Thank you for your question!
You submitted a photo and a question supporting the photo where you’re asked why were you
told that bruising wouldn’t occur and then once you got a Botox™ injection at your
dermatologist’s office which was done incidentally at the same time as you were having a medical
procedure for your forehead. And of course you state that you developed swelling and
a bruise that resulted in you having to change the way you are working because of your work
as a psychoanalyst.
Well certainly, I can help you with this question. I’m a board certified cosmetic surgeon and
fellowship trained facial and oculofacial plastic and reconstructive surgeon practicing
in Manhattan and Long Island for over 20 years and I have been treating patients with Botox™
since the early 90s. In fact, our specialty, oculofacial plastic surgery, were amongst
the first physicians to use Botox™ for the treatment of medical conditions such as benign
essential blepharospasms and then naturally, as the popularity of Botox™ in the cosmetic
realm expanded to where it is today, certainly, I’ve had tremendous experience in this area.
So now, the context in which you got this injection certainly raises some concerns.
It’s something that I hear a lot about when patients come to me. The challenge for people
who go to a dermatologist and I don’t mean to disparage dermatologists in general but
there is a certain amount of consistency in what I hear when I hear questions like this.
A lot of times dermatologists are very busy. They have big practices, they see a lot of
patients and they bounce from room to room really fast. And in the interest of maximizing
maybe a patient’s convenience or introducing them to an anesthetic procedure, whatever
the reason or motivation, a lot of times, I think the consultations are a bit rushed.
I’ll show you in contrast how we take care of patients in our practice and how sometimes
this type of situation can be avoided.
To begin with, let’s start with just the possibility of a bruise. As a reminder again,
I’m a cosmetic oculofacial plastic surgeon. That means I trained in eye surgery and I
did specialty training through the American Society of Ophthalmic Plastic and Reconstructive
Surgery of surgery around the eyes, the eyelids, the orbit, the lacrimal system. So I certainly
know my way around eyes. And I can tell you, I can never guarantee to anybody that they
won’t bruise no matter how good I am at delivering injections in this area. The reality
is that the eyelid area is vascular and there’s always a possibility. Very often, when patients
come to me, they’ll be nice about the results I give them and once of the things they’ll
say is “Oh, you’re a very good doctor. You didn’t give me a bruise.” And honestly,
it’s not being about a good doctor but sometimes it’s a combination of course of using the
right type of instrumentation and a gentle touch which is fine but it doesn’t mean
that I have the ability to see every capillary that runs through the delicate eyelid skin
and I do occasionally create bruises.
So I think what was the challenge here was there wasn’t preparation for the possibility
of a bruise. When I talk to patients about doing Botox™ or any injectable for the first
time, I discuss the possibility of a bruise and I ask what’s their situation or the
context of what they do. I explain that if they have to see patients, if they have to
meet with people, if they have to speak in front of people, if they have to appear in
media then you don’t want to do something when there’s a risk of a bruise that can
really impact how things are going in the other parts of your life. I think that what
was not considered was this possibility and of course Murphy’s law, you got a hematoma
or a local collection of blood which eventually spread downwards and makes you look like you
were on some type of altercation.
The bruise will of course clear up. I find that sometimes, women handle this a little
bit with greater facility because they’re used to applying makeup and probably they’re
used to having these injections when we talk about the risk of bruising. So yes, you can
get a bruise and female patient may say “Well, yes I understand but I’m pretty good with
covering with makeup.” So there’s a dialogue and so I think that unfortunately, your first
experience with Botox™ was a negative experience. I would say that don’t let this be the only
experience for you but in the future, you may want to have this procedure done with
the understanding that maybe you’ll have a day or two off. A lot of times I tell my
patients who work Monday to Friday that come to the office on a Friday and that way, you
can try whether it’s the first time or just for the sake of convenience, you’ll have
Saturday and Sunday in case you get a bruise. And it is rare to get a significant bruise
like you have but certainly, this was not an emergency and so I think a little discussion
might have had some value before this. Now of course this assumption I’m making, based
on your question, I wasn’t there on your consultation.
So again, the risk of bruising is always a possibility any time anyone enters a skin
with a needle. And so, that’s something to be mindful of but otherwise, Botox™ is
the number one non-surgical cosmetic procedure for a lot of good reasons. It’s very effective,
it’s very useful and makes people extremely happy so hopefully you’ll learn something
from this experience and you may want to discuss this with your dermatologist next time you
see the doctor.
So I hope that was helpful, I wish you the best of luck and thank you for your question!