Preoperative marking for face and neck liposuction

Before the operation of changing the contour of the sub-chin area in the preoperative room, the zones of growth of adipose tissue and important anatomical landmarks on the face are marked, such as the sternocleidomastoid muscle, the hyoid bone and the angle of the lower jaw. This is done in the patient's sitting position. The need for pre-operative marking is due to the fact that when the patient lies on his back on the operating table, fat accumulations are shifted and can become invisible. Before performing local anesthesia, there are also places of incisions in the sub-chin and under the ear. Patients with protruding submandibular salivary glands should be warned that they will not decrease in size and may even appear more after liposuction in the submaxillary and sub-chin areas.

In most cases, liposuction, the subcutaneous tunnels spread laterally to the sternocleid-pectoralis muscle and down, at least to the hyoid bone. The sub-chicken fat is usually centrally located, so that dissection and suction, within these boundaries, perform the smoothing function, and most of the fat deposits are sucked from the problem area. Marking should indicate the area in which liposuction is needed to create a smooth contour transition. When the restoration of the jaw contour is required, access can be made through an incision under the ear or on the eve of the nose with the help of very thin cannulas and under low pressure to prevent excessive suction or damage to the nerves.

The importance of pre-operative labeling can not be overemphasized. Negligent marking can lead to asymmetry and undesirable deformation of the contour. The protruding cords of the hypodermic neck muscles and hanging skin folds should also be labeled prior to surgery for better orientation when correcting them.

Anesthesia with Liposuction on the Face and Neck Liposuction on the neck and face is usually performed under local infiltration anesthesia and may additionally require intravenous sedation. However, patients have the right to choose, and some are even inclined to general anesthesia. When liposuction is combined with other rejuvenating operations, such as rhinoplasty or rhytidectomy, patients usually prefer general anesthesia.

Tumescence technique on the face and neck, which is not often used in our practice, consists in using solutions of 0.5% lidocaine with adrenaline 1: 200000 and hypotonic saline solution. If the patient is anesthetized, the diluted solution of epinephrine is used infusion. In addition to local infiltration, 0.25% solution of bupivacaine hydrochloride (marcaine) with epinephrine at the Erba point, in the region of the sub-chin nerve and around the area planned for treatment is applied, which provides a longer anesthesia. After the administration of solutions, it is important to wait 15 minutes to develop a vasoconstrictor and anesthetic effect of the hypotonic solution. If hypotonic solution is not used, anesthesia and vasoconstriction are provided by infiltration of a 1% solution of lidocaine with adrenaline 1: 100,000. With this technique, regional blockades are also used. Usually, 15-20 ml of anesthetic is added to the neck, supplemented by the introduction of another 10 ml into each operative area on the face. The planning of the operation should include a detailed list of drugs with the maximum dose of anesthetic for this patient; at the same time at hand should be the basic means for resuscitation. If the anesthetic solution is prepared by an assistant, each syringe must be appropriately labeled.

[1], [2], [3], [4], [5], [6], [7], [8]