Cervicofacial liposuction is usually performed with local infiltrative anesthesia and in addition may require intravenous sedation. Patients have a choice, however, and some even elect for a general anesthetic. When the technique is combined with other facial rejuvenation procedures, such as rhinoplasty or rhytidectomy, patients have usually already. elected for a general anesthetic.
A tumescent technique in the face and neck-although not frequently used in our practice-consists of varied mixtures of 0.5% lidocaine with 1:200,000 epinephrine and hypotonic saline. If the patient is under a general anesthetic, a dilute epinephrine solution is infused. In addition to local infiltration, regional blocks with 0.25% bupivacaine hydrochloride (Marcaine) with epinephrine at Erb's point, in the area of the mental nerve, and circumferential to the planned treatment area will provide longer term definitive anesthesia. It is important to allow 15 minutes by the clock for the vasoconstrictive and anesthetic effects of the tumescent solution to be effective. Anesthesia and suitable vasoconstriction in the nontumescent technique are provided by injection of 1% lidocaine with 1:100,000 epinephrine as field infiltration. Regional blocks are also used in this technique. It is not uncommon in the neck to infiltrate 15 to 20 cm3 of anesthesia and an additional 10 cm3 for any areas of concern in the face proper. Pre-procedure planning should include detailed medication lists noting the patient's maximum local anesthetic dose, keeping the basic resuscitation drugs available as well. If an assistant prepares the anesthetic solutions, all syringes should be labeled at the time of preparation.
