INTRODUCTION
Liposuction was first introduced by Drs. Arpad and Georgio Fischer in 1976.1 Prior to Fischers’ method, excess fat was removed by excision lipectomy or curetted through small incisions.2 They also introduced blunt cannula liposuction and the criss-cross technique. Fournier was another early pioneer who favored syringe liposuction. Illouz, a French gynecologist, utilized Fischers’ technique with the Karman cannula and introduced the “wet technique” of injecting hypotonic saline and hyaluronic acid directly into fat prior to liposuction. The wet technique was popular in Europe while the “dry technique” was more common in the United States until Klein’s introduction of tumescent local anesthesia. The dry technique necessitated general anesthesia with minimal local anesthesia, which led to increased risk of significant blood loss.Several American dermatologists including Asken, Stegman, and Tromovitch first experimented with local anesthesia for liposuction in the early 1980s. Jeffrey Klein performed his first liposuction case under tumescent local anesthesia in 1985. The benefits of liposuction with tumescent local anesthesia include removal of large volumes of fat with minimal blood loss, decreased postoperative morbidity, and a high safety profile. The tolerance of tumescent local lidocaine dosed at 35 mg/kg was described by Klein in 1990.3 The safety of even higher doses of tumescent local anesthesia, 55 mg/kg, was reported by Ostad, Kageyama, and Moy.4 Hanke, Bernstein, and Bullock published on rare and minor complications, and lack of overall major complications in 15,336 patients.5The neck is one of the most common areas treated by liposuction. In the submental region, liposuction decreases fat volume and leads to skin contraction. These effects lead to improved cephalometric parameters, elevation of the perceived cervical point, and reduction of the cervicomental angle.6 In addition, liposuction can restore a more youthful appearance to the neck including a defined lower mandibular border, visible thyroid cartilage bulge, and visible anterior border of the sternocleidomastoid muscle. Tumescent liposuction of the neck is a safe procedure when performed properly. With tumescent local anesthesia, oral sedatives can be avoided. Additionally, low volumes of tumescent local anesthesia are required for neck liposuction leading to reduced risk of systemic toxicity. This report documents the low surgical complication rates of temporary and permanent marginal mandibular nerve injury, over-resection of fat, bleeding, hematoma, seroma, post-inflammatory hyperpigmentation, infection, and scarring in patients who undergo neck liposuction with tumescent local anesthesia.Standard Technique for Liposuction of the Neck Using Tumescent Local AnesthesiaThe ideal patient is in good general health and has excess submental fat and good skin quality. However, patients with lesser amounts of fat and skin laxity can also achieve considerable improvement following liposuction.A routine physical examination and blood coagulation studies are performed. The submental fat compartment is identified clinically and is outlined with Gentian Violet. The skin markings may be extended to the jawline and jowls if appropriate. The skin is washed with antibacterial soap. A small area of submental skin is infiltrated with 1% lidocaine with 1:100,000 epinephrine. A small stab wound is made and the neck is slowly infiltrated with tumescent local anesthesia (0.05-0.1% lidocaine with 1:100,000 epinephrine) using a 2.0 mm in diameter
