After local anesthesia infiltration, it is very useful to perform hyperinfiltration with physiologic serum underneath the skin all over one side of face and neck
(Fig. 39.1). It is convenient to emphasize that it must be performed by the surgeon, only on one hemiface and neck, since the surgery must start immediately. We do not recommend using a needle to perform this type of infiltration because it may change the plane of the tissue cleavage. We use special microcannulas just beneath the skin of the face and neck in order to separate the skin from the subcutaneous fatty layers (Fig. 39.2) and soft deeper tissues as well. Approximately 300 ml is used on one side of the face and neck. The next step of the operation, which is subcutaneous tunnelization, should be performed immediately. Owing to hyperinfiltration, the skin is separated from the subcutaneous adipose tissue beneath the skin, on areas with localized adiposities (Fig. 39.3), even on those regions where the panniculus is very thin as occurs on the postauricular and mastoid areas. For patients with a thin face without localized adiposities, this procedure is very useful in order to preserve all anatomical structures below the cutaneous flap (Fig. 39.4).
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