KKORETREAT
AC-002 · v1.4EN / ES01 / 03
Clinical protocol · BiViDerma III / V

Mid-face
bruising protocol.

A two-sided, evidence-aligned protocol for minimising and managing bruising in mid-face dermal filler treatments. For clinician reference and patient handoff.

Risk

Why mid-face?

The mid-face contains the facial, transverse facial, and infraorbital vessels in close proximity to common injection planes. Bruise incidence in published series ranges 18–34%.

Window

Critical 7 days.

Most prevention happens in the 7 days before treatment. Most management happens in the 72 hours after.

Cannula

First-line tool.

25G blunt-tip cannula reduces bruise rate by ~40% in the mid-face vs sharp needle in head-to-head data. Default for cheek, NLF, marionette.

Vascular emergency takes precedence

Blanching, severe pain disproportionate to procedure, or skin discolouration with delayed capillary refill is presumed vascular occlusion until proven otherwise. Stop. Aspirate. Hyaluronidase. Warm compress. See page 3.

Koretreat Market SAS · ARCSA-2023-3.3-0000041For clinical use
KKORETREAT
AC-002 · Mid-face bruising02 / 03
Phase 1 · Prevention

Seven days before treatment.

Discontinue (with patient's GP)

  • NSAIDs (ibuprofen, naproxen, aspirin*) — 7 days prior.
  • Fish oil / omega-3 supplements — 7 days prior.
  • Vitamin E > 400 IU — 7 days prior.
  • Ginkgo biloba, garlic, ginseng — 7 days prior.
  • Alcohol — 48 hours prior.
  • *Cardiac aspirin: do not discontinue without GP approval.

Consider adding

  • Arnica montana oral, starting 5 days prior, continuing 3 days post.
  • Bromelain 500 mg/day, starting 3 days prior.
  • Vitamin K topical, applied to treatment areas 3 days prior.
Evidence is moderate. Discuss with patient; not mandatory.
On the day

Pre-procedure setup.

  1. Mark anatomical landmarks with patient upright: facial artery (1 cm lateral to oral commissure), infraorbital foramen (vertical line from medial limbus, 1 cm below inferior orbital rim), transverse facial artery.
  2. Photograph the rested face at 0°, 45°, 90° angles. Standardised lighting. This is your medico-legal baseline.
  3. Cleanse with chlorhexidine 0.5% in 70% ethanol. Avoid betadine in mid-face — staining and possible iodine sensitivity.
  4. Apply topical anaesthetic (lidocaine 4% / prilocaine 2.5%) for 20 minutes. Remove fully before injection.
  5. Select cannula 25G × 50 mm as default for mid-face. Use 27G needle only for precise periosteal boluses and isolated lines.
  6. Aspirate before each injection with a sharp needle. Hold 5 seconds. No aspiration on cannula.
  7. Inject slowly — < 0.3 ml/min. Move continuously when injecting on the move. Never bolus on retraction without a fanning pattern.
Clinical · Mid-face bruisingv1.4 · 2026
KKORETREAT
AC-002 · Mid-face bruising03 / 03
Phase 2 · Management

Bruising vs occlusion. Decide fast.

Differentiating bruise from vascular occlusion

SignBruiseOcclusion
OnsetMinutes to hoursImmediate or < 1 hour
PainMild / tenderSevere, disproportionate
ColourRed → purple → yellowBlanched white, then dusky / mottled
Capillary refill< 2 s> 3 s, sluggish
CourseResolves over 7–14 daysWorsens without intervention

Bruise — routine management

  1. Firm pressure for 60 seconds at injection site.
  2. Intermittent cold compress, 10 min on / 10 min off, first 4 hours.
  3. Topical arnica gel 2–3× daily from 24 h.
  4. Pulsed-dye laser at 48–72 h accelerates resolution (optional).
  5. Review at 7 days. Document with photography.

Occlusion — emergency algorithm

  1. Stop injection immediately. Do not continue.
  2. Hyaluronidase 200–450 U at the affected territory. Larger volumes for proximal vessels.
  3. Massage firmly after hyaluronidase to disperse.
  4. Warm compress to encourage vasodilation.
  5. Aspirin 325 mg chewed (unless contraindicated).
  6. Reassess every 60 minutes. Repeat hyaluronidase if no improvement.
  7. Hospital referral if symptoms persist > 4 hours, or for any visual symptom.

Documentation

Every adverse event must be documented in the patient record with photography, time of onset, intervention, and outcome. Report to Koretreat pharmacovigilance within 48 hours; ARCSA notification is handled on the practitioner's behalf.

Koretreat Market SAS · ARCSA-2023-3.3-0000041AC-002 · v1.4 · 2026