* Operative Report - April 18, 2001
PATIENT: Lucille Iacovelli
4/18/2001 Dr. X
OPERATIVE REPORT
chart: 19058
PREOPERATIVE DIAGNOSIS: 1. Facial ageing.
2. Status post facelift and rhinoplasty.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE: 1 Full facelift with SMAS.
2. Bilateral upper and lower blepharoplasties.
SURGEON: Dr. X
ASSISTANT: Pawel Stachowicz, M.D.
ANESTHESIA: General laryngeal mask
ANESTHESIOLOGIST: Kevin O’Neill, M.D.
DICTATED BY: Dr. X
HISTORY:
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.
OPERATIVE NOTE:
The patient was seen in the holding area, preoperative photographs were obtained,surgicalmade 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 postauricular and occipital incisions. These were then infiltrated with l% 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 adequatetime for hemostasis, her old incisions were opened from the temporal,preauricular, postauricular, and occipital areas. Initially, a long flap skinsubcutaneous 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 plicated with running 3-0 PDS suture. The skin flaps were then developed laterally to the midline so that they were connected. The SMAS was then developed going 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 thin A long SMAS flap was then developed just lateral to the nasolabial fold and into the neck bilaterally. 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 The SMAS was then split and the inferior portion was then sewn behind the ear into the mastoid fascia with interrupted 2-0 vicryl. 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 with running 6-0 plain for underneath the eyelashes and interrupted 6-0 nylon for the lateral canthal area. Her previous blepharoplasties removed an adequate amount of fat and only skin is to be removed in this area.
The patient tolerated this procedure well. Total operative time was three hours. She was then placed in a lightly compressive circumferential facelift dressing .
The patient tolerated the procedure well. The patient was then awakened and taken to 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
Dr. X
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