rimonidine, a selective α-2 adrenergic receptor (AR) agonist, causes direct vasoconstriction of cutaneous vessels and has been approved for the treatment of persistent facial erythema of rosacea. 1 The use of topical adrenergic agonists as hemostatic agents has been well utilized by nasosinal surgery 2 and ophthalmology. 3 Two of us (R.S. and E.W.) 4 previously reported the use of topical brimonidine, 0.33%, gel in controlling mild postoperative bleeding after Mohs micrographic surgery (MMS). Herein, we report 2 cases of altered mental status likely secondary to central nervous system (CNS) depression after the use of topical brimonidine, 0.33%, gel for hemostasis.

This technique of using local 1% lidocaine allows the practitioner to devise a neurotoxin distribution map tailored for each patient to limit unwanted paralysis from improper neurotoxin placement.