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We start the full incision by making three small incisions, each about 1 cm long, in the line for the long incision. The first small incision is pretagal; the second is at the earlobe; the third is at the mastoid hairline. The skin is carefully incised and a hermostat or scissor is used to find the correct subcutaneous plane (Fig 12-4). It is possible to go right through the parotid fascia and under the SMAS unless great care is taken. The SMAS and parotid fascia are usually tough, thick, and glistening in the preauricular area. Once the plane is established, a 3 or 4 mm blunt-tipped liposuction cannula is inserted and pushed forward to the level of the anterior edge of the masseter at the midcheek and to a line at the anterior one-third and middle one-third junction along jawline. The machine is turned on and the cheek area is suctioned if needed.
The cannula is withdrawn and inserted through the earlobe opening. From this vantage point, the cannula is pushed over the angle of the jaw and makes tunnels through the sub-mandibular triangle to the anterior edge of the sternocleidomastoid. The cannula is then withdrawn and inserted in the third or mastoid hole.
Here, the dissection is difficult and the cannula may need to be smaller-possibly 3 mm. As much as possible, free up the skin over the mastoid and sternocleidomastoid muscle and join the tunnels made from the earlobe opening. This area is often so stuck down that sharp dissection with a scalpel may be necessary. Some surgeons always use a scalpel of this area.
Translation - English Penyayatan
Kita mulai pemotongan penuh dengan cara membuat tiga sayatan kecil, masing-masing sepanjang 1 cm, digaris untuk sayatan panjang. Sayatan kecil yang pertama berada di petragal; yang kedua di dekat cuping telinga; ketiga adalah dekat garis rambut mastoid. Kulit dengan hati-hati disayat dan sebuah hemostat atau gunting digunakan untuk dapat menemukan dinding rongga subcutaneous yang benar (gambar 12-4). Boleh juga menyayat lewat parotid fascia (selaput parotid) dan dibawah SMAS kecuali jika diambil perawatan mendalam. Daerah SMAS dan parotid fascia biasanya agak menyusahkan, tebal, dan berminyak di area preauricular. Ketika dinding rongga subcutaneous ditemukan, sebuah pipa cannula liposuction ujung tumpul berukuran 3 sampai 4 mm dimasukkan dan ditekan kedepan sampai ketingkat pinggiran depan masseter (otot pengunyah) pipi tengah dan ke satu garis di sepertiga depan dan ditengah sepertiga simpangan disepanjang rahang. Mesin dihidupkan dan area pipi di pompa jika perlu.
Pipa cannula kemudian ditarik dan dimasukkan lewat bukaan cuping telinga. Dari sudut pandang ini, pipa cannula ditekan di sudut rahang dan membuat liang disepanjang segitiga submandibular ke pinggiran depan sternocleidomastoid. Pipa cannula kemudian ditarik dan dimasukkan ke lubang mastoid. Dari sini, pemisahan akan menjadi susah dan pipa cannula akan membutuhkan ukuran yang lebih kecil, mungkin ukuran 3 mm. Sebisa mungkin biarkan saja kulit disekitar mastoid dan otot sternocleidomastoid dan sambungkan liang-liang yang berasal dari pembedahan cuping telinga. Area ini sering menjadi sangat alot dan sebuah gunting scalpel mungkin penting untuk mengatasinya. Beberapa dokter bedah menggunakan gunting scalpel didaerah ini.
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Years of experience: 25. Registered at ProZ.com: May 2007.
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