Losing Face: November 2007

Friday, November 30, 2007

Dear Dr. Eppley:

In answer to some of your comments regarding what you called my "bizarre and irrational" behavior, I wish to point out the following:

>>a) Showing up for surgery believing that you were going to have it done under local anesthesia. This is something that we specifically discussed during your prior consultation.<<>>b) Showing up for surgery and having no mechanism to pay for it. Then immediately after surgery, canceling the venues that had been established to pay for it.<<

To the contrary, my bank statement shows a cash deposit and balance on April 18, 2001 in an amount MORE than sufficient to cover ALL costs. A cash deposit for $10,000 was made 2 days before my surgery; irrefutable proof that I had every intention of making PAYMENT IN FULL upon presenting for surgery. Therefore, your above statement is nonsensical, and only meant to divert attention from the real problem, which is the negligent manner in which you performed my surgery.

I was not aware that Fleet Bank imposed a $4,000 withdrawal limit per 24 hr. period. Meridian staff discovered this just before I was taken to the OR. I gave your staff my bank PIN code, to facilitate withdrawal of the entire amount. However, the bank said they would have wait 24 hours between each withdrawal. Therefore, you revieved $4,000 initially.

My reasons for stopping payment on the BALANCE, after the initial $4,000 was paid:

1.) Upon my return to the hotel after seeing you the day after surgery for removal of the drain, I found a phone message from Meridian informing me that an additional fee would be withdrawn from my account for "an extended stay" at the facility. In light of the reason I decided NOT to stay, (waking from anesthesia, unattended,and unable to breathe), I was obviously being exploited. In total, I received four very nasty calls regarding MONEY, but not a single inquiry about how I was doing.... NOT ONE. (Meridian notes LIE about this, as they state a call was made to find out how I was doing. THIS IS A LIE.

2.) By the second day I ascertained that you did NOT perform a full facelift on me as we had thoroughly discussed. You had NOT dissected down to the nasolabial fold (as per my previous facelift of which you had the operative report, accurate in every detail). Since the agreed PURPOSE of the surgery for which I engaged you was an attempt to re-establish adhesion between tissue planes that had become lax and detached from the muscles of expression (as stated in your consultation notes) this clearly could not have been achieved without dissection of the areas undermined in previous surgery. During our meeting 2 months before surgery, I explained that the hydrodissection had been carried down to the nasolabial fold and fibrous attachments freed at that juncture, as per Dr. Driscoll's report. Your comment was: "They all say they do that, but they really don't." I told you I was CERTAIN it HAD been done in my case, and showed you the intra-op photo which clearly depicts, in vivid color, the extent of the undermining.

A message left by your secretary, Machele Hebert, stated that she " would have a credit agent call upon me". In my debilitated post operative condition, ALONE in a hotel room 1,000 miles frohttp://groups.msn.com/LosingFace/dreppleysresponse.msnw http://groups.msn.com/LosingFace/aftertheoperation.msnw http://groups.msn.com/LosingFace/immediatedenial.msnw http://groups.msn.com/LosingFace/dreppleysoperativereport4182001.msnw http://groups.msn.com/LosingFace/omittedmostimportantpartofoperation.msnw http://groups.msn.com/LosingFace/neveransweredthisormanyotherquestions.msnw http://groups.msn.com/LosingFace/emailtodreppleyoneyearlater.msnw http://groups.msn.com/LosingFace/mystoppaymentdreppleycutshislosses.msnw http://groups.msn.com/LosingFace/dreppleystalentfortwistingthetruth.msnw http://groups.msn.com/LosingFace/confidentialitynotatmeridianplastsurgcenter.msnw http://groups.msn.com/LosingFace/dreppleyplaysblamethevictim.msnw http://groups.msn.com/LosingFace/yourwebpage3.msnw http://groups.msn.com/LosingFace/expertsquestiondreppleyshighinfectionrate.msnw http://groups.msn.com/LosingFace/massachusettsgeneralhospitalresidentsclinic.msnw http://groups.msn.com/LosingFace/documentationofphotographs.msnw http://groups.msn.com/LosingFace/documentationofmyappearance.msnw http://groups.msn.com/LosingFace/opinionsfromexperiencedradiologists.msnw http://groups.msn.com/LosingFace/evaluationofbrilliantradiologist.msnw http://groups.msn.com/LosingFace/entspecialistconfirmsdrdoaksopinionandmore.msnw http://groups.msn.com/LosingFace/modifiedbariumswallow.msnw http://groups.msn.com/LosingFace/mbsreportbyspeechpathologist.msnw http://groups.msn.com/LosingFace/mbs503and1203.msnw http://groups.msn.com/LosingFace/consultationwithpulmonaryspecialist.msnw http://groups.msn.com/LosingFace/followupreportfrompulmonologist.msnw http://groups.msn.com/LosingFace/entreport02july2004.msnw http://groups.msn.com/LosingFace/entreportjuly162004.msnw http://groups.msn.com/LosingFace/april2002reportofconsultationwithsurgeon.msnw http://groups.msn.com/LosingFace/comparisonofxrays.msnw http://groups.msn.com/LosingFace/myexperienceatmghresidentsclinic.msnw

m home, I found this to be an extremely callous, if not threatening.

losing face

Date: 03/07/2002 8:15:24 AM Eastern Standard TimeFrom: beppley@iupui.edu (Eppley, Barry L.)To: luciacovelli@aol.com ('luciacovelli@aol.com')Dear Lucille, In reponse to your recent faxed letter and the overall situation in general, I would like to offer the following comments (particularly, since you have taken the numerous opportunities to voice yours through many venues): 1) Your overall behavior as a patient has been unacceptable. While I have a great obligation to any patient that I put through surgery, patients also have some responsibility to act in a rationale manner. Your behavior since the inception of surgery has been, to say the least, bizarre and irrational. This has been demonstrated by you in the following manner: a) Showing up for surgery believing that you were going to have it done under local anesthesia. This is something that we specifically discussed during your prior consultation. I have never done, nor will ever do, any major surgery under local anesthesia. Just because this is the way your prior surgery was done does not obligate me to do the same. How you could have believed that this was the way it was going to be done is unknown. b) Showing up for surgery and having no mechanism to pay for it. Then immediately after surgery, cancelling the venues that had been established to pay for it. (e.g, cancelling checks) This was particularly disappointing given the compassion that everyone showed in allowing the surgery to proceed in the first place. We all felt bad that someone had come so far and we didn't want you to have to make another trip so we trusted your integrity. c) Your vulgar behavior to the nurses in the recovery room. The kind of language that was used can not be explained by an 'anesthetic' reaction. No prior patient has ever demonstrated this kind of postoperative reaction. Such language and behavior is not acceptable from any patient. The comments that 'people were trying to kill you' in the recovery room is very unusual. d) Your hostile letter writing and threats of reprisal to anyone (e.g., Meridian Center) that made any inquiry as to the paying of the surgical services that you opted to undergo. e) The posting of web pages that describe your horrible ordeal at the Meridian Center. This is particularly disappointing given how everyone went out of their way to help you through your surgery and recovery as an outpatient for this procedure. f) Your communications that describe how you feel there is a conspiracy to prevent you from getting the proper information from your surgery or the people have communicated with other physicans about your surgery and are preventing you from getting the care that you need. To set the record straight, I have only ever spoken to one other physican (that one who took out your sutures after surgery) about your surgery. Other than sending records to Dr. Carey, I have never even been contacted by anyone else about your surgery. Furthermore, the obtaing of medical records on anyone, including the patient themselves, requires authorization and releases on the proper institutional forms. Simply sending a letter with your signature is not a prope release form. We have been fully compliant and timely, when the proper forms have been obtained, about the release of your medical records. 2) The facelift operation that was performed on you with a full SMAS plication was not an unusual procedure of which the details of its execution are hard to fathom. You simply had an extended SMAS, from the cheek to the neck, which was plicated with overlying skin resection. As per your request, this was tightened significantly to deal with your preoperative complaints of subcutaneous tissue and skin laxity. This procedure was very similar to most patients that undergo facelifts with significant face and neck tissue laxity. There was no mystery to the procedure that makes it difficult to understand. You,unlike most patients, have a better preoperative understanding of the anatomy of the face based on our preoperative consultations. Therefore, it should be more understandable to you than most patients. 3) Your postoperative symptoms of facial pain and 'severe physical problems' from this procedure, which is now done almost a year ago, is certainly uncommon at one which I have never seen or heard of before your procedure. While certain facelift patients may have some aesthetic concerns about their postoperative result, the issues of unmitigating pain, difficulty with eating, and non-facial physical problems one year after surgery is difficult to medically explain. I know of no solution for them and certainly further surgery is unlikely to be of help. As you can see from the above, the postoperative path that you have chosen to undertake has made yourself a difficult patient. While I would not question the symptoms that you currently have or the desire/need for further plastic surgery, your behavior has made my continued participation in your care untenable. Proper medical care requires that both parties, physican and patient, act responsibly and in the best interest of obtaining a good outcome. I do not feel in our relationship that you have demonstrated good faith in that regard. I will certainly continue to provide any records to or talk to any other physican about your specific procedure that you deem may be helpful. I would only ask that you makesuch requests formally in writing (not e-mails) that have the appropriate medical release forms. I will continue to make every effort to aid you in obtaining further medical care. Lastly, it should be understood that the my aforementioned comments to you are held in the strictest confidence. I will not share with anyone those thoughts/comments that I have detailed above. I am very sorry that a more favorable postoperative outcome has not been obtained for you. Respectfully, Barry L. Eppley, M.D., D.M.D. Associate Professor of Plastic Surgery Indiana University School of Medicine Read my response:http://groups.msn.com/LosingFace/yourwebpage3.msnw
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Subj: Lisa Harris e-mail Date: 02/03/2002 Dear Dr. Eppley: I wish to call your attention to the e-mail at the end of this message, containing statements by Lisa Harris regarding her discussion of me with you and a member of the Meridian staff. These are excerpt from some lengthy messages, but I have no desire to embarrass Lisa by sending you the entire contents at present. They are authentic, and I have the tracking information which appears at the end of the messages. Dr. Eppley, I have reason to believe that similar comments passed between you and another surgeon whom I consulted regarding the serious problems I have had since my surgery with you. This doctor expressed his willingness to help me until his conversation with you. I think it is time you and I have a talk. I do not want to cause any problems of ANY kind for you, and only ask that you either provide me with a much more detailed explanation of my surgery or that you make every effort to provide another surgeon with sufficient information regarding my procedure, WITHOUT embellishment of derogatory comments that will preclude my receiving the necessary SURGICAL intervention I require to correct the functional problems resulting from my operation in April. My health is deteriorating as a direct result of the PHYSICAL complications caused by my inability to lift my head, which causes my jaw to pull down and back and my tongue with it, thus obstructing my airway with my head in an upright position. I have a very severe pulling downward of the lip depressor area and I am CERTAIN you plicated the SMAS in that area, which has made even normal animation impossible without the restriction of the platysma pulling down the plicated area in a severe contraction upon repose. Dr. Eppley, I could cover, point by point, why the techniques you used created these problems, but quite frankly, I shouldn't have to. All I want is the possibility of regaining some function lost from your operation and a chance to return to the good health I enjoyed before last April. I hope you will see your way clear to calling me as soon as possible. It would be a great relief to us both to clear the air. I am not the "dangerously mentally ill" person that Lisa Harris and others would have you believe. The only thing of which I am guilty is being smart enough to know what has gone wrong with my operations and why. If I do not hear from you by February 10th, one week from today, I will assume that you do not wish to amend our differences one on one, and that you would prefer doing on a more official level. Sincerely, Lucille Iacovelli _____________________________________________________________________ Subj: lucille Date: 01/26/2002 11:41:01 AM Eastern Standard Time To: Wallpepper@aol.com i don't know about all the financial stuff, but i do know that because of her threats to kill her last surgeon and her obvious unstable nature, dr eppley is afraid she could come back and kill him... i talked to him about that... i think that is probably the reason he didn't pursue the money. lisa _____________________________________________________________________ Subj: Re: ps.. ?? Date: 01/26/2002 3:22:42 PM Eastern Standard Time To: Wallpepper@aol.com by the way... as for the length of time spent, did she tell you that she threw a fit when they told her that she had to have anesthesia? it took over an hour to get her to understand that she could not go into surgery without it... could be that was one of the reasons things had to be 'rushed' along... lisa _____________________________________________________________________
Subj: Re: ps.. ?? Date: 01/26/2002 To: >>did she tell you that she threw a fit when they told her that she had to have anesthesia? it took over an hour to get her to understand that she could not go into surgery without it.. <To: Wallpepper@aol.com actually one of the ladies who works there i know who is a friend of mine. _____________________________________________________________________
Here is the TRUTH about the above:>> i do know that because of her threats to kill her last surgeon and her obvious unstable nature, dr eppley is afraid she could come back and kill him... i talked to him about that...<< This is a blatant LIE. The doctors who sued me and obtained restraining orders against me NEVER made such an accusation. Why did Lisa?
>> as for the length of time spent, did she tell you that she threw a fit when they told her that she had to have anesthesia? it took over an hour to get her to understand that she could not go into surgery without it... This so-called "fit" is another flagrant LIE. My operation, for which Meridian charged the full fee for the 4 1/2 hours time estimated by Dr. Eppley, was cut short when the nurse came rushing into the OR just before I got on the table with my consent form in hand, and pointed out the line I crossed out stating that I allow the surgeon to use the anesthesia of his choice, and wrote in "NO GENERAL/INTUBATED ANESTHESIA". The very first thing I establish with all surgeons I have ever consulted is that I would never, under any circumstances, agree to surgery if it involved general anesthesia. Dr. Eppley was no exception. Therefore, when he said he could not perform my operation after reading my changes to the consent form, I was shocked. I reminded him of our first conversation and my making conscious sedation a prerequisite of any elective surgery. He claimed that there must have been a "misunderstanding", and then proceeded to take me into a room, where he and his anesthesiologist proceeded to cajole me into having the surgery with general anesthesia. (I later learned the so-called anesthesiologist was NOT an anesthesiologist at all) Given that I had planned this surgery with him for several months, after extensive written and verbal communication, had made the trip of 1,000 miles 2 months previous, for a face-to-face, lengthy consultation, and was then 1,000 miles from home, totally alone, I made the biggest mistake of my life in going through with the operation ... an operation he cut short to 3 hours from the 4 1/2 hours ... and operation he assured me was his "big case of the day" and therefore, he had booked it last, so he could "take his time".
These lies, which to him, were nothing more than sales tactics, are factors upon which I chose him to perform my operation. When I awoke from anesthesia, unable to breathe, only to learn that Dr. Eppley was in the OR with another case, I had my first realization of his capacity for deceit. What happened to my being his "last case of the day" so he could "take his time"? This makes the vicious lies in which he and his staff are guilty, all the more despicable. A more rational question to ask would be: What surgeon in his right mind would agree to operate on a patient who was "throwing a fit"? The motivation for such lies by Dr. Eppley and the Meridian staff are self evident, but what was Lisa's reason?
>>actually one of the ladies who works there i know who is a friend of mine.<

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In March of 2001, just one month before my surgery, I sent Dr. Eppley a 3 minute video of myself simulating the facelift effect I wanted by lifting with thumbs and forefingers, the areas just below and behind the earlobes at the angle of the jaw and preauricular area in line with the eye. This "lifting" with my fingers in an UPWARD, vertical or cephalid vector, produced the desired effect on the lower face, in particular, the platysma, and lifted the severe laxity from the previous surgery, accentuating a high hyoid position. My neck has always been long and slender, and until the first signs of platysmal banding appeared in my last 40's, I always had a well defined cervicomental angle. The lifting with forefingers in the preauricular area created a bunching of skin at the outer aspect of the eye, and correcting this would involve an extended lower blephroplasty incision, which Dr. Eppley and I discussed during our meeting in February, 2001. Remember, I flew out to meet with him BEFORE sending this video, the purpose of which was to further clarify the goals of the operation and make certain we were both "on the same page", to use one of his favorite expressions. I think it is evident that I am not placing an inordinate amount of tension on my face, however, I AM LIFTING UPWARD, which I expected Dr. Eppley to do in my operation. The post op pictures are also stills taken from a video, and show the cervicomental angle as MORE OBTUSE, not improved. Dr. Eppley actually SHORTENED the platysma and pulled the SMAS in a vector lateral and slightly DOWNWARD. He also "folded" or plicated the excess SMAS which appears to be sagging skin in my pre-op photos, but was actually laxity of both skin AND SMAS, which was "blown out" by the excessive swelling after the rhinoplasty, in which edema tracked along the path of least resistance, i.e., the insufficiently healed facelift dissection planes. Aside from the obviously "thicker" neck and the pulling downward of my jaw from the downward tension of Dr. Eppley's face "lift" (?), nearly 2 years after this surgery, the tension pulling downward on the auricular cartilage, to which he fixed the SMAS, (though he denies this, it is evident) continues to cause worse pain than it did even one year ago. If, as Dr. Eppley's e-mail response regarding this video indicates, he did, indeed, understand the necessity for lifting the skin and SMAS in APPROPRIATE vectors of tension, why did he do something so predictably injurious and INAPPROPRIATE as this? Why? His operative report states that I never had a previous platysma plication, yet he went in through the OLD INCISION from Dr. Driscoll's platysma plication and had a copy of this op report. This is only one error in a long list of Dr. Eppley's thoughtless misdeeds which resulted in changing an aesthetic problem with good chance for correction, to an irreversible surgical disaster that has left me suffering excruciating pain every day since the day her operated on me, inability to have any kind of normal facial animation whatsoever, turning an already strange countenance into physically painful and grotesque contortions with the slightest facial expression. Deafness, tinnittus,.. Dr. Eppley's operation makes what happened at MGH seem like a picnic in comparison.
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INDIANA UNIVERSITY MEDICAL CENTER DIVISION OF PLASTIC SURGERY MERIDIAN NOTE PATIENT NAME: Lucille Iacovelli DATE: 2-21-01 Lucille is a 48 (my correction: 51) year old female who presents for consideration for facial surgery. She has significant aesthetic facial surgery history. In 1997 she underwent an initial facelift followed 6 weeks later by a rhinoplasty both of which were performed by the same surgeon in Boston. According to her, her postoperative course was complicated after by tremendous facial swelling which she feels occurred due to the use of the tumescent technique for hydrodissection of her facelift. Her subsequent rhinoplasty was then followed by an inordinate amount of facial swelling which resulted very quickly and a considerable of postoperative skin elasticity of which she has never recovered. i have had the opportunity before today of to have discussions with her several times by email and by phone as well as l have received a 2 inch thick portfolio of facial photographs which documents in great detail and number her preoperative to her postoperative course to the present time. Therefore I have had some significant insight into her problem before today. When asked to list the areas that bother her in order of priority she has come up with the following list which includes: 1 . The down turning and stretched out look of her commissures which creates a significant postoperative difference in her smile. 2. The feeling that she has excess skin and that the skin is not really attached to the underlying bone. I believe this represents the fair amount of skin elasticity that she has. 3. She is bothered by the appearance of her eyes and neck which appears to be relatively straightforward aging concerns. 4. The sunken appearance to her cheek and lateral facial areas. On examination she has well-healed preauricular scars which go in the standard fashion with exception of that they run in front of the tragus and they block out the hairline running with step excision running horizontally across the preauricular hairline and then in front of the temporal hairline just above the level of the lateral canthus. Palpation of her overall skin demonstrates that it is fairly thin and there is not a lot of substance of soft tissue, particularly in the lateral facial area to the ,underlying bone. She has very prominent nasolabial crease with falling over the superior skin. Her overall skin quality is modestly thin and she has a fair amount of pitied acne scars throughout the cheek areas as well as multiple areas of hyopigmented scars throughout the neck areas. After a 2-hour discussion with her we both agreed to an overall treatment plan. This includes an initial nasolabial fold excision with simultaneous corner of the mouth lift. She has read a great deal particularly about these procedures and is well aware of the resultant scars of which she is very willing to accept. A second stage would then be, followed by a full facelift with platysmal plication through a submental incision of which she has not had before. In addition, she did ask about and showed an article connecting the lateral canthal incision from the lower blepharoplasties to her temporal line. She feels that this is a good procedure and is willing to accept the scar in an effort to get rid of more the skin in this direction. Having discussed this her this is not an unreasonable request given that the distance between the 2 is only about 15 mms. While it is an unusual place to place a scar, she has researched this out and has found an article which does report it being done. She again is aware of the resultant scar, is aware according the article that the majority of the patients were not happy with result, and she still desires to precede with it. l agreed that l would consider this option on an lntraoperative basis and would use it only if l felt the redundant skin in that area would merit the scar and could be improved by its placement. After our very lengthy discussion, l have asked her to put more thought into it and then get back to me in regards to scheduling. She is interested in scheduling the first stage within the next several weeks. Barry L.. Eppley, M.D., D.M.D.
http://groups.msn.com/LosingFace/dreppleysresponse.msnw http://groups.msn.com/LosingFace/aftertheoperation.msnw http://groups.msn.com/LosingFace/immediatedenial.msnw http://groups.msn.com/LosingFace/dreppleysoperativereport4182001.msnw http://groups.msn.com/LosingFace/omittedmostimportantpartofoperation.msnw http://groups.msn.com/LosingFace/neveransweredthisormanyotherquestions.msnw http://groups.msn.com/LosingFace/emailtodreppleyoneyearlater.msnw http://groups.msn.com/LosingFace/mystoppaymentdreppleycutshislosses.msnw http://groups.msn.com/LosingFace/dreppleystalentfortwistingthetruth.msnw http://groups.msn.com/LosingFace/confidentialitynotatmeridianplastsurgcenter.msnw http://groups.msn.com/LosingFace/dreppleyplaysblamethevictim.msnw http://groups.msn.com/LosingFace/yourwebpage3.msnw http://groups.msn.com/LosingFace/expertsquestiondreppleyshighinfectionrate.msnw http://groups.msn.com/LosingFace/massachusettsgeneralhospitalresidentsclinic.msnw http://groups.msn.com/LosingFace/documentationofphotographs.msnw http://groups.msn.com/LosingFace/documentationofmyappearance.msnw http://groups.msn.com/LosingFace/opinionsfromexperiencedradiologists.msnw http://groups.msn.com/LosingFace/evaluationofbrilliantradiologist.msnw http://groups.msn.com/LosingFace/entspecialistconfirmsdrdoaksopinionandmore.msnw http://groups.msn.com/LosingFace/modifiedbariumswallow.msnw http://groups.msn.com/LosingFace/mbsreportbyspeechpathologist.msnw http://groups.msn.com/LosingFace/mbs503and1203.msnw http://groups.msn.com/LosingFace/consultationwithpulmonaryspecialist.msnw http://groups.msn.com/LosingFace/followupreportfrompulmonologist.msnw http://groups.msn.com/LosingFace/entreport02july2004.msnw http://groups.msn.com/LosingFace/entreportjuly162004.msnw http://groups.msn.com/LosingFace/april2002reportofconsultationwithsurgeon.msnw http://groups.msn.com/LosingFace/comparisonofxrays.msnw http://groups.msn.com/LosingFace/myexperienceatmghresidentsclinic.msnw

MGH part 3

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MGH part 2

Senior surgeons received my presentation of the problem with intimidating remarks and negative body language. They did everything but snicker and sneer. I asked why my under eye area had a sunken appearance, Dr. Constable response was: "What did you expect?". I told him I did not expect the muscle to be tightened and shortened the way it was; that I expected Dr. Driscoll to do exactly what he assured me he was going to do. When I pointed out the laxity of the neck, jowl and above the nasolabial fold, Dr. Donelan said: "You certainly look better than the pre-ops; you have a great facelift" and "How do you like your nose?" I told him I loved my nose, but did not bargain to cut it off to spite my face. This meeting convinced me to never again meet with this group of doctors without a witness present or tape recording the conversation.
I voiced all of my concern about the area where hydrodissection was used seemed to have a thinned and lax quality. I explained my belief that hydrodissection may require a longer healing time before the insult of another surgery with a high degree of potential for causing edema from the breaking of nasal bones. I said that if it were considered routinely safe to do a rhinoplasty ( not a tip plasty only) 8 weeks after a face lift, then perhaps the mechanics of dissecting with a solution under pressure has a different effect on tissue adhesion than sharp instrument dissection. This was dismissed by all as "having nothing whatsoever" to do with the healing of the facelift . I was told that my facelift would lookexactly the same, even if I had NOT had a rhinoplasty. I have heard this countless times from all the doctors at MGH . If so, then there must be serious problem with the facelift.
After they conferred, Dr. Driscoll said they had nothing to offer for improvement and all agreed I had a great facelift. He suggested I was unhappy with other areas of my life and was projecting that attitude on to the results of my surgery. I told him there was nothing in my life other than my displeasure with the results of my surgery and my concern that the problem from the swelling was more serious than they were willing to admit.
During the next several weeks, I consulted with three plastic surgeons outside MGH. One told me he could do a tuck up and submalar implants, which would improve the hollow appearance of my cheeks, and the platysma should be tightened with a different plication technique. He said he thought there was too much fat removed from under my eyes and was surprised when I said no fat was removed. He said nothing could be done about the eye area. When I asked about the stretching of the skin from the edema post-rhinoplasty and the use of tumescent dissection he said he never uses it due to its causing distortion that makes it difficult to determine what things will look like with the redraping of the skin. He had no comment on whether the skin appeared stretched. He only said there was laxity that might be improved by a tuck up.
My next consult was with a surgeon I had seen in 1996 about laser resurfacing. I also saw him in January, after the facelift and before the rhinoplasty. At first he thought my facelift looked good . He was surprised about my having the rhinoplasty so soon. I asked what he thought about the swelling and stretching of skin. I explained my theory about the tumescent, etc... I expressed my frustration at being unable to get at the source of the condition of my face.
He examined my face thoroughly, had me activate different muscles and contort my features while he tested and stretched the skin in different directions. He did this all over my face, neck and even around my eyes. He looked thoughtful, but hesitated to give me an opinion.. I expressed my frustration with my inability to obtain straight answers about this when I absolutely knew what happened. I am an accurate observer of my own healing process. I promised I would not involve him or mention his name in connection with any disagreement I may have with the doctors at MGH if he would give me his honest opinion. He said my results were "bizarre" and if my account was accurate, he could think of no other explanation for this than exactly what I related. He also said he would never consider doing a rhinoplasty after a facelift in less than 6 months. His remark about my theory regarding the tumescent possibly taking longer to heal before another surgery was "I think you are on to something".
This doctor is Chief of Plastic Surgery at a major teaching hospital. His opinion of the possibility of further surgery making an improvement was cautious. He personally would be concerned as to the unpredictability due to the apparent changes and would not attempt anything himself. I am grateful for his honesty. It has also made me face the possibility that I may have to remain like this for the rest of my life, which I find unbearable. As time passes it gets noticeably worse, and it has only been not quite a year. What will I look like 6 months or a year from now?
I understand the ethical issues surrounding a surgeon's critical analysis of another doctor's work. Different surgeons have their own ways of doing things and cosmetic surgery techniques are in a class of their own as far as what is acceptable. Obviously there are limitations to which one must adhere for the patient's safety, however, the nature of this specialty allows a certain degree of "artistic license". I have never heard a doctor criticize another work except in a courtroom as an expert witness or among themselves. There the financial aspect to be considered in shedding unfavorable light on the entire specialty of cosmetic surgery. Why is it you never hear about patients like me? It is not because there are so few of us, but because most are hiding; they meekly take their ruined faces and lives and go away. They are too devastated and exhausted to engage themselves in the pursuit of holding the responsible parties accountable. I have been on the receiving end of good and bad cosmetic surgery. Before my experience at MGH, I was one of the greatest advocates of the beneficial effects that cosmetic surgery can have on a person's well being.
My next consult said he thought I would get an improvement only from doing another full face and neck lift. I asked him what he thought of the stretching from the rhinoplasty and his opinion of the tumescent technique involvement, he said he uses large volumes of anesthesia, but not introduced into the tissue under pressure as I described, so reserved comment. He said I know my own face better than anyone, and he always listens to what the patient thinks and says because they usually will tell him exactly what is wrong. He found my description 'graphic' and I felt he understood what I was attempting to put forth without any problem. . I voiced my concern about the possibility that the skin may respond to surgery in an unpredictable manner, and he told me of the usual risks, but felt comfortable with the fact that I healed so well form all my previous operations and would be willing to proceed if I wished. The estimated cost of this surgery is $8,000.
I have been concerned about my ability to communicate these details from the start, since the doctors at MGH always left me feeling as though what I was trying to explain was so extraordinary as to be impossible. I felt intimidated by their attitude of my description being so extreme as to be taken with a grain of salt. I am not doing this to prove I am right, I am doing this because I feel I deserve an explanation. I have suffered visible damage that has caused me emotional devastation, and their denial has largely contributed to my distress
At my meeting with Dr. Driscoll on March 12, 1998, as I was leaving the clinic I remembered one more question I had forgotten to ask, and so walked back to the conference room where he was seated at the table, making notations in my medical record. I asked him about the bunching of the muscle under my left eye and the bruise that had remained all this time. He picked up a sheet of color slides and held them up to the light to show me the area before surgery. These were the photos taken in the OR and I could see that most of them had been taken during the procedure, and the first few just before I was placed on the table. There were about 24 slides in this plastic protector . Iwas able to discern some of the stages of the operation, but did not look at them long enough to see each one individually, as Dr. Driscoll held them up while I looked.
I later wrote to him asking if I could have copies of these photos and never received a reply. I wanted these photos because I felt it would help any surgeon I might see in the future determine exactly what was done and assist them in any attempt at revision surgery. I feel the photos will help me in proving the damaged areas of my face directly correspond with the undermined areas. You cannot help but recognize this if you examine my face. I have shown show them how the skin balloons out even if you stretch it to its maximum and seen their faces suddenly take on a puzzled look, then the quick control of their features as their minds register that something is very wrong with what they are looking at. I am familiar with this "look"; I have seen iton the face of the doctor I worked with many times. It is the expression the patient hardly ever perceives as trepidation, but that's exactly what it is.
One of my consultants did not think the undermining went down as far as the nasolabial line. I knew it did, but did not have the operative report at that time. He thought becausethe skin was loose and folded over when I smiled was due to the undermining not including that area. I can understand his thinking this way, since he also did not believe my face had swelled to the extent I described. If anything, my description has been on the conservative side, since I myself still cannot believe that experience. Only my landlady saw me at the worst point and she said she will never forget it. Her recollection is more dramatic than mine. She is willing to sign any testimony as to witnessing my condition. She is a responsible intelligent person whose judgment is beyond reproach

My expeirence with mgh

Important note: The following was written long before I had revision surgery by Dr. Eppley in 2001. I was distressed over the deterioration of my appearance after surgery at MGH. My pre-op photos, opinions of family and friends prove this. Any normal woman would be distraught at having her attractive face ruined. While my distress after the MGH surgery was justified, it did not prevent me from engaging in physical activity. I still enjoyed excellent health. The MGH surgery injured my appearance by causing permanent tissue damage. Dr. Eppley's "revision" surgery in 2001 destroyed my health, leaving me with serious, debilitating, life threatening medical conditions. After experiencing BOTH types of injury, I wish to emphasize that no degree of destruction of one's APPEARANCE ONLY can destroy one's life as does the loss of GOOD HEALTH. Before Dr. Eppley's surgery, I was still able to enjoy the most important things in my life.. working out doors, having a healthy, functioning body capable of enjoy breathing, swallowing, moving normally..AND FREE OF PAIN. You can adjust to the loss of your pretty face and STILL enjoy life. You CANNOT enjoy ANYTHING when you are suffering physically each and every day . The most important message I wish to convey in sharing my experience is NEVER PLACE YOUR GOOD HEALTH AT RISK simply to improve your appearance!! If you think your appearance makes you unhappy, you do not KNOW what TRUE misery is like until destruction of your ability to walk, eat, breathe, makes appearance the LAST OF YOUR CONCERNS. If you think the nightmares happen to OTHER people, you are WRONG. If you are able to laugh, breathe, swallow, talk, walk.. all the things you take for granted when you are not thinking about the way you look, then you are more fortunate than you know. Do not risk the most precious thing in life.. a body that does not NEED an operation to relieve pain or disease.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~THE FOLLOWING IS AN ACCURATE ACCOUNT OF MY EXPERIENCE AT THE PLASTIC SURGERY RESIDENTS CLINIC OF MASSACHUSETTS GENERAL HOSPITAL
I had a full facelift and lower blephroplasty on November 24, 1997 at the Plastic Surgery Residents' Clinic of Massachusetts General Hospital. At my first consultation on 10-16-1997, I was interviewed, examined and medical history taken by the Chief Resident, Dr. Daniel Driscoll, clinical instructors and other residents. After the doctors conferred, Dr. Driscoll said he could perform my facelift under the supervision of Dr. Eugene Courtiss. The resident surgeon's fee was $1,000 and the OR fee was $889... a full facelift under the supervision of a professor of plastic surgery for less then $2,000. Clinical photos were taken and the surgery was scheduled.
Dr. Driscoll went to great lengths to satisfy my need for information regarding technical details of the procedure. I emphasized that my decision to undergo surgery was based on my knowledge of specific details and he seemed comfortable with this. I made it clear to all that I intended to become actively involved in decisions about what I would allow to be done to my face. Nobody objected to my expectation of having this kind of control over my operation.
Some of my questions were: Exactly where would the incision be placed; would it extend into the hairline, would drains be placed in the neck, what type and size suture would be used, etc. We discussed doing a lower blephroplasty which he agreed to discuss with Dr.Courtiss. He explained the risk of extropion in removal of too much skin. He drew a diagram showing how the skin bunched under the eye from a facelift incision and how the side burn could be spared by placing an incision above and behind it in the hairline to get the desirable degree of elevation and drape of the skin. We both agreed that doing less was better than too much. I admired his reasoning in regard to technique for achieving optimal results tempered with caution and conservatism.
Dr. Driscoll assured me I could call him any time to discuss things further and remarked on my being a well informed patient. I asked if I would need pre-op blood work. He said no, but I him to order a CBC, PT and PTT at Cape Cod Hospital and he agreed. The results were normal. Dr. Driscoll asked if I would mind coming in again, during the next week, for him to present my case to a visiting professor. I agreed, and so had the benefit of reviewing everything in more detail. I felt I was in good hands.
I called him a few days before the surgery for a prescription for clindamycin and asked if we would be doing the blephroplasty. He had not checked with Dr. Courtiss, but was concerned about the time involved in the facelift, estimating it to be a 6 to 6 1/2 hours, and the bleph would increase this by another 1 1/2 hours. He said he planned to work slowly and was concerned about my being under sedation and undergoing a procedure of that length.
My medical records showed I was in the OR from 8:45am to 12:05am, exactly 3 hrs. and 20 min. start to finish for both facelift and bleph. I knew Dr. Driscoll could not have made such a great miscalculation and I learned afterward that he did not execute the procedure as we had planned, which accounted for the discrepancy in time.
He was able to do both procedures in this brief time because he used tumescent anesthesia injected under pressure, of which I was not informed. When I questioned him about this, he said he had to defer to Dr. Courtiss' instruction. I feel this was a breach of my trust. He knew the importance I placed on having full knowledge of the procedure beforehand,
I was a guinea pig without my knowledge or consent. I had faith in Dr. Driscoll's ability to carry out the procedure as we had planned. I based my consent on information we discussed at length, the reason for all my questions, taking of notes and phone calls. There was no medical reason to deviate from our original plan. I was not expecting the use of tumescent technique, knew nothing about it in regard to facelift, was not informed before hand, and would never have consented to its use. Due to the lack of information available in the literature and the fact that most surgeons rarely use it, I believe a high probability exists for unforeseen complications. I am convinced by my personal experience that a longer healing time is required after the use of tumescent technique before a subsequent procedure can safely be performed.
The blephroplasty technique Dr. Driscoll used on my lower lids was not what he described in our meeting. I had only excess skin, but a good snap response, yet he used a technique that would have been appropriate for a much older patient with a poor snap response. He removed 1mm of skin and the swelling from the rhinoplasty has stretched the scar out to a greater degree that 1mm. Every surgeon who has seen my eyes says that too much fat was removed, yet no fat was removed. The sunken appearance is a combination of the inappropriate bleph technique and the equally inappropriate SMAS elevation which bunched under the outer aspect of the eye. I complained about the eyes on my first follow up visit, but did not feel it was unsightly. Overall, I was pleased with the result of the facelift and expressed my satisfaction to Dr. Driscoll. In spite of my shock at the use of the tumescent technique and dissatisfaction with the appearance of the lower eyelid hollows, I had an easy and rapid recovery.
I had several weeks before return to work in April as a gardener. I inquired about a rhinoplasty and how soon it could safely be done. I was told it could be done 8 weeks after the facelift. My rhinoplasty at the same clinic was scheduled for January 28, 1998 with the new incoming senior resident, Dr. Melissa Schneider. Upon learning that Dr. Joel Feldman, "facelift specialist" , would supervise my surgery, Any uncertainty I felt about having the rhinoplasty too soon after the facelift was dispelled, I figured it MUST be safe if such a highly regarded facial plastic surgeon as Dr. Feldman was involved in this decision.
I tolerated the procedure well, but on the 2nd day post-op had extensive swelling of the eyes, mid-face and neck. I called Dr. Schneider and reported the degree of swelling. I also noted that there was a difference in the quality of the skin undermined in the facelift from adjacent areas which were swollen but not involved in the facelift. These included a small area in the center of my neck, under my chin, the sides of my nose, and about 1" lateral to the facelift incision. These small, well defined areas did not stretch as did the remainder of the face undermined in the tumescent facelift. I knew there was a serious problem this early on.
I was extremely concerned that the skin involved in the facelift would permanently stretch because the edema was extreme. My instinct was to put a light compression bandage under the chin to keep the area from stretching, but when I asked Dr. Schneider about this she replied with an emphatic NO! My landlady was the only one who saw me at this time and though I took some pictures with her camera, they did not come out. There are no photos to document the extent of the swelling, but I do have a signed statement from my landlady. Dr. Schneider did not take photos on my visit with her 1 week post op when there was still a considerable degree of swelling.
My instinct told me that there was a relation between this extensive swelling as the quality of that skin and the use of hydrodissection (tumescent technique) in the facelift. After the rhinoplasty, my skin lost its adhesion to the SMAS layer beneath. It was as if something had "let go".
A few days before the rhinoplasty I had a dental appointment at Tufts. They could not take regular x-rays because I was unable to open my mouth due to the taught skin and muscle from the facelift. I was barely able to put a thin probe between my front teeth for a Panex x-ray. I was still using a child's toothbrush. Immediately after the rhinoplasty all the taught skin/SMAS that prevented me from opening my mouth were so stretched, I could easily open my mouth wide. Before the rhinoplasty I was not able to smile a full smile due to the facelift, and was careful not to overly animate my facial muscles so my facelift would heal properly. Right after the rhinoplasty I was able to smile widely without any tight feeling. Post-op edema from the rhinoplasty tracked into the dissected planes of the facelift, compromising the new adhesion. This adhesion essentially holds the facelift in place. Some surgeons call this "favorable fibrosis". The only tight feeling that remained was from the internal sutures, which remained intact, except in the platysma, where I could feel the suture had torn through on the right side.
Expressions of perplexed incredulity were plastered on the faces of the doctors at MGH when I described what happened and showed them how drastically different the skin reacted to traction than the areas not involved in the facelift.. . Two general surgeons and one ENT specialist I spoke to were not surprised and thought it would have been a miracle NOT to stretch out only 8 weeks after the facelift. These doctors are friends; I did not consult with them professionally, however, they are still surgeons and familiar with the healing process of the body.
I called Dr. Schneider several times during the first week, telling her I feared something was terribly wrong and could not imagine skin going back to its normal state after being stretched to such an extent. She offered to see me in the clinic on Friday, but there was nothing that could be done for it anyway. She said it was "impossible" that skin can remain stretched out after swelling. When I questioned this she used the following analogy: (exact words) "The chances of your facelift being stretched out are like the chances that a stop light will turn purple rather than red". She called Dr. Feldman, who supervised my rhinoplasty. He said he had never seen permanent stretching of skin from this. On my first follow up a week after the surgery, I was still considerably swollen and bruising had developed along the nasolabial, jowl and neck areas. I was told by several surgeons that they never heard of a neck swelling from a rhinoplasty, let alone developing bruising. The bruising followed the exact areas of dissection in the face/neck lift. This is where the blood settled and followed the path of least resistance. This does NOT happen in a rhinoplasty. The face and neck were swollen to a greater extent at this point than ever it was after the facelift, and was very lax.
I saw Dr. Schneider again 2 weeks post-op for the removal of the splint. May face was still swollen, and I was aware that a rhinoplasty can take up to one year for complete resolution of the swelling. I was pleased with the rhinoplasty, though still concerned about the skin laxity and peculiar appearance of my face when smiling, as there was no adhesion of the skin/SMAS to the deep muscles of expression. Dr. Schneider said she would get as much input from other doctors as she could. She took lots of photos, smiling and in repose. As the edema subsided over the next several weeks, there was a laxity in all the areas undermined by hydrodissection. Dr. Schneider arranged an appointment for me in the clinic with the group and Dr. Driscoll March 12, 1998. Dr. Schnieder did not attend this meeting.

Losing Face

Friday, November 30, 2007

losing face

MGH part 3

MGH part 2

My expeirence with mgh

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