Scalpels, LASERs, and Endoscopes
There are new developments in medicine which are now reported to the public long before they have proven benefit. This is particularly common in facial plastic surgery where both cosmetic surgeons and instrument companies try and promote new technologies to increase their share of the market.
LASERs are touted as a tool which is superior to scalpels and scissors.
Endoscopes are the latest method of looking under tissues and using smaller incisions more safely. Each of these techniques and tools improves our ability to perform facial plastic and reconstructive surgery.
We, at the University of California, San Diego are fully aware of the advantages of LASERs and endoscopes. We use them daily, but disapprove of the marketing, commercialization, and the promotional materials shown in the newspapers, televisions and public interest magazines. A few specifics are mentioned.
While it is true that LASERs can make incisions that bleed less than those made by scalpels and scissors, the LASER causes some tissue damage and therefore the incision takes longer to heal and the scar is never as "good." There are, however, occasions in which LASERs provides sufficient advantage that they are routinely employed. Hemangiomas are small blood vessel tumors which are often better vaporized with LASERs than resected with excisions. Certain operations for snoring and vocal cord tumors are better performed with the LASER. The same is true with some nasal and ear work. The newest use of a LASER is to rid the face of wrinkles. This is called LASER resurfacing. At the time of the writing of this book, this is a brand new technique. The LASER companies have promoted this, but long-term results are not yet available.
The initial impressions show LASER to be as good for resurfacing as is achieved with chemical peels. The patient's skin remains reddened for 3-6 months, and the heeling process is substantially longer than with dermabrasion and a chemical peels. At this point, no one knows whether the long-term result has any advantage over dermabrasion and a chemical peels. We know nothing about the fate of the skin and whether this predisposes to early aging, skin cancer or any other typed deformity.
You are encouraged to ask about LASERs, but are also encouraged to focus more on the choice of procedures then on the exact tools which will be used.
Endoscopes provide opportunity to make smaller incisions and for some situations such as the forehead lift they do have benefit. The surgery takes longer, it has different risks, it costs more and to date no one has shown that the results are as good, let alone better. Ask about endoscopes, ask about anything you have heard or read about, but do not let good judgement be ruined by Madison Avenue advertisement.