416 CHIN or CHEEK IMPLANTS

Chin implant is placed through a submental incision.

Cheek implants are placed through an intra-oral incision.

Note: This procedure can be done alone but is usually added to another, larger procedure such as facelift, submental lipectomy or rhinoplasty

Updated March 3, 2013Page 1

 

OPERATIVE TIME: add ½ hour to main procedure, 1hr if alone

FREQUENCY 1-2 per year

ASSISTANT: Gwen

CPT CODE(S):

ICD9 CODE: V50.1 Elective Cosmetic, 744.9 face Neck

 

ANESTHESIA NOTES

In holding patient receives oral pre-sedation:

        Valium, Demerol, Benadryl, and/or Clonidine.

Nasal O2 cannula with CO2 monitor.

If under general, see facelift sheet.

PATIENT POSITION | SETUP

HOLDING AREA:

    On Stryker Eye Bed Dr. C marks pt. in holding.

    Have holding start IV on right side, O2 in Holding.

IN OR:

    Pillows under knees.

    Gel pad, w/ rolled Teri cloth towel.

    Kerlix wrist retainers

    [2] blue Chux under head, [2] blankets to tuck arms

    Nasal prongs with CO2 monitor.

    Aquaphor to lips

TABLE POSITION

rotate clockwise 135°

side rails down on Stryker, patient belt, Kerlix wrist restraints

ROOM SETUP

normal temperature DO NOT pre-warm

Warm up Bovie grounding pad and EKG leads

NO Bair hugger

 

EQUIPMENT

Headlight and [2] light sources, [2] stools

SPECIALS | IMPLANTS

Dr. C will bring implants and sizers.

PREP

PCMX or Chlorxylenol, lightly with very little H2O

DRAPING

Head sheet, 1000 drape, split sheet, 4 towels,

[2] rigid bovie holsters, [2] packs green towels

Custom ENT pack #315360

CAUTERY

Bovie 20/20 pure, 3 tips: Flat silver tip, long needle tip (018A), [2] holsters

SUCTION

[2] suction tubing, Saf-T-Vac, Yankauer, baby Yankauer

 

SOLUTIONS | IRRIGATION

● NS irrigation

● Small blue bulb syringe.

● Kefzol antibiotic irrigation in separate bowl

NEEDLES | SYRINGES

[2] 25g 1½" needles

[2] 27g 1" needle on [2] 10cc syringe

[2] 30g ½" needles on [2] 3cc syringes

LOCAL ANESTHETIC

Mix 50/50:

     1% lidocaine w/ epi 1:100,000 - 20cc, [2] vials

     0.5 % marcaine w/epi 1:100,000 - 20cc [2] vials

MEDICATIONS

● [2-4] Versed

● [2-4] Fentanyl

● [1] Zofran

● [1] Kefzol

● Bacitracin ointment 2oz

416 CHIN or CHEEK IMPLANTS Page 2

 

SETS TO OPEN

Dr. C Facelift, Minor set, and Rhino set for elevators and retractors

INSTRUMENTS USED (ON 2 MAYO STANDS)

     FORCEPS

01- 03 - 05 Adsons, Smooth Adson, Adson Brown, Cushing, Short Debakey, Tissue forceps

     SCISSORS

cvd and str Stevens, Small Freemans, cvd and str Metzenbaums, Joseph

     NEEDLE HOLDERS

Webster smooth and serrated, Crile-Wood

     RETRACTORS

Senn, Ragnell, L-retractor, small facelift, chin senn,

Converse nasal.

     KNIFE | BLADES

[2] No 15, [2] No 10, round blue handle needle holder

ELEVATORS

Joseph, Freer, Tebbetts

     OTHER

Cutting board w/silastic sheet

 

 

Note: what to pull extra when doing chin or cheek implants

with other major procedure

ELEVATORS: Joseph, Key, Freer, Tebbetts (Rhino set)

RETRACTORS: Converse nasal, Ragnell, Senn (Rhino set)

SCISSORS: Joseph, curved black iris (Facelift set)

LOCAL: same as main procedure

OTHER: ½" steri-strips

 

 

STERILE SUPPLIES

● steri-drape 1000

● [2] needle counters

● med glasses

● surgical marker pens

● labels for local

● magnetic pad

● ½" steri-strips

● Mastisol

SPONGES

Raytec

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

SUTURES 

[ 2 ]

3-0 Vicryl SH

J416

 

hold

[ 2 ]

5-0 Monocryl P-3

J493

 

hold

[ 2 ]

4-0 Chromic PS-2

1638

 

hold

[ 2 ]

5-0 Chromic P-3

Y493

 

hold

[ 2 ]

5-0 Plain P3

686

 

hold

 

DRAINS

none, unless doing simultaneous facelift

DRESSINGS

ASK before opening: Bacitracin ointment, Vaseline gauze, Mastisol, ½ inch Steri-strips, 4" Kling or Kerlix, 4" Ace.

crushed ice in cooler

POSTOPERATIVE

Remove head cushion, put 2nd pillow under head, lift head of bed

DATES MODIFIED

March 2008, December 2008, October 2011, Dec 2012, Mar 2013