The most important advantages of endoscopic surgery (minimally invasive/“keyhole” surgery) are nearly invisible scars, a much faster recovery process, and minimal postoperative complaints such as pain and swelling. In this modern technique, millimetric entry points are used instead of long incisions, and tissues are handled with maximum precision thanks to high-resolution cameras. This approach offers superior comfort—especially for those seeking natural results in facial and body aesthetics—by causing less tissue trauma and enabling an uninterrupted return to social life. It is possible to achieve aesthetic goals without leaving behind evidence of surgical intervention.

İçerik Haritası

What Is Endoscopic Surgery?

To better visualize endoscopic surgery, consider this: In traditional, open surgery, a long incision is required to access a region, allowing the surgeon to operate by seeing directly with the naked eye. In the endoscopic method, however, the philosophy is entirely different. Instead of opening a large “window” to look inside the body, we use only a keyhole-sized opening.

This “keyhole” consists of several tiny incisions—each no more than 1–2 centimeters—made near the target area, typically placed in concealed locations such as the hairline, the armpit, or natural body folds. Through one of these incisions, an endoscope—an slender tube with a high-resolution camera and a powerful light source at its tip—is inserted. The endoscope projects the internal view onto a large operating room monitor. In this way, the surgical field can be viewed 10–15 times larger and far brighter than normal. Through the other small incisions, long pencil-thin surgical instruments (scissors, graspers, dissectors) specifically designed for this technique are used.

In short, instead of directly touching the tissue with their hands, the surgeon operates using the extensions of these delicate instruments while focusing entirely on the enlarged, crisp image on the screen. This is an invaluable advantage for protecting structures in areas such as the face, where millimetric calculations are made and where delicate nerves and vessels are present.

What Are the Advantages of Endoscopic Surgery?

The reason the endoscopic technique is so popular and preferred lies in the concrete, meaningful benefits it offers patients. These advantages form an interconnected chain of improvements. The key advantages of endoscopic surgery include:

Nearly invisible scars
A much faster recovery process
Less postoperative pain
Minimal swelling and bruising
Lower risk of bleeding
Better preservation of delicate structures (nerves and vessels)
Often shorter hospital stays

The fundamental reason for these advantages is that the damage to the body is kept to a minimum. Because only a few small openings are made instead of a long incision, the muscles, skin, and other soft tissues are exposed to far less trauma. The less damage the body sustains, the less energy it needs to spend on repair, and the faster and more comfortable the recovery. For example, after an endoscopic brow lift, patients can generally return to normal life within a few days, whereas this may take weeks with the classic method. Most importantly, after an aesthetic intervention, not having a prominent scar that “proves” the surgery is one of the leading factors that maximizes patient satisfaction.

How Is Endoscopy Used in Facial Rejuvenation Surgeries?

The face is both the area where signs of aging appear earliest and the area where surgical scars are most desired to be hidden. Endoscopic surgery elegantly solves this equation and brings a fresh approach to facial rejuvenation procedures. Instead of treating the face as a whole, this method allows us to perform a “precision strike” at the problem area. This means a fully personalized treatment plan can be created for each patient’s unique aging pattern. For example, it is possible to achieve a refreshed and rested appearance by performing only an endoscopic brow lift for a patient whose brows have descended while the jawline remains firm.

What Are the Details of Endoscopic Forehead Lift and Brow Lift?

The forehead and brow region forms the foundation of facial expression. Low brows and deep forehead lines can give a tired, angry, or older-than-actual look. Endoscopic forehead lift and brow lift are among the most modern methods used to give this area a youthful and dynamic appearance. In the traditional approach, the scalp is incised from one ear to the other, whereas this is completely eliminated in the endoscopic technique.

Ideal candidates for this surgery often share the following features:

Mild to moderate brow ptosis (droop)
Deep “frown” lines between the eyebrows
No significant skin redundancy on the forehead
A desire for a more youthful, dynamic, and positive facial expression
Individuals who are sensitive about scarring

The procedure is performed through 3 to 5 incisions of about 1.5 cm hidden within the scalp. Using the endoscope and specialized instruments inserted through these incisions, the forehead skin and underlying tissues are gently released from the bone. Muscles that pull the brows downward and create a stern look (the corrugator and procerus) are weakened. Then the entire forehead and brow unit is elevated to its proper position and secured using small absorbable screws or specialized suture techniques. The goal is not to create a surprised expression, but to achieve a rested, lively, and natural look.

How Is an Endoscopic Mid-Face Lift Performed?

Over time, cheek fullness diminishes, the malar (cheekbone) area flattens, and the cheek tissues descend due to gravity. This deepens the “nasolabial” lines from the sides of the nose to the corners of the mouth and creates a tired look. The endoscopic mid-face lift is a highly sophisticated technique targeting these issues. It is specifically designed to address the signs of aging that become pronounced in the middle third of the face.

The main concerns targeted by an endoscopic mid-face lift are:

Descended cheek tissues (malar ptosis)
Flattened cheekbones
Deepening nasolabial folds (nose-to-mouth lines)
Hollows under the eyes and a tired expression
Restoring the lost “youthful triangle”

This procedure is typically performed through small, hidden incisions within the hair-bearing temple region and sometimes inside the mouth (at the gum-cheek junction). With endoscopic assistance, all soft tissue over the cheekbone—namely the malar fat pad—is carefully released beneath the periosteum (bone covering). The tissue is then moved not laterally, but in a vertical vector—upward—back to its original youthful position and secured with permanent sutures. This vertical elevation is the key to restoring lost volume and fullness to the mid-face while avoiding a “pulled” appearance and achieving a natural rejuvenation. Ideal candidates are generally patients from their late 30s to early 50s who have not yet lost skin elasticity but have begun to experience cheek descent.

Is an Endoscopic Tummy Tuck Possible?

This is one of the topics where patient expectations must be managed in the most accurate and honest way. The answer is yes—an endoscopic approach can be used to address the abdominal region—but this is not the classic abdominoplasty (tummy tuck) we know. They are entirely different operations serving different purposes and addressing different patient needs. Understanding this distinction is crucial to choosing the right treatment and being satisfied with the outcome.

Who Is a Good Candidate for Endoscopic Abdominal Surgery?

Absolutely no skin laxity or looseness in the abdomen
Excellent or very good skin quality
No or minimal stretch marks (striae) on the abdominal skin
A single complaint of outward bulging due to separation of the abdominal muscles (diastasis recti), especially after childbirth
Being at or near ideal body weight

Who Is NOT a Good Candidate for Endoscopic Abdominal Surgery?

Mild, moderate, or severe skin laxity in the abdominal area
Skin looseness after weight gain and loss
Significant excess fat in the abdomen
Extensive and deep stretch marks

The single goal of endoscopic abdominal surgery is to repair the separation of the anterior abdominal wall muscles (diastasis recti) caused by childbirth or other reasons. This separation creates a protruding appearance as if there is a constant bloating in the abdomen. The procedure is performed through small incisions placed within the navel or below the bikini line. Using the endoscope, the separated muscles are approximated like a corset with robust sutures, tightening and flattening the abdominal wall. No skin is removed in this procedure. Therefore, if the patient has even a small amount of excess skin, this method is not suitable, because once the muscles are tightened, the overlying lax skin may look more wrinkled and aesthetically unpleasing.

Can Endoscopy Be Used in Breast Augmentation?

Yes, the endoscopic technique is an extremely valuable option in breast augmentation—particularly for patients who want absolutely no scar on the breast itself. This approach is usually performed through the armpit (transaxillary) or the navel (transumbilical), with the armpit approach being the most common.

Through an approximately 3–4 cm incision concealed within the natural axillary crease, the endoscope and surgical instruments are advanced. Thanks to the magnified and clear view provided by the endoscope, the pocket (space) where the silicone implant will be placed—either above or below the pectoral muscle—is created with great precision. The surgeon can clearly see blood vessels and nerves, minimizing bleeding and crafting a perfectly symmetric pocket. This precise work ensures the implant sits correctly and reduces the risk of future displacement. Once the pocket is prepared, the implant is inserted through the same incision.

The greatest advantage of this method is that no incision is made on the breast tissue, the nipple-areola complex, or the inframammary fold. Thus, the scar remains completely hidden in the armpit. This is an excellent alternative for patients who prefer no visible breast scar when wearing low-cut clothing or at the beach.

Are There Risks or Limitations to Endoscopic Surgery?

Every surgical procedure has its own risks, and endoscopic surgery is no exception. However, due to the nature of the technique, these risks are generally lower and manageable. For transparent counseling, it is important to understand these potential risks and limitations.

Possible risks and considerations include:

Temporary numbness or sensory changes (paresthesia)
The possibility of conversion to open surgery (very rare)
Infection
Bleeding or hematoma (blood accumulation)
Seroma (fluid accumulation)
Asymmetry

The most commonly mentioned of these is temporary sensory loss in the operated area. Especially when working near facial nerves, numbness may occur in regions such as the forehead or cheeks due to traction on the nerves during the procedure. This is almost always temporary and resolves completely within weeks or months as the nerve tissue repairs itself. The magnified view provided by the endoscope minimizes the risk of permanent nerve injury.

The most important limitation is patient selection. To reiterate, endoscopic surgery is not a suitable solution for patients with significant excess skin. This method is based on repositioning and reshaping tissue—not on removing it. Therefore, whether a patient is suitable for endoscopy can only be determined after a detailed medical examination by a physician.

Dr. Erman Ak

Op. Dr. Erman Ak who is one of the best cosmetic and plastic surgeon in Turkey, completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.