Introduction 

Lip fillers are one of the most popular non-surgical procedures on the market. They are an essential part of the celebrity toolkit and are increasingly seen as an accessible way for anyone to restore or update their look.

The popularity of lip fillers is at least partly because the procedure is seen as very low risk. 

It’s definitely true that injectables, like fillers, can create great results while not requiring the permanent commitment or weeks of recovery needed for most surgical procedures. Fillers also fit into our busy lives as a consultation and then treatment with a practitioner can be achieved in just an hour.

However, although lip fillers are a low risk, quick and convenient procedure, patients are likely to experience some redness, swelling and bruising after treatment which can last for up to two weeks.

It is important for aesthetic practitioners to understand why this bruising occurs and the best practice ways to manage it. 

This will allow them to: 

• Minimise bruising when conducting treatments
• Explain how their clients can manage post-procedure care 
• Set realistic expectations around recovery time

What Causes Bruising with Lip Fillers?

A 2013 study showed that up to 68% of people who have lip fillers experience may experience some bruising. Why is that and what can be done to ensure patients experience as little bruising as possible?

Lip filling procedures involve injecting small amounts of dermal fillers into selected places in or around the lips. These fillers are usually made of Hyaluronic Acid gel, a naturally occurring substance in the body which holds on to water. 

Lips are very vascular. It’s the network of veins under the thin, lip-skin that gives lips their characteristic pinkish colour. Injecting into vascular areas is always likely to cause bruising and swelling because some of the network of blood vessels will be punctured by the needle. 

Experienced and skilful aesthetic practitioners can keep bruising to a minimum by both making sure that patients are properly prepared for the treatment and also by paying careful attention to technique throughout the procedure.

Preparing Your Patient for Lip Fillers

It is important to communicate with patients that they may experience bruising and swelling and that they therefore shouldn’t book their treatment immediately before an important event or occasion. They should leave at least two weeks, or more, so that they can show off the results of their treatment with confidence. 

Patients should also be aware that there are some supplements and medicines that will increase the level of bruising because they stop blood from clotting as quickly as usual. 

If patients are taking these high-dose supplements, they should consider stopping taking them for at least a few days before the treatment. 

• John’s Wort
• Ginger
• Ginkgo biloba
• Ginseng
• Vitamin E
• Green tea
• Flaxseed oils
• Fish oils

Patients should also avoid taking over-the-counter ibuprofen or aspirin before treatment.

If your patient has been prescribed aspirin or a blood-thinner like warfarin or rivaroxaban they must discuss with their doctor whether it is safe for them to have lip fillers and how to manage their medication and their treatment. 

Patients should also avoid alcohol for 1-2 days before and after treatment as it dilates blood vessels.

Which Patients Are More Likely to Experience Bruising?

Not everyone reacts to injections in the same way. As we age our skin gets thinner so older patients are likely to experience more bruising. Bruising may also be more visible on patients who are very pale. A good practitioner will emphasise the importance of after-care for these patients in particular.

If you are unsure, it can be helpful to ask your patient how their body usually responds to knocks and bumps. Bruises from lip fillers should be no different to any other bruise and their body should react in the same way.

How Can the Practitioner Minimise Bruising and Swelling? 

There are a number of techniques practitioners can use to keep bruising to a minimum.

Injection Depth

Lip fillers should be injected into the subdermal plane. This is a fairly superficial depth, below the top layer of skin but above the hypodermis (bottom layer of skin) where bigger blood vessels are sited. If a technician injects too deeply into the skin they risk vascular complications like significant bruising. 

Positioning of Injections

There are many different techniques that can be used for lip filler. A client who wants to minimise fine-lines around the mouth may require a different technique to one that wants to primarily increase lip volume. Some techniques involve multiple injections and are therefore more likely to cause bruising. Aestheticians need to discuss the pros and cons with the client and help them to understand both the end-result of the technique and any temporary draw-backs.

Needle Size

Some experienced aestheticians move to using cannulas rather than needles. Using a cannula to inject from a single entry point (the fan technique) can result in less bruising because there is only one injection site. However, this technique isn’t right for all patients or all technicians. 

Post-Treatment Care after Lip Fillers

Immediate Post-Treatment Care 

As an aesthetics practitioner, your job is not over once you have finished injecting the filler. After-care is an essential part of treatment and can make a huge difference to your patient’s experience.  

Ice

As soon as you have finished injecting the filler, and massaging the lips to position the filler as desired, you should apply ice or an ice pack to your patient’s lips. Ice works to reduce swelling, redness and bruising and is the best first step to stop any punctured blood vessels from leaking blood under the skin, causing bruising. Patients should keep using ice for at least the first 24 hours post-treatment, icing their lips for about ten minutes a time, every few hours.

Paracetamol

If your patient wants to take an over-the-counter painkiller to minimise soreness, they should avoid ibuprofen or aspirin for at least the first 48 hours. Only paracetamol has no blood-thinning side-effect so this is the only painkiller recommended for patients who have had fillers.

No make-up

Patients may be tempted to apply lipstick to disguise redness or swelling but they should keep their lips clean and bare for at least 24 hours after treatment. 

No alcohol

Patients may want to celebrate their treatment with a glass of champagne but drinking alcohol within the first 48 hours after treatment is very likely to make bruising and swelling worse.

Keep things cool

Heat on the lips (for example, sipping hot coffee), within the first 24 hours post-treatment is likely to increase swelling and bruising.

Healing at Home After Lip-Fillers 

In the first few days after treatment, patients can make small changes which will speed up recovery. 

Patients should avoid:

• Vigorous exercise for at least the first two days because it increases blood flow to the lips.
• Extreme heat for at least the first three days. That means no saunas, no sunbathing and no hot yoga.
• Any pressure on the lips for the first two days including kissing or touching the lips.
• Flying for at least a week after treatment. The air pressure can make bruising and swelling worse. 

Patients should:

• After the first 24 hours alternate between ice and a warm compress to encourage any bruising to heal.
• Drink plenty of water to minimise swelling.
• Use arnica cream to reduce swelling and ease pain.
• Sleep with an extra pillow to help blood to drain away from their lips. (And avoid sleeping face-down).
• Use aloe vera gel to soothe the lips.
• Take Vitamin K to help with blood clotting. Vitamin K is found in leafy, green vegetables but can also be taken as a supplement. 
• Eat pineapple. Pineapple contains bromelain, an enzyme that is thought to reduce swelling and inflammation.

Complications from Lip-Fillers 

Lip fillers are extremely safe and complications are very rare. However, it is important that patients are aware of the signs that they may need to seek medical attention.

If patients experience any of the following, rare, symptoms, they should immediately seek a medical consultation:

• Significant pain. This is pain that can’t be managed by taking paracetamol and doesn’t subside after a few hours. If a patient has serious pain and their lip whitens or turns purple they should seek help urgently as a blood vessel may be blocked.
• Worsening redness. Redness that doesn’t subside and which spreads to cover more of the face can be a sign of infection.
• Serious bruising. Very dark bruising, particularly if it covers a large area, might be a sign that a larger vascular vessel has been punctured with the needle. If a hard mass under the skin can be felt it is important that this is checked to make sure that it isn’t a haematoma as this can cause tissue damage.
• Stiff  lips. It is entirely normal for lips to be a bit stiff and even a bit lumpy immediately after fillers are injected. However, lumpy, uncomfortable, itchy lips can be a sign of an allergy to the filler used. 

The best way of avoiding complications is for patients to seek out well-trained and expert aesthetics practitioners. Most of the complications that arise are because of errors on the part of the practitioner including poor technique, lack of experience and a lack of understanding of the anatomy of the face.

Practitioners with both a back-ground in health-care and access to high-quality training, like those trained by Acquisition Aesthetics, will always be the safest choices for patients. Their knowledge and experience of how to work with facial structures will ensure the best aesthetic results and also maximise patient safety. 

Why Train with Acquisition Aesthetics

The popularity of lip fillers is only set to grow as more people understand how it can enhance their look and help create a youthful, attractive appearance. 

Training with Acquisition Aesthetics opens up a successful and sustainable career in aesthetics. Practitioners will be trained in all of the appropriate techniques for lip fillers and will learn how to use the knowledge of anatomy, patient care and safety that have come from their healthcare background to create brilliant results for patients.

 Our expertise in lip fillers ensures our trainees can stay ahead in this competitive and fast-changing market while also learning how to prioritise patient care and minimise the chances of bruising, swelling and more serious complications. 

Conclusion

Bruising after lip fillers is a normal and expected side-effect of treatment but practitioners with the right training and expertise have the skills to manage bruising and minimise its impact on their patients. 

By choosing aestheticians with excellent knowledge of facial anatomy and expert training in how to enhance the lips with fillers, patients can be confident that they will get the results they want with as few side effects as possible and minimal discomfort.

Practitioners who have trained with Acquisition Aesthetics have the skills and the know-how to treat patients with confidence and to enjoy a successful career in aesthetic medicine.