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 preor 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