Bruising and Swelling after Cosmetic Injections and What to Expect

Some of my most FAQ are about bruising and swelling after filler or botox treatments. The short answer is, there is always a possibilty of bruising and swelling. Due to the complexity of blood supply in the face there is no way to completely avoid bruising and swelling. Yes, even the most meticulous and precise injections can sometimes result in bruising but the good news is it doesn’t mean anything bad.

In case you missed it I have a blog post here on what to expect when getting fillers and how to work with your provider to choose which area is best for you.

This blog post however, will dive into aftercare and what to expect!

What to Expect During an Injection Treatment

Whether it’s fillers or botox I always tell my patients to allow for a few days for bruising and swelling. Although, more often than not the bruising and swelling is minimal! The bruising is typically easily covered with makeup and might even only be noticeable by you! Plus it will resolve in just a few days. However, it’s never a good idea to plan your injection in the same week as an important event! Even if you didn’t bruise or swell during a previous appointment, it doesn’t mean that will always be the case. You can bruise one visit and not the next.

Bruising and Swelling with Botox vs. Fillers

The chances of bruising with botox is much less than with fillers. A bruise from botox usually presents as a little hard spot on the forehead. Botox is more of a “lunchtime” treatment and most patients return directly to work after their treatment. Check out my Botox 101 Blog to learn more about what to expect after your treatment with Botox. Although it doesn’t happen every time, bruising from Botox is more likely to occur around the eyes where we are much more vascular.   

Filler appointments take a little more planning and most patients do not want to return to work the next day in case they experience bruising or swelling. Bruising can last up to one week and swelling typically peaks between 24-48 hours and slowly dissipates over a few days. Taking the next day or two of work is typically plenty, and after that point most bruising and swelling can be more easily concealed. 

When it comes to filler injections here are the real, raw, and honest truths:

  • You will likely swell and
  • You will likely swell unevenly.
  • You will likely bruise.
  • You are likely to feel lumps and bumps.
  • You are likely to be a bit asymmetrical while swollen

What if I Don’t Like the Look After My Appointment?

When it comes to filler I always say, it will look “good” the day of treatment (instant gratification!) but “great” at two weeks. There are 2 reasons for this:

  1. Swelling can take a couple of weeks to completely resolve.
  2. The fillers need time to settle.

The fillers are made with hyaluronic acid, which is a naturally occurring carbohydrate in the body. HA is very hydrophilic, which means it will attract water and get super soft and smooth. This process of this happening takes about 2 weeks. So yes, at first the filler can seem a little hard and swollen and by 2 weeks it will be soft, fluid, and super smooth as it settles in.   

Always give your filler 2 weeks to settle before messing with it, and before judging it – do not panic at the site of swelling!  I have had patient’s ask me to reverse their filler 24 hours post filler when they are super swollen because they are in panic mode. BAD IDEA and I won’t do it. It is SWELLING not filler and it would be a total waste of your hard earned money! We need to give the filler time to settle. Once it settles and the swelling has resolved we can make an educated decision on whether the filler should be tweaked or even dissolved (10/10 times that same person does NOT want it resolved at the two week mark).

And don’t worry, just because you can no longer feel it – it’s still there!  This is where before and after photos are HUGE! We sometimes get so used to seeing our faces every day that we forget just how much they have changed.

What Areas Are Most Likely to Swell?

There are two areas that typically involve the most swelling and/or bruising: lips & under eyes.

When it comes to lips here are the stages of healing:

  • You will think they are HUGE at first, and panic for the first 2-3 days. Thinking “I did too much!!”
  • Then, at the two week mark, when it is time to come in for your follow up and all the swelling is gone, you’ll tell me “OK I need more.”  (yes, this happens 98% of the time ;)).

When it comes to under eyes, for many in this area it is improvement and not perfection. It takes two weeks for filler to settle. This area is meticulous, sensitive and technical and can take a few treatments to get it perfect. I always recommend a touch up visit for under-eye filler and often times we need to tweak the filler by adding a little, taking a little out, or blending.

Ways to Help Before your Injections:

  1. Hold off on taking NSAIDS (ibuprofen, aleve, advil, motrin), vitamins and fish oils, and other blood thinners within 10 days of your visit.  This can greatly reduce bruising and swelling. Tylenol is OK if you need to take something for pain.

  2. No alcohol for 24 hours can reduce bruising and swelling.

  3. Come hydrated!

Ways to Reduce Swelling Post Injections:

  1. With fillers, ice the treated area for 10 minutes at a time when you can for the first 24 hours. (I do not recommend icing after botox – we do not want you pressing on those areas, and there is really no need for icing)

  2. Holding off on exercise for 24 hours after fillers if you are worried about swelling.  Exercise will not hurt the filler, but it can increase swelling.

  3. Another helpful tip is to sleep on your back.  I know, I know – this one is hard to do (side sleeper here!). Again this will not hurt the filler, but it can increase swelling if you sleep on the face (plus increase wrinkles!).

  4. Slightly elevating on a couple of pillows will definitely help reduce swelling.

  5. I also recommend Arnica Montana and Bromelain, which are homeopathic supplements used to cut down on bruising and swelling. These come in several forms; creams, tablets, and patches. Any form is okay, just follow the instructions on the package.  You can purchase these at your local health food or supplement stores.

  6. Drink lots of water!

At The End Of The Day…

Seeing an experienced provider is important because although some bruising is unavoidable, an expert injector knows how to avoid certain vulnerable areas and use cannula techniques to cut down on bruising and swelling. The good news is, like I mentioned, the bruising is typically very easily covered with makeup and resolves in just a few days.

Ultimately, my patients always know that I want them to be 100% happy no matter what and I will do what it takes to make that happen. We set realistic expectations and I strive to deliver them every time. If you ever have questions or concerns about your filler always schedule a follow up and I will make sure we address/correct/assess what needs to be done!


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Racquel Frisella

Board Certified Nurse Practitioner & Aesthetic Specialist based in Saint Louis, Missouri

I work as a cosmetic injector and skincare specialist with 12 years of experience in the Aesthetic Industry. I see patients both in-office at Racquel Aesthetics for treatments as well as online for customized, complimentary skincare plans. I focus heavily on preventative and corrective injections, treatments, and skincare.  My career is my passion and I love to help people feel like the very best version of themselves. I am a wife and a mother of 3 beautiful children under the age of 3. I love all things beauty, fashion, and fitness. I am creating this site as a place to share my expertise on beauty, anti-aging, and skin while also giving a glimpse into my lifestyle as a mom, wife and lover of fitness!  


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