email just before surgery

The following e-mail exchange between Dr. Eppley and myself is only one of many during the many months he and I corresponded before my revision surgery. The entries posted here may not appear in the proper chronological order and MOST of our the detailed messages have been lost from my AOL account due to corrupted AOL software. The entire contents of the screen name I reserved exclusively for e-mail exchange with Dr. Eppley was lost with the screen name. Copies of these interchanges were sent to another of his patients with whom I had a long time e-mail exchange, but this woman is not longer communicating with me. However, I assume she and Dr. Eppley still have this information saved on their own computers.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Date: 04/16/2001To: beppley@iupui.eduCC: Mchlewlsn
Dear Dr. Eppley:
Thank you for the call last Friday. Our talk did address my concerns,however, there remains one factor that cannot be determined until I actually meet with you on Wednesday when you have the opportunity to do a hands-on examination my face again.
I know it is impossible for you to determine exactly how much "tightening" is feasible until you actually perform the operation as well as consideration of my age, condition of my skin, aberration in tissue from previous surgery, individual capacity for healing, etc. With that understood, I would like to stand in front of a mirror and have you actually pull up the skin on both sides of my face (sort of like what I did in the video) to give me an idea of how much you think you can lift the neck and lower face and the vectors of tension involved. I need you to feel the unyielding quality of this skin/SMAS (?), appreciate the severity of its hypoelastic condition and the manner in which placing sufficient tensionto create an improvement while I am smiling stretches my mouth out to a grotesque degree while in repose.
I'm not sure I explained that very well, but I guess I need to see how far it is possible to effect a change to determine whether the surgery can accomplish enough change to make it worth the undertaking. I apologize for not bringing this up when we met, but there is a degree of change that I feel will make the financial, physical and emotional sacrifice of surgery worth while, as opposed to an improvement that is so slight as to be disappointing. Dr. Eppley, I do not have unrealistic expectations and know you cannot promise results, but I do not plan to have another facelift again and I want this one to accomplish the maximum degree of improvement because it will be my last.
It may help you understand if I tell you something about my financial situation. The money for this surgery is my entire life's savings. As you are aware from my medical records, I have narcolepsy and while I am able and fortunate enough to work at a job that allows me the flexibility to work "around" the inconvenience posed by this disorder, I do receive SSI disability and medical insurance because I have no material assets. It hastaken me 3 years and an advance in pay to save the money for this surgery and though I realize there are no guarantees, I would like to feel secure in being able to attain a certain degree of improvement, or at least have the odds on my side.
I realize that the financial status of a patient is not something any doctor feels is his concern, particularly with cosmetic procedures that are deemed a "luxury" , but sometimes it's helpful to know how important these things are to patients who are willing to sacrifice all they have in order to recapture some degree of what they consider a more "normal"appearance. If I had not experienced the problem after the rhinoplasty I would have happily continued living my life without wanting to undergo another surgery to "improve" anything else.
I have chosen you to perform my surgery over the other surgeons who have offered to do so because I believe you understand my problem and how I feel about it better than they and I feel comfortable in expressing myself to you and trust your skill and experience. I know you want me to be satisfied with the results and that you place as much importance onour understanding the possibilities and limitations involved as I.
I think we are on the "same page" and have been from the beginning, but I would feel better knowing that should you find the possibilities more limited upon examining me Wednesday, that I may have the option of doing the nasolabial excision and corner lip lift as an alternative to the major surgery we have planned.
Dr. Eppley, I believe we WILL go ahead with the big operation, but I still have this thing in my mind about the SMAS being stretched out as well as the skin and as many ways as I have pulled and lifted this face in front of a mirror myself, I cannot get the neck and jaw line defined enough without stretching my mouth out to the sides of my face! (I hope that made you laugh!) I see the success of this operation involving: 1.) the readhesion of the tissue plane that has been "loosened or detached" from the deeper muscles (whether that is skin or SMAS, will the dissection have to be on that plane to form a fibrosis and thus "reattach?) and 2.) being able to tailor the "excess" in such a way that it drapes in as natural a manner as its condition allows. If this involves direct excision and scars, that is quite acceptable to me. I would readily accept the scars to obtain the better contour.
I have even thought about the possibility of a Z plasty for the neck if the skin is stretched out in a way that only a direct excision would address. I know that would involve another procedure, but isn't it the same principle involved in the nasolabial area where you have the "parachute" effect of the tissue which may not be improved through lifting through the face/neck lift incision? Can the platysma plication/plasty be addressed in this fashion? I haven't read anything about Z plasty in this area.. just a few abstracts, but no complete articles.
I apologize for this long letter. I hope I haven't discouraged you from wanting to operate on me. I think I am just giving voice to all my last minute concerns to clear the slate for Wednesday. I hope you will not misunderstand anything I have said as a reluctance to move forward.
Thank you for all your time and understanding, Dr. Eppley, I truly appreciate it more than you know.
Lucille
PS: I have attached a diagram of the platysma transection I mentioned on the phone that you did not receive in my last e-mail.

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