Short answer: no. With injections such as filler, botulinum toxin (commonly called “botox”) or mesotherapy, the needle or cannula can hit one of the small blood vessels in the skin. This can happen even with the most careful technique, and this is why bruising is among the most common side effects. However, not every purple colour is a bruise: a purplish colour spreading like a net, whitening or severe pain requires urgent assessment.
Why does bruising occur?
A bruise is blood that has leaked from very small vessels under the skin and collected in the tissue. The face is an area rich in blood vessels, and not all of these vessels can be seen from the outside. When the needle or cannula hits one of them during an injection, some blood leaks into the tissue and a bruise can appear within a few hours.
This is why many sources, including the US Food and Drug Administration (FDA), list bruising among the common risks of filler treatments. Expert consensus documents also emphasise that most side effects after injections, including bruising, are mild and temporary.
The part of the rumour that is true
Injection technique can affect the risk of bruising. Factors such as the depth of the injection, the needle or cannula used, the number of entry points and the speed of the injection can increase or decrease the likelihood of bruising. So technique matters; however, even with the most careful technique, the risk of bruising does not drop to zero.
This is why a single bruise is not proof of poor technique. If you get very extensive bruising at every session, or if bruising lasts much longer than expected, the reasons can be discussed with your physician; sometimes an underlying tendency to bleed or a medicine you take can contribute to this.
What increases the risk of bruising?
- Area: bruising is more common in areas with thin skin rich in blood vessels, such as the lips and under the eyes.
- Personal characteristics: thin skin, older age and a tendency to bruise easily can increase the risk.
- Medicines: blood thinners and medicines that affect bleeding, such as acetylsalicylic acid (aspirin), can increase bruising. Do not stop these prescription medicines on your own; talk to the physician who prescribed them.
- Supplements: some supplements, such as high-dose vitamin E, ginkgo and garlic, are thought to increase bleeding. Tell your physician about every supplement you take before the procedure.
- Alcohol and strenuous exercise: alcohol and strenuous effort just before or after the procedure can increase bruising and swelling.
How long does a bruise last, and how does the colour change?
A bruise is at first reddish or purplish, then bluish, and then fades as it turns greenish and yellowish. This change in colour is a natural part of the body clearing the collected blood. Most bruises go away on their own within a few days to two weeks. They have clear edges, get smaller over time and the colour fades.
For detailed aftercare advice, see our article “Aftercare Following Medical Aesthetic Procedures”, and for how bruising and swelling develop, our article “Bruising and Swelling”. If your physician recommends it, brief cold compresses that do not touch the skin directly may be helpful. Do not massage the area and do not apply heat without asking your physician.
Bruising can occur even after a well-performed procedure. What matters is being able to tell a bruise apart from the signs of a blocked blood vessel; if in doubt, call your physician.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
When is it not a bruise?
The most dangerous aspect of the rumour is mistaking every purple colour after a procedure for an ordinary bruise. Especially after filler, the product blocking a blood vessel is a rare but serious complication and can look like a bruise at first glance. It is important to know the difference:
| Ordinary bruise | May be a sign of vascular occlusion |
|---|---|
| A round or oval mark with clear edges | A mottled purplish-bluish colour spreading like a net or lace pattern |
| Mild tenderness | Severe, increasing or unexpected pain |
| The area is at normal temperature | Whitening, paleness or coldness in the area |
| The colour turns yellow-green over days and the bruise gets smaller | The colour darkens within hours; blisters or crusting may appear |
| Vision is normal | Blurred, darkening or double vision |
Do not mistake it for a bruise: with these symptoms, call 112 (or your local emergency number) without waiting or go to the nearest emergency department
- A purplish colour spreading like a net, whitening or coldness with severe pain
- Blurred vision, loss of vision or double vision
- Slurred speech, facial drooping, weakness in an arm or leg
- Rapidly growing, tense and painful swelling
Be sure to read our article “After Fillers: When Is It an Emergency?” for details of these symptoms and what to do first. For other filler-related problems, the article “Filler Complications” can be a useful guide.
With which bruises should I call the physician?
- If the bruise is not getting smaller within a few days, or is getting bigger
- If a swelling that becomes increasingly hard or painful forms under the bruise
- If the colour has not faded after more than two weeks, or a brown mark remains
- If there is warmth, discharge or fever in the area
- If you notice unexplained bruises in other parts of your body as well
What can be done to reduce the risk of bruising?
Before the procedure, tell your physician about all the medicines and supplements you take, do not plan a procedure just before an important event, and follow the aftercare instructions. For general precautions, see our article “Reducing the Risk of Complications”. There is no method that prevents bruising completely, and the evidence for the effect of some methods is limited.
Conclusion
Bruising after an injection is a side effect that is common even after a well-performed procedure and usually goes away on its own. Technique can affect the risk, but a single bruise is not proof of poor technique. What really matters is being able to tell an ordinary bruise apart from emergencies such as vascular occlusion, and contacting a physician when in doubt.
Questions to ask your physician
- How often does bruising occur with this procedure, and how long does it last?
- Do the medicines and supplements I take increase my risk of bruising?
- Do I need to talk to the physician who prescribed my prescription medicines?
- If I get a bruise, can I use cold compresses, and how?
- With which colour changes should I call you immediately?
- How long before an important event should I have the procedure?
- If I bruise at every session, should the cause be investigated?
Frequently asked questions
Is bruising after filler normal?
Yes, bruising is one of the most common side effects of filler treatments and can occur even when experienced physicians perform them. It usually goes away on its own within a few days to two weeks. If there is a colour spreading like a net, whitening or severe pain, it is not an ordinary bruise; immediate assessment is needed.
Can bruising occur after botulinum toxin?
Small bruises at the injection site can also occur after botulinum toxin injections. They are usually small and go away on their own. Symptoms other than bruising, such as a drooping eyelid or difficulty swallowing, should be assessed separately.
If I bruised, did the physician make a mistake?
Not on its own. The needle can hit small vessels that cannot be seen from the outside, and this can happen even with the most careful technique. If you get very extensive bruising at every session, it is useful to discuss this with your physician.
What can I do to make a bruise go away faster?
If your physician recommends it, you can use brief cold compresses that do not touch the skin directly. Do not massage the area, do not apply heat without asking your physician, and ask before using any over-the-counter medicine or cream. There is no method that prevents bruising completely or makes it disappear at once.
Can I cover a bruise with make-up?
Once the injection points have closed, make-up is usually possible, but ask your physician when you can start. Using clean products and brushes helps reduce the risk of infection.
Should I avoid taking painkillers before the procedure?
Some painkillers can affect bleeding and increase the risk of bruising. Ask your physician before the procedure which painkiller you can take. Do not, however, stop a medicine you take regularly for a heart or blood vessel condition on your own.
Sources
- Minimizing bruising following fillers and other cosmetic injectables (Hamman MS, Goldman MP). J Clin Aesthet Dermatol 2013;6(8):16–18 — Journal of Clinical and Aesthetic Dermatology, 2013
- Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes (Goodman GJ et al.). Australas J Dermatol 2020;61(3):217–225 — Australasian Journal of Dermatology, 2020
- Dermal Fillers (Soft Tissue Fillers) — U.S. Food and Drug Administration (FDA)
- Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion (Murray G, Convery C, Walker L, Davies E). J Clin Aesthet Dermatol 2021;14(5):E61–E69 — Journal of Clinical and Aesthetic Dermatology, 2021
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
