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