I've been consulting several plastic surgeons about a facelift. Given equal skill levels of surgeons, would you go with someone skilled with a laser scalpel or traditional? I'm captivated by the idea of the laser scalpel (cauterizes immediately), but does it really result in shorter healing times? Does it last longer? In short, what are the real advantages (if any) to a laser scalpel? (I'm sure this applies to other surgical procedures, too, but I'm shopping for a facelift surgeon. Thanks.
Laser Scalpel Vs. Traditional for Facelift?
Doctor Answers 16
Laser scalpel is pure marketing fluff for a facelift
As Dr. Aldea and Moelleken have so nicely stated, you are being scammed by a doctor who is telling you his/her tools will make a better result than someone else's. (I'll bet they are either young or not a real plastic surgeon, or both).
It isn't the tools but who is using them that makes the result so I would be very cautious about your opening statement "given equal skill levels" because no 2 surgeons are equal.
Just to continue the Tiger Woods analogy, there are thousands of pro golfers who can shoot under par every day but does Tiger Woods possess the "same skill levels"? I think not and his results prove that. You want the best surgeon in your area and you can tell this by viewing many of their photos and seing their skill level in the results. Let them use the tools they feel are best and don't make the instrumentation or the price be the deciding factor or you will possibly regret the decision in the long run.
Laser scalpel- innovation or hype
Dr. Aldea is spot on with his assessment.
There is absolutely no advantage to using a laser scalpel.
An experienced facelift expert will do a facelift procedure with virtually no blood loss.
The laser has the disadvantage of inadvertently burning a nerve, permanently damaging it.
LASER versus Scalpel
Although a LASER sounds more technologically advanced and therefore a better option than a standard scalpel, it is not a good option for facelift incisions for the following reasons:
- Heat damage created to the surrounding tissues
- Possibility of damage to hair
- No evidence to support better incisions
- More time spent on incisions- however not necessarily providing any benefit
- Inability to bevel incisions (can allow hair growth through the incision with a scalpel)
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Laser scalpel vs traditional scalpel for facelift
The laser is a burning and cutting tool. The actual facelift procedure is the same. A laser, a knife, and scissors are all cutting tools used to perform the facelift operation. The only advantage that the laser has is that there is minimal bleeding. When properly performed, there is minimal bleeding with a facelift anyway, especially when Jackson-Pratt drains are used in the postoperative phase. Since the laser is a burning tool, the healing and swelling takes much longer and stitches have to be left in much longer, which can lead to railroad tracking along the incisions. Most surgeons do not use a laser to do a facelift. If the laser happens to cut the facial nerve inadvertently, there will be no return of function from it.
More important that you are having the right type of Facelift
As you can see from the well stated answers here, the type of scalpel doesn't matter.
For me personally I don't like the laser scalpel for two reasons:
1. I prefer the "clean cut" of a traditional scalpel for dissecting out the layers of the skin / SMAS / muscle
2. I prefer "pinpoint" cautery as opposed to the "broad" cautery of the laser scalpel. It is my feeling that this results in less compromise of the blood vessels / capillaries that are important for the healing process. Could this result in more bruising? Possibly, but I think that bruising is more directly related to inherent patient healing, gentle technique, and experienced use of tumescent solution
More important than the scalpel is to make sure that the type of facelift you are having is the right one for your anatomy and your needs.
Healing time and scarring potentially greater with laser for facelift
There are studies that have shown that the healing time and ultimately scarring is potentially greater with the use of the laser as scalpel vs. the traditional use of a surgical knife blade. Use of the laser is more cumbersome, time consuming and costly. There are added inherent risks in using the laser. Lasers have many wonderful indications and uses. In my opinion, the use of a laser as a scalpel for facelift or eyelid surgery is unnecessary, unwarranted and inappropriate.
Pick the surgeon, not the instrument. You should only be concerned about the final result. No studies have demonstrated a consistent advantage of one technique over the other. Your "captivation" with lasers will not guarantee better results, but demonstrates the rationale for this marketing campaign.
It is the surgeon that is the important part of the operation
See an experienced facelift surgeon if you want to get the best result. See live patients he has done that you like. Forget the marketing of how he does it and go for established quality of results.
Best Scalpel for a Facelift
The best scalpel is the one that the surgeon is used to. Every surgeon has a level of comfort with her/his own instrument choice.
The concept of laser scalpel is great but it causes a lot of heat trauma to tissues and also can cause laser related fires in the operating room burning drapes and at times the patient as well.
Here are your scalpel options:
1. Cold Steel (the regular old fashioned blade)
2. Electric cautery (Bovie) It is a radiofrequency instrument that cuts and coags(stopping bleeding by plugging up the blood vessel ends with a protein coagulum) immediately. It generates heat and causes heat damage to the surrounding tissues if not used properly. The complete circuit involves flow of current from the point of contact on the patient in a loop back to the machin through a grounding pad attached to patient's leg usually. (It does not effect the leg but works only where the tip of the instrument is touched)
3. Bipolar Cautery: This works by using radiofrequency waves between the tips of the instrument and does not go through patient's body in a loop. It is safer to use as the heat is limited to the tips of the instrument.
4. Shaw Scalpel: It is a regular blade with a lot of heat in it created through electric current and it burns the blood vessel as it cuts and stops the bleeding.
5. Laser (Fiber tip or Pointing type): Different lasers work on the principle of cutting and burning. The lasers are very strong and generate a lot of heat on cutting and burning tissue. This leads to collateral thermal damage as well. There are certain areas in medicine where lasers are unmatched for their utility for example eye surgery. However, for faceleift surgery lasers do not provide any added advantage.
Lasers and facelift surgery
Not all lasers cauterize as they cut and so you still must use a cautery unit in addition to the laser. A laser does not guide the surgery and putting a laser into the hands of a surgeon does not make him/her a great surgeon.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.