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.

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.

Uses in plastic surgery

As research continues, it's expected that many new uses for endoscopy will be developed. In the meantime, some plastic surgeons are using the technique on carefully selected patients. Some procedures that may be assisted by endoscopy are:

Cosmetic surgery

Abdominoplasty (tummy tuck) -- Endoscopy is sometimes used as an adjunct for selected patients who have lost abdominal muscle tone. Guided by the endoscope, the muscles that run vertically down the length of the abdomen may be tightened through several short incisions. Endoscopy is generally not used in patients who have a significant amount of loose abdominal skin.

Breast augmentation -- Inserted through a small incision in the underarm or the navel, an endoscope can assist the surgeon in positioning breast implants within the chest wall. Endoscopy may also assist in the correction of capsular contracture (scar tissue that sometimes forms around an implant, causing it to feel firm), and in the evaluation of existing implants.

Facelift -- Although the traditional facelift operation is still the best choice for most patients -- especially those with a significant amount of excess skin -- certain selected individuals may benefit from an endoscopically assisted procedure. When an endoscope is used, the customary incision along, or in the hairline is usually eliminated. Instead, small incisions may be strategically placed in areas where the most correction is needed. If the muscles and skin of the mid-face need to be smoothed and tightened, incisions may be hidden in the lower eyelid and in the upper gumline. To tighten the loose muscles of the neck, incisions may be concealed beneath the chin and behind the ears. The endoscope may also assist in the positioning of cheek and chin implants.

Forehead lift -- Of all the cosmetic procedures that use endoscopy, forehead lift is the one which plastic surgeons more commonly perform. Instead of the usual ear-to-ear incision, three or more "puncture-type" incisions are made just at the hairline. The endoscope helps guide the surgeon, who removes the muscles that produce frown lines, and repositions the eyebrows at a higher level.

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.