The Bruise Blog

general health

May 27

My practice is VERY needle heavy, using them to inject: botox, fillers, kybella, and sculptra. I draw blood out and then inject it back for PRP treatments. I set catheters for IV therapy and needle into muscles for vitamin injections. With needles comes risk of bruising; not a rare occurrence. One study estimated a 19-24 % chance (1) with filler treatment and another as high as 68% (2)! There are ways to minimize risk, but nothing to eliminate it (3). This week I talk about what a bruise is, what to expect over time, and how to care for it.

When a needle enters the skin, there is potential for blood vessel damage. This damage causes blood to spill under the skin, and a bruise forms. When we see a bruise, we know that there is bleeding beneath the skin (4). In rare cases, blood pools beneath the skin and becomes trapped forming a firm mass called a hematoma. These almost always resolve naturally over time as the body breaks down the blood over time (5).

As a bruise heals, our body naturally breaks down the blood under the skin. Blood contains hemoglobin, which makes the blood red, and as it's being broken down, bilirubin and biliverdin are released (6); these compounds are yellow and green in color and responsible for the yellow or green hue of a healing bruise (7). Bruises will normally heal on their own within 10-14 days (8).

We can employ strategies to reduce the chance of bruising. If you have a history of easy bruising, you may be more prone. The older we are, the thinner and more fragile our skin and slower our recovery. Alcohol can be avoided 24 hours prior to a treatment to avoid the blood thinning effects, and vitamin C and iron deficiency can also predispose us to bruising (9).

Many medications thin the blood and make it more probable to bruise. It is not recommended to stop any medication prescribed by a specialist for an aesthetic procedure. Over the counter medications such as aspirins and NSAIDS (like ibuprofen and naproxen) should be avoided for one week prior to a procedure (9). Other supplements to be avoided two weeks prior to a procedure include: fish oils, omega 3 fatty acids, vitamin E, St, John’s wort, gingko, and garlic (9).

If a bruise happens, there are ways we can support its healing. During its acute phase, apply a wrapped ice pack for 15 minute intervals throughout the day for about 48 hours (9). Ice causes vasoconstriction and minimizes the severity. After the acute phase of injury, switch to heat to increase circulation and allow trapped blood to release.

Other supportive therapies to help resolve a bruise include topical arnica, vitamin K, and bromelain (9). Oral bromelain and oral homeopathic arnica are also available to support.

Bruising happens! Any time we use a needle, the risk for bruising is there. Most commonly these are minor complications, but worrying complications do occur occasionally. Knowing how to support the healing process of a bruise is handy knowledge.

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