PREOPERATIVE DIAGNOSIS(ES):
Recurrent laxity of skin in the neck, post neck lift
POSTOPERATIVE DIAGNOSIS(ES):
Laxity of skin in the neck,
PROCEDURE(S)/OPERATION(S) PERFORMED:
Scar/ lift revision with intraoperative use of liposuction for excess fatty
tissue of the neck.
SPECIMENS TO LABORATORY:
None.
ESTIMATED BLOOD LOSS:
Minimal.
DRAINS PLACED:
None.
COMPLICATIONS:
None.
CONDITION:
Satisfactory.
SUMMARY:
With the patient in the preoperative area, the operative site was
verified. The operative plan was reviewed with the patient. The
patient had an opportunity of all questions regarding the
procedure answered and the operative plan, location of the
incisions, intraoperative use of liposuction for areas of excess
fat of the central neck, submental was discussed. Perioperative
wound care including use of the wrap and compression was also
discussed. The patient had an opportunity of all questions
answered. Preoperative photographs were obtained. The patient
was taken to the operating following a time-out verification,
sterile prep and drape, administration of general anesthesia with
PCD DVT prophylaxis, and prophylactic antibiotics, the procedure
was commenced. 1% lidocaine with epinephrine diluted 50:50
mixture was injected with a spinal 25-gauge needle for local
infiltration and hemostasis. The dissection was performed in a
subcutaneous plane using a face lift scissor dissection following
the incision through the previous scar Care was taken
to avoid subfascial plane of dissection and maintaining a
subcutaneous plane to the area of the mid cheek and area of
bilateral jawline. This was also extended following lipoplasty
through the submental incision yielding small volume aspirate . Scissor
dissection was then used to reach the area of lipo creating a
cutaneous undermining to the neck maintaining discontinuous
undermining to the midline. The wounds were copiously irrigated
and inspected for hemostasis with the loupe magnification. The
dissection showed good plane of dissection and hemostasis, the
initial sutures were placed and staples to achieve symmetric
tightening of the neck flaps, was then a permanent 2-0 Prolene
suture was then placed in the posterior auricular surface of the
scalp on both sides, and a second permanent suture was placed
near the hairline in the anterior surface of the ear. These are
2-0 interrupted Prolenes, and we will plan on removal in the
office in 2 weeks. The patient was assessed for symmetry, and
both neutral position and was turned to the left and right showed
evidence of good contour with the flaps and no evidence of
banding or pinching or folding. This was then converted to the
final closure with trimming of excess skin by scissor dissection
in a stepwise fashion and buried 5-0 Vicryl and running 6-0
Prolene. The posterior hairline incision was closed with a
running 4-0 Prolene. The patient showed good symmetry and shape
and good cervical mental angle. The submental incision was
closed with a single interrupted 6-0 nylon suture, also a bulky
wrap was applied. The patient tolerated the procedure without
complications.
Recurrent laxity of skin in the neck, post neck lift
POSTOPERATIVE DIAGNOSIS(ES):
Laxity of skin in the neck,
PROCEDURE(S)/OPERATION(S) PERFORMED:
Scar/ lift revision with intraoperative use of liposuction for excess fatty
tissue of the neck.
SPECIMENS TO LABORATORY:
None.
ESTIMATED BLOOD LOSS:
Minimal.
DRAINS PLACED:
None.
COMPLICATIONS:
None.
CONDITION:
Satisfactory.
SUMMARY:
With the patient in the preoperative area, the operative site was
verified. The operative plan was reviewed with the patient. The
patient had an opportunity of all questions regarding the
procedure answered and the operative plan, location of the
incisions, intraoperative use of liposuction for areas of excess
fat of the central neck, submental was discussed. Perioperative
wound care including use of the wrap and compression was also
discussed. The patient had an opportunity of all questions
answered. Preoperative photographs were obtained. The patient
was taken to the operating following a time-out verification,
sterile prep and drape, administration of general anesthesia with
PCD DVT prophylaxis, and prophylactic antibiotics, the procedure
was commenced. 1% lidocaine with epinephrine diluted 50:50
mixture was injected with a spinal 25-gauge needle for local
infiltration and hemostasis. The dissection was performed in a
subcutaneous plane using a face lift scissor dissection following
the incision through the previous scar Care was taken
to avoid subfascial plane of dissection and maintaining a
subcutaneous plane to the area of the mid cheek and area of
bilateral jawline. This was also extended following lipoplasty
through the submental incision yielding small volume aspirate . Scissor
dissection was then used to reach the area of lipo creating a
cutaneous undermining to the neck maintaining discontinuous
undermining to the midline. The wounds were copiously irrigated
and inspected for hemostasis with the loupe magnification. The
dissection showed good plane of dissection and hemostasis, the
initial sutures were placed and staples to achieve symmetric
tightening of the neck flaps, was then a permanent 2-0 Prolene
suture was then placed in the posterior auricular surface of the
scalp on both sides, and a second permanent suture was placed
near the hairline in the anterior surface of the ear. These are
2-0 interrupted Prolenes, and we will plan on removal in the
office in 2 weeks. The patient was assessed for symmetry, and
both neutral position and was turned to the left and right showed
evidence of good contour with the flaps and no evidence of
banding or pinching or folding. This was then converted to the
final closure with trimming of excess skin by scissor dissection
in a stepwise fashion and buried 5-0 Vicryl and running 6-0
Prolene. The posterior hairline incision was closed with a
running 4-0 Prolene. The patient showed good symmetry and shape
and good cervical mental angle. The submental incision was
closed with a single interrupted 6-0 nylon suture, also a bulky
wrap was applied. The patient tolerated the procedure without
complications.