Body By Leverett

To whom it may concern: Thank you for forwarding to me the written complaint from Mrs. [redacted] regarding her neck/platysma lift. Briefly, she is a 44 y.o female who is a previous patient. Regarding this instance, she presented on 12/1/2016 for improvement of her neck (cervico- mental angle). She...

had a very obtuse angle such that her chin angled straight down to her chest with no break in between. She had a hypoplastic chin but normal occlusion. She had jowls, thick cheeks, palpable mandibular glands and prominent medial banding of her platysma muscles.  In order to fulfill her concerns, without a facelift, I suggested buccal fat pad removal, platysmaplasty and a chin implant. She refused everything except the neck lift. She also had a history of a previous neck burn that, after secondary healing, the scar was excised elsewhere. However, the incision was low, on the cricoid area, rather than in the submentum. Therefore, I used the existing scar for entry in order to avoid having two incisions, one above and the other below a bridge of skin, which might otherwise be an ischemic bi-pedicled flap that risks necrosis. Intra –op, most of the fullness proved to be subplatysmal, as expected. In other words, there was not a significant fatty deposit underneath the skin. Therefore, simple liposuction would have made no significant improvement. The incision was lengthened slightly in minimize redundancy (dog-ears). A dressing was placed and she did well. Unfortunately, she developed a post op seroma which needed serial aspirations to resolve. She was somewhat understandably upset during this time but the volume diminished and stopped as expected, but at a rate which cannot be controlled by me. Unfortunately, we were unable to start prophylactic scar message in the early period because I wanted to minimize mechanical stress until the seroma resolved. To date, she has a very much improved neck contour. The skin/jowls/buccal fat pads were not removed so the neck is not a clean as it would be if she had a concomitant facelift. We discussed additional modalities that could help the incision heal faster. We discussed the pros and cons of lasers, micro needling, professional massaging, and topical treatments, offered at my office and/or elsewhere in the community. Without these, we still expect her to heal well (if she is compliant), but with massage and micro needling, we expect her to heal faster. However, I understand that she attended one session and quit. As to her accusations, I am aware and very disappointed that she is not yet pleased. I never mentioned anything about any number of sutures. Nothing went wrong in the OR that caused the seroma. The seroma was handled in my office, using local anesthesia and at no additional cost to her. The only reason to enlarge the skin incision was excise a small rim of minimally viable skin and to remove the dog ears.  Finally, the lines of communication are still open on my end and I am committed to seeing her through this to a satisfactory outcome. I just wish that 1) she were significantly less confrontational and accusatory when she is in the office and 2) she would allow other professionals help her hasten the result since she wants to heal faster. Attached is her incision post-surgery and prior to micro needling. Larry L[redacted], MD