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.