DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Midface laxity after previous facelift.
POSTOPERATIVE DIAGNOSIS:
Midface laxity after previous facelift.
PROCEDURE PERFORMED:
Secondary facelift with dermal fat grafting of the malar areas.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
COMPLICATIONS: None apparent.
DISPOSITION: To recovery in stable condition.
BRIEF CLINICAL HISTORY: The patient is over two years status post a facelift procedure. She had some creasing of the cheek areas and also had some residual laxity in the right neck. After discussion of risks, benefits and alternatives, she agreed with secondary facelift with dermal fat grafting of the malar areas.
DESCRIPTION OF OPERATION: The patient was marked for the areas of lift and undermining in the holding area, in the sitting position. She was taken to the operating room and placed in the supine position. General anesthetic was administered. The abdomen as well as the full face and neck were prepared and draped in a sterile manner after a Foley catheter was sterilely inserted. Thromboguard boots were applied. The patient received parenteral antibiotics. The subcutaneous planes were infiltrated with dilute local anesthetic with Xylocaine and Marcaine in 250 mL of saline, 25 mL of 2% Xylocaine and 25 mL of 0.5% Marcaine and 1 mg of epinephrine were used. We used approximately 120 mL over the course of the 6-hour procedure.
The left cheek was elevated first in a subcutaneous plane, protecting the branches of the facial nerve, especially due to the fact that she had had a previous superficial parotidectomy. We undermined the area of concern. This included a subcutaneous dissection around the lateral temple keeping the frontal branch protected. Meticulous hemostasis was obtained. A template was made of the defect after a superior pexy of the cheek soft tissue and cheek fat was performed with interrupted running 4-0 Vicryl.
The same procedure was done on her right side, again pexing the descended cheek tissue with interrupted running 4-0 Vicryl. We also defatted an area just below the mandible where she had a redundancy apparent on the right side. The left neck was fine and not dissected.
Appropriate dermal fat graft was harvested from the abdomen, and the donor site closed directly with 3-0 Vicryl and 4-0 Vicryl. Dermal fat grafts were tailored and inset in resting tension with 4-0 Vicryl with the dermal side down. They were further tailored for symmetry. After meticulous hemostasis, the wounds were closed with interrupted 3-0 Vicryl, staples in the hair-bearing scalp and 5-0 nylon for the preauricular sutures. Minimal skin was resected. The patient tolerated the procedure well. After having a right lower lid canthopexy, a head dressing was applied, and she went to recovery in stable condition.
