News & Features

8 “Keyhole” Plastic & Cosmetic Surgeries

Seen on “Dr. 90210” Staff Report
Medically reviewed by Gilbert Lee, M.D.

The endoscope, a system of special surgical instruments, allows physicians to see and work under your skin down to and including internal structures like the gall bladder. But in cosmetic and plastic surgery, the endoscope is extremely handy because the tiny viewing scope – along with the tools that do the actual work – are inserted through very small, “keyhole” incisions. It all results in enhancements with barely noticeable scars and operations that heal quicker.

8 Keyhole Plastic & Cosmetic Surgeries When Robert Rey, M.D., one of the surgeon-stars featured on T.V.’s medical reality show, “Dr. 90210,” was completing his surgical residency at Harvard, he took extra training and learned a new way to perform breast augmentations. The new procedure leaves virtually no scars, offers reduced healing time and has few complications and infections.

“A little after my 38th birthday, I tossed my worldly possessions onto the back seat of my beat-up Mustang and set out for Beverly Hills,” Dr. Rey told “My most notable possession was a $200,000 bill for my medical education.”

Dr. Rey was going for the brass ring because Beverly Hills is the world capitol of plastic surgeons and he wanted to be one of the best, if not the best, surgeons there. But things were slim for the young physician who had no plastic surgery patients at first and made his living on the weekends, providing health care to migrant farm workers.

The E! Channel

After about a year, Dr. Rey used his Harvard training to do the new breast augmentation on a receptionist who worked at the E! Channel in Hollywood. She was absolutely over the moon with her results and told everybody about the new procedure and the good-looking, young surgeon doing it. Then, thanks to word of mouth, Dr. Rey started doing many more of the novel, breast operations.

Soon, some health producers at the E Channel heard about the new operation and invited the classically handsome Dr. Rey to appear on cable, performing the procedure which is known as the T.U.B.A., or “trans-umbilical breast augmentation.” (The term means the breast enhancement is done through the patient’s belly button.)

After another year, Dr. Rey had been filmed in several dozen episodes of various plastic surgeries, had a Screen Actor’s Card and a new office.

“My office is in a Beverly Hills medical building that houses more plastic surgeons than are found in the entire state of Montana,” Dr. Rey says. Moreover, he, his new wife, Haley, and the Rey toddler were soon being regularly seen on “Dr. 90210.”

Today, Dr. Rey is seen on television in 173 of the world’s 193 nations. Daily, his office receives 2000 phone calls and countless email. Consequently, his surgical calendar is booked nine months in advance. And, you could argue he owes it all to the T.U.B.A. and endoscopic surgery.

Audrey Carlson, a 23-year-old model in the San Francisco Bay area, thought her career was suffering because of her 34B bust size.

“Some model friends told me about the T.U.B.A. and a couple of guys on a commercial shoot said I would get more work if I were larger,” says Audrey who appears in ads. “The operation took almost two hours but I was back at work in only five days. And I have gotten more modeling jobs as a 34C.” Audrey was recently featured on an MTV documentary as a patient going after the Jessica Simpson look.

8 Operations

Actually, eight common endoscopic operations take place under the skin. Your forehead, mid-face, neck, tummy and other body sections can be surgically rejuvenated – or repaired – by keyhole surgery.

Endoscopic gizmos have two major parts; one is a tiny camera with lights on a one-quarter inch cable inserted under your skin through a one-inch incision. Yet another thin tube with tiny surgical tools -- like scalpel, scissors or forceps -- is inserted though a separate incision. The surgeon then watches a television screen to guide his work. Still other endoscopes have camera, lights and tools, all on one tube.

But why go to all this trouble? According to the American Society of Plastic Surgeons, endoscopic surgery offers smaller and hidden scars, faster healing, less bruising, pain, bleeding, nerve damage and a quicker return to work. Moreover, most are done under local anesthesia which can mean less expense because no overnight hospital stay is required.

The T.U.B.A., which helped launch Dr. Rey’s career, is done by making two tunnels just under the skin, from the belly button up to each breast where a pocket of extra space is created, either on top the breast muscles or under them. Next the implants are rolled up like cigars, inserted into the tunnel and worked up to the prepared position in the breast. Then, the implants are inflated with a saline solution through a thin tube that trails out through the belly button incision. Some surgeons place breast implants through Lilliputian incisions in the armpits.

“After a while, an experienced surgeon can perform the T.U.B.A. entirely by feel,” says San Francisco’s Edmond A. Zingaro, M.D., a board certified plastic surgeon who says he’s one of the few providers in Northern California offering the procedure. “Thin women are especially happy when their implant is placed under the chest muscle.”

Forehead Lift

Even more commonly done, however, is the endoscopic eyebrow lift. Also known as a forehead lift, it’s popular with both surgeons and patients because, before endoscopes, the incision for that procedure was done from ear to ear across the top of the patient’s head. Now, surgeons can tighten the deep facial muscles that allow drooping and frown lines and lift eyebrows and forehead tissues. Like the other keyhole procedures, the surgeon works under the skin through small incisions in the hairline. The operation usually results in a smooth forehead and more youthful looking eyes and is especially popular with bald patients or those who are rapidly losing their hair.

For patients who don’t quite need a full facelift – those without a lot of drooping facial skin – an endoscopic facelift (also known as a midface lift,) hides its entry points in the eyelid and gums. Experts say the typical patient is 40ish to 55, has good skin and some facial laxity but not enough for a full surgical facelift. To tighten loose neck muscles, endoscopic incisions can be hidden under the chin and behind the ears.

Keyhole surgery may also help put cheek and chin implants into place. Additionally, a mini-tummy tuck procedure is often used for patients to reign in bay window stomachs. However, if you have a lot of weight to lose, an endoscopic mini-tummy tuck may not be for you. The procedure sews the two, long stomach muscles – the so-called “six pack abs” -- back together when they’ve been separated by pregnancy, too much beer or by an unfortunate choice of genes.

Flat, Trim Waistline

“Many men with ‘beer bellies’ ask for an endoscopic tummy tuck,” says Leonard Grossman, M.D., a plastic surgeon at the Center for Plastic Surgery and Spa in Brooklyn, New York. “Usually, I ask them to first lose ten or twenty pounds and return in several months. Weight loss and the ‘keyhole’ mini-tummy tuck usually results in a flat, trim waistline.”

Keyhole surgery also works in some reconstructive procedures like sinus surgery, to stop carpal tunnel numbness pain in the wrist and to help in reconstructive breast surgery. The procedure is also used for women with implants who have capsular contracture – a condition wherein scar tissue has formed inside the breast around the implant.

“Some surgeons don’t favor endoscopic surgery because they only have a two-dimensional view of what’s inside the body,” says James J. Romano, M.D. a San Francisco plastic surgeon trained in endoscopic surgery. “Sometimes the surgeon can better see what he is doing with an open incision. Plus, the actual procedures can take longer because of the special surgical instruments that must be used.”

According to the A.S.P.S., endoscopic surgery carries about the same risks as found in standard surgery. Although complications are rare, they happen in about five percent of endoscopy cases.

But if you’re like most people, you probably don’t want to see anything at all of an operation, especially when it’s being done on your own body.

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