Plastic surgery of the face

Endoscopic Plastic Surgery

If your doctor has recommended endoscopy...

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions.

Endoscopic plastic surgery illustration

This brochure will give you a basic understanding of endoscopy in plastic surgery--how it's performed, what risks are involved, and the type of surgical training to look for in a surgeon. Please ask your doctor if there is anything you don't understand about the specific procedure you're planning to have.

The endoscope

An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.

It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of entry and manipulated within the tissue.

Advantages of endoscopy

All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, your scars are likely to be hidden, much smaller and some of the after effects of surgery may be minimized.

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the endoscope's camera allows a surgeon to view the surgical site almost clearly as if the skin were opened from a long incision.

Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, you may recover more quickly and return to work earlier than if you had undergone open surgery.

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Be sure to discuss this possibility with your doctor.

In endoscopic surgery, a probe with a tiny camera transmits images inside the body to a video monitor.

Finding a well-trained surgeon

Because endoscopy is a relatively new technique in plastic surgery, it's extremely important that you select a board-certified plastic surgeon who has adequate training and experience.

Many endoscopic procedures do not require a hospital stay and are performed in a surgeon's office or an out-patient surgery center. If you're planning to have out-patient surgery, be sure that the surgeon you've selected has privileges to perform your particular endoscopic procedure at an accredited hospital. This assures you that your surgeon has been evaluated by the hospital's quality-assurance review committee and is generally considered to have the needed training.

Be sure to find out if the surgeon's hospital privileges cover both the endoscopic and the open version of the procedure you plan to have, since your doctor may have to switch to a traditional open procedure if a complication occurs during surgery.

Keep in mind that many plastic surgeons in practice today received endoscopy training as part of their plastic surgery or general surgery residency training. And, all board-certified plastic surgeons are continually being trained in new procedures.

Special consideration and risks

It's important to keep in mind that the endoscopic approach has only recently been applied to plastic surgery procedures. There are some known risks, which vary in severity depending on the procedure being performed. These include infection, fluid accumulation beneath the skin (which must be drained), blood vessel damage, nerve damage or loss of feeling, internal perforation injury, and skin injury.

And, keep in mind that if a complication occurs at any time during the operation your surgeon may have to switch to an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such complications are rare--estimated to occur in less that 5 percent of all endoscopy procedures.

Deciding if endoscopic surgery is right for you

Although much is still unknown about endoscopic plastic surgery, you may want to focus on what is known as you make your decision. Considering the following:

For decades, endoscopy has been used successfully in orthopedic, urologic, and gynecologic procedures. Improved technology now permits endoscopy to be used by plastic surgeons.

If performed by an experienced, well-trained plastic surgeon, endoscopic procedures may provide the same results as open-method procedures, but with less scarring.

In some cases, endoscopic surgery may require less recovery time than is usually required for open procedures.

Patients who tend to be the best candidates for cosmetic endoscopic procedures are those who don't have large amounts of loose hanging skin. Patients with loose facial or abdominal skin may benefit from a combination of classic and endoscopic techniques, in face or forehead lift, or abdominoplasty.