OREM — Plastic surgeons no longer have to drive blind as they maneuver around the planes of the face, working out the technical difficulties involved in raising a brow line or lifting facial tissue.
Endoscopic cameras have opened up the procedure, providing a doctor with a look inside and beneath the skin.
Dr. Todd B. Engen, with the Excel Cosmetic Surgery Centers in Provo, Payson, Orem and American Fork, is one of the plastic surgeons trained in endoscopic surgery, which can be used for forehead and brow lifts, breast augmentation, abdominoplasty and nose surgery.
Engen and an associate have developed a way of performing an endoscopic mid-face suspension that literally separates the facial skin from the lining of the bone, or periosteum, and allows it to be moved.
Only a handful of plastic surgeons do the endoscopic procedure for the mid-face.
The endoscopic fiber-optic camera, which is 3 millimeters in diameter, is inserted through one of several small incisions in the face and scalp and helps guide the dissection and stretching so nerves and blood vessels aren't harmed along the way.
Tissue is lifted, and dissolvable stitches are put in strategic places. After the procedure, the skin reattaches to the lining.
"With this procedure, we get an entire suspension that lasts longer and elevates the whole face," Engen said.
"In the past, to get that periosteum to move, we had to be fairly aggressive," he said. "This is not a blind dissection with the endoscope. We can see the nerves and the vessels and avoid them."
Nerves accidentally cut or disrupted can leave a patient with numbness, paralysis or pain.
Engen has done 150 mid-face elevations and 400 brow lifts over the past four years using the endoscopic camera. But before that, he studied intensively with Dr. Richard Anderson in Scottsdale, Ariz., to become proficient in the procedure.
"The advantage to endoscopic surgery is that the patients are so happy with it. There's minimal scarring because the incisions are so tiny, and we get a better appearance afterward," he said. "There's also minimal discomfort."
To accomplish the same effect without the endoscopic camera in action would require the combination of several surgical procedures.
Engen much prefers the endoscopy, although the surgical equipment is expensive and the learning curve is high. The actual cost to the patient is about the same as a bi-coronal elevation.
"The gold standard before endoscopy was a bi-coronal elevation, where we made an incision from ear-to-ear across the forehead and then peeled the skin forward so we could work on the muscle and take out the excess skin," he said. "It left numbness where the nerves were cut and wasn't popular because of the scar, especially in men who had no way to hide it."
Patients who want a mid-face suspension or brow lift are usually between 30 and 60 years old and are experiencing a sagging in the cheeks or forehead.
"We try to undo what gravity has done," Engen said.
Most are women, although Engen has treated a few men who wanted a brow lift to reduce headaches or to open up a field of vision.
The endoscopic surgery itself takes only about 2 1/2 hours. Patients generally are back at work within a week, although the swelling takes two to three months to fully disappear.
Engen performs the surgery in either the Timpanogos Regional Hospital in Orem or at the Central Utah Surgery Center in Provo.