Endoscopic Plastic Surgery: Small Scars and Smaller Recovery

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Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.


December 10 2008

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One of the biggest growth areas in plastic surgery—indeed in all of medicine—in the last 25 years has been in the use of endoscopic cosmetic surgery techniques. Endoscopy gives surgeons and other physicians the ability to directly examine organs and other tissue inside your body. It also allows them to perform surgery using very small incisions which can greatly shorten recovery times.

Plastic surgeons use endoscopic techniques in abdominoplasty, face lifts, brow lifts, abdominoplasty (tummy tuck), and breast augmentation. More endoscopic cosmetic surgery procedures are being created every day. Endoscopy is also being used in several types of reconstructive plastic surgery.

The main instrument in endoscopy is the endoscope, which is basically a tube that contains a way to deliver light to the area that is to be examined and a way to transmit the image back out to the viewer. The word endoscopy means "looking inside." Often, endoscopes use fiber optics, which are thin glass fibers that can transmit light. In some set-ups, the surgeon can watch what he or she is doing on a video screen. In other set-ups, the surgeon views the action through an eyepiece.

The endoscope itself does nothing but give the surgeon a view port into your body. Other surgical instruments are inserted down other tubes and make surgery possible. These instruments may include specially made scalpels, scissors, or forceps, among other tools. The endoscope and other instruments are inserted through incisions about an inch or so long, and sometimes smaller. Usually there are two or three incisions, but more may be used depending on the type of surgery.

It is the tiny size of the incisions that provides the primary benefits of endoscopic surgery. Short incisions heal faster than long incisions, which cuts down on the length of a person's recovery and on the amount of discomfort they have. Small incisions are less likely to cause nerve damage and may reduce the chance of serious bleeding, bruising, or swelling. And of course, tiny incisions make for tiny scars—sometimes even virtually invisible scars. Plastic surgeons are good at placing these incisions where they will be least conspicuous.

These benefits of endoscopy are why its use has grown in leaps and bounds over the last two decades. However, there are limits to what it can do. Because of the small operating area, your surgeon may not be able to provide as much correction or improvement as he or she could do with an open surgery. An endoscopic procedure limits the amount of tissue that can be removed. If you need a lot of skin on your face lifted and the excess removed or if you have a lot of skin and subcutaneous fat on your abdomen, your surgeon may not recommend an endoscopic procedure. An endoscopic tummy tuck cannot provide the amount of correction to the abdomen that a standard tummy tuck can. However, endoscopic techniques can be combined with open surgery.

If anything goes wrong during your endoscopic surgery, or if your surgeon encounters anything unexpected, he or she might have to convert to an open surgery. There are also the risks that are inherent with all surgery, such as infection and excessive bleeding.

If you are considering an endoscopic cosmetic surgery, make sure to work with a board-certified plastic surgeon. Ask about his or her experience with endoscopy at your consultation.