Bilevel anesthesia and blunt dissection: rapid and safe surgery.

[BACKGROUND] A new concept of bilevel anesthesia, initially instilling a subcutaneous tumescent solution followed by surface anesthesia, and then dissection limited to blunt instrumentation has been developed.

[OBJECTIVE] The purpose of these developments has been to evolve more rapid and safe surgical intervention.

[METHODS] This work has included a wide variety of surgeries on patients over several years, including grafts, flaps, and hair transplantation.

[RESULTS] Excellent anesthesia with virtually bloodless surgical fields has followed the adoption of bilevel anesthesia with blunt dissection practices.

[CONCLUSION] Adoption of the previously described tumescent anesthetic infiltration with blunt dissection principles combined now with stronger epidermal-dermal anesthetic and epinephrine solutions allows the safest and most rapid surgery described to date.