Bruising, Swelling and the First 72 Hours: Aftercare That Works
Aftercare is where a good treatment is either protected or quietly undone. It is also the part of the consultation most often delivered as a leaflet handed over while the patient is still putting their coat on — which is a shame, because the first seventy-two hours determine much of what the patient will remember about the experience.
Much of the advice in circulation is inherited rather than evidenced. This is an attempt to separate the two.
Before the needle: where bruising is actually prevented
Bruising is decided more by what happens before and during treatment than by anything applied afterwards.
Where it is medically safe — and only then — asking patients to pause discretionary blood-thinning agents for several days beforehand reduces bruising: fish oil, vitamin E, high-dose ginkgo, and alcohol in the twenty-four hours before. Prescribed anticoagulants and antiplatelets are never stopped for a cosmetic procedure, and a patient who offers to do so should be corrected firmly. Bruising is inconvenient; a thrombotic event is not.
During treatment, the technique choices matter: a cannula rather than a needle in vascular territories, fewer entry points, slow delivery, and good lighting so that visible superficial vessels are avoided rather than found [3].
The first 24 hours
Cold, briefly and gently. Intermittent cool compresses in the first day reduce swelling and may limit bruise spread. Not ice directly on skin, not pressure, and not on a region where the product's position matters.
One exception matters more than the rest of this section. Cooling is for ordinary swelling only. If the skin blanches, mottles or turns dusky, or the pain is increasing rather than settling, stop cooling immediately and treat it as a possible vascular event — cold is the wrong thing to be doing to tissue that may be losing its blood supply [1].
Head elevated. Sleeping propped up for the first night or two is simple, free and genuinely reduces morning oedema, particularly around the eyes.
No strenuous exercise, heat or alcohol. Anything that raises facial blood flow — hard training, sauna, hot yoga, a long steam — increases swelling and bruising. Twenty-four to forty-eight hours is the usual advice, and it is one of the better-supported restrictions.
Leave it alone. No massage unless you have specifically prescribed it for that product and that placement, no facials, no pressing to "check". After botulinum toxin, avoid rubbing the treated area; the traditional instruction to stay upright for a few hours has weak evidence but costs nothing.
Makeup: wait. Injection points are small breaches in the skin barrier. Twelve to twenty-four hours of nothing on them is a reasonable, low-cost infection precaution.
What probably does nothing
Arnica, in oral and topical form, is close to universal in aesthetic aftercare and has never produced convincing evidence of benefit for injection bruising. Bromelain is in a similar position. Neither appears harmful, and there is a reasonable argument that a patient who feels they are doing something copes better with a bruise — but they should not be sold as effective, and they must never displace advice that is.
The same scepticism belongs to elaborate product protocols in the first days. Most post-injection swelling resolves on its own schedule regardless of what is applied to it.
Days two and three
This is where patients panic, and where a properly set expectation is worth more than any intervention. Swelling frequently peaks on the second day rather than immediately, bruises darken before they fade, and lips in particular can look alarming at forty-eight hours and entirely normal at ten days.
Say this in advance, in the consultation, and repeat it in writing. A patient told beforehand that day two is the worst day experiences day two as expected; a patient told nothing experiences it as a complication.
The two-week rules worth keeping
Dental work. Bacteraemia from dental procedures is a recognised route to late inflammatory nodules around hyaluronic acid filler. Where it is elective, leaving a couple of weeks between filler and dental treatment in either direction is a sensible precaution [2].
Vaccinations and significant illness. Immune activation is another recognised trigger for delayed reactions. It is not a reason to refuse either, but it is a reason to space them where the timing is flexible, and to warn the patient rather than surprise them.
No assessment of the result before two weeks. This protects the patient from requesting correction of a problem that is still resolving, and protects you from dissolving or topping up an outcome that had not yet arrived.
What must trigger a call
Every patient should leave with a way to reach you and a short, unambiguous list of reasons to use it:
- Pain that is increasing rather than settling, or out of proportion to the treatment.
- Skin that turns white, then dusky, mottled or grey — particularly in a pattern on one side only.
- Any change in vision, or pain around the eye.
- Spreading redness, heat or fever after the first day.
- A new lump appearing weeks or months later.
The first three are potential vascular occlusion and are urgent — same hour, not same week. The wording matters: patients under-report because they do not want to seem difficult. "If anything worries you, phone me, and I would rather hear about ten normal bruises than miss one thing that mattered" reliably produces earlier calls than a printed warning.
Aftercare as part of consent
Finally, aftercare belongs in the consent conversation rather than after it. A patient who learns at the end that they cannot train for two days, cannot have their planned dental appointment next week and will look worse before better has not really consented to what they bought. Told beforehand, the same facts read as professionalism.