DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Facial aging.
POSTOPERATIVE DIAGNOSIS: Facial aging.
OPERATIONS PERFORMED:
1. Upper and lower blepharoplasty.
2. Facelift.
3. Fat injections to the upper lip.
4. Fat injections to the marionette lines and nasolabial folds bilaterally.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Minimal.
DESCRIPTION OF OPERATION: After the patient was explained the risks and benefits of undergoing upper and lower lid blepharoplasty, facelifting and fat injections to her upper lip, nasolabial folds and marionette lines as well as dermabrasion to the lip, she was brought to the operating room and placed supine on the operating room table. General endotracheal anesthesia was induced, and the patient’s head and neck as well as a small portion of her abdomen were prepped and draped in the usual sterile fashion. Following this, approximately 50 mL of local anesthesia was injected into her abdomen as well as several milliliters into her upper lids bilaterally after they had been marked with a classic blepharoplasty elliptical incision. Following this, approximately 15 mL of fat was liposuctioned from her abdomen using a #5 French liposuction cannula and the fat was placed in a washing tub and rinsed several times until it was purified fat. It was then placed in 10 mL syringes to be injected later into the upper lip, nasolabial folds and marionette lines.
Following this, attention was turned to the bilateral upper eyelids and a 15 blade was used to incise down through skin and subcutaneous tissue through the orbicularis oculi muscles and a skin-only resection of upper eyelid skin was performed. Following this, tenotomy scissors were used to dissect the orbicularis muscle free from its underlying structures and a small strip of orbicularis muscle was also excised. Of note, the vertical dimensions of the upper eyelid skin resection were approximately 13 mm in vertical diameter at the midpupillary line. Following this, careful hemostasis was obtained and a small incision was made in the medial aspect of the eyelid to access the medial fat pad of the upper eyelid. A small amount of medial upper eyelid fat was resected in order to deal with the pseudoherniation of the patient’s upper medial fat pad. Following this, once again, careful hemostasis was obtained and the patient’s eyelids were then closed in two layers. The first layer was several interrupted 6-0 nylon sutures and the final layer was a running nylon in classic fashion.
Following this, the bilateral lower eyelids were injected with approximately 8 mL of our local anesthetic mix. After allowing 10 minutes to elapse during which time 4 mL of fat were injected into the upper lip, the patient’s lower blepharoplasty subciliary incision was made with a 15 blade. Following this, a skin-only flap was dissected on the preorbital orbicularis oculi, and following this, skin and muscle flap was elevated down to the upper orbital rim. The patient’s lower eyelid, skin and muscle were elevated, thus revealing the septum and beneath that the infraorbital fat pad. The medial and middle fat pads were accessed and approximately 1 mL of fat was resected from the fat pads on each side. Care was taken to resect a symmetrical amount of fat from both sides, and following this, Bovie electrocautery was used to obtain very careful hemostasis. Following resection of the fat pads, a 2 mm rim of lower eyelid skin was removed. A 4-0 interrupted Vicryl suture was used to pass through the lateral orbicularis oculi muscle to the lateral orbital rim and then the lower eyelids were closed in a single layer of running 6-0 nylon sutures.
Following this, attention was turned to injecting approximately 2.5 mL of fat in the bilateral nasolabial folds and bilateral marionette lines, and following this, a standard facelift incision was incised using a 15 blade down through the skin and dermis. Following this, the subcutaneous plane was dissected free in classic facelift fashion using facelift scissors. Careful hemostasis was then obtained on all the subcutaneous spots as well as the deep tissues taking care to avoid injury to any underlying neurovascular structures. Once this had been performed, bilateral SMAS flaps were elevated and were sutured into position in a vertical vector using an interrupted 4-0 Monocryl suture. Excess skin of the facelift incisions was then resected and the facelift was closed in two layers. The dermis was closed with interrupted 5-0 Vicryl sutures and the skin was closed with running 5-0 nylon in a preauricular position and running the 4-0 chromic in the postauricular and hairline region. The patient was then awoken from general anesthesia and taken to the recovery room in good condition.
