“The bruise is still there after two weeks” — the order bruising and swelling resolve
This is the message we get most often from the day after a treatment onwards. In most cases it is a course that simply needs to be waited out, and that is genuinely what we tell people. But there are cases where waiting is the wrong thing to do, and those look different. Below is what counts as a normal course, what does not, and how to tell the two apart.
The short answer
Bruising after an injectable treatment usually lasts one to two weeks, and up to three in slow-circulation areas such as under the eyes. If the colour is moving through red → blue → green → yellow, it is being reabsorbed and you can wait it out. Swelling is far quicker — usually two to five days. Conversely, if the treated area blanches white, if a net-like mottling appears, if pain gets worse rather than better as time passes, or if your vision changes, this is not a bruise. Do not wait; contact us immediately.
Why this needs saying
We say “you may get some bruising” when we explain a treatment beforehand. That one sentence, though, is of no help at all once the bruise actually appears. Without knowing how long it lasts, how it changes, and at what point it stops being normal, you can spend a perfectly ordinary recovery feeling anxious — and, when something really is wrong, tell yourself “it is probably just a bruise” and wait.
The most important part of this piece is the last two sections. Most of what comes before is reassurance; what comes after is what the cases you should not be reassured about look like. Please do not read the first half and close the page.
One note on scope: this piece is about recovery after injections and energy-based device treatments. Recovery after surgery or other procedures follows a different pattern.
Bruising and swelling are not the same thing
People often fold the two into a single word, but they have different causes and clear at different speeds. Separating them makes it much easier to place where you currently are.
| Bruise (ecchymosis) | Swelling (oedema) | |
|---|---|---|
| Cause | The needle catches a small vessel and blood pools under the skin | Fluid collects between tissues in response to the injected material |
| When it shows | Same day to next day. Usually looks darker on day two | Immediately after treatment. Generally peaks at 24–48 hours |
| How long | Usually 1–2 weeks; under the eyes up to 3 | Usually 2–5 days |
| Colour | Starts red and changes several times | Colour barely changes; only the volume goes down |
| On pressing | May be tender, but leaves no indentation | Depending on the area, a pressed mark may linger briefly |
A bruise clears in this order
What you see is the breakdown of the pooled blood showing through the skin as colour. The fact that the colour is changing at all means it is being reabsorbed. The sequence below is the general pattern; individual and site-to-site variation is wide.
| When | Colour | What is happening |
|---|---|---|
| Day 0–2 | Red · purple | Red cells that have left the vessel are still intact |
| Day 3–5 | Blue · deep navy | Haemoglobin loses its oxygen and darkens. This is the stage that looks worst, and the point at which people tell us it has “got worse” |
| Day 5–10 | Green | Haemoglobin is breaking down into biliverdin |
| Day 7–14 | Yellow · pale brown | Converted to bilirubin and absorbed — the final stage |
| After that | Gone | Slow-circulation areas such as under the eyes, the jawline and the backs of the hands can take up to three weeks |
When someone tells us “it is week two and it is still there”, the first thing we ask about is not the elapsed time but the colour. If it is heading towards yellow or pale brown, that is the last stage and waiting is right. But if two weeks have passed and it is still the original red or purple, that is a different matter and it should be looked at.
Why it varies so much between people
The same treatment at the same dose produces very different amounts of bruising. “My friend was fine and I am the only one with this” is usually not a sign that something went wrong, but a case of several of the following stacking up.
- Medication that thins the blood. On aspirin, antiplatelet or anticoagulant therapy, the same treatment bruises far more and for far longer. Supplements such as ginkgo, omega-3 and vitamin E, and a drink the night before, push in the same direction, if more weakly. But never stop a prescribed medication on your own judgement — we have written about this separately in eight things to tell your doctor before an injectable treatment
- The area. Under the eyes the skin is thin and the vessels dense, so it bruises most easily and lasts longest. The forehead, temples and area around the mouth come next; the cheeks are relatively less prone
- Needle or cannula. A blunt-tipped cannula pushes vessels aside as it passes, so it generally bruises less. But not every area can be treated with a cannula, and treatments that need to be laid down broadly in a superficial plane call for a needle
- Depth and plane of injection. Treatments placed densely in the superficial dermis create many tiny bleeding points by their very design. That is why pinpoint bruising can appear across the whole face after multi-point superficial injection treatments
- Age and skin condition. As the dermis thins with age and the tissue supporting the vessels reduces, vessels rupture more easily under the same stimulus. And the thinner the skin, the more visible the bruise that does form
- What you did straight afterwards. A sauna, hard exercise or alcohol on the day dilate the vessels and enlarge both bruising and swelling
It looks different depending on the product family
The seven boosters we use have different compositions, so the first few days after treatment look different too. The table below is a general tendency; even the same product behaves differently according to the plane and the volume placed.
| Family | Swelling | Bruising | Character |
|---|---|---|---|
| Cross-linked HA (BYRYZN) |
Present early on | Depends on the plane | It draws water, so for the first few days it can look larger than the volume actually placed. This is the only family that can be reversed with hyaluronidase |
| PN (Rejuran) |
Injection marks for a few days | Pinpoint | Placed densely in a superficial plane, so it leaves a number of small raised points. These usually flatten within 2–3 days |
| hADM (Re2O · CellREDM) |
Present | Depends on the area | These are particulate preparations, so something may be palpable early on; it generally settles with time |
| CaHA (Radiesse · DCLASSY) |
Present | Depends on the plane | Some of the volume seen immediately after placement settles as it beds in. Because there is no agent that dissolves it and reverses the result, the principle is not to overcorrect at the outset |
| Liquid PCL (GOURI) |
Less | Less | Being a particle-free liquid, we regard it as a family with a low risk of palpable nodules. “Low” does not mean “none” |
| RF · ultrasound devices (XERF · Density · Oligio Kiss) |
Redness and warmth on the day | Usually none | These use heat rather than a needle, so bruising is uncommon. The real risk in this family is not bruising but burns |
What helps, and what has thinner evidence than people assume
We are asked a great deal about how to clear a bruise faster. Honestly, time does most of the work and the range of what a person can do is not wide. Still, here is what points in the right direction and what rests on thin evidence.
| What | When | How we see it |
|---|---|---|
| Cold compress | First 24–48 hours | Constricts vessels, so it works towards less further bleeding and less swelling. Most useful immediately after treatment. Do not put ice directly on the skin — wrap it in a towel and keep it brief |
| Warm compress | After 48 hours | Increases blood flow, so it works towards reabsorbing blood that has already pooled. In the wrong order it makes things worse, so do not do this in the first two days |
| Sleeping with the head raised | First 2–3 days | Points in the right direction for facial swelling. It costs nothing and carries no risk |
| Arnica · bromelain | — | The studies conflict. There are small studies showing benefit and others showing no difference, so what we say is: use them if you like, but we cannot promise an effect |
| Laser for bruising | After a few days | There are reports that certain wavelengths speed up clearance of a bruise. But it is not needed for every bruise, and whether it is right to add another procedure to something that will resolve anyway is a judgement to make after looking at it |
| Rubbing hard | — | We do not recommend it. It can disturb where the material sits, and it can disturb vessels that are still healing |
This is not a bruise — when to contact us immediately
This is the most important part of the piece. The situations below do not improve by waiting, and the earlier they are dealt with the more the outcome differs. Contact us whatever the hour, night or weekend. If not us, then some other medical provider — but tell someone.
- The skin blanches white. One area going pale during or immediately after treatment — the earliest sign that a vessel has been compressed or blocked
- A net-like mottling appears. A red-to-purple pattern spreading like a net or the branches of a tree is not the shape a simple bruise takes
- Pain gets worse as time passes. Normally it hurts most right after treatment and improves from there. Pain going the other way, or pain out of proportion to the scale of the treatment, is a signal
- Blurred vision or eye pain. This is an emergency. Contact us and go to a medical facility immediately
- The area turns cold and a dusky grey-purple. Discoloration that darkens as time passes does not follow the colour sequence of a bruise
- Fever, or the area becoming hot with spreading redness, or pus. Infection has to be considered
- A firm lump that can be felt and is growing. This includes nodules appearing well after the treatment
- A bruise that is unchanged past three weeks, or is getting larger. Stalling with no colour change, or widening in area, needs checking
Why this distinction matters. Rarely, injected material can enter a vessel or press on one and block the blood flow. When that happens, cross-linked hyaluronic acid can be dissolved and reversed with hyaluronidase, and the sooner that is done the better the outcome. By contrast, CaHA and the other families have no dissolving agent. So there really are situations in which thinking “it is probably just a bruise” and waiting a few days costs you something. If it turns out to be nothing, so much the better — coming in to have it checked is not an imposition.
What we do before treating
Bruising is not something that can be eliminated; it is a matter of lowering the probability and the degree. Broadly, this is what we do at Miso Clinic.
- We ask about your medication first. Depending on the answer we change how the areas are planned, or, if you have something important coming up, suggest moving the date
- We choose between cannula and needle by area. Where bruising is likely, we favour a cannula as far as the treatment allows
- We check whether you have anything important in the diary. A wedding in a week and under-eye treatment on the same day is not a good combination
- We do not overcorrect. With families that cannot be reversed in particular, we build up across visits rather than filling in one go
Frequently asked questions
The bruise is still there in week two — should I come in?
The bruise is darker than it was at first — has something gone wrong?
Is there any way to clear a bruise faster?
Can I massage a bruised area?
How many days until the swelling goes?
When can I drink alcohol or exercise again?
I have a bruise — should I postpone my next session?
In what situations should I contact you immediately?
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. The clinic keeps seven collagen and skin boosters of differing composition and three lifting devices, and chooses between them according to the kind of ageing a face is going through. Our approach is unforced, natural-looking results, and we regard deciding to do less as part of the practice of medicine.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
| Other languages | 한국어 · 日本語 · 简体中文 · Español |
References
- The colour change of a bruise reflects the breakdown of haemoglobin in the pooled blood into biliverdin and then bilirubin. The time bands given above are a general tendency; variation between individuals and between sites is wide, so they are not a basis for promising exact dates.
- That a cannula bruises less than a needle is a tendency widely accepted in practice, but the result varies with the site treated, the plane of injection and the operator. It does not mean a cannula is better for every treatment.
- The effect of arnica and bromelain on bruising differs from study to study. Small studies showing benefit sit alongside studies showing no difference, so we have not stated an effect as settled in the text above.
- The early signs of vascular occlusion (blanching, reticulated mottling, worsening pain, visual disturbance) and hyaluronidase treatment for cross-linked hyaluronic acid are part of standard safety guidance for aesthetic injectables. Non-HA families including CaHA have no equivalent dissolving agent — a point recorded separately in the Radiesse and DCLASSY references.
- The table of recovery by family is a general tendency for the products Miso Clinic actually uses, and even the same product behaves differently according to the plane, volume and area. It is not a table for predicting an individual outcome.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician. If you think your situation falls under “when to contact us immediately” above, do not use this article to judge for yourself — contact a medical provider at once.