One of the most exciting, recent advances in cosmetic surgery has been the use of the endoscope in facial rejuvenation. An endoscope is a small camera which can be inserted through a tiny cut in the skin and which transmits an image of the underlying tissues to a T.V. Screen. Many people are familiar with endoscopy as it is applied by orthopedic surgeons to treat cartilage damage in joints (arthroscopy) and by gynecologists to examine pelvic organs (laparoscopy). This relatively old technology has now been applied to cosmetic surgery. Plastic surgeons are now able to perform brow lifts through several tiny incisions in the scalp. Until recently, the only way a brow lift could be performed was with an “ear to ear” incision.
Even more exciting is that plastic surgeons are now performing face lifts through the endoscope. In those patients whose complaints are of mid face and jowl sagging rather than skin excess, a face lift can be performed through several small incisions in the scalp and lower eyelids. The best candidates for this procedure are those patients in their 30s and 40s with good skin tone. Recovery time is somewhat longer than with traditional facelifts due to swelling that persists for several weeks. However, these procedures have allowed the treatment of the aging face to extend to much younger patients with improved long term results.
Just as the endoscope has revolutionized facial rejuvenation, so too has the tumescent technique of liposuction changed how plastic surgeons reduce adipose fat tissue in all areas of the body. With tumescent liposuction, a surgeon distends the fat and soft tissues with local anesthesia, adrenaline, and salt water. By doing so, blood loss has been shown to be dramatically reduced as compared to more traditional technique of liposuction, far more fat can be safely aspirated at one sitting, frequently without the necessity of hospitalization or even general anesthesia. Currently, experimental procedures involving ultrasound and liposuction are being perfected which will hopefully improve techniques further. Regardless of the technique, liposuction is still not a treatment for generalized obesity, but rather for treatment of localized fat excess and disproportion.
A very commonly asked question of plastic surgeons is “will you be using a laser to perform my operation?” Due to widespread media coverage, lasers are now thought of by many lay people as the best way for surgeons to cut tissue during surgery. While lasers represent new and exciting technology, this notion is an unfortunate misconception. For most operations, traditional cutting methods provide better control for the surgeon and more precise and smaller scars. Where, then, do lasers play a role?
One of the new and interesting uses of lasers is in skin resurfacing. Specifically, carbon dioxide lasers, pulsed at very high frequencies are now being used by some plastic surgeons instead of dermabrasion. By using such a laser, fine wrinkles around the mouth and eyelids can be markedly reduced with reportedly less tissue destruction than seen with traditional dermabrasion techniques.
Removal of tattoos is another use of lasers, Different laser types are needed for various colors found in the average tattoo. Several surgical settings are frequently needed to eliminate a tattoo completely. Scarring tends to be less than with either direct surgical excision or dermabrasion.
Lasers can also be used to treat red, vascular lesions such as port wine stains. Lifelong lesions can be dramatically reduced using laser surgery in a painless, outpatient setting.
Finally, lasers can be utilized to reduce age spots on hands and other locations on the body, so that a newly “lifted face” can have youthful hands to match. Who says that youth has to be wasted on the young?
Along with advances in cosmetic surgical techniques, have come improvements in plastic surgeons’ abilities to communicate with their patients. One tool for aiding in such communication has been new computer hardware and software that allows a physician to photograph a patient and modify their image on the computer screen. By doing so, a surgeon can show a patient an image of a reasonable outcome of a cosmetic procedure. It also gives a patient the opportunity to show a doctor what they like and dislike about their current features or about the proposed outcome of a cosmetic procedure. Good physician-patient communication is essential to maintaining a satisfied patient. Indeed, computer video imaging, when used ethically and with adequate explanation, enhances most patients’ understanding of facial cosmetic operations.
Finally, many patients routinely ask for their plastic surgeon to recommend skin care products that can be used at home to improve wrinkled, blotchy, rough, or sun damaged skin. Many are not interested in surgery, but rather a more modest, less costly, improvement in their quality. Chemical peels and a full line of home skin care products are available from many plastic surgeons’ offices, including mine.
Several types of fruit acid peels and moisturizers can now be purchased directly from plastic surgeons and used at home on a daily basis. These products are only available through a physician and cannot be purchased in stores. In many cases, these products replace more commercially available skin care items for less money! Sun damaged skin, not responsive to home preparations, can be treated by an in office chemical peel, using a stronger fruit acid solution. Even these stronger, in office treatments require minimal healing time, and allow patients to reapply makeup immediately. Yet stronger chemical peels, requiring a healing period of several weeks, are performed with anesthesia, and can achieve a more dramatic result. The peels serve to increase collagen and elastic formation in the skin and reduce the fine wrinkling seen as a result of sun, age and smoking.
While the cost of each procedure varies somewhat among plastic surgeons’ offices in the area, many offices, including my own, offer a complimentary initial consultation for aesthetic surgery patients. Most plastic surgeons in the Washington D.C. area are very well trained. The best advice is to find one that makes you feel comfortable and who answers all of your questions and concerns.