title: Bilevel anesthesia and blunt dissection: rapid and safe surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Dermatologic Surgery, University of California, San Francisco, California, USA. lmfieldmd@aol.com
authors.forename: L M
authors.initials: LM
authors.lastname: Field
mesh_terms: D000772:Anesthesia, Local / Q000379:methods; D062109:Dermatologic Surgical Procedures; D004210:Dissection; D006801:Humans