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.
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