BACKGROUND: Eyelid surgery is one of the top five aesthetic procedures. It is performed to improve both appearance and function, but intraoperative bleeding leads to adverse events which perturb patients. The objective of this study was to demonstrate the efficacy of TXA combined with epinephrine in decreasing intraoperative blood loss and postoperative inflammation.
METHODS: This prospective randomized control trial was performed on the 30 eyelids of 15 patients who underwent upper blepharoplasty. One of each patient\'s eyes was randomly assigned to the TXA group, and the other eye was in the control group. Eyes in the TXA group were given 2% lidocaine with epinephrine (1:100000) mixed with TXA (50 mg/ml) in 1:1 mixture subcutaneously as a local anesthetic. The eyes in the control group received 2% lidocaine with epinephrine (1:100000) diluted with normal saline in 1:1 mixture. Intraoperative blood loss and postoperative swelling were compared between the two groups.
RESULTS: Intraoperative blood loss was significantly higher in the TXA group [4.86 (1.83) ml] than it was in the control group [2.53 (1.49) ml] (p < 0.001). There was no statistically significant difference between the two groups in operative time (p = 0.645), pain score (p = 0.498), lid crease (p = 0.548), or MRD1 (p = 0.626). On postoperative day 7, there was no difference in lid crease (p = 0.879), MRD1 (p = 0.463), pain score (p = 0.934), or ecchymosis (p = 0.976) between two groups.
CONCLUSIONS: TXA in lidocaine with epinephrine was found to increase intraoperative bleeding compared to lidocaine with epinephrine alone, but there was no difference in postoperative swelling or ecchymosis. TXA combined with lidocaine and epinephrine injected subcutaneously should be avoided until additional relevant data are obtained. Further drug interaction study is needed.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications.
We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision.
A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software.
Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively.
Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .