title: Bilevel tumescent anesthetic infiltration for hair transplantation.
abstract: BACKGROUND
  A dual level of tumescent anesthetic infiltration has been found to expedite hair graft or strip harvesting for hair transplantation, reducing bleeding, and increasing the exit angle of the hairs, thereby promoting increased survivorship of hair shafts and bulbs.
  
  
  OBJECTIVE
  To acquaint the readership with this variation of anesthetic tumescent technique in hair transplantation.
  
  
  METHODS
  Patients were utilized for this study during international teaching exchanges. Larger multiport infiltrators were used for the deep infiltration; smaller and more narrow infiltrators were used for the more superficial anesthetic administration.
  
  
  RESULTS
  Subcutaneous compression and a bilevel vasoconstriction in both donor and recipient sites resulted in an increased upwardly angled exit angle of the hairs to be harvested, an increased separation of individual hair shafts, and reduced bleeding. Placement of the correct incisional angle of instruments inserted into the donor site was facilitated.
  
  
  CONCLUSIONS
  Utilization of a bilevel tumescent anesthetic infiltration technique is a superior method of anesthesia for hair transplant harvesting and transplanting. Bleeding at both occipital donor and frontal recipient sites was negligible.
authors.affiliation: Department of Dermatology, University of California, San Francisco, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Field
authors.forename: A
authors.initials: A
authors.lastname: Namias
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D006197:Hair / Q000637:transplantation*; D006801:Humans; D016377:Organ Transplantation / Q000379:methods