Dr. Barry Eppley- False Statement on Operative Report by Boxer47


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Meridian Plastic Surgery Center
PATIENT: Lucille Iacovelli
CHART: 19058
Facial aging.
Status post facelift and rhinoplasty.
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
DICTATED BY: Barry Eppley, M.D.
This is a 51 year-old female from Cape .Cod, Massachusetts who has a prior
history of having had a facelift and rhinoplasty done at Mass General in
1997. She also has a prior history of having had upper blepharoplasties
performed in 1992. Since her surgery, she has been extremely unhappy with
the results feeling that she has considerable more skin and a laxity and a
detachment of the overlying skin from the underlying muscular and bony
structures. I have had multiple long preoperative discussions with her over
the telephone, internet, and as well as a prior consultation here several
months ago. We have collectively agreed upon a plan of a full facelift with
the primary objective of obtaining a better jowl and neckline and reducing
the skin laxity, as well as upper and lower blepharoplasties. We have
discussed the risks and complications and she has agreed to proceed.
The patient was seen in the holding area, preoperative photographs were
obtained, surgical made in the sitting position, and the procedure was again
reviewed including the risks and complications. She was then taken to the
operating room where she was anesthetized via oral laryngeal mask anesthesia.
Her face was then prepped and draped in a sterile fashion. Ophthalmic
ointment was placed into both eyes. Her incisions had been marked which
would utilize her previous preauricular and temporal hairline incisions, as
well as her old poatauricular and occipital incisions. These were then
infiltrated with 1% Xylocaine with 1:100,000 epinephrine. The remainder of
the face and neck were then infiltrated with 1:200,000 epinephrine solution.
After allowing an adequate time for hemostasis, her old incisiops were opened
from the temporal, preauricular, postauricular, and occipital areas.
Initially, a long flap skin subcutaneous skin dissection was carried out.
This was combined with going through her old submental incision where the
area was defatted _both above and below the platysma and the platysma was then
317 278 Q939
,g 23 01 03: 29p
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Meridian Plastic Surgery Center
PATIENT: Lucille Iaccvelli
plicated with runninc 3-0 gps suture. The skin flaps were then developed
laterally to the midline so that they were connected. The SMAS was then
developed goir.g beneath the zygomatic arch horizontally and down in front of
the ear to the mandibular angle. The SMAS flap was then bluntly dissected
with fingers and scissors. On the left side this flap was seen to be quite
chin. A long SMAS flap was then developed -hist lateral to the nasolabial ? V
fold and into the neck bilaterally. The SMAS was then split and the mferior
pcrtion was then sewn behind thenar_intfl._the mastoid fascia with interrupted
2-0 vicryl. Superiorly, the upper portion of the SMAS was then directed into
the temporal area and was sewn with interrupted 3-0 vicryl. This then
allowed the skin to be redraped out laterally which was then cut around the
ear and trimmed and was sewn with 4-0 vicryl for the dermis and 5-0 plain for
the skin. In the occipital area, staples were used with deeper 3-0 vicryl
sutures for the dermis. The submental incision was then closed with 5-0
vicryl for the dermis and running 5-0 plain for the skin. Attention was then
directed towards the eyes. They were previously infiltrated with 1%
xylocaine with 1:100,000 epinephrine. A strip of orbicularis skin and muscle
was then removed from the upper eyelid and this was then closed with
interrupted 6-0 nylons and running 6-0 plain. The lower eyelids then
■underwent a pinch technique after hydrodissection, which was carried out into
the lateral canthal area. This area was then trimmed and was then closed
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with running 6-0 plain for underneath the eyelashes and interrupted 6-0 nylon
for the lateral canthal area. Her previous blepharoplasties removed an r\o -f*1
adequate amount of fat and only skin is to be removed in this area.
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The patient tolerated this procedure well. Total operative time was three
hours. She was then placed ir. a lightly compressive circumferential facelift
The patient tolerated the procedure well. The patient was then awakened and
taken Co the recovery room in stable condition. This elective procedure was
completed without complication. The patient was discharged to home in
satisfactory condition. A routine follow up appointment was scheduled,
routine postoperative medications were prescribed, and postoperative
instructions given.
Signature on file
3arry L. Epplcy, M.D.

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