The steady development of facelift techniques and modifications has continued to make the rhytidectomy procedure safer and better. The remarkably rapid acceptance of lipo-suction-assisted rhytidectomy has significantly altered this form of cosmetic surgery, resulting in more pleasing results for patients and surgeons alike.

More complex methods of outpatient anesthesia, including I.V. sedation and general anesthesia, have become commonplace. Patient selection and preoperative evaluation are discussed, as well as the choice of who will deliver anesthesia. Appropriate outpatient facilities and monitoring are reviewed. The authors' favorite methods of anesthesia, caveats, and suggestions are presented, as well as prevention and treatment of anesthesia problems and emergencies.

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The aesthetic importance of the periocular area often prompts requests for surgical alteration or improvement. The complex array of anatomical differences in this area, coupled with a wide range of patient ages, taxes the examination and consultation skills, as well as the operative ingenuity, of the surgeon. Blepharoplasty and browlift in the non-white patient have not received their fair share in the English literature. Nevertheless, these procedures are applicable, perhaps even in the keloid-prone patient.

Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.