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Plastic Surgery


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DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room and placed on the operating table.  The area of the face was prepped with Betadine solution.  Sterile oxygen tubing consisting of a red rubber catheter was placed in the right nostril and held in place with Steri-Strips on the upper and lower lips.  Intravenous sedation was given.  The patient was draped with sterile towels in the usual fashion.  Both lower eyelids were marked, and infiltrated with local solution.  The right lower eyelid was incised through a lateral crow's foot incision using a #15 scalpel blade.  The skin flap was developed using tenotomy scissors, then a subciliary incision was performed using tenotomy scissors.  The skin flap was elevated using skin hooks.  The orbicularis oculi muscle was incised with a spreading motion using tenotomy scissors, exposing the central lateral fat pad and the medial fat pad.  These were excised using Bovie electrocautery.  The wound was dressed with sterile saline gauze.  The left lower eyelid was developed in a similar fashion.  A #15 scalpel blade was used to make the lateral crow's foot incision.  Tenotomy scissors were used to develop the skin flap, then to make the subciliary incision.  The skin flap was reflected with skin hooks.  The orbicularis oculi muscle was examined.  Hemostasis was obtained with Bovie electrocautery.  Tenotomy scissors were used to spread the incision, exposing the central and medial fat pads, as well as the lateral fat pad.  The central lateral fat pad was excised using Bovie electrocautery.  The medial fat pad was removed in a similar fashion.  This was also dressed with saline-soaked gauze.  The right lower eyelid oricularis oculi muscle was inset laterally with interrupted inverted 4-0 Vicryl sutures.  The skin flap was closed with interrupted 6-0 Prolene sutures.  Excess skin was removed laterally and superiorly, and the rest of the skin was inset with simple interrupted 6-0 Prolene sutures.  The left lower eyelid incision was closed in a similar fashion.  Both lower eyelids were washed with saline, dried, and dressed with 1/2-inch Steri-Strips. The patient tolerated the procedure well and was taken to the recovery room in stable condition.  All needle, sponge and instruments counts were correct at the end of the procedure.