Anesthetic injection pain and hematoma occurrence during upper blepharoplasty: Comparison between thin needles and thick needles

Background: Upper blepharoplasty is one of the most commonly performed esthetic surgeries, but injection pain during local anesthesia often disturbs patients. The objective of this study was to identify the pain levels associated with anesthetizing the upper eyelids in blepharoplasty and determine whether injection with thin needles is associated with less pain and bleeding than injection with thick needles. Methods: The study included 50 patients who underwent bilateral upper blepharoplasty. The eyelids were anesthetized using 2% lidocaine with 1:100 ​000 epinephrine. One upper eyelid was randomly injected with a thin needle (26G) and the other with a thick needle (22G). The pain level was scored by patients immediately after the injection of each eyelid using a visual analog scale (VAS) ranging from 0 to 10. The incidence of eyelid hematomas caused by the anesthetic injection was also recorded. Results: The VAS scores in eyelids injected with thin needles were not significantly lower than those in eyelids injected with thick needles (4.0 vs. 4.0, P=0.393). The formation of eyelid bruises caused by thin-needle injection was less frequent than that caused by thick-needle injection (16% vs. 26%), but there was no significant difference between the two groups (P=0.326). Conclusion: Using thin needles for local anesthesia during upper blepharoplasty could not significantly decrease injection pain or hematoma occurrence compared with that associated with using thick needles