schedule then they must consider postponing or avoiding the procedure.”

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