Step 3 Infiltration of Vasoconstrictor

The Preauricular area is quite vascular. A vasoconstrictor can be injected subcutaneously in the area of the incision to decrease incisional bleeding. If a local anesthetic is also being injected, however, it should not be injected deeply because it may be necessary to use a nerve stimulator on exposed facial nerve branches. Step 4. Skin Incision

The incision is made through skin and subcutaneous connective tissues (including temporoparietal fascia) to the depth of the temporalis fascia (superficial layer) (Fig. 12-6). Any bleeding skin vessels are cauterized before deeper dissection proceeds.

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