Dimitrije E. Panfilov
Developments in the fields of technology and chemistry and other scientific achievements have brought some magnificent advances. Quite a number of operative procedures which were unthinkable only a short time ago have now become routine work.
Today we have sources of heat at our disposal to "spot-weld" even the smallest vessels. Manufacturers supply us with different electrocoagulators. They provide various options ranging from bloodless cutting to coagulating and are a great help when operating inasmuch as they allow precise and speedy haemostasis. Because they produce extra heat, they are not the first choice when cutting the skin - they may produce burns of wound edges with prolonged wound healing.
Light sources are very important for properly distinguishing tissue elements from each other during the operation. Operating lights are becoming increasingly better. Head lamps are also available which follow the movements of the surgeon's head and line of vision, as well as cold-light sources with flexible cables which can be introduced into the body's interior.
Nowadays we have microcameras with their own light source with a diameter of 4 or even 2.7 mm. For endoscopic surgery, a few, barely 1-cm-long, incisions are made through which probes are inserted, which in turn direct light sources, miniature video cameras, and instruments to the actual site of the operation. This requires some degree of rethinking. Usually the surgeon's attention is concentrated on the operating field of the patient while operating. During endoscop-ic surgery, however, the surgeon has to look at a monitor on to which an enlarged image of the operative procedure is displayed. Much has become possible in aesthetic facial surgery today using endoscopic surgery. The forehead lifting should be a routine endoscopic procedure in modern offices. Once a surgeon is used to it, the surgeon will find ways to access the deeper layers of the midface to achieve astonishing results through minimal skin incisions. Several invited co-authors explain this technique in their guest chapters.
Laser technology is one of the great achievements of our time and enjoys a wide variety of uses in medicine. It uses a bundled ray of light with the following characteristics: single-coloured (monochromaticity), synchronous oscillation (coherence), and high emit-tance. So much energy, intensity, and precision was hitherto unknown. The mechanism of the effect has three components:
Particularly the first and third components are desired and utilized in medicine.
The core of a laser is the resonator. Here the light ray is generated and transmitted via a system of mirrors to the site where the photochemical effect is needed. Different wavelengths result in different colours. A distinction is made between several types of laser: argon laser, CO2 laser, helium-neon laser, neodymium-YAG laser, excimer laser, etc. The spectrum ranges from simple "soft-laser" systems, which produce hardly more than an irritation and general toning of the skin, to the ultrapulse laser, with a computer-controlled scatter effect. Admittedly, an overdose cannot always be ruled out, even with the latest and most expensive system, also referred to as a resurfacing laser.
Unlike when using the cold or electric knife, eye-hand-foot coordination is required when lasering. All those present must wear protective glasses and the assistant holds an air aspirator ready to draw off the evaporations. Surgeons have their "sights" on the operating field, the laser handle with the infrared light maker in their hand, and their foot over the release pedal. They have to focus their concentration on the target site. Any cloths in the vicinity should be kept as moist as possible, otherwise swabs and strips of tulle gras would easily ignite.
It is also possible to learn this technically most demanding form of therapy with "practice runs". Countless apples, oranges, and grapefruits serve as "guinea pigs".
With a laser one can cut, coagulate, and remove small tumours, Tattoos and port-wine stains react well to laser therapy. Care should be taken with pigmented moles, however: a very experienced diagnostician must first dispel any final suspicion of a malignant pigmented tumour - malignant melanoma.
Not only the latest ultrapulse resurfacing CO2 laser is capable of removing the most superficial layer of skin. The principle is the same as with the already known methods of dermabrasion or peeling. Industry sometimes invests vast sums in advertising campaigns, however, so that the impression is forced upon people that the laser is a universal remedy. Blind trust in technology takes on its strongest form when it comes to laser technology. Of course, excellent results can be also achieved with lasers for the removal of superficial wrinkles, but the patients must be very well selected and the doses optimally adjusted. See the special chapters on this by Ashok Gupta (Chap. 70) and Carlos Oscar Nebel (Chap. 71).
Please see the general bibliography at the end of this book.
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