(Important note:  The following  was written  before my revision surgery in 2001, while distressed over the deterioration of my appearance after surgery at MGH.  Any woman would have been distraught at these results, however,  this did not prevent me from engaging in normal physical activity.  While the MGH surgery ruined my appearance by causing permanent tissue damage,  Dr. Eppley's  "revision" surgery  destroyed my health, leaving me with  serious, debilitating, life threatening medical conditions.    After experiencing BOTH types of injury, I wish to emphasize that ruination of one's APPEARANCE ONLY cannot destroy one's life as does the loss of GOOD HEALTH.  Before the revision, I was still able to enjoy the most important things in my life.. working out doors with a healthy, functioning body capable of  breathing, swallowing, moving normally..AND FREE OF PAIN.   One can adjust to the loss of a pretty face and STILL enjoy life.  One CANNOT enjoy ANYTHING when  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 what you have by subjecting your body to  an operation you do not NEED to relieve pain or disease. 

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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. On 10-16-1997, I was interviewed, examined and medical history taken by the Chief Resident, Dr. Daniel Driscoll,  clinical instructors and residents.  After they 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.   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 and seemed comfortable with this. I emphasized my intention to be actively involved in deciding what would be done to my face and how it would be executed.   There were no objections over my having this degree of control over my operation.

Some of my questions were:  Exactly where would the  incision be placed? Extend into the hairline?  Would drains be placed in the neck?  What type and size suture would be used?    I asked about lower blephroplasty which he agreed to discuss with Dr. Courtiss.  Dr. Driscoll explained the risk of extropion and  drew a diagram showing  how  skin bunches under the eye from a  facelift incision and how the side-burn could be spared by placing the incision above and behind it in the hairline to get the desirable degree of elevation and drape of the skin.    We agreed that doing less was better than too much.  I admired his reasoning for achieving optimal results tempered with caution and conservatism.

Dr. Driscoll said I could call him at any time to discuss things further and remarked on my being a  well  informed patient. He said I did not need pre-op blood work, but as a precaution I asked  him to order a CBC, PT and PTT at Cape Cod Hospital and he agreed.  Results were normal.  Dr. Driscoll asked me to come in the following week, when he  presented my case to a visiting professor.  We reviewed everything again and  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 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 expressed concern about my undergoing a procedure of that length.

He was able to do both procedures in 3 hours 40 minutes because he used tumescent anesthesia injected under pressure, greatly decreasing the time involved in undermining.  I was not informed of this before surgery.   When I later asked about this, he said he had  to defer to  Dr. Courtiss' instruction.  I feel this breached my trust.  He knew the importance I placed on  having full knowledge of the procedure beforehand.   

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.  There was no medical reason to deviate from  our original  plan.  I did not expect 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 used 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 used on my lower lids was not as 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. (Subsequent swelling from the rhinoplasty  stretched the skin, causing the under- eye area to appear far more aged and wrinkled than before the lower lid bleph.)  Every surgeon I have seen since, remarks  that too much fat was removed,  yet no fat was removed.  The sunken appearance is a combination of the  bleph technique and the SMAS elevation  bunched under the outer aspect of the eye.   I expressed my concern 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 disappointment with the lower eyelid hollows, I had an easy and rapid recovery and, over-all, was happy. 

Happy enough, in fact, that I asked how soon a rhinoplasty could  safely be done and 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 so 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 .

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 swelling 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 emphatically told me  NOT to do this!  My landlady was the only person who saw me at this time.  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 first follow-up visit 1 week post-op when there was still a  considerable degree of swelling. Instinct told me that there was a relation between this extensive swelling, the stretching of the 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".

I had a dental appointment at Tufts a few days before the rhinoplasty.  They could not take regular x-rays because I was unable to open my mouth sufficient to hold the film because my new facelift was still too tight. The newly forming adhesion was firm and intact.   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  the taught skin/SMAS  that prevented me from opening my mouth became stretched and lax. Overnight, my mouth opened wide.  Before the rhinoplasty I was not able to smile broadly due to the facelift, and was careful not to overly animate  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.   A few weeks later, I could feel the suture had torn through the platysma on the right side of the neck.  

Expressions of perplexed  incredulity were plastered on the faces of the doctors at MGH when I described what happened and showed them the drastic difference in the skin's reaction  to traction than the areas not involved in the facelift.. .  Two  general surgeons  and one ENT specialist  I spoke with  thought it would have been a miracle NOT to stretch out only 8 weeks after the facelift. 

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 said it was "impossible" for skin to remain stretched out after swelling.  When I questioned this her exact words were:  "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. My face and neck were swollen to a greater extent than after the facelift.  The soft tissue was very lax and "detached" from the deep muscles. 

I saw Dr. Schneider again 2 weeks post-op for the removal of the splint.   May face was still swollen.  I was aware that a rhinoplasty can take up to one year for complete resolution of the swelling.  I was  pleased with the rhinoplasty itself,  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.    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. Schneider did not attend this meeting.

......continued