What are the treatment recommendations for facial bruising?

Treatment Recommendations for Facial Bruising

The treatment of facial bruising should focus on local application of cold, compression, and elevation as the primary interventions to reduce swelling and prevent further complications. 1

Assessment of Facial Bruising

Before initiating treatment, it's important to determine the cause of facial bruising:

• Evaluate if bruising may be related to child maltreatment, especially in children under 24 months with bruising in concerning locations (cheek, eye area, ear, neck) 2, 3
• Consider potential underlying medical conditions that may predispose to easy bruising, such as bleeding disorders 4
• Assess for more serious injuries that may be associated with facial bruising 5

First-Line Treatment Recommendations

Immediate Care (First 24-48 Hours)

• Apply cold compresses to the bruised area for 15-20 minutes at a time to reduce blood flow and minimize swelling 1
• Maintain gentle compression when possible to limit extravasation of blood 1
• Elevate the head to reduce blood flow to the facial area 1
• For patients who receive injections in the facial area (such as cosmetic treatments), apply pressure for 5-10 seconds if bleeding occurs 2

Subsequent Care

• After 48-72 hours, switch to warm compresses to help increase blood flow and accelerate healing 1
• For patients with frequent or excessive bruising, carefully assess injection technique if applicable, and evaluate for possible coagulopathy or use of anticoagulant medications 2

Special Considerations

For Children

• In children under 6 months with facial bruising, consider skeletal survey to rule out non-accidental trauma 2
• For children 6-12 months, skeletal survey is necessary if bruising is located on the cheek, eye area, ear, or neck 2
• Reassure parents that minor bruising typically heals without complications 5

For Patients Receiving Cosmetic Treatments

• Patients should be warned about potential bruising and swelling when receiving treatments in the periocular region 2
• When performing injections in facial areas:
  • Use small gauge needles (30G) for periocular treatments 2
  • Count to 10 after injection before removing the needle to prevent leakage 2
  • Reassure patients that local bruising does not adversely affect clinical outcomes 2

Wound Care for Associated Injuries

• Clean superficial abrasions or lacerations associated with facial bruising using clean water 5
• Remove all foreign material from wounds 5
• For deeper wounds with suspected damage to nerves or blood vessels, formal exploration under anesthesia may be required 5

When to Refer

• Refer to a hematologist if bruising is recurrent, extensive, or disproportionate to the injury 4
• Consider referral to appropriate specialists if bruising is associated with underlying medical conditions 4

Common Pitfalls to Avoid

• Don't assume all facial bruising is benign, especially in young children or elderly patients 2, 6
• Avoid dismissing bruising that follows unusual patterns or appears in locations uncommon for accidental injuries 3
• Don't overlook the possibility of post-mortem extravasation of blood simulating antemortem bruising in forensic cases 6