SEP 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Highest Risk for Bruising Patients with fair and thinner skin who already have ecchymosis showing are especially prone to postpro- cedure bruising, says H.L. Greenberg, MD, founder of Las Vegas Dermatology in Las Vegas. "Also, anyone on a blood thinner such as Coumadin or Xarelto can bruise, as well as people who take aspirin." Certain areas of the face, including the lips and tear troughs, are also more likely to experience postpro- cedure bruising. "The lips are highly vascularized and the periorbital skin bruises because it is so thin," says Dr. Greenberg. In addition to thinner skin, the undereye area is also well vascularized. "Not only is any bleeding under the skin more easily seen in this area, but it also spreads rapidly into the surrounding tissue to create a 'black eye' appearance anytime a blood vessel is pierced," says Robyn Siperstein, MD, founder of Siperstein Dermatology Group in Boca Raton, Florida. Thinking Ahead Several pretreatment techniques can help minimize bruising. Ruth Tedaldi, MD, of Dermatology Partners, in Wellesley, Massachusetts, encourages patients to avoid aspirin or any nonsteroidal anti-infl ammatory for a week prior to treatment, if it is safe for them to do so. "In terms of increasing bleeding time, these medica- tions are active for about a week," she says. "So we usually tell patients to stop a medication if it's appro- priate. If a patient takes a blood thinner because of a heart condition, for instance, we do not want them to stop taking that medication. But if they have a choice of taking Tylenol or ibuprofen or aspirin, I would tell them to take Tylenol the week before the injection." Dr. Tedaldi also encourages patients not to drink alcohol, which can increase postprocedure bruising, for two days prior to injections. "We also have them stop homeopathic remedies that can lead to more bruising, such as ginger and garlic," she says. Michael Gold, MD, founder of Gold Skin Care Cen- ter in Nashville ices the area prior to injecting. "Topical numbing medicine doesn't do much to stop bruising," he says. "But ice will actually help a little because it constricts some of the blood vessels. It's not going to prevent bruising completely, but it does help." | SEPTEMBER 2018 29

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