Patients look to dermal fillers as a fast and safe option to improve their appearance. Unfortunately, many are surprised and frustrated with postprocedure bruising and swelling that causes social downtime they did not factor into their schedules.
Counseling patients on expected bruising and swelling and making sure they leave enough time between treatments and public events is crucial. There are also several strategies both in-office and related to pre- and post-care that can help reduce these unwanted after-effects.
“It starts with the pre-care,” says Z. Paul Lorenc, MD, an aesthetic plastic surgeon based in New York City. “We tell patients no aspirin or herbal supplements for a week prior to injections.”
Carolyn Jacob, MD, medical director of Chicago Cosmetic Surgery and Dermatology, goes over the patient’s medications to make sure they are not on blood thinners, which can increase post-injectable bruising, and provides an “anti-bruising” handout that includes things to avoid, such as aspirin, ibuprofen and omega-3 supplements, as well things patients can do to mitigate bruising.
“We tell them to stop the listed medications and supplements two weeks beforehand; we also look at vitamins and nutraceuticals that might be helpful, such as arnica tablets,” she says. “We also talk about bromelain, but arnica seems to be the most popular and well-known one, and we do offer arnica here in our office. We tell them to start the arnica one or two days beforehand, if they want to use this.”
On the day of the injections, Mariano Busso, MD, a dermatologist with practices in Miami, Florida, and Beverly Hills, California, uses the Accuvein to map out the vasculature in the area he is injecting. “This allows you to see under the skin and detect where each vein or artery is, so we can avoid them,” he says.
Using a cannula can reduce the risk of nicking veins and also reduces the number of entry points, both of which reduce post-injectable bruising. “I can do a tear trough injection via one puncture with a cannula, versus 10 to 12 little injections with a needle, so you minimize the trauma to the tissue and that, by definition, causes less swelling and bruising,” says Dr. Lorenc.