I read with interest the article by O’Connell et al1 that concludes “improved scar cosmesis should not be acknowledged as an advantage of performing MA-T [minimal access thyroid] or MA-P [minimal access parathyroid] surgery.” While I applaud the authors for their efforts to quantify the cosmetic value of minimal access surgery, their report suffers from serious limitations. These limitations bear scrutiny lest readers be left with an impression that patients are not interested in smaller, more cosmetic scars, which would conflict with the experience of most minimally invasive thyroid surgeons. I would draw particular attention to the offering of definitive conclusions based on the responses of fewer than a dozen geriatric-aged women as to whether they are dissatisfied with their scar result and the unsubstantiated extrapolation of parathyroid surgery to thyroid surgery.