DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Aging face.
POSTOPERATIVE DIAGNOSIS:
Aging face.
OPERATION PERFORMED:
1. Rhytidectomy.
2. Upper lid blepharoplasty.
3. Lower lid blepharoplasty with orbicularis suspension.
4. Fat transfer to the central face.
5. Shave excision to the right upper lid.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Negligible.
FLUIDS: Crystalloid.
COMPLICATIONS: None.
DISPOSITION: To postoperative recovery room in stable condition at the completion of rhytidectomy and blepharoplasty.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position for rhytidectomy and blepharoplasty. SCD hose was in place and functioning prior to the induction of general endotracheal anesthesia. A Foley catheter was placed after the induction of anesthesia. Lacri-Lube was placed in the eyes, and her head and neck was prepped and draped in the usual sterile fashion. Then, 0.5% lidocaine with 1:200,000 epinephrine was injected into the right hemiface. Suction-assisted lipectomy was then performed in the submental region with 2.5 mm cannula
A rhytidectomy incision was performed along the sideburn, the root of the helix, post-tragally around the lobule to the postauricular sulcus with a high mastoid transition to the posterior hairline. A subcutaneous plane of dissection was performed with the skin elevated with help of transillumination. After elevation was performed, SMAS flap was designed along the body and arch of the zygoma. This was elevated from lateral to medial and from superior to inferior. Dissection continued below the angle of the mandible and medially to the zygomaticus major muscle. The flap was elevated in a superolateral direction and fixed to the superficial layer of the deep temporal fascia above the arch of the zygoma using 3-0 Surgilon.
Further inset was performed along the arch and body of the zygoma and along the preauricular area of dissection. The platysma was then advanced to the mastoid where it was affixed with a 3-0 Surgilon. Further inset was performed to the superficial cervical fascia posteriorly and the platysma anteriorly. Meticulous hemostasis was performed. The above was then repeated on the opposite side of the face. A submental incision was then performed with subcutaneous dissection performed. A modest amount of subplatysmal fat was excised with the medial bands of the platysma advanced medially and affixed with 3-0 Surgilon x5. A back-cut was performed at the cricoid cartilage using electrocautery.
The flaps were then elevated, irrigated, and hemostasis assured. The skin flap was then elevated in a superolateral direction with a pilot cut performed and inset performed with a cardinal stitch in the preauricular area with a 3-0 nylon. Cardinal stitch was placed at the apex of the postauricular sulcus using a 3-0 nylon. The redundant skin was excised. Inset was performed with a half-buried 5-0 Prolene along the posterior hairline, with an interrupted 5-0 Prolene along the postauricular sulcus, with a running 6-0 Prolene along the lobule and root of the helix. The tragal flap was defatted with inset performed with a 4-0 Vicryl in the pretragal sulcus with inset performed with a fast-absorbing 5-0 gut. A 7-French drain was placed prior to closure. This was performed bilaterally. The submental area was then closed with a running 5-0 Prolene.
Then, 1% lidocaine with 1:100,000 epinephrine was placed in the proposed pattern skin excision of the upper lids. She had been previously marked, awake in the holding area, for the estimated amount of excision. The amount of excision was again tested with a pinch test. A #15 blade was used to perform the required excision with skin only dissected. The orbicularis remained intact. The orbicularis and septum was perforated nasally with a modest amount of the medial fat pad excised. This was performed bilaterally.
Closure was then performed with a running 5-0 Prolene. This was performed bilaterally. Corneal protectors and Lacri-Lube were placed. Then, 1% lidocaine with 1:100,000 epinephrine was injected into the proposed subciliary incision. A #15 blade was used to make the incision laterally, which was then extended using blepharoplasty scissors.
A subcutaneous dissection was performed to the junction of the pretarsal and preseptal orbicularis with a suborbicular plane of dissection then obtained at this location. The cotton-tip applicator was then used to sweep the fat from the septum to the orbital rim. Electrocautery was used to incise the orbital retaining ligament. A modest amount of fat was excised primarily from the central fat compartment with less fat excised from the medial and lateral fat compartment.
The origin of the orbicularis was incised nasally with previously harvested fat placed in the submuscular plane as a graft. A pretarsal orbicular flap was created, which was then affixed to the lateral orbital rim using a 4-0 Monocryl. The redundant skin was excised with closure performed with a running 6-0 fast-absorbing gut. The above was then repeated on the opposite eye. The corneal protectors were removed, and the eyes were irrigated.
A sebaceous keratosis was shaved from the right upper lid. The periumbilical area was prepped with 40 mL of fat harvested. This was then centrifuged in 3 mL syringes with supernatant discarded. Fat was then injected into the perinasal hollow and the pre-jowl hollow with a Coleman injection needle. An anterior support was placed with 18-gauge needle. The head and neck were then cleansed. Polysporin and Xeroform were placed followed by Kerlix and Flexinet. All sponge and needle counts were correct x2. The patient was then brought to postoperative recovery room in stable condition at the completion of rhytidectomy and blepharoplasty procedure.
