Preoperative marking for liposuction of the face and neck

Before the submental contouring surgery, the areas of fat tissue growth and important facial anatomical landmarks such as the sternocleidomastoid muscle, hyoid bone, and mandibular angle are marked in the preoperative room. This is done with the patient in a sitting position. Preoperative marking is necessary because when the patient lies on his back on the operating table, fat deposits shift and may become unnoticeable. Before local anesthesia is administered, the incision sites in the submental area and under the ear are also marked. Patients with prominent submandibular salivary glands should be warned that they will not decrease in size and may become even more noticeable after liposuction in the submandibular and submental areas.

In most cases of liposuction, the subcutaneous tunnels extend laterally to the sternocleidomastoid muscle and inferiorly to at least the hyoid bone. The submental fat is usually located centrally, so that the preparation and suction within these boundaries serve a smoothing function, and most of the fat deposits are suctioned away from the problem area. Markings should indicate the area in which liposuction is needed to create a smooth contour transition. When jaw contour restoration is required, access can be achieved through an incision under the ear or in the nasal vestibule using very fine cannulas and low pressure to prevent excessive suction or nerve damage.

The importance of preoperative marking cannot be overstated. Careless marking can lead to asymmetry and unwanted contour deformation. Protruding platysma bands and hanging skin folds should also be marked before surgery for better orientation during their correction.

Anesthesia for 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 even prefer general anesthesia. When liposuction is combined with other rejuvenating surgeries, such as rhinoplasty or rhytidectomy, patients usually prefer general anesthesia.

The tumescent technique on the face and neck, which is not often used in our practice, consists of using mixtures of 0.5% lidocaine with 1:200,000 adrenaline and hypotonic saline. If the patient is under anesthesia, the diluted adrenaline solution is used by infusion. In addition to local infiltration, a blockade of 0.25% bupivacaine hydrochloride (Marcaine) with adrenaline is used at Erb's point, in the area of the submental nerve and around the area planned for treatment, which ensures longer anesthesia. After the introduction of the solutions, it is important to wait 15 minutes for the vasoconstrictor and anesthetic effect of the hypotonic solution to develop. If the hypotonic solution is not used, anesthesia and vasoconstriction are provided by infiltration of 1% lidocaine with adrenaline 1:100,000. Regional blocks are also used with this technique. Typically, 15 to 20 ml of anesthetic is injected into the neck, with an additional 10 ml injected into each area of the face. Surgical planning should include a detailed list of the maximum dose of anesthetic for the patient, with basic resuscitation supplies on hand. If an assistant is preparing anesthetic solutions, each syringe should be labeled accordingly.

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