For What Purposes And How Is The Endoscope Used In Facial Rejuvenation Surgery?
1 August 2020 onur
Endo-sc/opus (a compound word of Latin origin)
It means “showing what is inside”.
The endoscope is the general name of the optical systems we use to observe the internal cavities of the body in medicine.
Endoscopy, on the other hand, is the general name of medical interventions in which we view and observe the internal cavities of the body.
Endoscopic surgery, on the other hand, is the common name of surgical interventions that we perform with the help of special surgical instruments by viewing body cavities with an endoscope.
That’s the terminology bit.
We do not extensively deal with body cavities in plastic surgery (intranasal examination being an exception).
The purpose and potential benefit of endoscopic techniques in plastic surgery is to be better able to see the inside of the cavities we have created during surgery and to perform the same surgical procedures through shorter incisions or hidden incisions at a greater distance.
We use the endoscope as a supporting instrument in 3 different facial rejuvenation procedures.
Endoscopic forehead lift
Endoscopic midface lift
Endoscopic superficial neck lift
Now, let’s review the pros and cons of the endoscopic surgical approach in these surgeries one by one.
In forehead lift, after making small, vertical incisions hidden in the scalp, we dissect the forehead and temporal tissue on the plane just above the bone. This dissection creates an optical cavity. We use an endoscope to view the inside of this optical cavity and we advance our dissection towards the eyebrow with the help of endoscopic surgical instruments. In forehead lift surgery, it is critical to open the ligaments that fix the eyebrow. Using the endoscopic approach, we can view and mobilize these ligaments. We utilize endoscopic imaging for safe manipulation of the sentinel vessels in the temporal area, of the supraorbital nerve under the eyebrow and of corrugator muscles.
The endoscopic approach enables some critical steps to be performed visually in short-scar forehead lift surgeries, if the upper eyelid surgery is not performed in the same session. This is its main contribution to forehead lift surgery. It is unnecessary to use an endoscope if the upper eyelid will be done in the same session or if large incisions such as hairline incision or crown (coronal) incision will be preferred. The coronal technique, hairline forehead lift and retrograde forehead lift from the upper eyelid have their own advantages and disadvantages.
Technique selection in forehead lift should be individualized. It is impossible to say that any technique is superior to the others in every aspect. You can find posts detailing different forehead lift techniques in the blog.
In endoscopic midface lift surgery, we create an optical cavity above the masticatory (chewing) muscle in the temporal area. Through this optical cavity, we access the cheekbone with the help of the endoscope and then proceed to the midface area. In endoscopic midface lift, a 2-cm incision is made in the scalp in the temporal area. In addition to this incision, another 1-cm incision is made on one of the crow’s feet wrinkles on the side of the eye. The advantage of the procedure is that the midface lift can be performed without need for a lower eyelid or intraoral incision. The infraorbital nerve can be safely manipulated with endoscopic imaging.
The endoscopic approach ensures that some critical steps can be viewed and performed without lower eyelid or intraoral incisions in short-scar midface lift surgery. If the lower eyelid is to be done in the same session or if an intraoral incision is to be performed, it is completely unnecessary to use an endoscope. The endoscopic, lower eyelid (subciliary) and in-mouth (intraoral) approaches have their own advantages and disadvantages in midface lift surgery.
The midface lift decision or the choice of surgical technique must also be individualized.
Note: Endoscopic forehead lift + Endoscopic midface lift = Endoscopic face lift.
I have a dedicated blog post on endoscopic facelift surgery. I recommend you take a look at it.
Superficial Neck Lift:
This is a technique that can be used in the young patient group who have no pathologies in the deep plane neck structures (salivary gland enlargement, digastric muscle hypertrophy, excess subplatysmal fat) and no sagging of the facial skin. Firstly, the subcutaneous fat layer on the neck is thinned by liposuction. Subsequently, the neck skin is dissected from the underlying platysma muscle through a 1-1.5 cm incision in the submental crease under the chin. This will create an optical cavity under the neck skin. Subsequently, endoscopy-assisted surgical procedures can be performed for the platysma muscle (platysmaplasty).
In superficial short-scar neck lift surgery, the critically-important “bleeding control” can be performed adequately from within a very small scar. If the incision under the chin will be longer than 2 cm, it is unnecessary to use an endoscope. The procedure can also be performed easily with fiberoptic retractors. Since there is almost no cosmetic difference between the hidden incision under the chin being 1.5 cm or 2.5 cm, the use of an endoscope in neck lift surgery does not mean anything other than hoodwinking the patient and satisfying the surgeon’s ego.
Now let’s cover the most important bit:
Do not think that endoscopic procedures are state-of-the-art, faster healing, more effective, safer, more “superior” surgical procedures.
It was the early 1990s when a surgery called “endoscopic” was “modern”.
They are beautiful, elegant and enjoyable surgeries.
However, they provide good results only in the appropriate patient.
As in all surgical procedures.
For instance, endoscopic forehead lift does not work in a patient whose hairline-brow distance is greater than 6 cm, signs of aging are advanced, superficial volume loss is predominant, and brow bone is curved.
A major problem in terms of surgical technique is the “fixation” issue in endoscopic approaches. Surgical dissection and tissue release maneuvers can be performed very successfully in endoscopic procedures. However, “fixation” maneuvers that allow tissues to be fixed in their new position are a weakness of endoscopic approaches.
For instance, in two different midface lift surgeries, one through a lower eyelid incision and the other endoscopic, tissue mobilization is performed in almost the same way. In the lower eyelid approach, we can fix the tissue very firmly through multiple tunnels opening to the under-eye bone. In the endoscopic approach, fixation is done through long suspension sutures or absorbable suspending prostheses on the chewing muscle in the temporal area.
Therefore, I prefer more conventional techniques instead of endoscopic techniques in patients for whom we need “strong fixation” (because mimic muscles are hyperactive, face is heavy and bone support is weak).
Last but not the least, please don’t be fooled by marketing gimmicks.
Sometimes a patient comes to see me for the first time. There is an incision scar at the bottom of eyelashes in the lower eyelid or inside the mouth. The patient says she had an endoscopic midface lift. She thinks so.
Another patient comes. She has a 5-cm incision in her temporal scalp. The patient says she had an endoscopic forehead lift. She thinks so.
You can use the endoscope in any surgery. Using the endoscope in a case or getting help from the endoscope does not automatically make a surgery “endoscopic”. The term “endoscope-assisted” is a more appropriate term for such hybrid procedures.
Please feel free to contact us to find out if endoscopic approaches can be employed in your facial rejuvenation project and to get detailed information about the procedures.
Take good care…
… of yourself and your beauty.