Today's cosmetic surgery seeks more than a good result. It also seeks to produce the result without leaving telltale tracts behind. This article will describe some of the ways I and other modern plastic surgeons accomplish that dual goal. I will discuss both facial and body contour procedures.

The most significant innovation in facial rejuvenation in the past several years has been the adaptation of endoscopic techniques. An endoscope is a surgical tool that incorporates a miniature video camera. It provides surgeons access to deeper layers with visualization of essential anatomy through minimal incisions. For example, the old forehead lift operation required a long incision across the top of the head from ear to ear. In my opinion, that operation has been made obsolete. I can do the endoscopic assisted forehead lift through small incisions, all hidden within the hair and provide the same benefits of forehead and brow area rejuvenation, all without removal of any scalp and therefore no hair loss. Not even your hairdresser need know.

The middle-third of the face is that part of the anterior cheek area below the eyes and above the lips. I perform mid-face lifts by combining the endoscopic forehead lift described above with an incision under the lip. I can then lift all layers together, and support them in place. The result is a more harmonious rejuvenation, including reduction in circles under the eyes, all without a single visible scar on the face.

Other areas of the face can also be improved without leaving any sign that you have had surgery, other than the fact that you look better. Lower eyelid fat bags can be removed from the inner, backside of the eyelid, leaving no scars. Jowl fat can be removed from inside the mouth. Cheek implants, which can have the effect of enhancing and balancing facial features as well as producing a more youthful look, are generally inserted through incisions under the lip inside the mouth. Double chins and poorly defined necklines can be recontoured with very small liposuction instruments passed through tiny incisions behind the earlobes and in the crease under the chin. Even neck muscle tightening can be done with only a slightly longer incision under the chin. The same approach is used for chin enhancement, using implants that I custom design to your particular need.

Another approach to facial contouring and rejuvenation is fat injection. Fat is harvested from your own body stores (like it or not, an almost inexhaustible resource), and prepared for reinjection. It is then used to fill in lines and wrinkles, correct hollows, and enhance structures such as cheekbones, jaw lines, and lips. Often, several sessions are needed to achieve the final result. The great attraction is that the material comes from your own body so that allergic reactions are impossible, the material (your own fat) is free, and the process uses needle injection so that surgical scars are avoided. Alternatively, there are permanent grafts that are well tolerated by the body that can also be implanted without leaving noticeable marks behind. I have had particularly good success in lip enhancement using one of these, made from a Gore-Tex material. A newer, softer version has now been released which studies show works even better.

Breast augmentation has reemerged as one of the most popular cosmetic surgery procedures. An important decision is the location of the incision. I prefer to avoid a scar on the chest, for obvious reasons. My preference is the axillary incision, and I place the implant under the large pectoral muscle to obscure the upper margin of the implant. The final scar, which is high in the armpit, usually fades to a fine white line mimicking a natural skin fold. Other surgeons use the umbilical approach that also leaves the breast unscarred.

Recent statistics released by the American Society of Plastic Surgeons, Inc., once again shows that liposuction is the most commonly performed cosmetic surgery in the United States. One of the big attractions of liposuction from the very beginning has been the possibility of dramatic results and very small incisions that can be hidden within natural body creases, and covered by even the skimpiest clothing. This remains so today. Technology has improved and results are even better without sacrificing the possibility of no detectable scars.

The plastic surgery profession has always, with good reason, prided itself on its attention to detail and on minimizing scars. Our traditional, more extensive procedures, including major facelifts and tummy tucks, achieve these goals and are still the best choice in many cases. The newer techniques I have described above build on that tradition. We truly can achieve great results in a stealthy fashion.

For more information and to contact me please visit my websites www.plasticsurgeryvermont.md and www.drmetzner.com.