Makeup Pencils in Plastic Surgery

Planning is the key for success in plastic surgery, and accurate and meticulous tissue marking is a key step in pre- or intraoperative planning. Preoperative skin marking actually is an exceptionally effective exercise for the young trainee to try her or his hand at proposing and planning a surgical procedure. Such a preliminary step is also of great help in obtaining fully informed consent from the patient, who can be shown the actual nature and extent of the procedure and the position and length of the eventual scars. A huge variety of dermographic pens, pencils, pen nibs, and dyes are currently available for such a purpose. All of these tools have to be sterilizable for intraoperative use, and vital dyes only should be used to avoid any permanent skin tattoo. Furthermore, the stroke has to be long-lasting and should not be faded by antiseptic solutions and organic fluids. Nevertheless, an excessively long-lasting stroke may sometimes be a problem in the preoperative phase of surgical planning when multiple and different options have to be critically assessed, considering their pros and cons. Everyday life tools have been gaining an increasing popularity for ingenious “off-label” use in medicine and surgery. In our practice, we have been favoring a common makeup pencil for skin marking during our preliminary clinical consultations when the most appropriate surgical strategy is discussed and tailored to each individual patient. A makeup pencil stroke is easy to erase and can be completely removed by a gentle wiping with cleansing milk ([Figs. 1A, ] [1B]). In our opinion, such a simple pencil proves to be an invaluable tool for the hands-on training in plastic surgery, allowing the young trainee to try her or his hand at the preoperative simulation of different surgical plans with minimal patient discomfort and doctor anxiety. A makeup pencil is dermocompatible and is allowed for use on healthy skin only. Markings are precise and do not smudge, and the stroke can be either thick or sharp depending on the pencil sharpening. Such a tool does not lose effectiveness as time goes by, unlike a fiber-tip pen that inevitably undergoes desiccation. It can be reused in as many patients as its life span allows by simply sharpening the tip. Further advantages are the ease of use, the availability in different colors, and least but not last, the low cost. Indeed, a makeup pencil is not intended at all to replace a traditional orthodox surgical marking pen in outlining the definitive preoperative surgical sketch nor any intraoperative marking, if required.

Figure 1 In-office consultation of a patient with two basal cell carcinomas of the right cheek and glabella. (A) The proposed surgical plan is marked with a fiber-tip marker in the right cheek and with a makeup pencil in the glabella. (B) Marking is removed with an appropriate dermocompatible solvent and cleansing milk, respectively. A sketch “phantom” is still appreciated in the right cheek while the markings in the glabella have been easily and completely removed.