Post Filler Ecchymosis Resolution With Intense Pulsed Light

Pulsed dye lasers (PDL), typically set in the high 500 nm range, have been the typical technology used and this has been documented.² Although there is some reduction in the ecchymosis from the PDL, the limited depth achieved due to the nature of the wavelength and the short pulse duration does not deliver a consistent level of clearance. The contusion must fully form before treatment with the PDL, with the most effective treatments being observed when the ecchymosis is treated 5 days post operation.² Because of the high absorption coefficient of oxyhemoglobin with the PDL, there is very little spread of the energy; therefore, a partial clearance of the contusion is oftentimes the result. Confinement of thermal damage to micro vessels is, in theory, related to the laser exposure time (pulse duration) on selective vascular injury.³ Although there are longer pulse durations available with the PDL, there is still a substantial amount of thermal confinement at the longest pulse durations. While this is an ideal condition for certain vascular treatments, in the indication of ecchymosis this thermal confinement (high level of absorption combined with relatively short pulse durations) presents the need for a multiple treatment protocol, which is not ideal given the short duration of the visible aspect of the condition. Full clearance in a single treatment should be the end goal, which has been observed in this study using the Max G.As the first IPL systems were introduced in 1996, and since then have developed into a formidable technology, poly chromatic, non-coherent pulses of light have been utilized for a variety of cosmetic treatments. The Max G utilizes a patented dual band filtration, which produces a “smooth” pulse profile with a spectral output of 500nm-670nm and 870nm-1200nm, while filtering out the middle wavelengths where absorption coefficients of most blood components drop well below those of melanin. This creates an optimal system for the treatment of vascularbased conditions as this spectrum overs a variety of levels of absorption, all more readily absorbed by oxyhemoglobin that melanin or water. Since this type of pulse encompasses multiple wavelengths with varying potential absorption coefficients corresponding to various components of the blood, this type of light is ideal for targeting the blood in the interstitial space as its ability to spread along a targeted chromophore is beneficial in this situation. This type of absorption also better addresses the multiple levels of affected tissue, as the methemoglobin absorption spike in the longer wavelengths corresponds to deeper penetration. By targeting this hemorrhaged blood, the ecchymosisis usually dramatically reduced in one treatment session when compared to a non-treated contusion (Figure 1) or PDL treated contusions. This type of technology is developed for the treatment of skin type I-IV, so it has similar treatment ranges to PDL in terms of patients. The darker the skin type, the greater the risk of pigmentary changes and the lower the intended clinical response of vascular lesions.⁴

We report the first series of patients prospectively treated with the Max G IPL for post procedure bruising from dermal filler injections and following time to resolution of the bruising. Treatment of bruising can lead to dramatic reduction in the downtime a patient experiences due to the obvious contusion caused after undergoing an implantation of an injectable filler. The majority of treated contusions are reduced to a barely visible state in 3 days post treatment with the IPL. This makes this a valuable tool in the treatment of post-filler injection ecchymoses.

The author has no conflicts of interest to disclose.