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Comment & Response
AAFPRS Research Award Winner
Jul/Aug 2017

Optimizing Injection Technique to Minimize Ecchymosis in Blepharoplasty—Reply

Author Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
JAMA Facial Plast Surg. 2017;19(4):339-340. doi:10.1001/jamafacial.2017.0620

In Reply We thank Vrcek et al for their comments about our recently published article.1 We appreciate the opportunity to reply.

We thank them for their precise and detailed description of their specific control injection technique: First, 10 minutes prior to injection, a topical anesthetic, composed of benzocaine, lidocaine, and tetracaine, is applied. Then a small-caliber (30-gauge) needle with a short length (0.5-in) is applied for the specific control injection technique, which allows for precise control of the tip and direction of the needle, avoiding injury to the orbicularis muscle. Next, they place the tip of the needle into the thin eyelid skin in the immediate subcutaneous plane superficial to the orbicularis muscle, taking care to avoid visible subcutaneous vessels. The anesthetic mixture consists of 1 mL of hyaluronidase and 5 mL of 2.4 mEQ sodium bicarbonate mixed into 50 mL of 2% lidocaine with 1:100 000 epinephrine, which is combined 1:1 with 0.5% bupivacaine. The hyaluronidase allows for a single injection site to facilitate delivery of anesthetic throughout the tissues to points distant from the initial injection site. Minimizing multiple injection sites decreases the overall risk of ecchymosis.