Post Filler Ecchymosis Resolution With Intense Pulsed Light
November 2018 | Volume 17 | Issue 11 | Original Article | 1184 | Copyright © 2018
Vic A. Narurkar MD FAAD
Bay Area Laser Institute, San Francisco, CA
Bruising after dermal filler and neuromodulator injections is a common side effect and can have durations of 1 to 2 weeks. While it ultimately resolves, faster resolution can produce better outcomes for patients and also make patients more likely to return for future treatments. We report the successful reduction in bruising following injections of fillers with an intense pulsed light source. We also documented the onset of action of bruising resolution with serial photographs. Resolution started within the first hour of treatment and continued rapidly over 48 hours. This is the first-time reported study of resolution of bruising from injectables with intense pulsed light. Patient satisfaction is improved when such adverse events are minimized. J Drugs Dermatol. 2018;17(11):1184-1185.
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Dermal filler injections can often produce bruising, which can have extended duration and therefore produce unacceptable down time for minimally invasive aesthetic procedures. The introduction of cannulas has reduced this incidence, but it can still be prevalent regardless of needle versus cannula, especially in patients who may have taken anti-coagulants, or have thinner skin, and in certain areas such as the periorbital and perioral areas, which show higher incidence of bruising.Contusions (bruises) are ecchymoses that result when extravasated blood accumulates in the tissue,1 typically when trauma causes vessels to rupture and the blood hemorrhages into the interstitial tissue. When introducing a filler to the tissue, often times the needle causes such trauma, resulting in a contusion close to the skin that manifests as a bluish/purplish mark in the tissue surrounding the injection site. While there is no real scarring or danger from this resulting hematoma, this does present a very visible indication of having “work done”, which creates a type of “social downtime”. The ability to limit this type of downtime, which can span from 3-14 days depending on the severity, could benefit the patients in their day-to-day lives by resolving the issue in a short period of time (3 days). While various types of light-based technology have been utilized to treat this type of ecchymosis with marginal results, we report the use of a broadband light source with a selective filter that can promote rapid resolution of the ecchymosis within 3 days post treatment.
MATERIALS AND METHODS
Fifteen patients with bruising apparent within 24 to 48 hours after dermal filler injection with a variety of hyaluronic acid-based fillers were treated with the Max G Intense Pulse Light (IPL) handpiece at 28 joules/cm2 and 30 msec. No anesthesiawas applied prior to treatment and anesthesia post-treatment consisted of ice. The Max G Intense Pulsed Light (IPL) hand piece was developed as an accessory to the Icon® Laser and Pulsed Light System (Cynosure Inc., Westford, MA). This IPL hand piece has a 10mm x 15mm rectangular optic and is filtered from 500nm-670nm and then again from 870nm-1200nm, utilizing dichroic and absorption filters to cut out 0-499nm, 670nm-870nm, and 1200nm+. The resulting wavelengths (500-670nm, 870-1200nm) are primarily absorbed by the Q bands and NIR bands of oxyhemoglobin, deoxyhemoglobin, and methemoglobin, which is ideal as these are the target chromophores in the blood.The Canfield Visia camera system was utilized to obtain standardized before and after photography. Photography was performed after ecchymosis was noted and at 3 hours after treatment using the Max G at 30 msec and 28 joules/cm2 and then at 72 hours after treatment.Summary of ResultsAfter treating a group of 15 patients, there has been a consistent reduction in the duration of the injection created ecchymosis post treatment. This was first noted at 3 hours post treatment with the color of the bruise turning from purple to a strawberry red (Figure 1). Reduction of bruising ranged from 70% to 100% in all patients, with a mean reduction of 85% (Figure 1). There were no adverse events or complications and all patients tolerated the treatment well with only the use of post-treatment cooling.
The use of light-based technology is not a novel treatment for ecchymosis, however, the success to this point has been limited.