Should you have "scarless" transoral surgery?

When you find out that you need thyroid or parathyroid surgery, most people feel like they want to rush into surgery as quickly as possible. The data says that you might be better off considering your options.

When patients have neck scars, those scars can be problematic for some people. While I was at Johns Hopkins, I worked with the facial plastic surgery team to understand what happens when someone has a neck scar, and how others perceive patients with a thyroid or parathyroid scar in the middle of their neck. What our research found was that the presence of a neck scar distracts people who are talking to you, causes others to pass judgments about your well-being, and may even decrease attractiveness. More importantly for some of my patients, the presence of an obvious neck scar violates their health privacy, and causes awkward conversations with strangers about their health.

In another study, we followed the pupils of people looking at pictures of patients. When patients have a neck scar, the eye of observers is instantly drawn to the scar. The hypothesis is that this distraction impairs communication.

In 2024, we completed a review of all of my surgical patients at Johns Hopkins until 2023 who had been eligible for transoral thyroid surgery and had surgery with me. This was about 2000 patients. Of those 2000, about 700 chose "scarless" surgery while the other 1300 chose the traditional surgery. We evaluated this large group for safety outcomes, cancer outcomes, complications, and quality of life. What we found was that in every single dimension, the groups were equal, except for one: patients without a scar were less self-conscious about their scar. As such, their skin related quality of life score was better. In every other domain, there was a trend towards a better quality of life for the group of patients who chose to have scarless surgery.

In other words, if you have a choice to have scarless surgery, it is likely that you will have a slightly better quality of life than if you have a neck scar. And all other outcomes will be the same.

Is "scarless" transoral thyroid or parathyroid surgery right for you? If you have the choice, the answer is that you will probably be glad you did.