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You also stated (in e-mail and in person) "By addressing both the skin and SMAS, in different vectors, I do think that what is achieved simply by pulling it back with the fingers can be done surgically. Because you have had a prior facelift and do not smoke, one can be fairly aggressive with the amount of skin removed and the tension placed on the closure."

Dr. Eppley, by this statement, I had the RIGHT to believe that you or any plastic surgeon making such a statement,  would address the SMAS/platysma in  APPROPRIATE vectors of tension.  Instead, you pulled the platysma laterally, plicated the midline, which had already been done in the initial facelift,  and thus shortened  the muscle sheath and creating a  CAUDAL (DOWNWARD) TENSION.

Please  compare the pre and post op pictures.  The cervicomental area prior to surgery was  lax.   I was fully able to extend my neck, lift  my head and chin and look up,  with my mouth closed and my tongue able to touch the roof of my mouth.  I have not been able to do this since the day you operated on me.    How do you explain  the most common discomfort resulting from aggressive neck LIFT and tightening is the exact REVERSE of my results?  Appropriate address of  the platysma and  improvement of the cervicomental angle involve  INCREASED support and tightening which  LIFTS the hyoid, it does NOT LOWER it with tension, IN A DOWNWARD vector, thus pulling the jaw back and down, which is exactly what resulted in my case.  It is IMPOSSIBLE for this to  happen with even a modicum of attention to and consideration for the medial fibers of the platysma and biomechanics of the involved structures in relation to function and animation.

Improvement of the cervicomental angle  results in an increased  support of the floor of the mouth, often lifting the hyoid position.  If done aggressively, this causes some patients to experience a feeling of tightness AROUND the throat.  It does not exert tension in a CAUDAL vector, as is clearly apparent in my photos. Please note the position of the chin.  In recent x-rays compared with those taken prior to surgery, the change is apparent in the position of the hyoid bone.  This, in turn, causes the tongue to pull back and obstruct the airway when I lift my head.

<o:p>You claim you do not understand the various physical problems I  have suffered as a result of this operation.  Is it so hard for a SURGEON to understand the cause and effect I describe,  which is apparent in the photos?  Do you really think it possible for a person to "pose" such inability to close one's mouth or lift one's chin?  What did you expect to happen in not lifting the SMAS in a temporal vector, as my video plainly shows my fingers holding up the face at the temples and just behind the ear at the juncture of the mandible?  </o:p>

<o:p></o:p><o:p></o:p>You say you do not understand the problems of which I speak.  As a facial surgeon it is your RESPONSIBILITY to understand the biomechanics of the involved anatomy and its response to such manipulation.  How do you explain  a procedure where the stated  goal is  improvement  of the cervicomental angle, and end up with a MORE OBTUSE angle, in spite of your  pulling  and excising the involved tissue to the extreme, and unnecessarily and inappropriately "defatting"   a neck that obviously does not have enough to begin with?   You cannot understand my complaints? You had merely to check for the range of motion of the neck during the surgery to determine the appropriate fixation.  Obviously,  you did NOT, and I am suffering the consequences.

Continued....   http://groups.msn.com/LosingFace/yourwebpage4.msnw