Dear Gustavo

I rarely do.  Only in special cases and atypical situations where, for example there is some difficulty that prevents the traditional access can be made

As a general surgeon I use to draw only in cases of pilonidal disease, when Bascoms cleft lift is planned. Scrubbing the field is with povidone iodine. In thyroid surgery the place for the incision is made by a impression of a suture in the optimal place for incision.

Drawing is the key for success in Plastic Surgery. The best marking sometimes comes after several trials and errors. An interesting trick of ours is using a simple make-up pencil during the process of decision making. When the plan is eventually agreed the surgical landmarks are drawn with a standard surgical marking pen. Have a look at this paper of ours here attached and, please, let me know what you think about.

Article Makeup Pencils in Plastic Surgery

I agree entirely with Nelson, Yonko and Giovanni. I use drawing only in difficult cases for achieving the approriate  approach and operating field.  

In plastic surgery it is a very important tool.

Dear Gustavo,

I do not always draw skin incision and anatomical landmarks, bur whenever I do it makes surgery easier for me. I do draw in difficult cases however. If  one has marking pen available in any procedure, it is wise (in my opinion ) to draw . Drawing gives me a mental image of the steps to be taken during procedure.

Dear Nelson, Yonko, Giovanni, Panayot and Mehrdad thank you all for your contribution!

In fact, I think drawing Surgical Landmarks is a good tool for unusual surgeries or non-experienced young surgeons that could be more in alert when planning a surgery. However there are some related-problems with the skin marker such as permanent skin infiltration of the painting or drawing fading with antiseptic solutions (mentioned in the Giovanni´s article) specially worsened in arthroscopic procedures due to epinephrine saline irrigation.

Giovani, what an amazing trick, using a make-up pencil, as you said is cheaper, can be reused, and less infiltration in the scar and could be erased with Cleansing Milk, however it has to be long-lasting and resistant to the antiseptics, doesn´t it?Can you please tell us which make-up pencil do you usually use? 

One of the possibilities could be using alcohol solution, drawing and then using povidone iodine (as it does not fade the draw). However it has to be done intraoperatively.

Photo of Giovanni´s Article Make-Up Drawing (Makeup pencils in plastic surgery):

Dear Gustavo,

many thanks for your consideration about our little trick.

We use common make-up pencils and we use them only during the process of decision making or for teaching purposes. The definitive pre-operative surgical sketch is always done with a vital dye marking pen and therefore we do not paint the make-up pencil sketch with the surgical antiseptic solution.

Yes in pricedures that i pwrfirm less than 10 times per month

You're never too old or wise not to draw skin incisions and anatomical landmarks. When teaching, if a trainee can't accurately draw the intended surgical incision then they should not be allowed to perform the operative procedure even under supervision.