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--- resident:linda_huang [2022/01/31 12:33] – created jonathan
+++ resident:linda_huang [2022/01/31 12:50] (current) – jonathan
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 Upper Blepharoplasty. Likes to undermine obicularis and "tuck" muscle under deep dermal closure will even cut out lateral small triangle of muscleto open eye. Stresses that it is important to go laterally onto the temple to remove skin. Use bovie 15/15 to cut out on markings. Use cut. Undermine muscle with cut. Hit all arcade vessels with bovie to prevent bruising. Close with 5-0 moncryl deep dermal. 5-0 prolene. Leaves 1/2 cm medial incision open. When placing deep dermals, cheat upper lid medially to leave extra skin in upper medial and laterally tight. Very small deep dermal bites, but bigger running baseball bites. Tie end knots leave generous tails. Cover try tails with coverall. Wash out with BSS. Apply erythromycin appointment.
-Lower bleph trans conj. Make sure to have protected demarr retractor. Use skin hook and infiltrate below Tarsus. Use stitch to retract 5mm below Tarsus and pull superiorly.
+Lower bleph trans conj. Make sure to have protected demarr retractor. Use skin hook and infiltrate below Tarsus. Use stitch to retract 5mm below Tarsus and pull superiorly. Incise conjunctiva with bovie. At this point, feel orbital rim and place demarr on the edge of rim, not on top of rim. Spread with wescott scissors. Open fat compartments with bovie. Remember inferior rectya muscle is between nasal and central compartments.  Doesnt dig. Also doesn't believe in redrapping fat unless you are occuplastics. Doesnt close conj.
+Transaxillary breast augmentation. Note that this can be saline OR silicone because you can get them in with Keller funnel. Make a 3-4 cm incision in the axilla. Note that she prefers to mildly zig zag to reduce noticable scars. Straight scars are noticable. Find the pectoralis major edge. It's okay to come over the muscle to find this. Once you have done that, take S retractor and dissect underneath the muscle. Once in the plane between pectoralis major and minor, use the finger (yankouer suction piece) and push. Don't sweep or you will cause massive bleeding. Next dingmans. Make dingmans slippery with SpongeBob. That's a CHG scrub brush sponge lol.  Push don't sweep. There is a lateral connection that is superior, like 5 cm below incision that you want to keep intact to avoid lateralization of the Brest implant. Inflate with cold saline. Position with dingmans. Close with 2-0 moncryl and 3-0 moncryl. Tails are good for subcuticular.