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The MISSING pictorial link that would make my pictures more understandable is that of the severe edema of my face and neck after the rhinoplasty. Unfortunately, pictures were never taken at this point by my surgeons nor myself. I have an accurate and vivid recollection of the extent of this swelling, which gave my head a triangular appearance ... the base of the triangle being the jowls and neck; the top of my head the upper point (no exaggeration). In placing a ruler in a vertical position at the outer aspect of my eye, my face distended outward beyond 2" on either side of this linear trajectory at the jowls/neck. This edema stretched the entire face, gravity pulling down the lower face and stretching the mouth downward. On the first
day post-op, the distention had not progressed to this gross state and my instinct was to put a submental compression bandage in place because I could see where things were headed. Before taking this step, however, I called Dr. Schneider who emphatically told me NOT TO DO THIS! She said facelift specialist, Dr. Joel Feldman, confirmed this. BIG MISTAKE.
Several hours later the edema HAD progressed to an ominous degree. I phoned her again and receive the same response. I later learned from another surgeon that I could have prevented much of the PERMANENT damage if I had followed my instinct rather than her advice.
I have researched everything in the medical literature remotely related to my problem, with hope of finding something that would shed light on its etiology. The following is what I have ascertained from my research, careful observation and knowledge of my own facial anatomy:
My facelift was performed with tumescent dissection under HIGH pressure. (The operative report is vague on a few points; this is one of them. I was in the OR for 3 hr.. 20 min. for a full face/neck lift involving a subcutaneous and extended sub SMAS dissection AND a lower bleph. Due to minimal sedation at my request, I was aware of what was happening in the OR. There was much discussion about the degree of pressure used to inject the tumescent solution. I was aware of the terrible sensation of my face being forcefully "blown up" and off the underlying muscles, particularly on the right side, which was done first and for which the pressure was turned up too high. I heard them discussing it! There is little written about the use of tumescent
or hydrodissection in facelift. I am not referring to liposuction of the
face. I did not have any fat removed. I am referring to use of tumescent
dissection as a means of separating tissue planes. There is nothing written about the negative aspects of this technique, but it is common knowledge via word of mouth among surgeons that this causes so much distortion as to make it difficult to judge the rearrangement of tissue beneath. There is a high degree of nerve damage as well. (Addendum: 1/17/02: A paper was published recently about tumescent technique used on the face causing widespread necrosis and permanent tissue damage)
In correspondence with a research physiologist whose particular area of
interest is the long term effects of surgical techniques on facial anatomy, I learned that hydrodissection can cause changes in the mechanical properties of the dermis (and in my case the SMAS as well). It is my belief that the rhinoplasty was performed too soon after the facelift (8 weeks), causing the newly forming adhesion between tissue planes to separate and sustain severe elastosis. In other words, the insult of another facial surgery so soon after the facelift caused edema that would not have occurred if the rhinoplasty had been performed 6 months to one year after the facelift, which would have been
a far more judicious period between operations.
One cannot appreciate the extremity of the damage in my photographs. It is best appreciated with the face in animation, as that reflects the lack of connective fibers between the dermis, SMAS and the underlying muscles of expression. It is a classic case of iatrogenic elastosis and probable damage that may only be determined through microscopic examination of tissue samples
(which, with my time, I offered to contribute had they cared to study the situation as one would expect in an academic setting like MGH. This
suggestion was dismissed with a snicker).
In a meeting with Dr. James May, Chief of Plastic Surgery at Mass General, he stated that "It is IMPOSSIBLE for a facelift to stretch out from the swelling of a rhinoplasty" and that "my facelift would have looked the same if I had not had the rhinoplasty at all". For anyone who doubts this, I have a tape recording of these statements, made with his permission and would be happy to send a copy to any interested party. He also argued that "every good plastic surgeon uses tumescent technique in facelifts.. It is state of the art". However, I have yet to find ANY surgeon with whom I have spoken who uses tumescent technique in facelifts INCLUDING DR. MAY HIMSELF!
My advice to doctors: Never underestimate the intelligence of any patient nor their ability to grasp technical information. When you have a patient who is willing to forgive and accept a mijudgment and/or a bad outcome at the cost of a little honesty and humility on your part, speak the TRUTH and the patient will probably have such high regard for your integrity that the word "lawsuit" will not even enter their minds. I would not be naming the doctors responsible for my disastrous results on every cosmetic surgery board
available if they had treated me with respect or had expressed any
validation of and accountability for the problem. Instead, they lined up in front of me, arms folder over chests in closed, negative and intimidating body language and took turns making these comments: "you look better than you did before" , "what did you expect" and "you have BDD".
In the taped meeting with May, he stated in one breath "you had a better than average facelift" and in the next "your facelift results would be the same if you had not had a rhinpolasty" Look at my pictures an tell me if that makes sense to you? It doesn't take a rocket scientist or a plastic surgeon to see that I looked better BEFORE I ever walked into Mass General.
Should any plastic surgeons read this account, if you are in the Boston or Cape Cod area, and have a true medical interest in seeing a surgical result that you probably have never heard of nor seen before, I would be happy to meet with you. You can get my number from information under Lucille Iacovelli in Osterville, MA.
Also, if you know of anyone in the academic medical community interested in studying something like this, please let me know.
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