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The custom infraorbital-malar implant is the most effective approach to treating undereye hollows and in creating a specific cheek augmentation look. (high cheekbone look) It provides a linear line of bone augmentation from the nose to the end of the zygomatic arch. 

In placing such an implant through a lower eyelid incision the pocket dissection is considerable. As a result the swelling after the surgery is visually significant being right in one’s line of vision. While there are some employable strategies to help with the swelling resolution, the most aesthetically troublesome part of the swelling is the bruising that often accompanies it. Such bruising gets trapped in the lower eyelid tissues and clearance out of them can be slow…often longer than the swelling itself.

While lidocaine and epinephrine injections prior to making the eyelid incision is a standard strategy for reducing intraoperative bleeding, it alone does not provide assurance that considerable postoperative bruising will not occur.An additional strategy to use is Tranexamic acid. (TXA) This is an anti-bleeding solution that works as a clot stabilizer. This solution has come into vogue in plastic surgery, particularly in facelift surgery to reduce bleeding both intra- and post. Some prefer to inject it, similar to that of lidocaine and epinephrine, while others apply it as a topical solution.

To reduce how much postoperative bleeding/bruising occurs in custom infraorbital-malar implants, I use TXA-sponges. Once the dissection is done on one side a TXA-soaked sponge is placed into the pocket. It remains there until the other side pocket dissection is done and then it is packed. The sponges are then removed to allow placement of the implants.

In my experience so far with this topical solution I have seen less postoperative lower eyelid/chee bruising. Even a small amount of reduction is of benefit in the lower eyelid where heme clearing can be slow and its presence visually unavoidable.      

Dr. Barry Eppley

Indianapolis, Indiana

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