Botox (botulinum toxin type A) injections are the most common cosmetic surgical procedure. According to The American Society for Aesthetic Plastic Surgery Cosmetic Surgery National Databank 3,766,148 of these botulinum toxin injections (BOTOX Cosmetic, Dysport, Xeomin) were performed in 2013. In fact, twice as many Botox injections were performed last year than all the cosmetic surgical procedures combined. Soft tissue filler injections rank second in popularity. There were 2,116,044 filler injections (Belotero, Juvéderm, Perlane, Radiesse, Restylane, Sculptra, and Voluma being the most common) performed in 2013. These injection treatments are so popular because they are effective, extremely safe, have very few side effects, and patients can return to daily activities almost uninterrupted.
The most common side effects following Botox and dermal filler injections are redness, swelling, and bruising. Botox injections may produce a very temporary swelling related to the injection of the liquid. Temporary redness can occur at the injection sites but does not usually last long. Bruising after Botox injections is more likely to occur in the crow’s feet area where the skin is thin and there are many little vessels. Bruising is less common in the forehead, and quite uncommon around the frown lines.
More injection site responses / reactions are seen following filler injections than Botox injections. The amount of redness, swelling, and bruising that occurs after filler injections is related to the type of product used, the depth at which it is placed, and the number of needle pokes required to perform the treatment. Swelling commonly occurs following soft tissue filler injections. The presence of the product causes swelling; in addition the hyaluronic acid products bind water, which increases swelling. Visible swelling of the treatment area may be present for a few hours, or a couple days, but then gradually subsides. Redness also occurs commonly at the injection sites. This is more limited and may occur for several hours or up to a day or so. Bruising is less common in the nasolabial fold region, but can occur more frequently with injections in the lips, the marionette lines, and the cheeks.
Those patients that would consider themselves “easy bruisers” are more likely to experience bruising after these injection treatments. Cool compresses can be applied immediately after the treatment, and continued for 24 to 48 hours following treatment as needed. Cool compresses are rarely required after Botox injections, but are certainly helpful after soft tissue filler treatments.
Patients can help reduce the risk of bruising by avoiding medications that would thin the blood or aggravate bleeding. It is helpful to avoid aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs for two weeks prior to treatment. Avoiding vitamin E and fish oil for about 10 days prior to injection may also be helpful. Some herbal medications can also increase the risk for bruising. The early application of mild pressure, the use of cool compresses, and minimizing strenuous physical activity after treatment may also be helpful.
Makeup can be applied after Botox and filler treatments to help cover the minimal signs that might be present.