402 FACELIFT (inlcudes Mayo stand setup)
see also 408 Upper and/or Lower Blepharoplasty, 413 Browlift, 911 local solutions
Usually under Local anesthesia; note differences if under General
updated May 20, 2012- PAGE 1
OPERATIVE TIME:
4 hours facelift only, 6 hours with blepharoplasty or browlift
CPT CODE: 15825 FACELIFT
ICD9 CODES:V50.1ELECTIVE COSMETIC, 744.9 FACE NECK DEFORMITY
ANESTHESIA NOTES
Local anesthesia: patient receives preop Valium, Demerol, and
Bendaryl (Clonidine prn). Moderate sedation protocol.
Nasal O2 cannula with CO2 monitor
General anesthesia: Plexipulses, Foley catheter, eye bed, sew in
tube with 0-Vicryl CT1, needle holder, scissors
PATIENT POSITION | SETUP
ROOM SETUP
EQUIPMENT
PREP
DRAPING
CAUTERY
note 4 multiple tips
SUCTION
SOLUTIONS | IRRIGATION
NEEDLES | SYRINGES
LOCAL ANESTHETIC &
SOLUTIONS
HOLDING AREA: On Stryker Eye Bed. Dr. C marks in holding.
Start IV on right side.
IN OR: Position patient bed flat, pillow under knees, terry cloth
towel, gel pad, towels for headrest. [2[ blue Chux under head,
blankets to tuck arms. Rotate clockwise 135E
Nasal prongs with CO2 monitor. Aquaphor to lips
normal temperature DO NOT pre-warm
[2] ring stands (non-sterile) for dirty sponges
[3] Mayo stands, [1] large back table
Headlight w/light source, hydraulic stool
For General Anesthesia add: Plexipulses, 12 fr Foley catheter
U Dr. C’s ice cooler - get ice early
PCMX, 4x4 sponge box - do not add water.
Prep lightly to face, eyelids, forehead, neck, hair
Head sheet, 1000 drape, split sheet, 4 towels, rigid bovie holster,
[2] packs green towels
!
!
!
!
!
!
Valleylab flat short silver tip (E1450-X)
Valleylab silver extended needle tip (E1452-6)
Megadyne needle tip (0118A)
Megadyne pencil tip (0013A)
Safe-t-Vac
[2] holsters, Bovie 20/20 pure
[2] suction tubing: Saf-T-Vac & Yankauer
[3] liters NS irrigation, [2] Asepto syringes
U crushed ice at end to mix with saline for final irrigation
[10] 22g long Quincke spinal needles (405181)
[10] 25g 1½" needle
[10] 20cc syringes -> for solution C
[10] 10cc syringes -> for 0.5% lidocaine w/epi
[2] 5cc syringes -> for 0.25% marcaine w/epi
Solution “C”: 200cc mixture of
2% lidocaine w/epi 50cc + 0.5%Marcaine w/epi 50cc +
Normal Saline 100cc
draw up separate (but do not mix):
Lidocaine 0.5% w/epi (2 vials) - 100cc in 10cc syringes/25g
Marcaine 0.25% w/epi (1 vial) - 30cc in 10cc syringes/25g
MEDICATIONS (for local)
! [4] Versed
! [4] Fentanyl
! [1] Zofran
! [1] Kefzol
! Bacitracin ointment 2oz
402 FACELIFT
PAGE 2
SETS TO OPEN
Dr C Facelift set, plastic set,
INSTRUMENTS USED ON 3 MAYO STANDS:
1st MAYO – Opening and dissection
2nd MAYO – Local infiltration: syringes and needles, then dressings
3rd MAYO – Neck and Facelift closure instruments
O FORCEPS
O SCISSORS
O NEEDLE HOLDERS
O RETRACTORS
O KNIFE | BLADES
O OTHER
STERILE SUPPLIES
SPONGES
SUTURES
M
M
M
M
M
M
M
M
M
DRAINS
DRESSINGS
POSTOPERATIVE
NOTES
DATES MODIFIED
01- 03 - 05-08 Adsons, Smooth Adson, Long Adson Brown,
Cushings, Short Debakey, and Long Debakey
medium and long Kaye, Freemans, short and long Rees, gold
curved defatting, str Metz, str Mayo, 6" Reynolds
[4] 6" smooth Crile Wood, [1] 6" Debakey, [1] 9" Debakey
[2] Mayo Hagar, [2] Olsen Hagar, [2] smooth Webster
Breast retractor, Maxwell, Freeman facelift, Chin hook,
3/8" peds Deaver, L-shaped retractor
[6] No. 10 blades
Spoon, [2] Skin staplers (medium), mini kidney basin
! [2] Skin staplers, medium
HOLD
! steri-drape 1000
! [2] needle counters
! cotton balls for ears
! [3] med glasses
!
!
!
!
!
!
[4] surgical marker pens
Mastisol vial
labels for local
magnetic pad
½" steri-strips
[4] blue plastic bowels
[6] Raytec, [1] Lap
No
Type
SN
[8]
[3]
[5]
[2]
[6]
[6]
[2]
[3]
[1]
3-0 nylon PS-1
1662H
3-0 Vicryl SH
J416H
2-0 Vicryl SH
J417H
5-0 Monocryl P-3
Y493
4-0 Chromic PS-2
1637G
5-0 Chromic P3
687G
5-0 Prolene PC-3
8635
5-0 Plain P3
686
0 Ethibond CT1 - General only
status
open
open
open
open
open
open
open
open
hold
[2] 7mm flat Blake drains, fully fluted w/ trocar
(Reorder No. 2212) - with connectors and bulbs
!
!
!
!
Bacitracin ointment
tongue blade
[6] 2-packs Versalon 4x4's
[1] Abd
!
!
!
!
[1] 4" Ace
[2] 3x18 Vaseline gauze
[2] Kerlix
[2] Safety pins
Remove head cushion, put pillow under head, lift head of bed
see also 408 Upper and/or Lower Blepharoplasty
see also 413 Browlift
see also 911 local solutions
see also 402 a Facelift Mayo stand setup
Nov 2006, Aug 2007, Oct 2007, Nov 2007, March 2008, August 2008,
May 2009, July 2009, Sept 2009, Oct 2009, Mar 2010, Nov 2010, March 2012
May 2012
FACELIFT MAYO STAND SETUP
PAGE 3
1st MAYO – Opening and dissection
Knife handles [3] No. 10
Bovie tips
Valleylab flat short silver tip (E1450-X)
Valleylab silver extended needle tip (E1452-6)
Megadyne needle tip (0118A)
Megadyne pencil tip (0013A)
Scissors
Freemans
Gorney's
Long Freemans
Reese’s
Defatters
Str Mayos gold
Str Metz gold
Retractors
Baby deaver
Chin hook
Maxwell facelift
Freeman facelift
L-retractor
breast retractor
Tissue forceps
01 Adsons
03 Adsons
08 long Adsons
Foxy browns
Titanium Spoon
Raytec folded 2 x 8
2nd MAYO – Local infiltration: syringes and needles, then dressings
Solution C:
[10] 20cc syringe w/ 22g spinal Quinke needle
Lidocaine 0.5% with epi:
[10] 10cc syringe w/ 25g 1½” needle
Marcaine 0.25%with epi for end of case:
[2] 5cc syringe w/ 25 g 1½” needle
Smooth Adson, cotton balls, steri strips, Mastisol
Note: after local dissection, change Mayo stand to bleph setup or dressings
3rd MAYO – Neck and Facelift closure instruments
Neck dissection:
9" Debakey needle holder (2-0 Vicryl)
6" Debakey needle holder (3-0 Vicryl)
9" Debakey tissue forceps
6" Debakey tissue forceps
Suture Cutting Scissors:
Str Mayo scissors gold
Str Metz scissors gold
6" Reynolds scissors
Facelift closure forceps:
01 Adson
03 Adson
08 Long Adsons
Foxy Brown
Cushings
Str Mayos gold
Str Metz gold
Facelift closure needle holders and suture
[2] Olson Hagar (3-0 Nylon)
[2] Mayo Hagar (2-0 Vicryl)
[2] Crile Wood serrated (3-0 Vicryl, 4-0 Chromic)
[4] Crile wood smooth (5-0 Chromic, 5-0 Plain, 5-0 Prolene)
Skin stapler [hold]