Plastic Surgeon to Celebrities Explains Every Tool She Uses

Top board-certified plastic surgeon, Lara Devgan, takes Insider on a tour of her surgery and shows us each tool she uses during various plastic surgery procedures.

Following is a full transcript of this video.

- So, they're inserted right here all the way into the face. From here, all the way down here, through the neck, all the way over here. And you can really literally separate someone's face from the deep structures below it. Is it too scary?

Producer: No!

It's very cool.

Producer: In a good way.

It's, like, cool. I don't want it to be too twilight zone, but it's super cool.

I'm Dr. Lara Devgan. I'm a board-certified plastic surgeon, and these are some of the most commonly used instruments in my operating room.

This isn't even really all the instruments. This is, like, a fourth of the instruments for every surgery, but at least then I'm saying the main stuff.

The first things that I'm going to show you today are one of my favorite aspects of my job, which is the scalpels. And so I brought my banana from lunch. And I'm going to demonstrate these knives for you. This is a 10 blade. And you can see that the belly of a 10 blade is broader and more curved. So I'll frequently use a 10 blade for an operation like an abdominoplasty or a tummy tuck, where I'm making a large and swift incision. This is an 11 blade, and as you can see, it has a very fine and sharp precision point that goes all the way to the tip. So it's much more appropriate for tiny little precision cuts, like for a blepharoplasty or a lip-lift. You can really carve something extremely fine with an 11 blade. And this is a 15 blade. A 15 blade is one of the most common knives used in plastic surgery, and it has a curvilinear bevel at the tip and can be used for a medium type of incision and can be very multifunctional. So, for a face-lift or for a breast augmentation, a 15 blade can be a very beautiful option.

My favorite and most frequently performed operation is the face-lift. I like to use an 11 blade for a face-lift because it's a super-precise operation. So, I'll start by making a curvilinear incision hidden inside the ear and curving behind the back of the ear and a little one underneath the chin. And I use those incisions in order to dissect the deep plane of the face, free from the soft tissue of the face and the neck. In order to do that, I'm using a series of scalpels; small, fine, curved scissors; and larger curved scissors, in escalating sizes. And this is one of the most amazing instruments in all of plastic surgery. It's called the Gorney scissors or the face-lift scissors. So, they're inserted right here all the way into the face. So it's very cool, but very high stakes. And when the Gorney scissors are used appropriately, this pair of scissors can move freely exactly how I'm holding it. From here, all the way down here, through the neck, all the way over here. And you can really literally separate someone's face from the deep structures below it and separate someone's neck from the deep structures below it. So this small pair of scissors really represents the pinnacle of what is possible with plastic surgery in understanding the key anatomy of the face and how to do good and not harm with it.

Producer: What is the tiny rake for? [crew laughs]

The tiny rake? It's called a rake, actually. Or usually a Senn, more formally. So this little retractor is often used in a face-lift to lift up tissue planes to allow for better visualization.

These fine and beautiful instruments here in front are some of the instruments that I use for blepharoplasty. First, I use corneal shields to protect someone's eyes so that we don't get corneal scratches or irritation when we're doing the surgery. Next, I use these millimeter calibers to precisely measure the fine details of the operation, because you want to make sure that not only is the lid margin length the same on both sides, but that one eye is exactly the same as the contralateral eye. So the calibers are an elegant take on a millimeter ruler that is sterile and prepared for the surgical field. After planning and making my incision line, I use an assortment of fine surgical scissors, like Iris scissors, in order to dissect out excess skin and puffiness from the upper lids and from the lower lids. When I'm using the lower-lid-incision approach, I use instruments like this specialized Desmarres retractor to get placed inside the lower lid to retract out the tissues in here to better visualize puffiness and excess fat under the eyes. The skin around the eyes is the thinnest and finest on the body. And for that reason, the instruments that we use to close the tissues around the eyes are also some of the very finest that we use. And I love these instruments because they're so tiny and adorable. These are jewelers forceps, and these are very fine needle drivers, and they're both very tiny in caliber. And these are the instruments that I use to handle a needle and suture when I'm sewing closed the incision line for an upper- and lower-eyelid blepharoplasty surgery.

You may have noticed this interesting collection of instruments right in the center of the table. And these are some of the instruments that I frequently use for rhinoplasty surgery. And I will start by using the nasal speculum. And this goes inside the nostril and allows me to visualize what's going on, on the inside. And when we're looking at the nose, some of the things that I address aesthetically include issues related to the contour; the dorsum, or bridge, of the nose; and the tip. When someone has complaints about the bridge of the nose, often they're related to bumps on the nose. And one of the ways that we address bumps is with rasps. And these are kind of like the equivalent of surgical nail files. The ridges on the rasps are actually coated with diamond dust, so they're extremely sharp, and they're capable of filing down bony and cartilaginous humps on the sidewalls of the nose to make them narrower and the dorsum of the nose to make the prominence right here a little bit more refined. In some situations, rasping the nose is not enough to give someone the contour they desire. We sometimes need to in-fracture the nasal bones and reduce the size of the nasal bones by breaking them. And that's called performing an osteotomy. How do we do that? We use a mallet and an osteotome. So, in order to create controlled breaks of the nasal bones, I actually create postage-stamp little breaks along the sidewalls of the nasal bones using the mallet and osteotome. And we do that just like that. Tap tap, tap tap, tap tap, tap tap. By making little osteotomies all the way down the nasal bones on both sides and in-fracturing the nasal bones. So, this a very interesting and unique instrument. It looks a little barbaric, but it's actually incredibly controlled in precise hands with very controlled, precise movements.

One of the most commonly performed plastic-surgery procedures in the United States and in my practice is breast augmentation. And this is what a breast implant looks like. So this is a sample of a highly cohesive silicone gel breast implant. It's very squishy and feels very nice and natural. We place breast implants with a no-touch technique. So the incision used to place a breast implant is very small. It's about 2 centimeters, so less than an inch. It's placed in the inframammary fold, just underneath the breast crease. So right where an underwire sits on a bra. And I use this funnel, because it's almost like an icing funnel when you're decorating a cake, and it allows me to propel this implant through a very tiny incision right into the breast. There's been so much progress in breast augmentation. When I was starting my training, breast augmentation was an operation that took four or five hours. The incision was this big. It was under general anesthesia. Now, in my hands, the operation takes under 30 minutes, the incision is less than an inch, and it's done under sedation. It's truly like the difference between a cellphone from 20 years ago and the iPhone today.

Liposuction is a very hot topic, and I wanted to show you some liposuction cannulae. So, this is a spatula-tipped cannula. And this is basically a stainless-steel surgical straw used to suction fat out of the human body. These cannulae are used specifically for the submental region, so the double-chin accumulation of fat. But liposuction can be performed in any area of the body. There are many different cannulas that are available, and I use liposuction cannulae that have a variety of lengths; calibers, or thicknesses; and sizes. There are also many different shapes on the heads of the cannulae. So they can have a smooth tip, a round tip, a basket tip, a spatula tip, cutting tips, blunt tips, and many different types of tips.

Now we have to talk about one of the most important tools in a plastic surgeon's tool kit, and that is sutures. This is a little closer look at a 6-O nylon. It's a very fine surgical suture, finer than a human hair. And you may remember these two instruments that I mentioned earlier. This is a jewelers forceps and a fine needle driver from my blepharoplasty surgical instruments. So, there are many types of sutures that are important in plastic surgery. And there are two main categories of sutures, dissolvable and non-dissolvable sutures. And dissolvable sutures are used in areas where wounds are a little bit more forgiving, and non-dissolvable sutures are important in more cosmetically sensitive areas. So, if something is very precision-oriented, you're going to use a non-dissolvable, tiny, tiny stitch. And that's what I'm using right here.

These are my dad's initials carved on this mallet. My dad was a head and neck surgeon. But one thing that's cool is the same instrument my dad used decades ago is something that I'm still able to use in my practice.

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