* Dr. Raffi der-Sarkissian- Consultation - April 3, 2002
Raffi der-Sarkissian, M.D.
Boston Medical Center
April 3, 2002
RE: Lucille Iacovelli
This is a patient who approximately five years ago underwent a facelift procedure at Mass General and had a reasonably good result. Postoperative, she developed some laxity of the submental tissues and approximately one year ago underwent what sounds like a deep plane facelift in Indianapolis along with platysmaplasty and upper and lower blepharoplasty. Since that time, she notes significant tightness of the submental soft tissues and an inability to fully extend her neck and some difficulty with mouth closure upon neck extension. She also has had significant tightness in the pre and post auricular regions with a sensation of tethering of the tissues in these areas as well. She has had some ringing in the ears, which she feels is related to the revision surgery.
On physical exam, she has had an upper and lower blepharoplasty through a transcutaneous approach. The medial aspect of the upper blepharoplasty incision is visible and she has a mild degree of hypertrophic scarring in this area. The lower eyelid incision is similarly hypertrophic and there is a slight downward drift of the lower lid without significant scleral show. There is a paucity of lower eyelid fat. The facelift incisions are below the preauricular tuft and in a standard pattern anterior to the ear and posterior to the ear and extending below the neck hairline. There is mild hypertrophy of the scars in this area as well. There is very tight pull on the SMAS and platysma, which can be felt on palpation deep to the submental skin. There is very little submental fat. On extension of the neck, there is a tethering. which appears to be at the level of the platysma muscle. Facial nerve function is intact.
Impression: Significant tightening of the SMAS and platysma with what appears to be shortening of the platysma in vertical dimension in the submental region.
Plan: I have discussed with the patient the options that are available. First, I would like her to undergo a rigorous range of motion protocol with heat applied to the area and possible massage. She has considered the use of acupuncture and I have encouraged her to try whatever means possible to attempt to lengthen the platysma muscle and release some of the tethering and spasm, which she is presently experiencing. Non-steroidal anti-inflammatories would also be helpful. Should this not be effective over the next six months, options would include injection of Kenalog into the subcutaneous tissue to try to soften the scar band in the platysma versus open release of the platysmaplasty. Given the tightness in this area, it is likely that am imbrication or a Z-plasty technique may have been used in the platysma and ***release of the platysma, although it may contribute to some submental laxity, may help her with her present tight sensation and limitation of extension.
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*** release of the platysma. This means surgical release of the platysma muscle
Clearly, Dr. D thought there was “something tangible upon which to operate” when he first saw me. So what changed his mind?
Stumble It!
