Tissue glue is just as misunderstood by the public as laser surgery. This is likely due to the fact that it has been misrepresented and hyped to the public by a media that has little training in the biological sciences. When the public thought of stitches they thought of train tracks and unsightly lines, it's a natural reaction; when the public thinks of glue they think of a tightly and finely sealed envelope. Again, companies have a ware to sell and the media like a "good" (well-manufactured) story to increase readership and revenues. Let us approach the glue issue analytically.

The amount of tension on any part of your skin (envelope) is related to the location of the part of the body, your age, your genes and the kind of environment in which you placed your skin. One of the least amounts of skin tension possible is the upper eyelid skin in an older person. Wrinkles are created by an excess of skin. Tissue glues were tested here originally because "no stitches" sounded sexy to Americans. After all, eyelid tissues needed hardly any glue; a surgeon could just tape the edges together and get a fair, although not perfect or even a very good result. Nevertheless, some surgeons tried the new glue. The problem was that the glue could not maintain perfect alignment of the tissues and the results were mediocre at best. Would you want eyelids with ruffles or crumples along the incision line where the tissue had been removed by plastic surgery?

Now let's take a real-life situation, removal of a skin cancer from the back or the leg where the tissue is under tension of hundreds of pounds per square inch. In fact, proper closure may require stitching that is as thick as 100-pound test to do the job. No glue will hold most of those wounds if the tumors are excised (cut out) with the proper margins. It can be guaranteed, that many glued wounds in these areas will split apart. Splitting apart causes pain and may lead to infection and more tissue damage. Every 10 years a new company comes up with a new "wonder glue" to eliminate stitches, the products usually fail a short time period and are forgotten. Maybe someday an accurate highly specific molecular tissue glue will exist... but maintaining the proper tissue edges in alignment while the glue "firms" is the problem. Ragged, misaligned tissue edges with an obvious and open scar are the problems seen nowadays when such glues are used.

For the present, it is best to avoid tissue glues. Future glues may be better, but the author always likes to sit on the sidelines for a year or two with any new treatment that he feels intuitively is "shaky" and see what happens in the hands of other surgeons. The author has yet to see any treatment he judged intuitively as shaky last more than one year in the public spotlight. Many treatments even cause tremendous problems. For example, study the history of the original silicone breast implants, Retin-A for stretchmarks, face-lifting for acne scars and ultrasonic liposuction for cellulite. Refer to www.lipoinfo.com on the Internet for one of the most up-to-date liposuction Web sites.

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