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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She encourages her patients to use ice—never putting the ice directly on the skin, but rather, always having a thin layer of protection between the icepack and the skin. "We have them ice off and on for the rest of that day," says Dr. Tedaldi. "We also ask the patient to avoid exercise, which will cause swelling and congestion, for at least 24 hours. If the injection was in the face, we ask the patient to sleep on an extra pillow so that the hydrostatic pressure from lying fl at does not increase the likelihood of bruising." Dr. Greenberg also recommends the use of icepacks. He advises patients to apply them for 15 minutes on, 15 minutes off every hour for the fi rst day. His practice also recommends an arnica blister pack product. Oral arnica is typically taken at the time of injection and then every six hours after for a total of four tablets. Dr. Monaco offers SinEcch arnica packs, which the patient starts before leaving the offi ce. "Arnica is an herbal supple- ment that has been found to be helpful with bruising," she says. "Topical arnica is also worthwhile." Dr. Monaco and Dr. Nazarian both recommend OcuMend (Cearna Aesthetics), a hydrogel pad infused with arnica montana and ledum palustre. "This formula- tion of arnica has been found to be as much as 50 times more potent than other forms of arnica," says Dr. Monaco. "I particularly love this product for periorbital ecchymosis that can happen after periorbital fi ller rejuvenation." "It looks like a de-puffi ng patch you that wear under your eyes," says Dr. Nazarian. "It's a great product because it allows patients to get treatment even a couple days before an event. It brings down the swelling and prevents bruising." She sends patients home with enough patches to get them through the day and fi rst night after treatment. Dr. Siperstein recommends using postprocedure topi- cals with arnica, vitamin K and bromelain until all bruising is gone. She also advises patients not to exercise—especially upside down—until all bruising and swelling is gone. "Tak- ing these proactive steps to limit physical activity will sig- nifi cantly reduce the likelihood of large areas of bruising, as increased blood fl ow and pressure will usually worsen a bruise," she says. Banishing Bruises If a patient does experience bruising that lasts more than a few days, Dr. Siperstein offers complimentary intense pulsed light treatments. "This can cut down bruising time from seven to 10 days to three to four days," she says. "The simplest way to make a bruise go away is by using a laser light source," says Dr. Gold, who prefers the Vbeam Perfecta or Vbeam Prima (Syneron- Candela). "One or two zaps is usually all that you need, and it helps the progres- sion of the bruising go away a lot faster. Within several days, it's gone." Dr. Greenberg uses the Cynosure 585nm pulsed dye laser with a 7mm spot at 7 J/cm 2 and 10ms pulse duration. Another alternative is the Aerolase LightPod Neo, a short-pulsed, 1,064nm laser. "This really works well," says Dr. Gold. "I've used it to treat patients who underwent multiple injections throughout the face and were left bruised. Within a day or two, the bruises are gone." "Keep in mind, if you stick a blood vessel, there's a chance you're going cause bruising, no matter what pre-care treatment you use," says Dr. Gold. But sudden bruising—especially if it is accompanied by pain—can be a sign of something much more serious. "If somebody gets a bruise, that's OK," he says. "But they should be instructed to call their provider immediately if they get a bruise asso- ciated with a lot of pain and discomfort, because you may be dealing with a vessel that's occluded, and this can occur anywhere on the face." Daniel Casciato is a freelance writer based in Pittsburgh. PHOTO COURTESY OF SHEILA NAZARIAN, MD; © GETTY IMAGES WITHOUT A TRACE 32 SEPTEMBER 2018 | Med Esthetics The thin skin in the periorbital area is especially prone to show bruising, but this can be minimized with icing and gel pads applied immediately postprocedure. BEFORE AFTER

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