This operative report lists Dr. Kevin O'Neil, a board certified anesthesiologist, as the anesthesiologist who attended this surgery. This is false. Dr. O'Neil was not even in the OR for this operation. The person who did administer the anesthesia was not an anesthesiologist.
Rug 23 01 03:28p DR.B.EPPLEY 317 278 0933 P â¢ 1 Meridian Plastic Surgery Center PATIENT: Lucille Iacovelli 4/18/2001â¨OPERATIVE REPORT BARRY L. EPPLEY KD CHART: 19058 Facial aging. Status post facelift and rhinoplasty. PREOPERATIVE DIAGNOSIS: 1. 2. A POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE: 1. Full facelift with SMAS. 2. Bilateral upper and lower blepharoplasties. SURGEON: Barry Eppley, M.D. ASSISTANT: Pawel Stachowicz, M.D. ANESTHESIA: General laryngeal mask ANESTHESIOLOGIST: Kevin O'Neill, M.D. DICTATED BY: Barry Eppley, M.D. HISTORY: This is a 51 year-old female from Cape .Cod, Massachusetts who has a priorâ¨history of having had a facelift and rhinoplasty done at Mass General inâ¨1997. She also has a prior history of having had upper blepharoplastiesâ¨performed in 1992. Since her surgery, she has been extremely unhappy withâ¨the results feeling that she has considerable more skin and a laxity and aâ¨detachment of the overlying skin from the underlying muscular and bonyâ¨structures. I have had multiple long preoperative discussions with her overâ¨the telephone, internet, and as well as a prior consultation here severalâ¨months ago. We have collectively agreed upon a plan of a full facelift withâ¨the primary objective of obtaining a better jowl and neckline and reducingâ¨the skin laxity, as well as upper and lower blepharoplasties. We haveâ¨discussed the risks and complications and she has agreed to proceed. OPERATIVE NOTE: The patient was seen in the holding area, preoperative photographs wereâ¨obtained, surgical made in the sitting position, and the procedure was againâ¨reviewed including the risks and complications. She was then taken to theâ¨operating room where she was anesthetized via oral laryngeal mask anesthesia.â¨Her face was then prepped and draped in a sterile fashion. Ophthalmicâ¨ointment was placed into both eyes. Her incisions had been marked whichâ¨would utilize her previous preauricular and temporal hairline incisions, asâ¨well as her old poatauricular and occipital incisions. These were thenâ¨infiltrated with 1% Xylocaine with 1:100,000 epinephrine. The remainder ofâ¨the face and neck were then infiltrated with 1:200,000 epinephrine solution.â¨After allowing an adequate time for hemostasis, her old incisiops were openedâ¨from the temporal, preauricular, postauricular, and occipital areas.â¨Initially, a long flap skin subcutaneous skin dissection was carried out. This was combined with going through her old submental incision where theâ¨area was defatted _both above and below the platysma and the platysma was then I 317 278 Q939 DR.B.EPPLEY ,g 23 01 03: 29p P â¢ 5 Meridian Plastic Surgery Center PATIENT: Lucille Iaccvelli 4/13/2001â¨OPERATIVE REPORT plicated with runninc 3-0 gps suture. The skin flaps were then developedâ¨laterally to the midline so that they were connected. The SMAS was thenâ¨developed goir.g beneath the zygomatic arch horizontally and down in front ofâ¨the ear to the mandibular angle. The SMAS flap was then bluntly dissectedâ¨with fingers and scissors. On the left side this flap was seen to be quiteâ¨chin. A long SMAS flap was then developed -hist lateral to the nasolabial ? Vâ¨fold and into the neck bilaterally. The SMAS was then split and the mferiorâ¨pcrtion was then sewn behind thenar_intfl._the mastoid fascia with interruptedâ¨2-0 vicryl. Superiorly, the upper portion of the SMAS was then directed intoâ¨the temporal area and was sewn with interrupted 3-0 vicryl. This thenâ¨allowed the skin to be redraped out laterally which was then cut around theâ¨ear and trimmed and was sewn with 4-0 vicryl for the dermis and 5-0 plain forâ¨the skin. In the occipital area, staples were used with deeper 3-0 vicrylâ¨sutures for the dermis. The submental incision was then closed with 5-0â¨vicryl for the dermis and running 5-0 plain for the skin. Attention was thenâ¨directed towards the eyes. They were previously infiltrated with 1%â¨xylocaine with 1:100,000 epinephrine. A strip of orbicularis skin and muscleâ¨was then removed from the upper eyelid and this was then closed withâ¨interrupted 6-0 nylons and running 6-0 plain. The lower eyelids thenâ¨â underwent a pinch technique after hydrodissection, which was carried out intoâ¨the lateral canthal area. This area was then trimmed and was then closed BARRY L. EPPLEY MD . JU U.I/V.'â¨[MjCf* l*> iini ' , >.l' Aâ¨At f i i with running 6-0 plain for underneath the eyelashes and interrupted 6-0 nylonâ¨for the lateral canthal area. Her previous blepharoplasties removed an r\o -f*1â¨adequate amount of fat and only skin is to be removed in this area. . ft* |Ct'>lvJ The patient tolerated this procedure well. Total operative time was threeâ¨hours. She was then placed ir. a lightly compressive circumferential faceliftâ¨dressing. The patient tolerated the procedure well. The patient was then awakened andâ¨taken Co the recovery room in stable condition. This elective procedure wasâ¨completed without complication. The patient was discharged to home inâ¨satisfactory condition. A routine follow up appointment was scheduled,â¨routine postoperative medications were prescribed, and postoperativeâ¨instructions given. Signature on fileâ¨3arry L. Epplcy, M.D.â¨3LE/acj
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