* MGH Operative Report - facelift & belpharoplasty - 11/24/97
MASSACHUSETTS GENERAL HOSPITAL
NAME: IACOVELLI, LUCILLE M.
DATE: 11/24/97
SURGEON: DANIEL N. DRISCOLL, M.D.
EUGENE COURTISS, M.D.
NAME OF OPERATION: FACE LIFT AND LOWER BLEPHAROPLASTY.
INDICATIONS FOR PROCEDURE: The patient is a 48-year-old woman
presents for full facelift procedure. She does take erythromycin,
multivitamins and aspirin. She has stopped her aspirin for a short period of time.
DESCRIPTION OF PROCEDURE:
1. Markings of the patient: The areas of incisions were marked out into the area of the hairline itself and the area for the lower lid blephoplasty was similarly marked.
2. The local was injected and the patient was given IV sedation. IV
sedation consisted of Demerol and Valium. The local anesthesia was Wydase with 1:100,000 lidocaine with Marcaine as well. We used this anesthetic technique to do the lower lid blepharoplasty.
3. Lower lid blepharoplasties: The patient complains of redundant skin in the area of the lower lids bilaterally. She has a significant amount of skin bilaterally. It has a diffusely thin face at the area of the cheek bones as well as underneath the eyes. The plan for this procedure would be a skin only resection after raising a skin muscle flap. We then proceeded after the instillation of local to make a subciliary incision with a transverse incision laterally. This was followed down through the orbicularis muscle leaving a good size portion of orbicularis on the tarsus.
The plane was easily identified running along the infraorbital rim. This was incised to approximately 3 mm. shy of the punctum. The skin muscle flap was elevated using blunt dissection. The area of the lateral aspect where the skin was to be excised, the skin was removed yet the dermis and subcutaneous muscle tissue remained. This was then sutured to the lateral orbital rim in a type of canthopexy type of procedure. The re-draping of the skin on the lower lid was excellent. We were able to excise approximately 1 mm. of skin of the lower lid. There was sutures applied laterally and beneath the eye only Steri-strips.
We then proceeded with the face lifting procedure. We were using tumescent injection for able to give us appropriate hemostasis and help with dissection of tissue planes. We made small incisions at the area of the inferior aspect of the ear, behind the ear at the hairline as well as at the superior temple region. The tumescent was injected under pressure, giving excellent analgesia with the aid of IV sedation. The incisions were made, carried up along a tissue plane which was subcutaneous. This was carried down in the usual face lift neck, posterior and on top of the sternocleidomastoid fascia. The great auricular nerve was spared in this dissection. The area of the proximal aspect of the face lift toward the cheek was similarly dissected, yet after getting closer and distal to the actual area, the parotid dissection was accomplished using vertical placement of the Gorney scissors. This appropriately broke up the nasolabial fold line. This was accomplished on both sides. A 3 cm. incision was made along the area of the submental crease. This was dissected down in a plane superficial to the platysma. This appropriately exposed the diastasis of the platysma and the platysma was approximated using a figure of eight 3-0 Dexon at the area of the hyoid and carried anteriorly. This was carried anteriorly in a running fashion.
The fat of the neck did not require defatting and we were then able to close that incision in two layers. We obtained hemostasis at the end of the procedure which appeared to be excellent and we required no drain placement. The incisions was then closed with several deep 4-0 Dexons. Prior to completing our face lift procedure, we did a sub SMAS face lift procedure, excising a small amount of the SMAS in the area just in a parallel line to the nasolabial fold in order to improve the nasolabial fold line. This was approximated primarily after its excision. The skin was then sutured closed using a running 5-0 nylon. The patient tolerated the procedure well. A dressing was placed and she was brought to the recovery room in stable condition after sponge and needle counts were correct.
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