Does the Upside-Down Injection Trend Really Help Prevent Bruising? Doctors Weigh In

Bruising can be one of the most annoying parts of getting a neurotoxin injection. You’re excited for the results, but sometimes you have to wait for the bruises to clear to see them. Experts have found a myriad of ways to reduce the chances of bruising, from changing a patient’s diet ahead of injection to using super fine needles, but they’re always on the search for more. We recently heard about the upside-down injection technique and had to get to the bottom of what it is and how it could reduce bruising.

Featured experts

• Nina Hartman, MD is a board-certified dermatologist in Washington, D.C.
• Barry Weintraub, MD is a board-certified plastic surgeon in New York

What is the upside-down injection technique?

While the upside-down injection technique might sound whacky at first mention, experts say it’s a new name for something that’s been around for years. Upside-down injection “refers to injecting neuromodulators when a patient is positioned so that their feet are above the level of their heart—a position also known as the Trendelenburg position,” explains Washington, D.C. dermatologist Nina Hartman, MD.

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In contrast, most neurotoxin injections are “usually administered with the patient sitting upright, and without the ability to see the web of blood vessels of the forehead and face, making it more likely that the needle could puncture one of these vessels, causing bleeding to occur under the skin which translates into a bruise,” says New York plastic surgeon Barry Weintraub, MD, who says he’s been employing this technique for over 15 years.

What are the proposed benefits of this technique?

Ultimately, this technique helps make injection easier for doctors and you less likely for you to bruise. “In this position, gravity draws blood from the lower body toward the upper body, increasing venous pressure in the head and neck. Clinically, this results in distension of veins in the face so that they are more easily visualized and avoided when injecting the area with the neuromodulator needles to ultimately reduce the risk of bruising,” says Dr. Hartman.

The potential downfall? “The Trendelenburg position can be uncomfortable for some and can distort anatomy, which is counter-productive for certain types of injections,” says Dr. Hartman. On the other hand, Dr. Weintraub finds that many people find the position relaxing. “For patients who are needle phobic or nervous, lying in a relaxed position reduces anxiety and helps them to feel calmer.”

Other ways to prevent bruising

While a version of this position can be easily done in most exam chairs and can be helpful in some situations, Dr. Harman says there are plenty of other ways to reduce the risk of bruising. Dr. Hartman recommends avoiding alcohol and medications, supplements and foods that thin the blood.

Dr. Hartman notes that a skilled physician should be able to use small-gauge needles, inject slowly and gently, understand the anatomy and apply pressure and ice to help reduce bruising. Dr. Weintraub says, in addition to this technique, he uses needles finer than human hair to further diminish the chances of bruising. If bruises still pop up, Dr. Hartman says there are post-procedure hacks that can reduce the length of bruising, including lasers if necessary.