JUNE 8–11, 2023 REGISTRATION OPENING SPRING 2022
BEGIN AGAIN
2022 is set to be an amazing year for the IAOMS and its members. As we welcome a new president and officers, our volunteers and staff are renewing their commitment to advance the field of OMF surgery at every stage of its practitioners’ careers while connecting them with the community of their supportive fellow surgeons. We strive to care about our members with the same passion they show for the health and happiness of the patients whom they’ve dedicated their lives to help. We extend our thanks to every member who makes this possible, and we welcome you to enjoy our programs and events this year. We are also happy to introduce Xander Sobecki, joining IAOMS staff as Manager of Marketing and Communications.
IAOMS/ALACIBU NEXTGEN ONLINE CONFERENCE The IAOMS is excited to once again join with the Asociación Latinoamericana de Cirugía y Traumatología Bucomaxilofacial (ALACIBU) for a five-day virtual conference from May 9-13. Each day will include a variety of sessions presented by master surgeons from across the specialty, with a spotlight on the next generation of young OMF surgeons presenting their
work from all around the world. There is no cost to register, and attendees qualify for 2.5 hours of educational credits per day of content.
ICOMS VANCOUVER 2023 The 25th International Conference on Oral and Maxillofacial Surgery will be a much-needed reunion for our members in the spectacular backdrop of Vancouver, Canada. Registration will launch in June, stay tuned to our communications for announcements of speakers and social events. We can’t wait to see you again!
IAOMS PODCAST: HISTORY OF THE SPECIALTY Available on multiple listening platforms for every device and schedule, the latest season of the IAOMS Podcast sheds light on how each region has contributed with unique milestones and innovations to the surgical field. Get a feel for the culture and heritage that have led to the current practices, and learn about the trailblazers of OMS who have left their mark in our history.
Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS
®
Issue 66 / March 2022
Editor-in-Chief Deepak Krishnan Assistant Editors Noor Al Saadi Lilis Iskandar Graphic Designer María Montesinos Executive Committee 2022-2023 Board of Directors Alejandro Martinez, President Gabriele Millesi, Past President Sanjiv Nair, Vice President Rui Fernandes, Vice President-Elect Brett Ferguson, Treasurer Larry Nissen, IAOMS Foundation Chair Mitchell Dvorak, Executive Director Members-at-Large Nardy Casap Alfred Lau, Fred Rozema Regional Representatives Imad Elimairi, Africa Tetsu Takahaski, Asia Nick Kalavrezos, Europe Leopoldo Victor Meneses Rivadeneira, Latin America Ian Ross, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS Committee Chairs G.E. Ghali, Education Alfred Lau, NextGen Henry Garcia, NextGen Sean Edwards, Research Paul Sambrook, IBCSOMS Representative Ed Dore, 25th ICOMS-2023, Vancouver FACE TO FACE Registered in U.S. Patent and Trademark Office. ©Copyright 2018. I nternational Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions. Cover image Florian M. Thieringer.
CONTACT US
International Association of Oral and Maxillofacial Surgeons IAOMS Foundation 200 E. Randolph St., Suite 5100 Chicago, IL 60601 USA / communications@iaoms.org
Letter from the President
IT IS AN HONOR to greet you in my first F2F feature as your IAOMS president. Thanks to the versatility of our leadership and staff, our first fully-virtual Council election ran smoothly and welcomed us into our term. While we all wish it had been in-person like so many memories behind us, these years have shown us that duty takes many forms in the face of challenge. No matter what form it takes, it is a sincere responsibility to oversee the IAOMS and ensure our mission is fulfilled. As the world reopens with hesitancy and still holds risks, balancing the well-being of our members and patients with our duty to advance education and communication among our surgeons is critical. With numerous virtual programs coming up and ICOMS in Vancouver approaching in the distance, we want to welcome our members back to what we missed so dearly. I must mention that before this issue went to print, the pieces of surgeons’ art were auctioned off to benefit the IAOMS Foundation. I was besides myself in amazement at what our members were able to create outside of their daily practice. I highly
recommend taking the time to view each piece, taking in the immense creativity and talent that the artists donated for our benefit. Some say that to be a surgeon requires having an artist’s eye for detail, but these gifted members have gone above and beyond in exemplifying that ideal. I would like to extend my gratitude to the IAOMS headquarters staff striving to meet our needs and future potential with vigor and vision. They keep the wheels turning to keep it all possible, and never cease to amaze us no matter what obstacles have appeared. I would also like to thank our corporate sponsors such as KLS Martin who trust the IAOMS deeply enough to invest in our future, taking our conferences and webinars to new heights. I urge every member to pursue these opportunities, there is always something more to learn and a new point of view that can help your patients. Again, it is my honor to greet you as a president for the first time, and humbling to be able to give back to the organization that has given me so much in my career and life. Alejandro Martinez IAOMS PRESIDENT 2022-2023
CONTENTS March 2022 3
Begin Again Mitchell Dvorak
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Letter from the President Alejandro Martinez
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Art is sublime… Deepak Krishnan
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CHITCHAT limericks and haikus – multilingual with English translation
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SPECIAL REPORT ART Don’t hide your face Why I started sculpting... ART submission
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LIST OF OMS PODCASTS IAOMS podcast series OralMaxFax Podcast Let’s Talk Oral Surgery PCOMS listen on demand Oral and dental surgery with Dr. Jason Portnof Everyday Oral Surgery | Surgeons Talking Shop
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MEET ALEJANDRO MARTINEZ Our new President
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HOW I DO IT Tattoo removal
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IN MEMORIAM Tribute to Dr Laskin
ART IS SUBLIME…
ART IS SUBLIME, a refuge, a ray of hope and an escape. At this time when humankind is limping back to a new normalcy, art seems like the right window to exit into the next chapter. Surgeons are artists by training, not by talent. And then there is talent, and creativity. So much of it! In this unique edition of Face to Face, we thaw up the winter with a special visual treat of Art and Surgery. Not just visual art, but audio art through podcasts related to surgery, surgical art by removal of tattoos (oh the irony!) and use the opportunity to raise awareness and resources for the IAOMS Foundation. We get to profile two Presidents of the IAOMS - the newly minted Alejandro Martinez from Mexico and our recently departed Daniel Laskin from USA. Our peers are immensely gifted. Some of us took this opportunity to showcase a talent, and I know there are so many more that didn’t answer the call. To those that offered their art to the foundation auction, I speak on behalf of every trainee and student of surgery that your gesture was classy, and your art was priceless. ■ Deepak Krishnan EDITOR IN CHIEF
5
Chitchat poems
LIMERICKS AND HAIKUS multilingual with English translation Luis Quevedo SPANISH
Escribes poesía? Eso lo dejo a mi mente cuando reúne palabras aisladas que se sienten/lucen mejor cuando están juntas.
Do you write poetry? I leave that to my mind when it puts together isolated words that feel/look better when put together.
Shibani Das ORIYA
Only those are worthy of honour and glory The ones who work without any desire for fame and power The world recognises them through their work because nothing grows and prospers without labour!
Payam Afzali FARSI
Can’t change the whole world, Fortunately, we can change one patient’s whole world.
Snow Luo CANTONESE
A scene at sundown, The waves rumble and tumble. Our secret, their past.
Jorge I. Ravelo SPANISH
Se deja de querer, sin razón alguna sueños se desvanecen son el nuevo día vacío infinito, que recorre el alma solo el amor, nos trae la calma.
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you stop loving, for no reason dreams fade With the new day Infinite emptiness, which runs through the soul Only love brings us calm.
MAY 9–13, 2022 / 7:00 PM – 9:30 PM CST
The IAOMS/ALACIBU NextGen Online Conference will provide a dynamic and robust five-day program with live presentations followed by question and answer opportunities. Each day will include a variety of sessions presented by master surgeons from across the specialty as well as the next generation of young OMF surgeons. Participants will have the opportunity to participate in 2.5 hours of educational content per day throughout the duration of the conference.
SESSION TITLES BY DAY
Thank you to our Emerald Level sponsor for supporting this conference.
Thursday Insights and Novelties in Trauma
Monday Points and Counterpoints in OMS Tuesday Improving Your Results in Dental Implants Wednesday Evolving Protocols and Practice in Orthognathic Surgery
Friday What’s New and What’s Effective in TMJ Surgery
Visit www.iaoms.org/nextgenonlineconference to register today.
March 2022
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DON’T HIDE YOUR FACE initiative from Egypt
By Noor Al Saadi Oman
Matkhabeesh Weshak (Don’t hide your face), is a society-driven initiative founded in Egypt in 2018 to support individuals born with craniofacial anomalies. The initiative was founded by Prof. Karam Allam at Sohag University, Egypt. Working to raise public awareness and promoting society acceptance for individuals with craniofacial anomalies; the initiative had arranged an art exhibition in association with medical students from Sohag Medical university. We take the opportunity to present few of the most outstanding artworks by medical students.
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The following crewel embroidery is by ROA’A ELSAYED. She is a fifth year medical student. She embroidered an outstanding art piece inspired by a girl with Vitiligo.
The following art piece is by AFNAN ELKHIOUTY, a second year medical student. She is interested in crochet handicrafts. She crocheted an extraordinary amigurumi doll inspired by people with Vitiligo.
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The following pencil sketches are by AHMED ESAM. He is a fourth year medical student. His exceptional art work was inspired by two children with craniofacial anomalies.
The following colourful sketch is by ASMAA HAZEM. She is a second year medical student. Her beautiful art work was inspired by a child with bilateral cleft lip.
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WHY I STARTED SCULPTING... By Jose Luis Molina Moguel Mexico
ONE DAY, while I was operating on a bilateral sagittal split osteotomy, for some reason the orthodontist asked me if he could enter the operating theatre as a second assistant. Everything went well in surgery, there was a little bleeding on the right side, and I asked the orthodontist to gently compress using his finger in the cheek area. That day, we finished the surgery without problems. However, on the evening visit, I noticed that the patient had a right facial paralysis. It was my first time to encounter such a complication, although I had my share of experience in doing these osteotomies.
When I found out that clay and plasticine could get damaged easily, I converted my medium to bronze, which is almost indestructible. so, it was surgery that turned me on to sculpting!
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I talked to my teachers in the United States, and after seven days, purulent discharge began to drain from the right side. We thought that the etiology of this unusual complication was likely to be muscle necrosis in the area of the facial nerve caused by that finger compression. The patient recovered three months later without any problem, but this experience made me turn to sculpting “the monk”. I went and bought plasticine and started working on a sculpture of a monk with it. It was about 30 cm tall, and he was looking up to heaven asking God to help him. When I found out that clay and plasticine could get damaged easily, I converted my medium to bronze, which is almost indestructible. so, it was surgery that turned me on to sculpting! ■
DR JOSE LUIS MOLINA MOGUEL was recognized for his 50 years of meaningful contributions to the oral and maxillofacial surgery on January 8th 2022 in Mexico City. Friends, mentees and colleagues met at the Mexican Academy of Surgery, a national body which he serves at as the Secretary. A unique honor for an OMS.
ident of OMS Interhospitalaria Left to right: Ricardo Vidaurri: Pres President, Jose luis Molina Assoc., Alejandro Martinez IAOMS t of the Mexican Academy of Moguel, Felipe Cruz Vega: Presiden ry of the Mexican Academy of Surgery, Javier Davila Torres: Secreta ident of AMCBMC (Mexican Surgery (OMS), Jose luis Cadena: Pres Association of OMS).
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IAOMS President Alejandro Martine z with Prof. Jose Luis Molina Moguel
March 2022
SUBMISSION VAN GOGH SUNFLOWERS Acrylic on fabric
THROUGH TIMES Digital
Noor Al-Saadi Oman
Ramtin Dastgir Iran
March 2022
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HAPPINESS DESPITE CIRCUMSTANCES Oil on canvas
Ramon Aleman El Salvador
CAPRI ON MY MIND
Acrylic on canvas
Stephanie J. Drew USA
BONITA
Acrylic on canvas
KAROO SPACE Watercolor
Ravi Hebballi India
John Fisher South Africa
ANATOMY OF THE NECK
TEARS OF JOY
Prismacolor pencils on Strathmore paper
Digital Art
Victoria Manon USA
Moorthy Halsnad Scotland UK
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YING & YANG
Acrylic
Amir Marashi USA
FOOTPRINT
Digital Photograph
WINTER’S EVE Oil
Ebrahim Mohammadi Iran
John Moenning USA
HOPE
Digital Photograph
FEMALE NUDE Pastel
FACES OF CIVILIZATION
Maria Iliana Picco Diaz Mexico
Oil on canvas
Ahmed Merza Iraq
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THE HERMIT
THE QUEEN
THE MONK (BURROWING OWL)
Photography
Photography
Photography
Ideas and opinions never coincide, what is true, can you ever decide? There are times when you wish you implode, seeking refuge in the will-o'-the-wisp alone. On these bumpy roads of yesterday, on which you drive, Going further until you arrive.
DREAM CATCHER
To let a mind cripple with history, has no ability to release it from its misery.
Poem
Peering into the distance to find, the right blend of euphoria and peace of mind.
Dipesh Rao India
There is no moment like now, to be in it, but how? Close your eyes to see, the light that illuminates you is in me.
THE CHILD IN ME
ABEYANT SELF Poem
Poem
Shravan Renapurkar USA
Tabishur Rahman India
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FIREFLIES
Digital Photo
BIRTE'S PICTURE Oil painting
Birte Siegmund Germany
Kohei Sakaguchi Japan
SKULL STUDY
Graphite and white pencil on toned gray paper
DREAMS Poem
As I slowly drift into the realm of the night, My eyes wander into a divine sight, I cross the river in all its might, I hold the log and hug it tight, I cross again back to shore, With a peaceful snore, In the dreams of my sleep, I wander yore, Treasures of midnight, wandering in my mind, People I have met who have been benovelent and kind, I crossed my path in the deepest of my dreams, Of people whose words I cannot comprehend what they mean, Of trust and friendship they spoke at first, But Then their words like a volcano it burst, Trust and patience is all I had hoped, My dreams at times lay shattered and broke, As again I drift into a seamless night, It takes me in to canopy of darkness filled with light, Where joy and hope filled the room, Into the valley of flowers in all its bloom, As I drift back into a seamless night, My dreams take me afar into a wondrous sight, Melting the night into a day so bright. My eyes wander into a divine sight.
Marcel Zetina Mexico
KING OF CLAY
Graphite on paper
Pearlcid Siroraj India
Gokul Venkateschwar India
AUTHORS INDEX
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Lists of OMS IAOMS Podcast Series Season 5, Episode 2: History of Specialty in Asia
OralMaxFax Podcast Dr. Riddhi Patel DMD Cleveland children’s surgery center, Cleveland, Ohio Dr. Maryam Akbari DMD, MD, MPH Lincoln Medical center, New York, USA Let's Talk Oral Surgery 009 - How to Future-proof Oral and Maxillofacial Surgery with Dr. Srinivasa Chandra Dr. Marcus Hwang OMS resident at the Oregon Health & Science University
PCOMS listen on demand Dr. Jay Tabije OMF surgeon in Manila, Philippines
Oral and dental surgery Dr. Jason Portnof West Boca Medical Center Medical Moments with the Palm Beach Health Network Everyday Oral Surgery | Surgeons Talking Shop Dr. Grant K. Stucki DDS, MS Denver OMS private practice
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March 2022
MEET
Alex Martinez... OUR IAOMS PRESIDENT
1. If you were not an OMS, what would you be? A fisherman. 2. We hear you like grilling. What do vegetarians eat when they come to su casa? Sweet peppers with cheese and beans tacos. 3. W hat do you do when you are super stressed? I hug my wife and I am at peace.
March 2022
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4. If you had to share a recipe, what would it be? Rib eye cap tacos. 5. If you could have one superpower, what would it be? Love. 6. W hat is your favorite surgical procedure? BSSO. 7. What is a surgical procedure that you don’t do, that you wish you could do? Micro-vascular reconstruction.
8. How is OMS as a specialty going to change in the near future? OMS will adapt with technology, robotics among other changes. 9. What is your vision for IAOMS during your Presidency? More education, more members, more donations for more fellowship, secure the IAOMS as a best businesses practice model association. 10. What are you most grateful for? To be alive and healthy with a lovely family, friends, work.
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FOUNDATION CHAIRMAN REPORT
This issue of Face 2 Face welcomes us not only to a new year, but to a new slate of elected leadership within the IAOMS. I have the greatest support for IAOMS President, Dr. Alejandro Martinez, a good friend and a gracious practitioner who is devoted to his patients and peers alike. The title is a true honor across the world, but the courage and drive to take the position is an unmatched commitment of time and passion. I have to say in my tenure as Chair, I have never seen such a unique and inspiring fundraiser as the one Face 2 Face achieved as they prepared this very issue. Over twenty pieces of art by OMF surgeons that were featured in these pages were donated to a virtual auction with all proceeds going to the IAOMS Foundation. Viewing these pieces for the first time was a moving experience. The artists truly gave a piece of themselves that can remind us all why we chose this field. Watching the bids roll in was positively heartwarming and we cannot thank the donors and bidders enough for this outstanding effort. As they have year after year, our Emerald Level Sponsor KLS Martin continues to be a driving force for our Foundation’s missions. They proudly sponsored the IAOMS/Asian AOMS NextGen Online Conference this past fall, and never broke stride as they commit to supporting the upcoming IAOMS/ALACIBU NextGen Online Conference on May 9-13. Attendance is free for all and 2.5 education credits will be available for each session. As you may have heard, IAOMS has officially announced the details for ICOMS 2023 in Vancouver next year. Both as a chairman and as a member, I am deeply looking forward to it. We’re working ahead on opportunities for members to enjoy each other’s company at last while fundraising, stay tuned! We closed out our 25th Anniversary year with a “Virtual Toast” on December 16. Joining were colleagues from around the world – celebrating this Silver Anniversary. It was a grand event and a good time was had by all, even those of us who participated late at night and early in the morning. We look forward to celebrating the next 25 years of success for the IAOMS Foundation. We will be publishing the 2021 IAOMS Annual Report later in the spring which will detail our accomplishments and the devoted donors who made them possible. My ongoing gratitude to each donor, our Board of Trustees, staff, and for the IAOMS itself for giving back to our specialty.
Larry W. Nissen IAOMS Foundation Chairman
March 2022
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Building your career and our profession
Join IAOMS Today • Read Face to Face, written for and by Learn with IJOMS, one of the world’s leading members.
•
•
OMF journals with the highest impact factor of OMFwith publications; readofFace Face, written • all Learn IJOMS, one the to world’s leading for and by members OMF journals with the highest impact factor of •
all OMF publications. Enhance patient care through webinars, online
and other courses* online • conferences Enhance patient caree-learning through webinars, conferences andInternational other e-learning • Prepare for the Boardcourses*. for the Specialization of Board Oral and • Certification Prepare forof the International for the Maxillofacial Surgery (IBCSOMS) with the IAOMS Certification of Specialization of Oral and Review Course Maxillofacial Surgery (IBCSOMS) with the IAOMS Review Course. • Support the next generation through the IAOMS Foundation Fellowship and Scholarship • opportunities Support the next generation through the
IAOMS Foundation Fellowship and Scholarship opportunities.
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• Experience events for all OMF surgeons, Experience events for all OMF surgeons, ranging from trainee to experienced surgeons: ranging from trainee to experienced surgeons: ICOMS,the the IAOMS’ biennial signature ICOMS, IAOMS’ biennial signature educational and networking conference educational and networking conference and and “The Next Level Forum;” International “The Next Level Forum;” International Symposia, Symposia, regional conferences*. and regional and conferences* access innovative •Expand Expandyour yourknowledge; knowledge; access innovative best-in-class training best-in-class training.
Connect with peers throughout the world
• Connect with peers throughout the world.
Grow among the next generation of oral and
maxillofacial surgeons through our NextGen
• Grow among the next generation of oral and programmatic initiatives; network with your maxillofacial surgeons through our NextGen colleagues through our online community programmatic initiatives; network with your colleagues through our online community.
Visit iaoms.org to become a member or renew your membership. Questions? Contact Membership Manager Katie Cairns at kcairns@iaoms.org
Visit iaoms.org to become a member or renew your membership. Questions? Contact Membership Manager Katie Cairns at kcairns@iaoms.org
200 E. Randolph St., Suite 5100
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*IAOMS members may benefit from reduced fees.
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March 2022
How I do it
TATTOO REMOVAL JON D. PERENACK MD, DDS Adjunct Associate Clinical Professor and Fellow Director of Facial Cosmetic Surgery, Department of Oral and Maxillofacial Surgery Louisiana State University-New Orleans,
EXAMPLES OF VISUAL ARTISTIC EXPRESSION were present present in the excavations of the earliest sites of human culture. While etchings in stone have tremendous longevity, less stable human remains from as early as 5000BC have revealed tattooed skin, which is an artistic expression. Tattooing of the skin continues to have popularity and significance across all cultures today. As it might be expected, there are times when individuals might wish to remove a tattoo, possibly due to a change in meaning to the individual, an association with an unpleasant memory or a relationship, in order to make “space” for another tattoo, or just a casual whim.
1 Patient preop: Fitzpatrick two, professionally performed tattoo displaying primarily black/blue coloring, but also sub-levels of red and green pigment.
Contemporary tattoo removal typically involves the use of quality-switched (QS) lasers capable of delivering pulses of chromophore directed energy in the nanosecond range. These are QS Nd-YAG, QS Ruby, and QS Alexandrite lasers. These short pulse durations allows the pigment of the tattoo to be heated causing fragmentation, while being less than the pigment’s thermal relaxation time, thus minimizing heat transmission to the surrounding tissues. Fragmentation of pigment then allows the pigment particles to be removed by the patient’s activated inflammatory response. The control of heat dispersal aids in avoidance of blistering, hyper and hypopigmentation, scarring, and thickening of skin. The most recent QS Nd-YAG lasers that came to market, are capable of delivering energy in the
March 2022
2 Tattoo after 3 treatments with pico QS Nd-YAG laser on 1064nm setting. Plan for treatment with pico QS Nd-YAG with KTP on 532nm setting.
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3
Treatment of tattoo with pico QS Nd-YAG with KTP on 532nm setting. Note frosting formation, representing gas and vacuole formation within the epidermis from heating.
One day post-op after pico QS NdYAG with KTP on 532nm setting. Mild erythema is present haloing tattoo, with no crusting or blisters.
4
“Generally, tattoos can be considered one of five types: professional, amateur, cosmetic, medical, and traumatic.”
Patient with completed new tattoo in area.
picosecond range. Picosecond delivery appears to create considerably less heat than nanosecond Nd-YAG lasers at similar fluence energies, possibly by causing fragmentation through photo-acoustic vibrations. This decrease in heat generation provides a safer therapy and easier recovery. Additionally, the larger spot size of the pico laser handpiece allows a deeper penetrance of energy, minimizing damage to the epidermis. While QS Ruby, Alexandrite, and Nd-YAG lasers are all capable of clearing multiple pigments, the wavelength/ chromophore characteristics of each laser may make one better than another in clearing different pigments. The QS Ruby laser 694nm red light is ideal for dark black and blue pigments. The QS Nd-YAG 1064nm beam clears blue and black pigments, and through a KTP crystal, emits a 532nm light that more effectively clears red, yellow, and orange pigments. The QS Alexandrite laser emits a 755nm beam that clears black and blue pigments and is particularly effective for green pigments. Not uncommonly, multiple lasers may be required for clearance of different pigment aspects of one singular tattoo. Surgical removal of the entire tattoo, or multiple excisions of residual uncleared pigments after laser therapy is always a possible option depending on tattoo size and location. Occasionally, an ablative CO2 laser (10,200nm) may be used to potentiate a QS laser or to remove
5 Note residual pigment from previous tattoo present at detail near skull’s mouth.
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6 Before and after 8 sessions with pico QS Nd-YAG 1064/532nm
a tattoo by surface skin removal. The high cost of technology to perform tattoo removal is perhaps the greatest impediment to provide the service by new practitioners. Generally, tattoos can be considered one of five types: professional, amateur, cosmetic, medical, and traumatic. The pigments found in amateur and traumatic tattoos are usually easily cleared owing to their simple nature. Professional, cosmetic and medical tattoos may contain complex layering and pigment techniques that may result in incomplete clearance. Yellow, red, and orange colors are particularly difficult. Titanium dioxide used to create a white base pigment is rarely cleared and may paradoxically darken with treatment. Surgical excision is occasionally the only option for this pigment. Adding to the difficulty in assessing a tattoo, professional tattoo artists may layer a darker pigment on top of white or red colors for various visual effects. Only after clearing the dark pigment, the lighter pigment is revealed, often with the undesired side effects of paradoxical darkening.
“Evaluation of the patient desiring tattoo removal relies not only on the nature (color) of the tattoo, but also on the Fitzpatrick skin type of the patient.”
7 Before and after 8 sessions with QS Alexandrite 755nm
Evaluation of the patient desiring tattoo removal relies not only on the nature (color) of the tattoo, but also on the Fitzpatrick skin type of the patient. As QS lasers target a chromophore ink pigment, the higher melanin concentrations in darker skin types may also inadvertently absorb laser energy. Excessive energy absorption can lead to hyper or hypopigmentation and increases the risk of blistering and scarring. To avoid these complications, darker skin types can be treated but require more treatment sessions at a lower fluence energy setting. The Nd-YAG lasers is preferred for darker skin types as it penetrates deeper with less energy deposited in the epidermis. The Pico QS NdYAG offers even greater safety due to its short pulse duration and larger spot size, both of which reduce superficial heating of tissue. Patients of all skin types may be instructed to cover the area to prevent tanning for several weeks before treatment. There may also be a benefit to treat the area with topical 0.05% tretinoin/1% hydrocortisone/ 4% hydroquinone twice daily, for 4 – 6 weeks prior to laser therapy.
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8 Before and after 10 sessions with pico QS Nd-YAG 1064/532nm
“The patient should be informed that typically 6 to 10 sessions will be required break of not less than 4 to 6 weeks between sessions. Incomplete clearance is always a possibility, and the patient should be prepared for this as well.”
The tattoo should be examined for any signs of skin reaction to the ink. An eczemous or pruritic nodular development overlying a tattoo suggests a possible allergic reaction to the pigment used. Red and yellow pigments are the most allergenic. Laser treatment in these instances may be contraindicated as it could precipitate a systemic allergic response. The patient should be informed that typically 6 to 10 sessions will be required with a break of not less than 4 to 6 weeks between sessions. Incomplete clearance is always a possibility, and the patient should be prepared for this as well. The tattoo site is sterilely prepped and often anesthetized with local anesthetic or a tumescent solution, depending upon its size. (Tumescent solution: 500cc NS, 25cc 1% lidocaine, 1cc 1:1000 epinephrine) Use of a cooling instrument may also be used. The patient and technician wear protective eyewear. The appropriate laser, wavelength and an initial fluence energy is chosen. For most patients, we recommend starting with a Pico QS-Nd-YAG laser at 1064nm, if available. A test spot is checked for an appropriate reaction. The area treated should turn white and have a “frosted” look. This represents
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vapor and gas bubbles from the fast heating of the tissue. This should resolve within 20 minutes. After the tattoo is treated it is not uncommon to see petechia or mild ecchymosis of the area. Crusting of the area may be present for 7 to 10 days. During this time the patient is instructed on proper cleaning and dressing of the wound. Pico lasers often create little to no crusting and require no dressing. Tattoos that are quite large are best treated in segments to minimize risk of infection. For multi-colored tattoos we treat darker colors at the first 2 -4 sessions, with a Pico QS Nd-Yag set at 1064nm. Follow-up sessions to treat reds, yellows and orange pigments with the same laser using a KTP filter at 532nm. If green pigment remains, a QS Alexandrite laser is helpful for clearance. While complications are rare, the most common are: lack of pigment clearance, transient or permanent hyperpigmentation or hypopigmentation, and skin thickening and scarring. Superficial fungal or bacterial infection can occur secondary to inadvertent damage caused by excessive fluences and should be treated with topical and systemic antimicrobials. Thickening tissue or signs of a stimulated allergic response may be treated with local injection of steroids. ■
March 2022
In memoriam
Tribute to DR LASKIN By Nabil Samman Hong Kong
DANIEL LASKIN was a remarkable man for his many achievements and varied contributions to academia and oral and maxillofacial surgery. He was active in the profession until his passing on December 8, 2021. Dr Laskin was a tour de force of the profession and is remembered for his many different contributions only some of which I am able to recall in this setting. Each one of us has their own image of Dr Laskin’s work and its impact as they see it. Mine, limited as it is, hopefully serves to encompass an overview suitable for the younger generation that will have not had the opportunity and experience of meeting him or appreciating his work in real time. To me, Dr Laskin’s work as editor was most remarkable. He was chief editor of JOMS for 30 years, a journal that was and continues to be a leader in the field and a trend setter in the clinical direction of our specialty. He wrote an editorial for every issue without fail, and the topics he chose covered the gamut of issues, academic, social and political, facing the profession at the time. Since stepping down, he continued editorial work as a reviewer. I can definitely say that his reviews until the very last one were as incisive and focused as a review can ever be. He reviewed for IJOMS until his passing and in 2021 alone, he had reviewed 218 manuscripts for IJOMS. His legacy in editing is unparalleled. Dr Laskin the academic was long standing professor and department chair at Virginia Commonwealth University. As an educator, he had massive global impact through his published articles and textbooks. As an authority on the temporomandibular joint in the widest sense, he was a definitive and compelling opinion in the subject with a perspective that enabled colleagues and authors to clearly see the place a particular work occupies or should be aimed at. When he lectured on the TMJ, this otherwise complex subject melted into simplicity.
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One other side of Dr Laskin’s is his leadership role for the American (1976-77) and International (1983‑86) associations as president. Throughout his life, he continued to work for the benefit of both associations and was the recipient of multiple awards too numerous to list. The IAOMS Foundation has honored him with the establishment of the Laskin Society, a well-deserved legacy that sums up the IAOMS Foundation’s educational portfolio under Dr Laskin’s symbolic representation. It is with confidence and humility that I conclude this word with a statement that I make on behalf of all colleagues in fondly remembering Dan Laskin the academic, the editor, the surgeon and the man. ■
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A teacher and a reference for numerous generations of oral surgeons around the world. September 3, 1924 / December 8, 2021
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