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Original Investigation
Mar/Apr 2017

Occurrence of Bruise, Hematoma, and Pain in Upper Blepharoplasty Using Blunt-Needle vs Sharp-Needle Anesthetic Injection in Upper BlepharoplastyA Randomized Clinical Trial

Author Affiliations
  • 1Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Plastic and Reconstructive Surgery, Shanghai, China
  • 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
JAMA Facial Plast Surg. 2017;19(2):128-132. doi:10.1001/jamafacial.2016.1376
Key Points

Question  Is there a difference between occurrence of hematoma and pain in upper blepharoplasty using blunt- vs sharp-needle injection of local anesthesia?

Findings  In this randomized clinical trial of 44 women who underwent blepharoplasty with sharp-needle anesthesia injection in one eyelid and blunt-needle injection in the other, hematoma occurred at the sharp-needle site in 11 patients (25%) vs 0 patients at the blunt-needle site. The mean visual analog scale pain scores were 5.48 and 4.64 at the sharp- and blunt-needle sites, respectively.

Meaning  The use of blunt-needle injection for anesthesia administration in upper blepharoplasty may cause fewer complications and allow more accurate and refined work with faster patient recovery.


Importance  Though it has been a common practice to use sharp needles to administer local anesthesia for upper blepharoplasty, the evidence for their benefit is lacking.

Objective  To evaluate whether there is any benefit of using blunt-needle injection for local anesthesia when performing upper blepharoplasty to reduce postoperative bruise, hematoma, and pain.

Design, Setting, and Participants  Randomized clinical trial of 44 patients who underwent bilateral upper blepharoplasty in an academic medical setting were randomized to receive local anesthesia injections (lidocaine, 2%; 27-gauge needle) with a blunt needle in one eyelid and a sharp needle in the other eyelid.

Main Outcomes and Measures  Visual analog scale (VAS) score of 0 to 10 (lower score indicating lower level of pain) was used to blindly assess pain in patients receiving anesthesia injections with both needle types. After injection and skin incision, photographs of the eyelids of each patient were taken and used by 2 blinded observers to identify bruise or hematoma.

Results  In the 44 patients (88 eyelids) included in the study (all women; mean age, 31 years; age range, 18-56 years) bruise or hematoma occurred at the sharp-needle injection site in 11 women (25%) vs 0 women at the blunt-needle site (P < .001). The mean VAS scores were 5.48 and 4.64 for pain assessed at sites of sharp- and blunt-needle injections, respectively (P = .002).

Conclusions and Relevance  Use of blunt needles to administer local anesthesia when performing upper blepharoplasty is less likely to cause hemorrhage and require interventional pain procedures than use of sharp needles. Therefore, for a more accurate surgical procedure and faster recovery, a blunt needle may be a preferable choice. The use of the blunt needle presents fewer complications and allows more accurate and refined work with faster patient recovery.

Level of Evidence  1.

Trial Registration  Chinese Clinical Trial Registry identifier: ChiCTR-ONC-16007979