Tumescent Cervicofacial Rhytidectomy

A modification of the tumescent technique for body contouring has been adapted for patients undergoing face lift. Thirty women, average age 56 years, were prospectively studied, with a 1-year follow-up. All surgery was performed in a private ambulatory operating room facility. The patients were under intravenous sedation with a board-certified anesthesiologist in attendance at all times. The preferred solution was 0.3% lidocaine 1/250,000 epinephrine (average volume injected 500 mL). The solution was a mixture of Ringer's lactate 400 mL plus 2% lidocaine 50 mL and 1% lidocaine 50 mL plus 1:1000 epinephrine 2 mL. The average lidocaine dose per patient was 29.4 mg/kg. Serum lidocaine levels demonstrated a 1-hour peak at 2.7 microg/mL (no value exceeded 3.3 microg/mL). The technique began with superficial liposculpture followed by independent skin-lateral superficial musculoaponeurotic system-ectomy/platysmaplasty with wide skin undermining. Average operating time was 1 hour and 48 minutes. No operative complications were encountered. Excellent anesthetization was achieved in all patients without postoperative hematomas or nerve injuries. Tumescent cervicofacial rhytidectomy has been found to be a safe and effective rhytidectomy procedure that offers several advantages when compared with nontumescent techniques: avoidance of general inhalational agents, reduced operative bleeding and operative time, improved technical ease of superficial liposculpture and surgical dissection, and minimal postoperative bruising and swelling.