Anesthesia Options in Endoscopic Forehead Lifting

Abstract

Endoscopic forehead elevation can be comfortably performed under general anesthesia or local anesthesia with monitored anesthesia care. Regardless of the method chosen, local anesthesia should be administered to the forehead region to aid with hemostasis during the procedure and postoperative analgesia. Two techniques are available for the administration of the local anesthesia. The first is to administer lidocaine with epinephrine along the superior orbital rims and over the sensory nerve bundles and incision sites. A more dilute lidocaine with epinephrine solution is then administered throughout the rest of the forehead site. Bupivacaine with epinephrine can also be used to provide postoperative analgesia. The second technique is the creation and administration of a dilute tumescent solution of lidocaine with epinephrine under the forehead flap and temporal regions. A straight liposuction punch and cannulas attached to a syringe are utilized to place the dilute solution under the flaps. This technique has the advantage of fewer needle sticks, and it aids dissection of the flap since fluid is placed in the correct plane. The orbital rims and incisions sites are injected with higher-strength lidocaine with epinephrine since these sites undergo the most vigorous dissection. Regardless of the technique chosen, one must be careful to avoid local anesthetic and epinephrine toxicity. Depending on the strength of the solution chosen, the lidocaine typically becomes toxic before the epinephrine with the local anesthetic technique. With the tumescent technique, the epinephrine typically becomes toxic before the lidocaine. However, with the solution strengths and techniques discussed in this chapter, the amounts used typically fall well below the maximum safe doses.