Dark periorbital bruising after Lateral Canthus injections: 

Bruising after lateral canthus (crow’s feet) neurotoxin injections is one of the most common complications of injections in this area.

When it happens, it can be especially distressing because blood can “track” along periorbital tissue planes and pool beneath the lower eyelid, producing a pronounced dark spot that may persist for weeks. 

Risk factors that increase likelihood or duration of periorbital bruising

-Age (thinner dermis and more fragile vessels)

-Anticoagulant or antiplatelet medications (including aspirin, NSAIDs, fish oil, some supplements like ginkgo)

-Recent alcohol intake 

-Thin periorbital soft tissue and prior periorbital surgery or trauma
Assess these factors in pre-treatment consent and advise patients on medication/supplement management as clinically appropriate and in line with their prescriber’s guidance.

Why these bruises look so dramatic 

-The periorbital skin is extremely thin with minimal subcutaneous padding. Superficial capillaries and small venules lie close to the surface, so even a small vessel nick can deposit blood that is visible through skin. The anatomy of facial and orbital venous connections makes the periorbital area especially prone to venous pooling and tracking. The angular, infraorbital and palpebral venous tributaries communicate with the orbital venous plexus, allowing blood to track along the orbital rim and settle under the lower eyelid. 

-Venous blood (deoxygenated) appears darker and can spread beneath gravity-dependent tissues. Because the eyelid skin is thin, pooled venous blood often presents as a dark, localised bruising inferior to the orbit the “under-eye black spot” some patients show at 1–3 weeks post injection. 

How common is this after lateral canthus (crows feet) neurotoxin injections?

- Bruising at the lateral canthus is the most commonly reported local adverse event in some studies of neurotoxin complications - for example, a retrospective series (n≈845) reported a 2.6% overall adverse event rate with bruising at the lateral canthal area featuring among the common local events. Wiley Online Library

-For context, bruising rates after dermal filler are higher with studies showing various figures between 19-68%. This highlights that injection type and depth matter when consulting patients about expected bruising risks. 

Immediate steps to reduce bleeding and limit haematoma formation

Firm, sustained pressure at the site - if bleeding is suspected during or immediately after injection, apply direct, steady pressure with sterile gauze for several minutes rather than quick intermittent pressure. This reduces local bleeding and limits the initial haematoma. 

Cold / ice pack -apply cold immediately and intermittently (10–15 min on, then off) in the first 24–48 hours to vasoconstrict and reduce extravasation. An appropriately sized lip/eye ice pack is useful for the lateral canthus and infraorbital area.

Check your technique - use fine-gauge needles, limit the number of passes, avoid deep tunnelling near the lateral canthus, and use slow injection technique. (Technique modification is the single best way to prevent most injection-related bruises.)

 Arnica, hydration, and ice

-Arnica : there is clinical and anecdotal support for topical arnica cream in accelerating bruise resolution and reducing inflammation following minor trauma and injectables. Your clinic’s Arnicare range is particularly well suited to periorbital aftercare because it combines Arnica montana with hydrating and barrier-supporting actives (hyaluronicacid, niacinamide, turmeric extract), helping both bruise resolution and patient comfort. Apply as directed once the immediate fresh bleeding risk is reduced (commonly from day 1–2 post-procedure onward) and continue through the first 7–14 days as needed.

-Ice packs: continue intermittent cooling for the first 48 hours if swelling is present. The Arnicare lip-shaped ice pack (or a small, clean cold compress) is ideal for targeted application to the lateral canthal/infraorbital region.

When to escalate treatment? persistent, dark, well-defined bruises at 2 weeks

If the patient returns at the 2-week follow up with a discrete very dark (purple/black) spot under the eye that has not shifted or faded, consider escalation because natural resolution may be slow in the periorbital tissues. Two options depending on what is available in your clinic  are LED and light/vascular devices (IPL, PDL, vascular lasers):

LED 

-Rationale & evidence: Photobiomodulation (LED at red/near-infrared wavelengths) stimulates cellular metabolism (mitochondrial activity), increases local microcirculation, reduces inflammatory cytokines and can accelerate tissue repair. Systematic reviews of LED show benefits for skin healing and improving inflammation and repair metrics in multiple RCTs and trials. 

Vascular-targeted light devices (PDL / IPL / 532 nm / vascular lasers)

-Rationale & evidence: Vascular lasers/IPL target haemoglobin, causing photocoagulation or breakdown of the extravasated blood and injured capillaries, accelerating clearance of ecchymosis. Series and case reports have documented rapid improvement in bruising after IPL or pulsed dye laser (PDL) treatments, with visible clearing starting within hours to days after a session in some reports. PDL is often described as a gold standard for superficial vascular purpura in dermatology literature. JDDonline+1