DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Facial aging with perioral and periorbital wrinkling.
POSTOPERATIVE DIAGNOSIS: Facial aging with perioral and periorbital wrinkling.
OPERATION PERFORMED: Facelift and laser CO2 resurfacing, perioral and periorbital area.
SURGEON: John Doe, MD
ANESTHESIA: General.
BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMENS: None.
INDICATIONS: This is a pleasant (XX)-year-old Hispanic female with a history of progressive aging. She has had a neck lift as well as upper lobe blepharoplasty in the distant past. She has had progressive signs of facial aging with diffuse facial wrinkling, worse in the perioral area and periorbital area, and severe banding in the neck. The patient presents for facelift with CO2 resurfacing of perioral and periorbital areas.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative area, where in the sitting position, the facial skin and neck skin was wiped with alcohol and marked with a marking pen for surgery. The patient was brought into the operating room and placed supine on the operating room table. Administered general anesthesia successfully. A total of 10 mL of a 50:50 mixture of 1% lidocaine with epinephrine and 0.25% Marcaine with epinephrine was infiltrated into the neck and right face. Lacri-Lube was placed in the eyes. The entire face was prepped and draped in usual sterile fashion. Lacri-Lube coated eye shields were placed bilaterally.
The old submental scar was thinly excised, dermal scar discarded. Light suctioning was then performed in the submental area, where she had the fat pad with 1 mm single hole cannula staying in the plane above the platysma, being careful to be parallel to the platysmal plane while suctioning. The incision was then completed with cautery. The neck flap was then raised in the plane between superficial deep fat right up along the surface of the platysma.
Attention was then turned to the right face where a standard facelift incision was then performed beginning in the curvilinear incision in the temporal hair, extending around the preauricular plane, up over the tragus hugging the ear lobe, and up the postauricular sulcus. The skin flap was then raised initially with a knife and then with cautery and scissors out to the mid anterior cheek, and then in the submandibular area connecting to the previous dissection along the midline. Light suction was then performed of the jowl and of the submandibular neck laterally. This suction was turned down low.
Because of her thinness, a plication was then performed of this mass with 3-0 Mersilene sutures, designing a kind of oblique elliptical area that was in the preparotid plane, and performing a plication taking in, at greatest, approximately 1.5 cm to 2 cm. This extended down beneath the mandibular line and up to the upper malar area. A similar incision and facial skin flap was then raised on the opposite face after injecting with 10 mL of local anesthetic and similar plication was performed of this mass.
The platysmal plication was then performed through the submental incision in the midline down to the cricothyroid membrane, and then the platysma was minimally released in this area in order to reduce the effect of banding. A 7 mm Jackson-Pratt drain was brought through a small stab incision in the right occipital scalp, laid across the base of the neck dissection. The fields were irrigated with antibiotic solution. Hemostasis was obtained with cautery. Neck incision was closed with buried 5-0 Vicryl sutures and 6-0 Prolene interrupted repair.
Attention was then turned to the right and then left sides where skin was brought back under tension. The skin was released at the level of the ear lobe. Two sutures were then placed in the upper preauricular plane as well as at the base of the ear lobe in the upper postauricular plane with buried 3-0 Vicryl suture. Excess skin was marked with pen and cut with a #15 blade and discarded. The fat was then trimmed off the tragal flap. The 4-0 Vicryl sutures were then used to inset the incisions all the way around. Staples were used to close the scalp followed by 5-0 Prolene running repair in the pre and postauricular plane on each side. Drains were placed to bulb suction. The metal eye shields were then placed bilaterally. The endotracheal tube was coated with a damp green towel. Laser settings were then set for eyelid with 250 millijoules 50 watt, pattern size 3, density 5, and 2 passes were then performed at both the upper and lower eyelid extending up to just shy of the brow. Care was taken not to injure any of the eyelid lash line. Good pink color was still noted but good contraction was noted on the second pass. Perioral area was then treated with similar settings set for 300 millijoules.
Three passes were performed in the perioral area stopping when we saw some blanching of the skin. Tube was protected throughout this procedure. Dry skin was then wiped clean. K-Y jelly and Vaseline were placed around the mouth, and around the incisions around the ears in the submental area. Gauze dressings, ABD pads, and head wrap dressing were applied. Drain was placed to bulb suction. The patient tolerated the procedure well with no apparent complications. The patient was then extubated in the operating room and transferred to the recovery room in satisfactory condition.
