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Endoscopic Plastic Surgeries

"Keyhole" Surgery Doc

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Gilbert Lee, M.D., F.A.C.S.
Changes Plastic Surgery
11515 El Camino Real
Suite 150
San Diego, CA 92130
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Gilbert Lee, M.D. F.A.C.S.

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 a breast augmentation procedure known as 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."

T.U.B.A. stands for "trans-umbilical breast augmentation" and means the breast enhancement is done through the patient's belly button. Audrey was in the news because she was recently featured on an MTV documentary as a patient who wanted the look of Jessica Simpson.

Moreover, the T.U.B.A. is done by endoscopic surgery. An endoscope is a system of special surgical instruments that allows physicians to see and work under the skin down to and including internal structures like the gall bladder. However, in cosmetic and plastic surgery, the endoscope is extremely handy because the tiny viewing scopes - along with the tools that do the actual work - are inserted through very small, "keyhole" incisions. It all results in surgical enhancements with barely noticeable scars and incisions that heal quicker.

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," says Gilbert Lee, M.D., a plastic surgeon at Changes Plastic Surgery in San Diego.

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.

Breast enhancements via the T.U.B.A. method are 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 or under the breast muscles. 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 use an endoscope to place breast implants through Lilliputian incisions in the patients' armpits.

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 came along, the incision for that procedure was made 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 while lifting eyebrows and forehead. 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, 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," says Dr. Lee.

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.

Some men ask for an endoscopic mini-tummy tuck to rid themselves of beer bellies, say experts. But many plastic surgeons will often ask them to first lose ten or twenty pounds and then return in several months for another evaluation and surgical consult.

"Keyhole surgery also works in some reconstructive procedures like sinus surgery, to stop carpal tunnel numbness and pain in the wrist and to help in reconstructive breast surgery," says Dr. Lee.

The procedure is additionally used for women with implants who have capsular contracture - a condition wherein scar tissue has formed inside the breast around the implant.

According to the A.S.P.S., endoscopic surgery carries about the same risks as found in standard surgery. Complications are rare, happening in about five percent of cases.

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

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