IPRAS JOURNAL 4th ISSUE by MARIA PETSA

4th Issue April 2011

The e-magazine for 37.000 Plastic Surgeons

IPRAS Humanitarian mission Kenya, Nairobi (October 13th- 16th, 2010) ISSN: 1792-457X

AIMS AND SCOPE

• To promote the art and science of plastic surgery • To further plastic surgery education and research • To protect the safety of the patient and the profession of Plastic, Reconstructive and Aesthetic Surgery • To relief as far as it is possible the world from human violence or natural calamities through its humanitarian bodies • To encourage friendship among plastic surgeons and physicians of all countries

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CONTENTS • General Secretary’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 • Editor-in-Chief’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 • IPRAS Management office Report . . . . . . . . . . . . . . . . . . . . 8 • Parliamentarian’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 • Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

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The Cambodian drama

• Books Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 • Pioneers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 • Stars on the Horizon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 • Senior Ambassador . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 • Humanitarian Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

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Humanitarian Mission in Nairobi

• Biographies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 • World health organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 • Procedures and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 • IPRAS website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 • Up - coming Conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

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IPRAS 2011 Vancouver

• National & co-opted societies future events . . . . . . . 61 • National Associations & Plastic surgery organizations News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 • Industry News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 • Letters to the Editor

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• IPRAS Benefits for National Associations & individual members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

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AAPRAS 2011 Yerevan

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AR S EJTO U YRâ&#x20AC;&#x2122; N G E N E R A LI PS R EC AR SA MLE S S A G E

Dear colleagues,

ever before did we have to face so many fundamental changes in the lives of our colleagues, as within the last three months. Instability and unrest started in Tunisia, continued in many countries in the Arab world and is still going on in some of them. The news from Japan were horrifying, shocking and appalling! All we can do is offer our support with humanitarian missions, letters of sympathy or just expressions of our friendship, appreciation and affection for those whose lives will never be the same. It makes me happy to receive messages from them, knowing that they are well and, moreover, that they still plan on attending our congress in Vancouver. It will be a great relief to meet them there, to get a personal impression and, hopefully, proof that they manage to carry on. The Vancouver congress will stand for holding together in difficult times and designing the future of IPRAS together. There, we want to introduce all of you to our humanitarian projects and, hopefully, many of you will decide to get involved. We shall reach out to our young ones. Trainees and residents will meet us to discuss a global network for exchange of experience, to improve training conditions and promote training in areas where our specialty is not yet well established. We shall discuss by-laws changes, which will guarantee better continuity and broaden the base of our global activities, such as humanitarian actions, congresses, training, promotion and protection of our specialty. And we are bringing our role models back â&#x20AC;&#x201C; with the newly formed Board of Trustees. Globally well-known senior plastic surgeons, with great merits for the development of plastic surgery worldwide are honoured with this lifetime position. They will actively participate in our congresses as EXCO advisors and as senior session chairpersons. Their genius, passion and spirit will inspire us and carry us on to new frontiers. Our young members will have the chance to meet our legends, our heroes, our role models. I strongly believe that there can be no future without honouring the past and the personages who had the formative influence on our speciality. With them, the future of our beloved speciality will be brighter than ever before. Yours

Marita Eisenmann-Klein General Secretary Issue 4

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S HJ IOEUFR’ SN A E D I T O RI -PIRNA- C MLE S S A G E

EDITORIAL

t times the winds of change blow softly, brushing one’s cheek as one would kiss a small baby. Soft though they may be , these breezes can have the potential to promote great efforts….giant moves that can change the world. The gradual morphing of an abstraction into the clear concept of an indisputable principle can occur simultaneously with the sound of a single leaf brushing against its neighbor on a low limb close the the thinker’s ear. They can come as a decision in the early hours of the morning in June of 1944 in the general’s quarters where the only sound was the breeze from the window’s whispering against the papers on his desk, convincing him to proceed with plans to mount greatest movement of an army in the history of the world. At other times the winds of change can pick up a huge sea and move it as a wave with the speed of jet plane. This wave can crash into and across a great nation, destroying everything and everybody in its path, and paralyzing for a time one of the world’s most powerful existences. The destructive power of this wind of change can be felt around the world as friends, relatives, trading partners, and life loving humans everywhere felt helpless in their incapacity to relieve the immediate suffering of millions of their world family. Both these kinds of winds, gentle and great, may make us pause…to pause and wonder about who we are, why we are , where we are. Of course we’re unable to give a credible, scientific, peer reviewed answer to the question. But we still wonder. Regarding the great devastating wind wave that swept across Japan much can be written…too much for this brief essay….but I can say I’m pleased with the response of much of the world with an immediate forging of an effort to help. My own country was fortunate to have naval and other military facilities in the vicinity that were able to swing into productive efforts soon after recognition of the problem. Others followed suit quickly so the relief effort was a world wide affair. Despite the magnitude of this catastrophe (far greater than any of us can fully appreciate) we’re confident the energy, resourcefulness, and discipline of the Japanese people will prevail and they will fully recover from the physical destruction. The pain of the personal losses will ultimately be blunted, but never forgotten. On a more personal level I have just completed my work in Barcelona as co-director of a workshop involving a new form of suture to be used in facial rejuvenation as well as other forms of body contouring. The week before that I was in Monaco where I gave five presentations involving aesthetic breast surgery (and was honored by being Honorary President of the 5,300 attendee World Congress of Anti Aging).

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Now you ask “What does that have to do with “The winds of change”? The answer is that all the people attending these meetings came seeking some form of change. They came looking for new and better ways to utilize their talents in their service to their patients. Of course some came seeking new ways to increase their incomes, but most came seeking a clearer path to excellence. In the fifty-three years I’ve been involved in plastic surgery I’ve come to realize that we (plastic surgeons) are, for the most part, somewhat different from other specialists. I feel we have a slightly different perspective on our work. It seems that many of my dear friends and colleagues don’t consider work as work….but, instead, it’s “what we do”. Is this true? I think so. Why? Of course I don’t know…but perhaps it has to do with the fact that we’re not identified as an anatomical, regional, system defined specialty. Instead we’re a group of surgeons whose bond is innovation.

If this is true then we’re seeking change. I’ve said, and my friends have heard me say perhaps too often, that youth is the capacity to adapt to change. So maybe we’re seeking the Fountain of Youth and employing change as our magic potion. Or….and the cause to which I subscribe…is it we feel that excellence is our target and we’re not totally there yet, and therefore change we must to get closer to that point. So the winds of change have blown me recently into Monaco and now Barcelona…and will blow many of us to Boston, Vancouver, St. Petersburg, and many other cities in the coming months. The winds of change will blow us to become more intimate with all the web based benefits currently extant, and the winds of change will blow us into greater familiarity with software packages with which we’re not yet familiar but are on the near horizon. The winds of change are with us. We learn to survive the catastrophic, destructive, harsh outliers as we join forces to be of assistance to those directly involved, but we raise or sails to capture the soft breezes that take us closer to that never to be possessed prize…excellence. Dr Thomas Biggs Editor in Chief

2nd Issue

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3rd Issue

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II P PR RA AS S M MA AN NA AG GE EM ME EN NT T O OF FF F II C CE E R RE EP PO OR RT T

January 2011 - April 2011 Three months of dramatic ﬁnancial, social and political changes, natural disasters, but also, new challenges worldwide

Zacharias Kaplanidis

pproximately three months have passed since the last IPRAS Journal was published. Unavoidably our thoughts are focused on the large scale developments taking place in North Africa and the huge natural disaster in Japan, a country which continues to suffer from the great earthquake of March 11th 2011. The political and social “tsunami” which originally affected Tunisia, followed by Egypt and Libya and to a lesser extent Yemen and Syria, altered their socioeconomic and governmental framework dramatically. The natural tsunami in Japan deeply traumatized the 3rd largest economy in the world and temporarily paused its financial ascension. From the very first moment, IPRAS was mentally and practically by the side of the people and most specifically the Associations and the plastic surgeons of these Countries. Besides all the telephone calls and the emails of sympathy and support towards our plastic surgeon colleagues, IPRAS placed its humanitarian aid branch at the disposal of the Japanese Society, mainly through SHARE and Women for Women. Furthermore, the Board of Directors, following a suggestion by the Management Office, informed the Associations of Libya and Japan, who were extremely “wounded” by the political and the natural unrest respectively, that their financial obligations towards IPRAS (annual dues) have been waved for the year 2011. To conclude this prologue regarding the unfortunate developments in countries that are considered as dynamic Members/Associations of IPRAS, we would like to express an optimistic feeling for a rapid return to better conditions that will soften the pain and suffering of the big family of plastic surgery. We believe that in the whole commotion and catastrophe of human resources and inanimate material, new opportunities will arise, new powers will emerge and fresh ideas will lead the way to a more mature future, not only for these “injured” countries, but also for the entire 8

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world. We have always admired the Japanese people. We are certain that in a minimum period of time, they will show an inspiring recovery from the wounds of the natural catastrophe. Tenacity and discipline, two main characteristics of this great Nation, will help them make one step further towards their development and to further armor the security of such a beautiful Country which is sadly exposed to such cruel natural phenomena. The Board of Directors and all the members of IPRAS are confident that in the next edition of the IPRAS Journal in July, our optimistic predictions will have turned into reality. In the last three months, IPRAS and the Management Office continued their multiple duties with unabated pace. In January, the Executive Director, Mr. Zacharias Kaplanidis visited the National Association of Uzbekistan, where he had the opportunity to make a presentation regarding the goals of IPRAS, discussed ways of support in fields such as education, events and humanitarian actions. The Association promised Mr. Kaplanidis their full cooperation in the exceptionally important congress that will take place in Tashkent in May 2012 and will attract international participants from all over the world and especially from the countries of Central Asia. Furthermore, the President of the Uzbekistan Association, Mr. Murod Jafarov and the IPRAS Executive Director, Mr. Zacharias Kaplanidis, had the opportunity to meet the First Deputy Minister of the Uzbekistan Ministry of Health, Mr. Anvar V. Alimov, and brief him on IPRAS activities and its role on the developments in the field of plastic surgery. Moreover, the Deputy Minister received a copy of the 3rd edition of the IPRAS Journal, was updated on the conclusions of the last IQUAM Consensus Conference in Bratislava and was informed about the forthcoming congress, which he expressed his utmost support for, placing it under the auspices of the Ministry of Health of Uzbekistan. Finally, Prof. Murod Jafarov, guided Mr. Kaplanidis

is a guarantee for the best relations and the creative cooperation with our Confederation. We would like to thank her for her hospitality and her effort to bring IPRAS and the German Association even closer. Next journey was Italy in February and more precisely, Rome. With the collaboration of Prof. Nicolo Scuderi, Mr. Zacharias Kaplanidis had the opportunity to talk about IPRAS’ goals, at the La Sapienza University, to a considerable number of plastic surgeons, residents and students, to whom the 3rd edition of the IPRAS Journal was distributed. Other matters discussed with Mr. Scuderi, concerned the Italian bid for the IPRAS World Congress in 2017 and Rome’s relevant infrastructure. As you may know, Italy, Belgium, China and Turkey have submitted their bids and are nominees for the organization of the IPRAS World Congress of 2017. In a short period of time, in Vancouver, during the 16th World Congress, the council of National Delegates will be the one to decide about the final choice. We wish all candidates the best of luck. Left to right: First Deputy Minister of Health Mr. Anvar V. Alimov, Mr. Zacharias Kaplanidis and Dr. Murod Jafarov

through some public and private hospitals of Tashkent. Admittedly, it was a remarkable trip to a rather dynamic country and an exceptional Association, dominant in Central Asia. All members of the Association treated the IPRAS representative in a friendly, hospitable, and cooperative manner. We would like to thank them all and more specifically the President, Prof. Murod Jafarov, who did everything possible to make this a pleasant trip and - most importantly - a productive working time for both IPRAS and the Uzbekistan National Association. We would also like to thank the First Deputy Minister of the Uzbekistan Ministry of Health, Mr. Anvar V. Alimov and the Deputy Head, Mr. Ulugbek Khayrullaev for their especially friendly and creative meeting at their Ministry Offices. We are totally convinced that with their constant cooperation the congress of 2012 will prove beneficial for all parties concerned. In the beginning of February, during a very short journey, the Executive Director of IPRAS, Mr. Zacharias Kaplanidis, visited the offices of the German Association of Plastic, Reconstructive and Aesthetic Surgery in Berlin. In this meeting, which had a ceremonial character, various issues were discussed with the Executive Director of the National Association, Mrs. Kerstin Van Ark, such as collaboration, communication and informing the Members of the Association about the multiple benefits that IPRAS offers to the individual Plastic Surgeons. Mrs. Van Ark’s experience at the German Association

We would also like to thank Prof. Nicolo Scuderi for his warm hospitality and the opportunity to present IPRAS, mainly to residents and students of the La Sapienza University. Next on the list of long journeys were Chile and Argentina. The main reason of visiting the distant and interesting country of Chile was the organization of the 2013 IPRAS World Congress. We have to confess that this journey proved to be productive beyond any of my anticipations. Our knowledge of the country was elementary and mainly revolved around a financial and political level. On this journey, we had the opportunity to experience a country of continuous and exceptional economic growth, highly organized, with very good infrastructure and most importantly, with humane, hospitable and joyful people. Everyone we met there and cooperated with for the 2013 congress, impressed me to such a degree, that we are fully convinced about the chances of Chile hosting one of the most successful IPRAS world congresses in our history. Chile has fabulous conference venues, hotels, restaurants and museums. It is graced with beautiful modern and old buildings, well-structured streets, sites filled with green, favourable weather conditions (the climate in Santiago can be characterized as “Mediterranean”) and interesting areas outside the capital, both in the north and the south. The various suppliers offers excellent prices that we guaranteed for IPRAS participants for the 2013 congress while the hospitable people will make the visitors feel at home and amongst loved ones from the moment they arrive. We would like to congratulate the people of Chile on all their recent achievements in a

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economical and political level, highlight their unaltered South American temperament, and thank them dearly for their hospitality, their exceptional cooperation and their willingness to contribute to the success of the 2013 IPRAS World Congress. We would also like to thank the President of the Chilean Society, Prof. Patricio Leniz, and the President of the Congress, Prof. Wilfredo Calderon, who promised that they would start to cooperate immediately with all IPRAS bodies worldwide, in issues concerning, organizing and scientific committees and faculty. We are certain that

Argentine Association is one of the most dynamic members of IPRAS and a warm welcome awaited our General Secretary, Dr. Marita Eisenmann-Klein, and the Executive Director, Mr. Zacharias Kaplanidis, not only from the Argentine plastic surgeons, but also from the other South American Associations, such as Paraguay, Brazil etc. The congress attracted many participants (more than 400) and was characterized by organizing and scientific success. It took place at the beautiful Iguassu which is famous for its waterfalls and its green forests. Mr. Zacharias Kaplanidis, had the

Outside the Espacio Riesco: General Manager Sergio Gutierrez Torres, Sales Manager Dzella Campos and Commercial Executive Karla Benavente

in the following World Congress in Vancouver, the Chile 2013 booth will highlight the exhibition area. We look forward to seeing them so we can wish them every success.

opportunity to present the latest news of IPRAS to the participants and to speak about the benefits that IRPAS provides its Association Members and all individual plastic surgeons.

Finally, we would especially like to thank the staff of the officials of the Santiago Convention Center â&#x20AC;&#x153;ESPACIO RIESCOâ&#x20AC;? (General Manager, Mr. Sergio Gutierrez Torres, Sales Manager, Mrs. Dzella Campos and Commercial Executive Mrs. Karla Benavente) who treated us with an exceptionally professional manner and with a hospitable and warm attitude helping us understand the country of Chile and its people even better.

Furthermore, the hospitality from the President of the Association, Dr. Martha Mogliani and everybody else was more than warm. The President and the rest of the Argentine Board of Directors expressed their full support for the Congress that will take place in Chile in 2013. Moreover, our General Secretary, Dr. Marita Eisenmann-Klein, and the Executive Director, Mr. Zacharias Kaplanidis, visited all the exhibition booths, distributed IPRAS Journals and discussed issues of cooperation between the Confederation and the Industry. All exhibitors expressed their satisfaction for the work of IPRAS and for the potential of presenting the industry news free of charge in the IPRAS Journal.

The destination of the following journey of the IPRAS Management Office was Iguassu, Argentina, for the National Congress of the Argentine Association of Plastic, Reconstructive and Aesthetic Surgery. The 10

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The president of the Argentinian Association, Mrs. Martha Mogliani, IPRAS General Secretary, Mrs. Marita Eisenmann-Klein and IPRAS Executive Director, Mr. Zacharias Kaplanidis among members of the Organizing Committee.

Dr. Marita Eisenmann-Klein thanked them for their support of the Plastic Surgery Congresses worldwide. Additionally, our General Secretary, Mrs. Marita Eisenmann-Klein, presented the goals and role of IPRAS, during the opening and closing ceremony of the congress. Also, IPRAS Journals were distributed during the General Assembly of the members of the Argentine Association. The activities of the IPRAS Management office that took place “outdoors” during these three months were concluded by the short trip to Bulgaria, for the Second National Conference on Plastic, Reconstructive and Aesthetic Surgery of the Local Association. What impressed us there was the organization of the congress, the interest that the Bulgarian Plastic Surgeons showed towards IPRAS and the remarkable hospitality which we were treated with, especially by Dr. Dimitre Evstatiev. Mr. Zacharias Kaplanidis, demonstrated the IPRAS Benefits and scope, during the opening ceremony, while IPRAS Journals were distributed to all participants. Moreover, the General Secretary, Dr. Marita EisenmannKlein, the Parliamentarian, Dr. Andreas Yiacoumettis and the Executive Director, Mr. Zacharias Kaplanidis, visited all exhibitor booths (approximately 18) and spoke to all industry representatives on various issues. Moreover, we would like to congratulate the President

of the Society, Dr. Dimitre Evstatiev for everything he has accomplished with the Bulgarian Association and also the great work he did with the congress, which met success in both a scientific and organizing level. Additionally, apart from the activities that took place “outdoors”duringtheselastthreemonths,theManagement Office continued their hard work with equally important actions, such as the preparation of this 4th IPRAS Journal, the constant communication with all 99 associations of IPRAS for various issues, the constant collaboration for Humanitarian issues with Dr. Christian Echinard and Dr. Constance Neuhann-Lorenz, the preparations of the 3rd Congress of the Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (28-30 June 2011) and the 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery (27-29 October 2011), the intensive preparation for all the meetings of the IPRAS Bodies and sub-committees in the World Congress in Vancouver (22-27 May 2011), the constitution of the Media Office that will begin operation during April 2011, the promotion of the IPRAS Certificate to the individual members of the Confederation worldwide, the participation in the processes or the “to-be-established” ISPRES (International Society of Plastic Regenerative Surgery) that will be placed under the “umbrella” of IPRAS. Issue 4

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A general photo from the congress in Bulgaria outside Sofia

For all this important (in volume and substance) hard work, we would like to express our gratitude to the Assistant Executive Director, Mrs. Maria Petsa, the IPRAS congress director, Mr. Gerasimos Kouloumpis, the Association’s Management Director, Mr. Dimitris Synodinos and the Financial Director, Mr. George Panagiotou.

National Associations that face the challenges of IPRAS daily, and the whole IPRAS Board of Directors, whose harmonious collaboration and rapid contribution is vital to the work of IPRAS.

Also, we would like to thank all the Presidents and the members of the Board of Directors from all the

Good luck to all of us in Vancouver in May 2011 and farewell.

Finally, we would like to send a big “thank you” to our Chief Editor, Dr. Tom Biggs for his constant efforts and contribution in the success of the IPRAS Journal.

Zacharias Kaplanidis IPRAS Executive Director IPRAS Management Office Zita Congress Tel: +30 2111001770 – Fax: +30 2106642116 email: zacharias.kaplanidis@iprasmanagement.com URL: www.ipras.org

Don’t forget to visit the new IPRAS website

w w w . i p r a s . o r g 12

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PARLIAMENTARIAN’S MESSAGE

The Wind of Change is blowing through the World of Plastic Surgery

Prof Andreas Yiacoumettis

uring the ESPRAS Congress in Rhodes in September 2009, a very important meeting took place, which was not widely publicized, simply because

minimal to say the least. IPRAS finances were at an unacceptable level, a fact which hindered normal basic functioning, initiative and planning. Many Plastic

ESPRAS Rhodes, September 2009

it concerned the Members of the Board and the Executive Committee of IPRAS who were present. This meeting was the starting point to set off a series of actions, which in the last two years upgraded IPRAS in the eyes of all of us and the world at large. The meeting was named “On the Future of IPRAS”. Through the various issues discussed, the main issue of the meeting was that IPRAS should not remain an impersonal and sluggish Global Organization, but it should augment and promote its activities for the benefit of our precious specialty. It became obvious in this meeting that organizing one Congress every four years and even every two years somewhere in the world, was simply not enough. Very little happened in the periods between IPRAS World Conferences. Communication with the mother organization was

Surgeons around the world were not aware of their IPRAS individual membership through their National Societies and they did not feel the pride of being members of this huge international family. Although IPRAS is and shall remain a Federation, individual members around the world communicate with this mother organization rarely or never, to say the least. Thus, the benefits of membership remained at a low level. It was also felt and noted that it was up to IPRAS to make the effort to strengthen this relationship not only through the ever changing Executive Councils of National Societies, but to discover and use methods of creating additional direct links with individual Plastic Surgeons as well. To this effect the Board of Directors and the ExCo have approved the “IPRAS Certificate of Membership” available to individual Plastic Surgeons. Issue 4

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IPRAS is committed to be the “Defender of the Faith” for our Specialty. It is committed to employ means of promoting the image of Plastic Reconstructive and Aesthetic Surgery, training and humanitarian work. It is also committed to give guidance on important

of Tom Biggs this Journal includes interviews with renowned colleagues and rising stars of our specialty, news from the National and International Societies, reports, announcements and other interesting, to all, material. In an effort to strengthen our profession with industry related to Plastic Surgery, the initiative of including news from the various companies and firms in the Journal is proving popular and ever gaining momentum. Companies from all over the world can project their products through scientific reports (not advertizing) published in the Journal free of charge. Appointed Subcommittees in the IPRAS Structure are to be re-activated to fulfill their assigned tasks in the best possible way. Chairs and Members of Sub-committees are chosen and appointed according to their expertise on the relevant topic. Results are expected to provide useful information and define the course of action for a number of issues concerning our specialty.

Dr. Constance Neuhann Lorenz, WFW Mission in Bangladesh (29th November- 4th December 2010)

issues that crop up from time to time upsetting everyday practice, creating uncertainty and concern to all of us and to the public. IPRAS is also devoted to safeguard and promote quality of practice and patient safety. Above all, IPRAS should coordinate all issues concerning our specialty as the supreme and effective umbrella organization.

IQUAM (the International organization on Quality Assurance in Medical devices) is a pride to our structure. With its own President Prof Constance Neuhann-Lorenz, Vice President Prof Manuel Garcia Velasco and its Secretary Prof Daniel Marchac, bylaws and national

Pursuing all the above noble tasks in this modern age, demanded the upgrading of the Executive Management, the organizing of more international scientific events, especially in developing countries and the restructure of the hierarchy. To this effect, a substantial revision of the bylaws has been introduced. Among the changes, the most important are: the founding of the office of the President, the setting of the Scientific Board and the Board of Trustees. On the top hierarchy of IPRAS, besides the President and the General Secretary, the number of Deputy General Secretaries are increased to four and together with the Parliamentarian and the Treasurer the new Board of Directors will now have two more officers. With this change, the coordination of the sub-committees will be more effective and the representation of IPRAS around the world will be greater than before. As already stated the communication of IPRAS with the individual members is a very important topic. To this effect the JOURNAL of IPRAS which is published every three months has been sent electronically to over 37000 plastic surgeons around the world. Under the editorial leadership 14

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Prof. Andreas Yiacoumettis, 9th IQUAM congress in Slovakia, Bratislava, September 2010 (The International Committee of Quality Assurance and Medical Devices in Plastic Surgery)

delegates, IQUAM has renewed its valuable contribution with the “2010 Consensus Declaration”, which through our Executive Management has been sent to Health Ministries and Health Organizations as well as to all Plastic Surgery National Societies of all countries of the world. This last Consensus was put together by the IQUAM General Assembly during the 9th Consensus Conference (Bratislava - September 23rd to 26th 2010). This meeting was the biggest ever in the history of IQUAM attracting more than 150 participants from all over the world.

Our greatest pride however, is the IPRAS Humanitarian Activities. The ESPRAS SHARE President Prof Christian Echinard, who is heavily involved in this admirable role, has

Dr. Christian Echinard Pan African congress, Kenya, Nairobi, October 2010

joined forces with the â&#x20AC;&#x153;IPRAS Women for Womenâ&#x20AC;&#x2122; team and the Disaster Relief Subcommittee, in a new momentous effort to promote substantially IPRAS involvement. So far his performance, guidance and achievements have added prestige to IPRAS and to our Specialty.

has upgraded and tightened relations, solved local as well as international problems and has led to an ever increasing number of National Societies becoming more active in the IPRAS affairs. Last, but not least, congratulations are in order for our Executive Management team, headed by Director Zacharias Kaplanides and supported by Maria Petsa (Assistant Executive Director IPRAS Management Office) and all the staff of Zita Congress Company. In both its contractual obligations in Executive Management and as IPRAS Sponsored Event Official Organizer, Zita is performing their job in an impeccable way. Successes so far include the updating of the IPRAS Data from 99 countries, the publication and distribution of the JOURNAL OF IPRAS, the organization of IPRAS Sponsored events e.g. IQUAM Bratislava, 1st Pan-African - Nairobi Kenya, Pan-Arab Doha Qatar and others. Also maintaining our restructured and constantly updated website http://www.ipras.org; which provides information and news to all Plastic Surgeons of the world and to the public at large.

Pan Arab Congress in Qatar, Doha, December 2010 (Among others Prof Marita Eisenmann-Klein, Dr. Ahmed Noreldin, Dr. Thomas Biggs, Dr. Sydney Coleman, Prof. Andreas Yiacoumettis)

Finally I must pay tribute to our General Secretary Prof Marita Eisenmann-Klein who tirelessly serves the highest office in the hierarchy of IPRAS. Her leadership and extensive and exhaustive travelling to represent the organization in an impressive number of countries around the Globe, have been unparalleled. Her presence

We are all committed to IPRAS. Furthermore we are all invited to assist in the effort to make our Specialty Stronger and ever Greater. Prof Andreas Yiacoumettis IPRAS BOD - Parliamentarian Issue 4

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SURVEYS

Extracorporal Shock Wave Therapy: New Approach in Diabetic and Venous Ulcers and Burn Wounds Johannes Jeschke MD

Short running title Shock Wave Therapy in Chronic and Burn Wounds

Key words Shock wave, chronic wound, ulcer, burn, diabetic ulcer, healing

Abstract Experimental data after application of extracorporal shock wave (ESW) showed promoted healing due to the expression of growth factors and neoangiogenesis. Between 2004 and 2007, 30 patients with either diabetic or vascular ulcers or deep partial thickness burn wounds were treated with ESW. The goal of our experimental, prospective and controlled study has been the improvement of wound healing in chronic wounds and deep partial thickness burns, also in cases where skin grafting following surgical debridement was necessary. Within 35.7 days 72.7 % of the 11 diabetic wounds healed completely after ESW therapy. No recurrence was seen during 18 months of follow-up. In 20 vascular ulcers treated with ESW and skin grafting we observed a skin graft taking rate of 100 % in 11.9 days in 85 % of the cases. Recurrence was seen in two ulcers in a follow up of five months. So far conservative treatment of deep partial thickness burns has been characterised by the fact that wounds take over 21 days to heal and scarring may be severe. Deep partial thickness burns treated with ESW showed complete re- epithelialisation in 13 days. Based on our preliminary results we think that ESW might support modern wound management in chronic wounds and reduce the likelihood of surgical treatment in deep partial thickness burns.

Introduction Shock waves are defined as sonic pulses. They consist of transient pressure fluctuations with three-dimensional

spreading [1]. Despite a 30-year history in lithotripsy [2], ESW has only recently found orthopedic and traumatologic applications. Recent animal studies have proved that ESW treatment stimulates the early expression of several growth factors endogenously [3,4,5]. In animal experiments conducted in our department the authors found an impressive reduction of skin necrosis in epigastric skin flaps in rats treated with ESW compared to a control group [6]. Furthermore we saw reduced ischemic necrosis in skin flaps in rats after ESW compared to a control group treated with gene therapy with vascular endothelial growth factor [7] and transforming growth factor-Ă&#x; [8]. In a subsequent study we found significantly faster wound re- epithelialisation in the ESW group compared to a control group in an animal burn model (unpublished data) These experimental experiences encouraged us to use ESW therapy in clinical practice for the first time. Starting with deep partial thickness burns [9] we expanded the indications for ESW and treated patients with chronic wounds due to diabetes, peripheral arterial disease (PAD) or chronic venous insufficiency (CVI). The goal of our prospective and controlled study has been to improve wound healing with ESW, also in cases were skin grafting following surgical debridement was necessary.

Patients and Methods The 30 patients treated with ESW (from 2004 to 2007) were divided into three groups (group I: diabetic ulcers, group II: vascular ulcers, group III: deep partial thickness burn wounds). Our controlled trials were approved by the ethics committee of the Innsbruck Medical University. The patients with chronic wounds were presented to our department after they had been seen and treated at the outpatient clinics of the Departments of Dermatology, Internal Medicine and Vascular Surgery. According to the vascular surgeons, PAD or CVI in all patients had Issue 4

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reached a stage where vascular surgery or additional vascular surgery, respectively systemic medication, was highly unlikely to confer any benefits in the long run. ESW therapy was performed after local disinfection. Wounds were covered with a sterile ultrasound transmission gel, which was used as contact medium. 500 impulses at 0.11 mJ/mm2 each were applied by moving the probe head over the wound area (dermaPACE, SANUWAVE Inc., Lengwil, Switzerland). Changes of dressing and the condition of the wound were regularly documented by digital photography.

Group I The diabetic ulcers {6 female; 5 male, average 78 years (62-93), 4 following trauma, 10 PAD average fountain’s stage 2.8, 2 CVI} located on the lower leg (n=7) and on the foot (n=4) had existed for 289 days on average (71500). All patients had undergone unsuccessful “modern wound management” for 203 days on average (7-1100) before ESW, including different kinds of wound bed preparation (sharp debridement, enzymes, hydrogels and hydrocolloids) and alternative dressings, which were continued after ESW. Average wound size was 1.7 cm2 (0.3-3.9), measured using Visitrack (Smith & Nephew). In four patients various vascular surgical procedures had already been performed. Osteomyelitis was excluded clinically and radiologically in standard projection. Patient consent was obtained prior to the initiation of the therapy. Following standard procedure we treated the diabetic wounds four times with ESW (day 1, 4, 8, and 11). Treatment was painless because of peripheral polyneuropathy. Alleviation of the mechanical load on ulcers was achieved by half shoes in patients with lesions on the foot. (Tab.1)

Group II The 20 vascular ulcers in 14 patients {11 female, 3 male, average 68 years (37-90)}, all located on the lower leg had existed for 234 days on average (20-1825, “modern wound management” for 171 days on average, 5 posttraumatically, 5 patients with PAD average fountain’s stage 2.4 and 9 patients with CVI), average wound size was 52.9 cm2 (9-300). All patients had received conservative vascular treatment and in 7 out of 14 various vascular surgical procedures had been performed. Since ESW can be severely painful, these patients were treated under general anaesthesia and, for ethical reasons, we combined surgical debridement (excision of the wound bed and lipodermatosclerotic skin) with standardized intra-operative single ESW therapy and skin grafting. Dressings consisted of fat mesh gauze, wet cotton and, in the case of a venous ulcer, a bandage with compression was applied. Initially patients were mobilized by offloading the extremity operated on. The 18

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condition of wound surfaces was documented twice a week by digital photography. (Tab.2)

Group III The deep partial thickness burns {2 female; 3 male, average 53 years (34-81), wound size averaged 216 cm2, (20-500)} located on the lower arm (n=1) and the dorsum of the hand (n=4) were cleaned with skin disinfectant. General anaesthesia was used depending on the size of the wound and pain (60 % of the patients were treated without general anesthesia). Then single ESW therapy was applied. Fat mesh gauze and dexpanthenol were used as wound dressing. The dressing was changed once a day and the condition of the wound was regularly documented by digital photography. (Tab.3)

Results We did not encounter any complications during or after ESW therapy.

Group I Within 35.7 days on average (13-59) eight wounds (72.7 %) healed completely and the other three showed a reduction rate of 64.6 % during the observation period of eight weeks (Fig.1). No recurrence was seen during an average follow-up of 18 months (3-28). Recent data of this group enquired by phone (2007-2011) showed only one recurrence and one amputation of the lower leg (due to a closure of a femoral arterial bypass).

Group II In 85 % of the ulcers in group II (PAD 66 %, CVI 93.4 %) we found a 100 % taking rate of the skin grafts after 11.9 days (4-40) on average (Fig.2). In 15 % (n=3) we found a taking rate of 63 %. Patients were mobilized by offloading the extremity operated on for an average time period of 10 days (4-19). Recurrence was seen in 10 % (n=2) of the patients (due to local infection and due to another trauma) after an average of five months (2-6). Recent data of this group enquired by phone showed no recurrence from 2007-2011.

Group III In group III we observed complete re-epithelialisation of all deep partial thickness burn wounds after 13 days on average (7-20). Our follow up of 280 days (19-1197) on average was uneventful without severe scarring (Fig.3).

Discussion In recent animal studies Wang proved that after ESW therapy growth factors like endothelial nitric oxide synthase, proliferating cell nuclear antigen and vascular endothelial growth factor inducing growth of new

vessels, showed a significant rise [3]. He furthermore demonstrated that ESW treatment is effective in promoting the healing of fractures and injuries by stimulated expression of the growth factors mentioned above [4], as well as tumour growth factor-Ă&#x; [5]. Encouraged by promising experimental findings conducted in our lab [6,7,8] we examined shock wave treatment in diabetic and vascular ulcers and deep partial thickness burns. The ulcer located on the foot is the most common chronic wound in patients with diabetes. Diabetic ulcers, mostly combined with PAD, fail to heal because of tissue ischemia, infection, persisting trauma or poor management, and have the tendency to transform into chronic wounds. Studies have showed that, despite good diabetic ulcer management, healing rates in large multicenter trials were only 24% after 12 weeks and 31% after 20 weeks [10]. In our patients with diabetic ulcers, healing improved noticeable after ESW. We saw total wound closure in 72.7 % of our treated patients within an average of 35.7 days. No recurrence was seen during a follow up of 18 months on average. Current literature states that the traditional treatment of venous ulcers remains non-operative and includes extremity elevation, graded compression, wound care, and patient education [11]. Clinical experience has showed that with non-operative therapy most ulcers will heal over time but high rates of recurrences have been reported. Surgical options include venous stripping, superficial vein ligation and ligation of the deep perforator vein. Valvular reconstruction and venous valve transplantation from the upper to the lower extremities are performed infrequently. Literature reports that in the presence of vascular disease, split skin grafting itself is not an effective treatment for chronic leg ulceration because of healing rates of only 20% in venous ulcers and 33% in arterial ulcers [12]. Uncontrolled surgical trials and expert opinion support the role of skin grafting in very large venous ulcers or in ulcers present for more than 12 months [13], Kjaer saw a cumulative one year healing rate of 65 % after ulcer excision, split skin grafting and correction of superficial venous insufficiency in the wound area, 12 % had a recurrence of ulceration one year postoperatively. He saw no statistically significant differences in healing and recurrence between patients with isolated superficial and mixed superficial/deep venous insufficiency [14]. Turczynski reported healing rates of 15 days after split skin grafting in venous leg ulcers and of 13 days in arterial ulcers. In a follow-up of 120 days on average he observed a recurrence of venous ulcers in 43 % of the cases [15]. Our preliminary results show a fast healing rate after ESW and skin grafting within 11.5 days on average,

permitting faster mobilisation. Recurrence in only 10 % within the follow-up of five months was observed. Deep partial thickness burns extend into the deeper dermis, damaging hair follicles and glandular tissue. Depending on the extension and location, excision and skin grafting is common. So far conservative treatment has been characterised by the fact that it takes wounds over 21 days to heal and scarring may be severe [16]. Therefore early excision, beginning within less than 72 hours, is beneficial, especially in children and young adults less than 30 years old [17]. We saw early re-epithelialisation after 13 days and no severe scarring in the follow-up. In all patients surgical debridement could be avoided. After ESW therapy in deep partial thickness burns in selected regions, excision of the burned area and skin grafting might be avoided and a better aesthetic outcome could be achieved. ESW has already been used successfully in the treatment of urologic and orthopedic disorders; it might prove its value in chronic soft tissue wounds in patients with diabetes, PAD or CVI, and in partial thickness burns. Although further studies are needed to confirm our promising findings, this approach might be a feasible and cost effective treatment to support established wound management in many patients.

Acknowledgments There are no financial relationships that may pose a conflict of interest.

References 1. Gerdesmeyer L, Maier M, Haake M, Schmitz C: Physical-technical principles of extracorporeal shockwave therapy (ESWT). Orthopade 2002;31(7):610-7. 2. Bihl G, Meyers A: Recurrent renal stone disease: advances in pathogenesis and clinical management. Lancet 2001;358:651-6. 3. Wang CJ: An overview of shock wave therapy in musculoskeletal disorders. Chang Gung Med J 2003;26:220-32. 4. Wang CJ, Wang FS, Yang KD et al: Shock wave therapy induces neovascularization at the tendonbone junction. A study in rabbits. J Orthop Res 2003;21:984-9. 5. Wang FS, Yang KD, Chen RF, Wang CJ, Sheen-Chen SM: Extracorporal shock-wave promotes growth and differentiation of bone marrow stromal cells towards osteoprogenitors associated with induction of TGFbeta1. J Bone Joint Surg Br 2002;84:457-61. 6. Meirer R, Kamelger FS, Huemer GM, Wanner S, Piza-Katzer H: Extracorporal shock wave may enhance skin flap survival in an animal model. Br J Plast Surg 2005;58(1):53-7. Issue 4

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7. Meirer R, Huemer GM, Oehlbauer M, Wanner S, Piza-Katzer H, Kamelger FS: Comparison of the effectiveness of gene therapy with vascular endothelial growth factor or shock wave therapy to reduce ischemic necrosis in an epigastric skin flap model in rats. J Plast Reconstr Aesthet Surg 2007;60(3):266-71. 8. Huemer GM, Meirer R, Gurunluoglu R, Kamelger FS, Dunst KM, Wanner S, Piza-Katzer H: Comparison of the effectiveness of gene therapy with transforming growth factor-beta or extracorporal shock wave therapy to reduce ischemic necrosis in an epigastric skin flap model in rats. Wound Repair Regen 2005;13(3):262-8. 9. Meirer R, Kamelger FS, Piza-Katzer H: Shock wave therapy: An innovative treatment method for partial thickness burns. Burns 2005;31(7):921-2.. 10. Jeffcoate WJ, Harding KG: Diabetic foot ulcers. Lancet 2003;361:1545-51. 11. Alexander House Group, Consensus paper on venous leg ulcers. Phlebology 1992;7:48â&#x20AC;&#x201C;58. 12. Wood MK, Davies DM: Use of split skin grafting in the treatment of chronic leg ulcers. Ann R Coll Surg Engl 1995;77(3):222-3. 13. Douglas WS, Simpson NB: Guidelines for the management of chronic venous leg ulceration. Report of a multidisciplinary workshop. British Association of Dermatologists research of the royal college of physicians. Br J Dermatol 1995;132:446. 14. Kjaer ML, Jorgensen B, Karlsmark T, Holstein P, Simonsen L, Gorrtup F: Does the pattern of venous

insufficiency influence healing of venous leg ulcers after skin transplantation. Eur J Vasc Endovasc Surg 2003;25:562-7. 15. Turczynski R, Tarpila E: Treatment of leg ulcers with split skin grafts: early and late results. Scand J Plast Reconstr Surg Hand Surg 1999;33(3):301-5. 16. Baxter CR: Management of burn wounds. Dermatol Clin 1993;11(4):709-14. 17. Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, Abston S: A comparison of conservative versus early excision. Therapies in severely burned patients. Ann Surg 1989;209:547-2. Johannes Jeschke MD, Fabian Petschke MD, Hildegunde Piza-Katzer PhD Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, Austria Both authors have equally contributed to this paper Correspondence to: Univ.-Prof. Dr. Hildegunde Piza-Katzer Department of Plastic and Reconstructive Surgery Medical University of Innsbruck Anichstrasse 35, A-6020 Innsbruck, Austria Phone: ++43 512 504 22731 Fax: ++43 512 504 22735 E-mail: hildegunde.piza@i-med.ac.at

Surgical Strategies in Burns- Traditional and New Approach: The treatment and understanding of burns has quite a long history, but the last 40 years were extremely dynamic in many areas of knowledge and practice. The natural history of the severely burned patient is now an unfortunate complication. A lot of new products and techniques for the local care and surgical approach are emerging; but is all this really new? Local care and surgical approach from the early seventies, with up to date protocols, figures and outcome results are compared. Local care resources and strategies are discussed; the traditional approach compared to modern products. Nobody has the one miracle solution for burn care, but everybody is selling oneâ&#x20AC;Ś Early surgical approach of deep extensive burns, flexible protocols of mixed deep extensive burns in children, 20

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skin banking and alternative wound closure dramatically improved the survival rate of massive burns and the quality of life of major burns survivors. How far we can go on this pathway? We present surgical protocols for deep localized burns, deep extensive burns, and special burned areas. We discuss the results of Dermal Matrix Template in post burn reconstruction. The skin banking is still an important life saving resource and seems like it will continue to be in the future; synthetic skin substitutes and cell cultures are not always affordable and are not the ultimate solution for all burn wounds. Our statistics are based on 16,000 consecutive cases hospitalized over 20 years, with a general survival rate of 99, 87% and a M50 = 78% TBSA. Dan Mircea Enescu, MD, PhD

A Comparative Analysis of Cetirizine, Gabapentin and their Combination in the Relief of Post Burn Pruritus Gabapentin is successfully used to manage all forms of itch. With a paucity of randomized trials evaluating the role of gabapentin in post burn itch management the current study was undertaken to individually evaluate gabapentin, cetirizine and their combination in relieving itch. Sixty patients were randomly recruited in three groups A,B,C(twenty in each group) and the respective drug(s) were administered in doses determined by initial VAS (visual analogue scale) scores. There was no significant difference in all the three groups with respect to mean VAS score on day 0. VAS scores were evaluated over the next 28 days (day 3, 7, 14, 21 and 28). The initial mean VAS score was reduced by 95% in gabapentin group compared to 52% for the cetirizine group over days 0 to 28, which was statistically highly significant (p< 0.01). There was a 94% reduction in mean VAS score in the combination group which was comparable to the relief observed with gabapentin alone. Even the onset of

action with gabapentin was significantly faster than the cetirizine group, as is evident from the mean VAS scores on day 3, which decreased by 74% in the gabapentin group compared to 32% in the cetirizine group (p< 0.01). It is quite evident from this study that gabapentin is significantly better than cetirizine as monotherapy in relieving post burn itch and it also has a faster action. The hypothetical combination of a centrally acting drug with a peripherally acting agent didn’t result in any better control of post burn itch than monotherapy with gabapentin. Ahuja R.B. Lok Nayak Hospital, Department of Burns and Plastic Surgery, Delhi, India, Gupta R. LNJP Hospital, Burns and Plastic Surgery, Delhi, India, Gupta G.K., Shrivastava P. Lok Nayak Hospital, Burns and Plastic Surgery, Delhi, India

Study and Analysis of Grip Strength and the Effect of Static Wrist Position on Grip Strength. Background

Results

Grip Strength is the most commonly used outcome assessment tool for hand function. No standard values are available for the Indian population. The effect of the wrist position on grip strength after wrist arthrodesis is not clear.

Average grip strength of the Indian population: Dominant hand-- 33.1 kg force. Non dominant hand-30.2 kg force. Grip strength is higher in the dominant hand (8.8%). No difference was noticed between rightand left-handed subjects. Males have around 40% of a stronger grip than females. The splintage reduces grip strength in any position. Quantitatively the grip strength is maximal with splintage at 45º

Aim To assess the average grip strength of a sample of the Indian population, the quantitative gender difference, the dominant-vs- non-dominant hand difference and the effect of static wrist position on grip strength.

Materials and Methods Five hundred healthy adults were randomly chosen for the study of the average grip strength. The effect of static wrist position was analyzed on 100 of these subjects. Specially designed splints were used to hold the wrist in five different static positions 45º, 30º and 15º of wrist extension, neutral wrist position and 30º wrist flexion.

Conclusion Constrained grip strength is significantly less than the grip strength in the unconstrained position of the wrist. The grip strength was significantly reduced in flexed position of the wrist but there was no significant difference in the static grip strength between the neutral to 45º of wrist extension. Nayak SK, Bhardwaj P, Kiswar AD, Sabapathy SR, Department of Plastic Surgery, Hand and Microsurgery, Ganga Hospital, Coimbatore, India. Issue 4

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Lateral brow lift through temporal approach Combined with upper blepharoplasty Background

Result

In order to correct the drooping of the outer brow line, a surgeon may use the lateral brow lift. This technique is also known as a temporal brow lift, and almost exclusively addresses sagging around the outside of the eyebrow.

The brow ptosis was corrected without noticeable scars and with inconspicuous damage to the scalp hair follicles of the temporal region.

Method

To ensure complete release, and thus mobilization of the lateral brow, we make a point of skeletonizing the sentinel vein. In the temporal approach, following the skeletonizing of the sentinel vein, dissection continues minimally beyond the orbital rim and then through the temporal crest and into the subperiosteal space without endoscope. The corrugator is released via a transblepharoplasty approach.

Twelve female patients underwent bilateral temporal approach with a 3- 4 cm incision. The brow was rotated upward and laterally, and the superficial temporal fascia was anchored down to the deep temporal fascia. We usually place three 2 -0 PDS sutures between the temporoparietal and deep temporal fascia in a diagonal or vertical vector. Direct visualization of the corrugator and procerus muscles was achieved via a transblepharoplasty approach and the muscles were subsequently resected.

Conclusion

Key words: Brow lift, Temporal approach, upper Blepharoplasty, non - endoscopic Dr.S.Motamed , Dr.A.R.Roientan, Dr.A.R.Saberi Department of Plastic Surgery, Shahid Beheshti University, Tehran – Iran

Vertical Plication of Attenuated Orbital Septum: A Modification for Reduction of Lower Lid Bulge Background

Results

Surgery for correction of the lower lid bulge can be classified into three groups: Subtractive surgery, redraping, and repositioning. “Subtractive surgery” with excision of excess fat with or without skin has long been the standard technique but it does not address the anatomical pathogenesis of lower lid aging and may lead to exaggerated smile lines, hollowed or sunken appearance, or scleral show. “Redraping” techniques mobilize and use the fat bag to correct abnormalities such as lower orbital rim skeletonization, tear-trough deformity, and nasojugal groove. “Repositioning” techniques relocate the orbital fat inside the orbit by reinforcing supportive structures. The authors present a new repositioning technique with vertical plication of the orbital septum for correction of lower lid bulge.

There was no lower lid retraction or ectropion. Contour was smooth without any visible deformation or palpable suture line along the vertical plication. Substantial but not total improvement in tear trough deformity was almost always observed. In the follow-up visits of minimum of 3 months, no recurrence of bulge was present and the scar was inconspicuous.

Material and method This technique was performed on 50 individuals. The technique will be described in detail. The length of follow-up varied from 3 months to one year, with an average of 6 months.

Conclusion Vertical plication of the orbital septum is an effective way to reposition the orbital fat inside the orbit. It anatomically corrects the lower lid bulge, preserves the orbital fat pad and the vertical dimension of the lower lid, and provides a smooth contour in the periorbital area. It is a simple procedure with the same dissection of fat excision through a subciliary approach without the need to penetrate the orbital septum or manipulate the fat pad. Morbidity is minimal and transient, and the results are satisfactory. We suggest this technique for correction of lower lid bulge when there is excess lower lid skin and a subciliary approach is selected. Seyed Esmail Hassanpour, MD. Arash Bairaghi Toosi, MD. Shahid Beheshti University of medical science

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Auricle Amputation and Reconstruction with External Prosthesis (Epithesis) in a Giant Auricle Hemangioma â&#x20AC;&#x201C; A Case Report Hemangiomas are more frequent in the cephalic extremity than all other sites especially the cavernous type. Cavernous hemangiomas typically appear in the second month of life and have a progressive growth until the 8th -12th month of life, then they regress, sometimes to total disappearance. However, in a number of cases these hemangiomas persist until adulthood, producing both aesthetic problems, caused by their overgrowth, and problems caused by repeated bleeding and necrosis that can occur. Treatment of these hemangiomas is extremely difficult, because they usually have multiple arterial sources, both from the external and the internal carotid arterial system. Often, after repeated arterial ligations, large excisions are needed, eventually sacrificing aesthetic facial units. In this paper we present a case of a hemangiomas of the left external ear extended to parieto-temporal area. The patient had had multiple surgical procedures for the ligation of the arterial sources from the left external

carotid artery, without significant results. In the end, we decided to amputate the left auricle and use a silicone prosthesis (epithesis) for reconstruction. The result was judged as very good from an aesthetic point of view and also the auditory function remainied intact. S. Marinescu, Carmen Giuglea, Anca Oporanu, Ana-Maria Boiangiu, Prof. IP Florescu.

Simultaneous hemiface and vascularized bone marrow transplantation in rats Objective Clinical application of composite tissue allograft transplants opened the discussion on the restoration of facial deformities by allotransplantation. The authors introduce a hemifacial allograft transplant plus femur transplantation as a vascularized bone marrow model to investigate the rationale for the development of functional tolerance across the major histocompatibility complex barrier.

(RT1l) rats. Hemiface allotransplantation alone controls (n = 5) and both hemiface and femur allograft (n = 5) were treated with cyclosporine A 16 mg/kg/day during the first week; this dose was tapered to 2 mg/kg/day over 4 weeks and maintained at this level thereafter.

Results The number of rats that reject under cyclosporine A monotherapy protocol and the interval free of rejection was significant different between the two groups.

Methods

Conclusions

Ten rats in two groups were studied. The composite hemifacial allotransplantations including the ear and scalp and femur allotransplantation were performed between Lewis-Brown Norway (RT1l+n) and Lewis

These facts demonstrate the contribution of the superior microchimerism levels in the induction of partial tolerance in the group with simultaneous hemiface and vascularized bone marrow transplantation.

I Lascar, D. Zamfirescu, M Climov, A Bularda I, C Popoviciu, A Stefanescu, A Lupu â&#x20AC;&#x153;Carol Davilaâ&#x20AC;? Bucharest Medical University, Bucharest, Romania M Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania, M Lanzetta M Italian Institute for Hand Surgery and Microsurgery, Monza, Milan, Italy, University of Canberra, Australia Issue 4

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Comparison of Nerve Repair with End to End, End to Side with Window and End to Side without Window Methods in Lower Extremity of Rat Introduction & Objective: Despite different studies on end-to-side nerve repair, the results are controversial. The importance of the end-to-side method is that it is very useful in cases that the proximal nerve is not available and also in this method, the donor nerves remain intact and without injury. Finally, in comparison to other classic procedures, end-to-side repair need less time and less dissection. The majority of studies only evaluated nerve recovery by either non functional or functional parameters. As it has been proven, the results of functional and non functional studies do not always agree. This study was designed to evaluate this method by both functional (SFI) and non-functional parameters (histochemical study).

Materials & Methods In this study, 40 rats were randomly classified into 4 groups of 10 rats: 1- Control group (n=10) in which the nerve was exposed and cut and implanted into adductor muscles 2- End-to-end anastomosis (n=10) in which the peroneal nerve was cut and the two segments were anastomosed end-to-end 3- End-to-side anastomosis with window (n=10) in which the peroneal nerve was cut and anastomosed with window to the tibial nerve 4- End-to-side anastomosis without window (n=10) in which the peroneal nerve was cut and anastomosed without window to the tibial nerve. After the 1th, 8th and 16th week, functional (PFI) and non functional (histological) studies were performed and

the results were compared. The axon count was analyzed by the statistical tests Anova and paired sample t-test and were checked by post Hoc Tukyeâ&#x20AC;&#x2122;s test. The data for the FSI test were derived from repeated tests. Danet test was also used for the confirmation of the data.

Results In all experimental groups (group 2,3,4) motor recovery (SFI) at 8th, and 16th week were not statistically different (P >0.05). In the histological study, the axon count in end-to-side anastomosis with window was higher than the other experimental groups (P<0.05).

Conclusions According to this study, the authors believe that both nerve regeneration and functional recovery occur in end-to-side nerve anastomosis with a better outcome than the classic procedure of end-to-end anastomosis. Considering the different size and diameter of nerves and muscles between mouse and human, the results may be different for humans. The authors propose another similar study in larger animals, such as primates, to support these findings. Forotan S.K. MD, Associate Professor of Plastic Surgery, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran Salehi H. MD, Resident of Plastic Surgery, Iran University of Medical Sciences and Health Services, Hazrate Fateme Hospital, Tehran, Iran

Infra Red Thermography. The Evidence Based Monitoring of Tissue Blood Supply. An Experimental and Clinical Study Background Blood supply is very vital to all tissues, in order to remain alive. Monitoring of blood supply has always been a challenge, particularly in plastic surgery. Various methods have been developed for this purpose, but no single or collective method has come close to the ideal.

Material and Method For the first time, a unique method of tissue temperature monitoring is used with very promising results, with great sensitivity. Various experimental and clinical situations are used to evaluate and study the accuracy and the

results. This method surpassed all previous methods for this purpose.

Results With this new simple, reliable, reproducible, sensitive, non invasive, non radiating method we can objectively record changes in temperature even as low as 0.1 degree Celcius. We can consider this as an excellent method. Literature is scanty. Key words: Monitoring blood circulation, infra red thermography. Singhal S., Singhal V. Department of Plastic Surgery, Noble hospital, Udaipur, India

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Eye socket reconstruction by using secondary island flap and more advanced clinical application Presented at the 6th National Congress of Northern Cyprus Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons Anophtalmic socket reconstruction is a challenging problem in plastic surgery. We had described a prefabricated superficial temporal fascia island flap and used this technique in 50 enucleation patients with severe socket contraction ending in excellent or good results for 28 years (Altindas -1 procedure). However, the flap was not suitable for the exenteration patients with complete eyelid loss. The technique was modified and used in exenteration patients (Altindas-2 procedure). In this 2-stage procedure, the temporoparietal fascia is prepared with a full-thickness skin graft from the retroauricular area, and a strip of scalp is preserved in the middle of the flap. The flap is transferred to the orbit through a subcutaneous tunnel at the second stage. The prepared flap is used for the reconstruction of eyelids and periorbital skin; the scalp island is used for the reconstruction of lid margins and eyelashes; and the neighboring bare temporoparietal fascia is used for the augmentation of the periorbital soft tissues. The orbital lining is elevated as a centrally based skin flap and used for the reconstruction of the eye socket, fornicles, and posterior lining of the eyelids. The technique was used successfully in 5 total exenteration patients with complete

eyelid loss. In one patient, the ipsilateral temporal island flap had been used previously, and the flap was prepared from the contralateral site and transferred to the anophtalmic orbit as a free flap 5 years later. By this procedure, it is possible to reconstruct a stable eye socket that is suitable for ocular prosthesis, upper and lower fornicles , periorbital skin with good color matching, naturally looking eyelids with eyelashes and lid margins, and medial and lateral canthal areas. It is also possible to improve periorbital soft tissue atrophy, which is an important problem in patients who have had radiotherapy previously. Free transfer of the flap provides a new solution for the reconstruction of cases that have been previously operated on. As a conclusion, Altindas-2 procedure may provide a contribution to the plastic surgeon`s armamentarium for the reconstruction of the eyelids and eye socket in total exenteration cases. This technique not only reconstructs the eyelids, eyelashes, fornicles, and eye socket but also provides additional soft tissue to the periorbital area. It is possible to transfer the flap as a free flap, and thus provide an important solution for the difficult cases that had been a challenge to operate on previously. Muzaffer Altindas, M.D. Prof., Cerrahpasa Medical Faculty University of Istanbul, Turkey

A new approach in facial reanimation Presented at the 7th National Congress of Northern Cyprus Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons in July 8-12, 2009 The effects of facial nerve paralysis are debilitating and often cause depressing emotional conditions, along with a variety of possible functional and aesthetic problems. Despite the advances in plastic and reconstructive surgery in recent decades, including refinement of microsurgical techniques, reanimation of the paralyzed face still remains a great challenge. Long term goals of facial reanimation are to achieve normal appearance at rest, symmetry with movement, and restoration of mimics. Up until today, a number of skeletal muscles have been used for microsurgical restoration of the

paralyzed face. However, these procedures often fail to provide a symmetric smile. Bulkiness, functional deficit at donor site, and limited excursion have been reported as common drawbacks of these procedures. The essential principle of reconstructive surgery is to replace lost tissue with similar tissue. This is the best way to ensure functionally and aesthetically satisfactory results in all kinds of reconstructive problems. In facial restoration what we want to restore is the function of the paralyzed mimetic muscles. The author, therefore, believes that the best modality of treatment for the Issue 4

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patients with facial palsy would be the transfer of a mimetic muscle. In this study, the author presents microsurgical transfer of the contralateral depressor anguli oris (DAO) muscle for restoration of the function of the zygomaticus major at the paralyzed side as a new approach. This is the first report of microsurgical transfer of a mimetic muscle to restore the function of another mimetic muscle. Over 4 years, this procedure was successfully used in 8 patients. At 6 months, clinical examination and EMG studies showed an almost normal contractibility of the transferred muscle in all patients. All patients were satisfied with the functional and aesthetic results. No patient required further surgery. The smile pattern was assessed as good in 5 and excellent in the remaining 3 patients. Moreover,

asymmetry of the lower lip was eliminated due to harvest of the DAO at the normal side. Restoring the function of a paralyzed mimetic muscle with another mimetic muscle, this new approach perfectly follows the basic principle of reconstructive surgery. The muscle used in this procedure is a mimetic muscle presenting similar structural and functional characteristics including strength, excursion contractility, excitability, extensibility, and elasticity. Since it is a thin muscle, no additional surgery is needed for debulking. It does not cause any functional deficit at the donor site but corrects lower lip asymmetry as a secondary gain. The author believes that microsurgical transfer of DAO muscle has the potential to be the golden standard in facial reanimation. Mehmet Mutaf, M.D.,Prof. University of Gaziantep, Turkey.

DIEP planning and surgery for breast reconstruction Presented at the 7th National Congress of Northern Cyprus Turkish Plastic, Reconstructive and Aesthetic Surgeons on July 8-12, 2009 Autogenous breast reconstruction can often provide a better aesthetic outcome than other options because breast volume and shape can be extensively modified based on individual needs, behaves much like a real breast, tends to get larger if patient gains weight and complications such as capsular contracture are avoided. Deep inferior epigastric artery perforator (DIEP) flaps, the current mainstay in choice of autologous reconstruction, provide generally good outcomes. This flap produces the same dimensions of skin and fat island as the TRAM flap. However, the tissue is nourished by one or two perforator vessels from the deep inferior epigastric vessel. Outcome is closely related to the understanding of the individual anatomy. Perforator size, location, intramuscular and subcutaneous course, and association with motor nerves are all factors that can significantly affect operative technique, length of operation, and operative outcomes.

Patients and methods From January 2000 to May 2008, two hundred and four autologous breast reconstructions were performed. Data were collected and retrospectively analyzed. 26

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Results In 204 cases, (119) a DIEP flap, (32) free-TRAM flap, (14) Muscle sparing TRAM, (39) pedicled TRAM, (8) SGAP flaps were performed. The mean patient age was 44.6 years (24-72). Body Mass Index of the patients was 20-25 (24 patients), 26-30 (71 patients), 31-36 (29 patients) and BMI of 69 patients was not recorded. The average time for breast reconstruction after mastectomy operation was 34.6 months. The overall complication rate for autogenous breast reconstruction was 28%.

Conclusion Autogenous breast reconstruction provides very good results and DIEP flap breast reconstruction has limited donor-side morbidity. In our series, a definite learning curve was reflected in a larger number of complications in the beginning of our series. After the initial learning curve, complications decreased significantly, although the occasional DIEP flap breast reconstruction remains very tedious due to its anatomy. Arif Turkmen, M.D. FRCS (Glasg) EBOPRAS, FRCS (Plast) University of Gaziantep, Turkey.

Pectoral implants in aesthetic and reconstructive Summary

Material

Introduction: The pectoral implants with silicone gel are indicated for patient who presented uni or bilateral deformity, such as gynecomastia, Poland´s Syndrome and in aesthetic surgery. Material and Method: The smooth and textured pectoral implants with silicone gel are used. The incision is made in the axillary region about 6 cm and the pocket is obtained under or over the surface of the major pectoral muscle interrupted 2 cm below the areola. Result: The complications are similar to breast augmentations: hematoma, seroma, infection, extrusion. Conclusion: The patients presented in all of the cases satisfaction with their implants. References: Hodgkjnson D.J., Chest wall implants: their use for pectus excavatum, pectoralis muscle tears, Poland´s syndrome, and muscular insufficiency. Aesthetic Plast Surg, 1997 , 21(1):7-15. Pereira L.H. an col. Pectoral muscle implant: approach and procedure. Aesthetic Plast Surg, 2006 30(4):412-6. Pereira LH, Sabatovich O, Santana KP, Picanto R, Sterodimas A. Surgical correction of Poland’s syndrome in males – a purposely designed implant. J Plast Reconstr Aesthet Surg. 2008, 61(4):393-9.

The pectoral implants with silicone gel, high and cohesive have been developed for reconstructive and aesthetic surgery, the surface of the implants could be smooth or textured and the localization depends on, such as breast implants, the design is different for the right and left size and the dimensions usually can be between 190 cc and 230cc.

Methods The technique is very simple because the reference is at the axillary level, first is convenient to marker with a pencil like an Italic S, the position of the patient should be 90 º supine position with the arm and the body, the ideal anesthesia could be local with sedation in other case is indicated the regional anesthesia. The incision is make at the axillary region about 6 cm and the pocket is obtained under or over the surface of the major pectoral muscle interrupted 2 cm below the areola. Is very important the dissection with a special dissector, nevertheless sometimes the surgeon can use his/her own hand and fingers The smooth or textured pectoral implants with silicone gel, is introduced first into the right pocket and then into the left pocket.

Fig. 1 Textured pectoral implant

Fig. 2 Smooth pectoral implant

Fig. 5 Resection: Gynecomastia

Fig. 3 Incision axillary region

Fig. 4 Muscular dissection

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Result The position of the implant submuscular plane presented an excellent result. The position of the implant with subglandular dissection sometimes presented visibility of the implant. All patients are marked and the incisions is at the axillary region without pathologic scar. The complications are similarly like in breast augmentations, hematoma, seroma, infection, extrusion.

Conclusions In the last years the use of pectoral implants are increased in cosmetic surgery with good result, however we can find the principal indications in reconstructive surgery.

References Hodgkjnson D.J., Chest wall implants: their use for pectus excavatum, pectoralis muscle tears, Poland´s

syndrome, and muscular insufficiency. Aesthetic Plast Surg, 1997, 21(1):7-15. Pereira L.H. an col. Pectoral muscle implant: approach and procedure. Aesthetic Plast Surg, 2006 30(4):412-6. Pereira LH, Sabatovich O, Santana KP, Picanto R, Sterodimas A. Surgical correction of Poland’s syndrome in males – a purposely designed implant. J Plast Reconstr Aesthet Surg. 2008, 61(4):393-9

Case Report Author: M. Elsa Meza Britez Affiliation: National University of Asunción Paraguay, Sociedad Paraguaya de Cirugía Plástica Estética y Reconstructiva (SPACPRE), Federación Iberolatinoamericana de Cirugía Plástica, (FILACP) Society of Latin American Plastic Surgeons of United States and Canada, (SLAPS) International Confederation of Plastic Reconstructive and Aesthetic Surgery (IPRAS)

Diffusion tensor tractography for preoperative nerve visualisation in the management of peripheral nerve tumors Introduction and aims Diffusion tensor tractography (DTT) represents a recently developed non invasive MRI technique that has been successfully applied to visualize degeneration and regeneration of peripheral nerves. The purpose of this study was to examine the usefulness of DTT in the correct delineation of tumor and healthy nerve tissue and the value of this information in the preoperative planning for peripheral nerve tumors.

Methods In a prospective study patients with clinical suspicion of peripheral nerve tumor were investigated by using a DTT MRI scan. Intraoperatively the course and position of intact nerve fascicles in relation to the tumor were precisely documented by taking representative photographs. The clinical findings were then compared to the results of the DTT MRI scans.

Results 12 Patients (mean age 42 years [16-68]) with peripheral nerve tumors underwent DTT MRI scans. In 10 Patients the tumor was resected. In 9 of 12 patients with DTT 28

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scans good preoperative nerve fascicle visualisation could be achieved. In three patients only poor or no preoperative fascicle visualisation was possible. In 7 of 8 patients with good preoperative fascicle visualisation and surgery good intraoperative correlation of DTT scans and surgical anatomy was demonstrated.

Conclusion DTT proved capable of properly visualising nerve fascicles and their correct anatomic relation to peripheral nerve tumors. DTT represents a promising new method for preinterventional planning of nerve tumor resection. Limitations of DTT were encountered in extensive complex plexopathies, tumors in proximity to large vessels or smaller than 5mm. Further applications of this technique in peripheral nerve surgery are to be explored. Schmidt Manfred, Aszmann Oskar, Frey Manfred, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Austria Kasprian Gregor Department of Radiology, Medical University of Vienna, Austria

Polyurethane Breast implants Periareolar approach With Co-Relation Inflammatory Mammary Reaction Capsular Contracture Introduction The breast represents a significant factor in the female body. The patients often request for breast augmentation because of their small breast, and sometimes others motivation could be possible. The polyurethane silicone gel foam coated implants can used in aesthetic breast augmentation. The structure of the implants can decrease the capsular contracture because reducing the synthesis of collagen which is one of the precursor of fibrotic capsule:

• Female 27 year old • Female 32 year old • Female 26 year old unilateral asymmetric mammary gland • Female 42 year old (mycobacterium infection, 11 year before, Baker III / IV with indication of breast augmentation using polyurethane implants

27 year old

Conclusions The patient presented a great satisfaction with the periareolar scar. The approach and the plane of dissection were without complications With immunohistochemistry study the inflammatory cell showed a CD3, CD4, CD8, CD20 and CD68 + population.

Materials and Methods Periareolar approach, using polyurethane implants, subglandular dissection Immunopathologic study: avidine-biotine method was used with monoclonal antibodies

Case nº4 Immunohistochemistry study showed mixed lymphohistiocytic (CD3, CD8,CD20, CD68+),cd8, with cd4/ helper T inflammatory cell population and was negative for mycobacterium. Author: M.Elsa Meza Britez Co Author: Carmelo Caballero

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The Lipo-Facelift: From Lifting to Modelling N. Pallua: Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Centre. University Hospital of the RWTH, Aachen, Germany Introduction Since the introduction of the „classic“ SMAS Facelift by Skoog and by Mitz in the 1970s [1, 2], the focus of facial rejuvenation surgery shifted towards short scar, minimally invasive midface procedures. However many relevant changes occur in the lower face and neck region, including jowls, dropping chin or platysmal bands. Also, lipodystrophy of the face contributes to an aged look. Zones of fat accumulation like the submental area and in adipose patients the cheeks and the neck are found next to areas of fat atrophy like the lips or the nasolabial folds. Furthermore altered skin quality is an obvious but often overlooked central key of facial appearance. The biplanar Lipo-Facelift is a facial rejuvenation procedure that improves all of these aspects: Skin laxity, lipodystrophy and poor skin quality.

Surgical approach A Lipo-Facelift procedure consists of liposculpturing of the face and neck performed simultaneously with a biplanar SMAS face lift. The inferior vector is parallel to the long axis of the mandible and the vertical vector parallels the long axis of the zygomatic major muscle according to Hamra [3], Stutzin [4] and Marten [5]. By preserving the platysma-cutaneous retaining ligaments the “lateral sweep” deformity is avoided [6]. The skin is loosely over draped the tightened SMAS with a separate vector. Liposculpturing redistributes fat and restores natural volume in the aging face. I use a modified Coleman’s technique and infiltrate the fat in a monolayer technique through the existing facelift incisions. Typically the perioral and the adjacent cheek area as well as the temporal area are enhanced.

Results The Lipo-Facelift results in an impressive improvement of the skin quality, a youthful appearance and very high patient satisfaction in almost all cases. In a retrospective evaluation the results were rated to be superior to those with a conventional Facelift. Investigation of the microcirculation by transcutaneous Doppler imagining showed long lasting improved oxygen tension. Patients with a Lipo-Facelift had slightly longer post surgical bruising and swelling but no increase in complication rate. 30

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Fig. 1-6: Pre- and postoperative pictures of a 49 year old patient with a Lipo-Facelift: biplanar SMAS Facelift, liposuction of the jowls, cheeks and neck and perioral lipofilling.

Discussion

References

The biplanar SMAS Face lift corrects age related changes of the SMAS in the lower face and neck. Repositioning of Bichat’s fat pad, as in a midface lift, can also be achieved. Using the correct vectors a tight or pulled back appearance as well functional impairment is avoided and the ears are left in their natural position [7].

1. Lemmon, M.L. and S.T. Hamra, Skoog rhytidectomy: a five-year experience with 577 patients. Plast Reconstr Surg, 1980. 65(3): p. 283-97.

Liposculpturing effectively addresses age related lipodystrophy. It is useful in overweight patients with round faces (see patient example) as well as thin patients with loose sagging skin. Lipofilling is performed in a monolayer fashion and with volumes up to 15 cc per area. Up to 90% viable cells can be harvested [8]. Multilayer injection is not necessary because the transferred lipoaspirate contains sufficient levels of the growth to provide a stimulus for vascular ingrowth [9]. Also the danger of nerve and muscle injury is minimized. After lipofilling the skin quality returns to a more youthful color and radiance. Patients report a healthier “feel” after surgery. Infiltration of autologous fat induces angiogenesis and results in better microcirculation and increased rejuvenation of the skin. Adipose derived stem cells capable of inducing angiogenesis [10] are pooled by centrifuging [11] and transferred with the fat [12]. Differentiation of progenitor cells into fibroblasts increases collagen production, possibly contributing to a firmer skin [13]. My longest follow up on a Lipo-Facelift is now seven years and confirms the superb stability of the result. In conclusion the biplanar Lipo-Facelift corrects age-related skin and SMAS changes and age-related lipodystrophy, improves skin circulation and provides a long lasting and a natural result.

Corresponding author N. Pallua, M.D. Ph.D. Department of Plastic and Reconstructive Surgery, Hand Surgery – Burn Center University Hospital of the RWTH Pauwelsstrasse 30 D-52074 Aachen, Germany Tel: ++49 241 8089700 Fax: ++49 241 8082448 Email: npallua@ukaachen.de

2. Mitz, V. and M. Peyronie, The superficial musculoaponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg, 1976. 58(1): p. 80-8. 3. Hamra, S.T., The deep-plane rhytidectomy. Plast Reconstr Surg, 1990. 86(1): p. 53-61; discussion 62-3. 4. Stuzin, J.M., T.J. Baker, and T.M. Baker, Refinements in face lifting: enhanced facial contour using vicryl mesh incorporated into SMAS fixation. Plast Reconstr Surg, 2000. 105(1): p. 290-301. 5. Marten, T., Lamellar High SMAS Face and Midface Lift. The Art of Aesthetic Surgery, ed. F. Nahai. 2005, St. Louis: QMP Medical. 1110-1193. 6. Mendelson, B.C., A.R. Muzaffar, and W.P. Adams, Jr., Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg, 2002. 110(3): p. 885-96; discussion 897-911. 7. Knize, D.M., Periauricular face lift incisions and the auricular anchor. Plast Reconstr Surg, 1999. 104(5): p. 1508-20; discussion 1521-3. 8. Wolter, T.P., et al., Cryopreservation of mature human adipocytes: in vitro measurement of viability. Ann Plast Surg, 2005. 55(4): p. 408-13. 9. Pallua, N., et al., Content of the growth factors bFGF, IGF1, VEGF, and PDGF-BB in freshly harvested lipoaspirate after centrifugation and incubation. Plast Reconstr Surg, 2009. 123(3): p. 826-33. 10. Lu, F., et al., Improved viability of random pattern skin flaps through the use of adipose-derived stem cells. Plast Reconstr Surg, 2008. 121(1): p. 50-8. 11. Pulsfort, A.K., T.P. Wolter, and N. Pallua, The effect of centrifugal forces on viability of adipocytes in centrifuged lipoaspirates. Ann Plast Surg. 66(3): p. 292-5. 12. Moseley, T.A., M. Zhu, and M.H. Hedrick, Adiposederived stem and progenitor cells as fillers in plastic and reconstructive surgery. Plast Reconstr Surg, 2006. 118(3 Suppl): p. 121S-128S. 13. Mojallal, A., et al., Improvement of skin quality after fat grafting: clinical observation and an animal study. Plast Reconstr Surg, 2009. 124(3): p. 765-74.

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BOOKS REVIEW

HISTORY of MICROSURGERY 5 Generations from 1957 By Julia K. Terzis, M.D., Ph.D. Norfolk,VA: Julia K. Terzis; 2008, 845 pages, Price 190 Euros

Reviewed by Alfred C. Berger, M.D., Univ. Prof. Dr. Julia Terzis’s “History of Microsurgery” is a wonderful book compiling the narratives of the pioneers of Microsurgery from 1957 to the early ‘80’s, totaling 5 generations. It shows very personal experiences and the different ways that this milestone of reconstructive microsurgery started, which is still influencing our approaches to surgical reconstruction to date. It was also in my memory a fascinating time for all of us involved in microsurgery. The exchange of ideas and techniques of different groups and the fun that we all had sharing our experience with friends and colleagues from Australia, Europe, Asia and the U.S.A which further fertilized this unique field. The development of operating microscopes, micro-instruments and micro-sutures, from the very simple early ones to the nowadays sophisticated equipment, are all well described in this book. The pictures and photos are demonstrating a group of friends with a common intense interest in a new technique which made it possible to help our patients in ways that

were not possible 50 years ago. This technique changed our approach to the coverage of large skin defects and enabled the transfer of body parts, even a complete face or extremities in one stage from the donor to the recipient site. This book is very helpful for the younger generation to see what was already developed and for the older to recollect the difficult, but fascinating times of what transpired and remember all the friends involved in this topic from all over the world. The decision to divide this group of surgeons into different generations is a personal decision by the editor, but represents one way to deal with the history of microsurgery, which is not an easy task, because so many events transpired at the same time at the beginning in various parts around the world. Congratulations to Julia K. Terzis for compiling this work which brings fond memories of friends and colleagues that started it all. It is a book which should be in the library of all microsurgeons.

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HISTORY of MICROSURGERY 5 Generations from 1957 Just Released! 851 pages, beautifully illustrated.... Only 500 copies available Don’t miss the chance to add one of these to your library!

“Finally, something we all waited for. The Book on History of Microsurgery, narrated by the early pioneers whose struggle, perseverance, and effort altered forever the world of surgical reconstruction.”

Julia K. Terzis, M.D., Ph.D Microsurgical Research Center Eastern Virginia Medical School 700 Olney Road, LH2055 Norfolk, Virginia 23501 757-446-5272 office 757-446-5109 fax mrc@jkterzis.com

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Dear Su rgeon, The boo k of a co on the History mp of early pio ilation of pers Microsurgery onal na c neers of rratives onsists global m all, to m from th or icrosurg e e Microsu e recent contri butions ry that started i rgery th t to at follow four de cades. ed them Reconstructive , over th The pre e span o paration f spanned of this b o n ok was early the aut a proje hors, co two decades from c ct that llecting procure ont th ment of relevan eir narratives, acting There a t and for photogr re aphs. If you a a few remaini n re inter ested in g copies availab this uni le t qu ow to the w e book, please ning a signed oday. co o w importa w.jkterzis.com rder this text b py of nt histo y going rical do web site and s Please c e u l e ment. ct this fee com if y l free to cont ac ou need assistan t me at mrc@ Best Re c jkterzis. e. ga Julia K rds, . Terzis , M.D., Ph.D.

PIONEERS

Dr. Kitaro Ohmori

My plastic surgery and hand surgery training was done in Tokyo with E. Marumo In 1970, I became a House Surgeon of the Plastic Surgical Unit of Middlemore Hospital, in Auckland, New Zealand under the direction of Mr. Manchester. Four years later, in 1974, I was invited by Mr. Manchester to Middlemore Hospital to demonstrate a microsurgical free groin flap transfer to the lower leg. During this operation, I had great assistance from Mr. E. Brown who was one of my registrars in 1970. They gave me a chance to do the first microsurgical flap transfer in New Zealand. It is one of the most impressive and special events in my life. In these four years, I joined the staff of the Department of Plastic Surgery at Tokyo Metropolitan Police Hospital which was directed by Seiichi Ohmori (my father) and I started to learn about microsurgical vascular anastomoses from Harii who was the chief of the microsurgery team. I became a member of this team to find out what type of tissues or flaps could be transferred by this technique. On this topic, I had beneficial education at Middlemore Hospital from Mr. Brown who had come back from

Micro vascular anastomosis

Canniesburn Hospital and informed me of a new concept of axial pattern flaps such as the groin flap or the deltopectoral flap. He showed me the pedicle vessels of these flaps while performing pedicled flap surgery. With this knowledge I could elevate such flaps in island for, then free the donor site of the flap for free flap surgery. These free island flaps were transferred by microvascular anastomoses. At least in the early stages of our microsurgical team, in my way of saying, â&#x20AC;&#x153;CanniesburnMiddlemore styleâ&#x20AC;?, the groin and deltopectoral area were used as donor sites for flaps. This surgery came back to Middlemore Hospital in 1974. In 1976, I had a chance to come to New York to expand my knowledge of Craniofacial Surgery under Prof. Converse at NYU. I received an excellent education there and then I became the first active member of ISCFS from Japan. Also, it was quite fortunate for me to have a chance to demonstrate and talk about microsurgical free flap transfer on this trip. In some occasions I had good comments from Prof. Converse. He commented to me that the 10-0 needle available at that time was too large compared to the size of vessels which were needed to anastomose for the free groin flap transfer. This comment motivated me to find out other flap donor sites with pedicle vessels of larger size, such as the latissumus dorsi myocutaneous flaps. Related to Prof. Converse, the International Conference on Microsurgery was organized in his own style at Leeds Castle in 1980. This conference was a memorable one and I attended with honor. After I came back from New York, a long list of craniofacial surgical cases and micro-surgical cases was waiting for me. My surgical life became very tight for the following ten years and I was fully engaged in microsurgery and craniofacial surgery. During those days, I operated on microsurgery cases on Mondays Issue 4

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and Wednesdays and on craniofacial surgery cases on Tuesdays and Fridays. In some cases, a combination of these surgeries was applied. Despite my tight schedule, I attended medical meetings and congresses as much as possible and presented my experiences. In 1977, I was invited by the Argentine Society of Plastic Surgery (Mal Delplata) where I gave a lecture entitled “Microsurgery and Craniofacial Surgery”. At this occasion, I met Dr. Jose Juri who was a famous surgeon for the correction of baldness by his unique flap. He asked me “Can you reposition the temporo-parietel scalp flap by 180 degrees on the anterior hair line to obtain the normal hair direction?” I told him that it was difficult (mainly because his flap may be on the random pattern vasculality), but a scalp flap based on the superficial temporal vessels could be transferred for correction of the anterior hairline with normal hair direction. After this communication, Dr. Juri and I worked together to address the issue of “Micro-surgical free scalp flap for correction of baldness”. It took around 10 years. The result applied the microsurgical free flap transfer to the real aesthetic surgical application. In 1995, I attended the 6th ISCFS in St. Tropez. In this congress, Dr. Michael Longaker showed us wonderful

results after correction of craniofacial anomalies using microsurgery and craniofacial surgery. I was impressed that the results that appeared on the screen were superior to those I had created by these surgeries. Until the 1990`s, most of the craniofacial surgeons or specialists of this subject did not carry out micro-surgical free flap or tissue transfer. It would have been natural because craniofacial surgery was rather a territory subject, but microsurgery was recognized as a technical matter in the beginning. This presentation of Dr. Longaker showed, at least to me, that both microsurgery and craniofacial surgery were integrated as a part of plastic surgery by early years of the 1990`s. At the time of the banquet dinner party, I congratulated him on his work. Aesthetic surgery is a part of my job. After I became familiar with craniofacial surgery, I started to employ the facial bone osteotomies to correct aesthetical problems. In 1986, I made a presentation at the Japan Society of Plastic and Reconstructive Surgery (Sapporo), entitled “Profiloplasty of Japanese patient by facial bone osteotomies”. After my lecture, Prof. McCarthy of NYU, who was invited to the congress, came up to me and told that I might make a fortune in future. Soon after that, I had a chance to write a chapter entitled “Esthetic Surgery in the Asian Patient” in his famous textbook of Plastic Surgery (in 1990).

At Leeds Castle, 1980, with Prof. Converse at the center of the table. The second from the front right is Dr. Ohmori 36

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My father Seiichi Ohmori (who passed away in 1989) loved ISAPS. I followed his steps. I was the first vice president of ISAPS and organized one of its congresses as the Chairman of the Scientific Program (Tokyo, 1999). My father organized the Oriental Society of Aesthetic Plastic Surgery (OSAPS) of which I was the Secretary General until last year. In 1991 I introduced the Q-switched ruby laser for the treatment of nevi O’ta. The results obtained by this method might have satisfied Seiichi. In 1995, I served as Vice President of the IPRAS Congress in Yokohama with Harii as the President. With my father Seiichi, 1973. From left to right, Seiichi Ohmori, Kitaro Ohmori, Mr. O’Brien and Harii

Thanks to all that has happened to me, I think I had quite a lot of chances to express my experience on the subject of Plastic Surgery, with 200 papers, 40 contributions, 2 textbooks, and 446 presentations until now.

With Sir William (Manchester), 1985

In the last 10 years, I have been interested in the differences between the two sexes on the facial aesthetics, especially on the size and shape of the forehead and the horizontal level of the nasion. These points may possibly change by osteotomies with good results. I am enjoying this issue.

Many things have changed. Forty years ago the cleft lip and palate were common facial anomalies at our department, but now they have become something like the rare craniofacial clefts of Dr. Tessier. Microsurgery and craniofacial surgery are now fundamentals of Plastic Surgery. Laser surgery is now widely available. It looks like the new technology of stem cell related science will soon become available. For instance, Dr. Michael Longaker ,whom I mentioned in this article, is now Professor of Bioengineering of School of Medicine, Stanford University. We are now acquiring not only new surgical tools but a new technology of stem cell related science for correction of the aesthetic deformities. The results with the new methods should improve the quality of plastic surgery.

EDITOR’S NOTE: It was my great fortune to have met Dr. Seichi Ohmori on a visit to Japan in 1964. At the time of that visit I was a young plastic surgeon in the U.S. Air Force and had gone to Japan to present my work involving the use of injectable Silicone for the correction of facial defects. My accomplishments were miniscule but, despite all evidence to the contrary, Dr. Ohmori treated me as an authority and asked my advice regarding numerous problems. This made an impression on me so much that every time a young surgeon has visited me I’ve tried to be as gracious as Dr. Ohmori. Dr. Seichi Ohmori was clearly one of the giants of world wide plastic surgery in the latter half of the century. To see his son, Dr. Kitaro Ohmori, follow in his footsteps and make a mark on the body of knowledge common to our specialty as great as he has is truly inspirational. It’s with great joy that we present Dr. Kitaro Ohmori as our “Pioneer” for the individual work he has done well beyond his father’s giant shadow.

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STARS ON THE HORIZON

Dr Linda Cendales

he first time that I thought about a hand transplant was during my last year of medical school. I opted to do a year of research in immunology and rheumatology at the National Institute of Nutrition in Mexico City. The department was a referral center for complex and severe cases and I had the opportunity to join the multidisciplinary team during the clinical conferences. It was then that I thought, what if one can provide a hand to these patients? Solid organ transplantation was routine and patients with rheumatoid conditions are already under immunosuppression.

us the opportunity to provide her with a different option.

I finished my residency in General Surgery and was accepted to do my hand and microsurgery fellowship at the Kleinert Institute in Lousiville, KY. It was during my fellowship in Louisville that I saw the birth of vascularized composite allotransplantation in hand transplantation. I was a member of the first vascularized composite allotransplantation program in the US and participated in the first two hand transplants in Louisville.

I have benefited from having the best role model and the best mentor. I had the fortune to have a strong woman at home from whom I learned the passion for intellect, academia, and understanding the world around us through research. I have the most extraordinary and invaluable mentor. And I look forward to being the best mentor possible and to provide a step up to the future leaders in vascularized composite allotransplantation.

It was clear to me that the problems were not technical but in the immunobiology of the tissues. It was then that I left Louisville and was the first surgeon to be accepted for a Transplant Surgery and Research position at the National Institutes of Health in Bethesda, Maryland. I completed my fellowships becoming formally trained in general transplantation, laboratory immunology, hand and microsurgery, and vascularized composite allotransplantation. I accepted an academic appointment as an Assistant professor at Emory University School of Medicine to continue my pursuit of an academic career. Since my arrival at Emory, we have created a Vascularized Composite Allotransplantation Program from the bench to the bedside. We performed the first hand transplant in the state of Georgia at Emory on March 12, 2011 in a remarkable young woman who gave 38

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I take our first case of hand transplantation at Emory as a beginning. A beginning of a comprehensive program in vascularized composite allotransplantation that we hope, will help advance the field and bring vascularized peripheral tissue transplantation to many deserving individuals with un-reconstructable tissue defects. Of course, none of this or any other transplant would be possible without the altruistic gift of donor families. To them, we extend our deepest appreciation.

EDITOR’S NOTE: The field of vascularized composite allotransplantation is perhaps the most complex of disciplines in the entire field of medicine. In the case of the hand graft, one must master general surgical principles, hand surgery, vascular surgery, immunology, and fully appreciate the complexities having to do with the psychology of donor’s families, as well as the dedication to discipline required by the recipient. The fact of Dr. Cendales’s achievements in such a relatively short time is a testimony to the legitimacy of her being the recipient of this Journal’s designation of Rising Star. The only fault in this honor is the word “Rising”. Dr. Cendales’s star has already risen and is shining brightly. This Journal is proud to have her as our honored recipient.

SENIOR AMBASSADOR

Dr Jose Guerrerosantos

hile studying medicine at the Medical School of the University of Guadalajara, Jalisco, Mexico, I was inclined to specialize in Dermatology, and therefore in my free time I attended the activities of the Dermatological Institute of Guadalajara. There I learned how to make small skin surgeries for the treatment of cutaneous tumors. Upon finishing my studies of Medicine, I requested from the director of the Dermatological Institute of Guadalajara, Dr. José Barbarubio, that I be allowed to continue working in that small unit doing smaller surgical procedures, but the Director told me: “José, you should specialize in Plastic and Reconstructive Surgery”. My training there was excellent, but limited only to Reconstructive Surgery, not in Aesthetic Surgery. In order to receive this advanced training, I was granted a one-year fellowship in the Hospital of the University of Illinois, in Chicago, under the direction of Dr. Paul Greeley. When I returned from Chicago, Dr. José Barbarubio gave me the opportunity to create a small unit of Plastic Surgery in the Dermatological Institute of Guadalajara, in which only 3 surgical procedures were carried out per day. The Unit grew rapidly with prominent political officials being great supporters, and we engaged in providing Plastic Surgery services to many of the poor people of the area. I worked in this unit for 17 years, and in 1976 we founded the Jalisco Reconstructive Plastic Surgery Institute to attend to poor people who needed Plastic Surgery, and also created a program to train residents in Plastic Surgery. In my private practice I cared for important political officials without charging a fee for my efforts but only asked them to support the Jalisco Plastic Surgery Institute. The Institute grew progressively and we now perform 30 procedures of Plastic Surgery per day. In my practice I initially performed many procedures of Reconstructive Surgery and few cases of Aesthetic Surgery, and I am convinced that practicing Reconstructive Surgery, gave me experiences and ideas that I could apply to Aesthetic Surgery. For example, in the decade of the 60’s I did many cases with malignant tumors of the head and neck that needed a radical neck dissection. This allowed me to later develop and publish original articles in Aesthetic Surgery on maneuvering in the platysma muscle. The tongue flap came to my practice through a patient that had a severe lip deformity with lack of the vermilion. In this patient I initially planned to reconstruct the vermilion using

an abdominal tube flap. As we were preparing the last stage of the reconstruction, the patient nervously placed her tongue over the lip and I realized the close relationship between the tongue and lip mucosa. I then abandoned the tube flap plan and reconstructed the lip with a tongue flap. The result was successful and after this case we had a great experience utilizing the tongue flap in lip and palate repair. Thanks to the large volume of cases at the Institute and our burgeoning experience, we were able to conduct well controlled clinical trials, and subsequently authored and published many articles in the scientific literature, as well as five books, which achieved international success. We published our experience in the use of fat grafting, at first experimentally in rats and rabbits, and later in clinical cases of reconstructive surgery and subsequently in aesthetic cases. Because of my concern to be well prepared scientifically and practically, I have collaborated in several Plastic Surgery societies. I was President of the Mexican Association of Plastic Surgery, and then chaired the Second Ibero-Latin American Congress of Plastic Surgery. Later I was President of the International Society for Aesthetic Plastic Surgery (ISAPS) (1988 -1992), and in 1992 organized the ISAPS Biennial Congress in Guadalajara. For many years I have taught a Teaching Course on Facelift plus Fat Autografting in the Annual Congress of the American Society for Aesthetic Plastic Surgery (ASAPS). For over twenty years I have conducted an annual Congress of Aesthetic Plastic surgery, first in Guadalajara, now alternating between Guadalajara and Puerto Vallarta. The faculty has consisted of most of the world’s significant surgeons in the field of Aesthetic Surgery Perhaps the endeavor I am most proud of is the Jalisco Plastic and Reconstructive Surgery Institute, where I organized a training program in Plastic Surgery, combining Reconstructive and Aesthetic Surgery, and now have 396 graduates working in Mexico and around the world. We are a group of eight plastic surgeons who, along with the residents, perform at least thirty operations per day. We are extremely pleased with the level of education in Plastic Surgery, both reconstructive and aesthetic that we are able to provide to our residents who, upon their graduation, go into the communities in Mexico or around the world, technically and ethically well prepared to serve their patients. Issue 4

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HUMANITARIAN WORK

The Cambodian drama

Dr. Christian Echinard

ambodia is slowly emerging from a very difficult and dramatic period of its history. This smiling country, though still very poor, is becoming richer, at least in its main town and capital, Phnom Penh. However, one must never forget the terrible genocide that occurred a few decades ago. Completely hidden to the occidental world, it has totally destroyed the country, leaving it naked and bloodless. Between April 1975 and January 1979, over 2 million people were killed by the dreadful political regime of Pol Pot, the terrible “Khmer Rouges” leader. Teachers, doctors, nurses, engineers, lawyers, were assassinated in jail or in death camps, only because they had a small part of knowledge. More than one third of the population disappeared, leaving the rest of the country without science, without medical care, without any possibility to grow and develop…

considered as one of the poorest nations in the world, with no industry, no income sources, no intellectual possibilities, no real sanitary planning. This country depended only on the assistance of the international community. From the medical point of view, very few occidental nations had given them a hand until recently. There were no doctors and no nurses, and of course, no one to train new people in the health sector.

During the next decade, things were not better, due to a very complex political situation (permanent conflicts with Vietnam, the role and influence of various foreign countries, including China and the USA). Cambodia was Acid burn attack in Sihanoukville

Present-day Cambodia Cambodia is a kingdom, with a democratic government under the responsibility of the Prime Minister Hun Sen. About 16 million inhabitants live in this country, in most cases in very poor conditions, surrounded by two wealthy neighbors, Thailand in the west and Vietnam in the east. Over one half of the population still lives on less than two dollars per day.

Cleft-lip patient in the Koh-Kong province

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The public health care is organized in the four major hospitals of Phnom Penh (Hopital Calmette, Hopital Kossamak, Hopital Khmero-Sovietique, and the Pediatric Hospital) and in the few provincial hospitals. These hospitals are still rather poor and still need international support. In the main cities some private

clinics and hospitals (for the richest patients) are currently being built and their number will probably increase in the very near future. The public medical faculty is training a new generation of students. Lectures are given in French, following a European training system. A new, private, English speaking, medical school is now also teaching some of the future medical teams of the country, but all the practical medical and surgical training is done in the public hospitals in Phnom Penh. Certified plastic surgeons are not very numerous yet (eight or ten). Some of them have been trained in France or Italy during their two or three year training period, either through French-Cambodian cooperation programs, or by international NGOs like HumaniTerra. Some have had their training in Asian countries like Korea or Japan. It is now time for them to gather and create a national plastic surgery society that can be a member of IPRAS. This would give them the chance to federate and harmonize the discrepancies due to heteroclite training. It will also give them the possibility to train the very great amount of new interns and residents wishing to become plastic surgeons. At last it will give them the opportunity to participate to our international meetings and to share with us science and knowledge.

Pathologies involving the field of plastic surgery are numerous in Cambodia. Acid burns (acid attacks) are probably some of the most dreadful, and the most difficult to treat, but other burns like domestic flame burns, or hot liquid burns in children are very common. Statistics are very difficult to get due to a lack of information and data base. Congenital deformities, such as cleft lip or cleft palates, or hand deformities, are very numerous, due to consanguinity and chemicals used during many many years of war. Oncology is also important, although people do not usually reach very old age in this country. Traumatic pathology is increasing a lot in the big cities, because of the higher incidence of car and motorcycle accidents That did not happen before, when there were nearly no roads and vehicles; actually few people have an official driving license or car insurance. Until now, no real effort has been made in order to centralize and gather these pathologies in a unique top level department or hospital. HumaniTerra has signed a memorandum of understanding with the Ministry of Health, in order to create and build such a center in Phnom Penh; it will be the â&#x20AC;&#x153;National Plastic Surgery and Burn Center of Cambodiaâ&#x20AC;?.

Out patients in the Koh-Kong province

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Plastic Surgery teams in the nineties In the years 1990-95, when things were getting a little bit better in Cambodia, a few medical NGOs decided to help this dramatically destroyed land. It was purely medical help to combat malaria, tuberculosis, malnutrition, and provide primary health care and vaccinations.

Kossamak operating theatre with international staff

From 1995 to the early 2000, as many surgical cases of malformations, congenital diseases, burns and mine accidents were discovered, surgical volunteers from the richest parts of the world were sent in the country in order to operate on these difficult cases , under incredible conditions. Some teams, as Opération Sourire (Médecins Du Monde) la Chaine de l’Espoir, Operation Smile, were, at that time, performing a lot of surgical procedures in the main town, Phnom Penh, and were operating in the only proper hospital of the city, the Hopital Calmette, where the French cooperation had already set up a rather modern operating theatre. On the contrary, some other surgical NGOs, as HumaniTerra, decided to go in the poorest parts of the country, far from the main city, in places where no one could go and where no surgical care was provided at all. In Sihanoukville, the main harbor of Cambodia, and afterwards in Koh Kong, a completely isolated city in the south, close to Thailand, facing the sea, HumaniTerra has restored the operating rooms and the surgical facilities of the regional hospital. In 2000, this NGO was sending eight surgical teams per year, in plastic surgery, orthopedics, ophthalmology, gynecology and oral and maxillofacial surgery. Over 300 difficult surgical cases were treated every year in south Cambodia. Since then, the same rate of surgical camp has been performed. The aim of our work is to also train young doctors and nurses in order to give them full autonomy for medical 42

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and surgical care. Over twenty people from this part of the country have been trained in Europe by our NGOs between 1996 and 2008. In southern Cambodia, in the province of Koh Kong, people are so poor that they don’t have any money to reach the closest hospital. If they are admitted at the hospital they have no money to pay for the medical expenses. If they can pay for them, they have no more money to feed their family. This is a real problem. In order to operate on them and give them a better life, we also have to feed their families and to pay for the travel expenses to the hospital. This type of humanitarian surgery can be called a “humanitarian surgical aid of close proximity”, because our teams are prospecting in every village, visiting people in their own house. Our surgeons and nurses really go to meet the patients were they live, by car or by small boats, and bring them back to the regional hospital for surgical care. About 80 surgical teams altogether have been working there during 12 years, helping the local doctors to restore the health care system, treating difficult cases, and teaching the medical staff.

In Phnom Penh, the national centre for plastic and burn surgery The activity of our teams in the capital of Cambodia began a little later, more or less in connection with the teams of “opération sourire, MDM”, and was very much related to the medical and surgical annual national meeting in November. Lectures were regularly given there and operations were performed in the main hospital.

Official ceremony with Cambodian authorities in March 2011

In 2008, HumaniTerra signed a proposal with the Ministry of Health for a new, modern department for plastic surgery, built by the international community, given to the Cambodian people, under the co-responsibility of a Cambodian and an international team for the first years of its operation. This “Centre National de Chirurgie Plastique et de Grands Brulés” will be open to any plastic surgery team willing to cooperate. Teams of “ESPRASSHARE” and “IPRAS-HUGS” will participate in this

Students and professors in March 2011

new adventure and bring their knowledge and science to our Cambodian colleagues. On March 7th, 2011, the launching of this operation was done in Phnom Penh, with the French ambassador in Cambodia, the vice-minister of health and several other ministers, some representatives of the first financial partners (Veolia, Lâ&#x20AC;&#x2122;Oreal, and Solucom) and several other local medical authorities. During this ceremony, we stressed the fact that acute burn care should be done as early as possible, in good conditions, thus avoiding, if possible, the awful, so frequent, disfigurations and the horrible burn contractures. It was also mentioned that public plastic surgery in Cambodia should be centralized in a top quality, specialized center depending on the Cambodian Ministry of Health. It was explained to them that IPRAS could give them a hand with its numerous surgeons and the permanent possibility to cooperate and to participate to international meetings. This specific department will consist of a plastic

reconstructive surgery unit, an acute burn center, a burn rehabilitation center, an outpatient unit, and a section for teaching, research and database. This will be built in the enclosure of the second hospital of the town, Hospital Preah Kossamak. The opening should be in 2013. Prior to this, a series of teaching courses and lectures will be given, at the University and in the Hospital Kossamak, by our teams, in order to prepare the future local medical staff. Ten series of lectures are organized every year, each one lasting 10 to 12 days. Operations and in situ surgical training will be performed at the same time in the hospital. During the first three stages, in March and April 2011, the number of students has been increasing every day, and it is their wish and will to participate more and more. It is also our task and duty to help them to organize the â&#x20AC;&#x153;National Cambodian Society of Plastic, Reconstructive and Aesthetic surgeryâ&#x20AC;?, under the auspices of IPRAS. Marita Eisenmann Klein, our General Secretary, has already promised to come and sponsor them. Christian Echinard President, HumaniTerra. Chairman, ESPRAS/SHARE Co-chairman, IPRAS/HUGS. Chairman, IPRAS FORCE

Preah Kossamak Hospital

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5th Women for Women Humanitarian Mission in Nairobi, Kenya, October 2010 Dr. Vanessa Brebant

Where it took place

Our mission

Women for Women is a charity program supported by female plastic surgeons, whose goal is to help women suffering from disfiguring or socially excluding injuries and trauma.

his was the ﬁrst Women for Women Camp in Africa. The Republic of Kenya, a country in East Africa, has a population of 39 Million inhabitants. Seventy-ﬁve percent of Kenyans are under 30. Most of them are bilingual in English and Swahili. Nairobi, the capital city of Kenya, is the most populous city of East Africa, with a current population of 3 million. We were able to use the infrastructure of the Kenyatta National Hospital; it is a national referral and teaching hospital and has a bed capacity of 1800.

This enables such women to continue to lead happy and prosperous lives, despite the injuries and trauma they have suffered in the past. The patients we treated in Nairobi did not have any insurance coverage. We were able to operate on a selection of women who have fallen victim to domestic violence. One of our female patients with extended burn scar contracture in the face and both hands told us that her husband set her on fire because of jealousy. These victims live in the slums of Nairobi, they have nearly no access to surgical treatment with early debridement. If they survive the infection, they develop massive scar contracture. Surgery was performed at the Kenyatta National Hospital. Their surgical infrastructure, staff and equipment are excellent and each patient can stay in a recovery room with monitoring after surgery. The team of anesthetists as well as the nursing team were very well trained and excited about our work and it was pleasing

Among others Prof. Marita Eisenmann-Klein, Dr. Debra Reilly, Dr. Vanessa Brebant

Our team The mission was set up in cooperation with the Kenyan National Society of Plastic Surgery. Our local colleague and Plastic Surgeon, Loise Kahoro, preselected patients with burn sequels and no financial resources. Christian Echinard, President of the ESPRAS SHARE (Surgeon’s Humanitarian Aid Resource Europe) and co-founder of HumaniTerra, has a long-standing experience of humanitarian work and helped us in the planning and realization of the mission. The Women for Women Team consisted of Marita EisenmannKlein (General Secretary of the IPRAS and founder of the Women for Women program), Debra Ann Reilly (founding member of the Women for Women program, Plastic Surgeon in Nebraska) and Vanessa Brebant (Consultant in the Department of Plastic Surgery in Regensburg, Germany) 44

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Patient with Burn injuries

and motivating to operate with them. Loise Kahoro was present during the whole mission and was in charge of the postoperative treatment of our patients. IPRAS Women for Women refunded the hospital for the expenses of these patients. The Kenyan Society for Plastic Surgery asked Women for Women to come back to Nairobi every year in order to pursue our mission. Vanessa Brebant Plastic and Aesthetic surgeon, Consultant, Caritas Hospital St. Josef, Regensburg, Germany

Healing touch for burns patients “Women for Women” programme of IPRAS proves to be a boon for them Special Correspondent VIJAYAWADA: Life became a “living hell” for Niharika (name changed) after she attempted suicide by self-immolation. For her mother who had to feed, bathe and tend to her continuously, it became an intolerable task. Burn scar contractures on her lip, neck and arms had made her life unliveable. Burn scar contracture refers to the tightening of the skin after second or third degree burns. When the skin is burned, the surrounding skin pulls together and contracts. If not treated as soon as possible, the scar results in restriction of movement around the injured area. The chin becomes attached to the chest, and the arms and fingers lose their mobility. Bad burn scar contractures do not heal by themselves and such patients require skin grafting.

Niharika, who had a very bad case of neck contracture, was operated on for the second time by Dr. Pusic, who said that, in the future, her dependency on her mother would be greatly reduced. As there were no cases of women suffering burns due to violence and suicide attempts in the West, their heart really went out to such women, said the three plastic surgeons, who took time off from their schedules to come here and perform the operations free of charge. “It is very difficult to do these procedures alone. But as a team it was easier and the risk for the patient was also considerably lower” said Dr. Hazen.

“From teams”

In a message to other women plastic surgeons in the country, the IPRAS Women for Women program members said that they should Photo of Hindu Article form into teams and perform the operations to reduce the drudgery. Deliverance came to Niharika in the form of the women plastic surgeons of the International Confederation for Devika (name changed), a victim of domestic violence, Plastic Reconstructive and Aesthetic Surgery (IPRAS) is yet another patient to whose rescue the IPRAS plastic “Women for Women” program. surgeons came. Burn scar contracture on her hand was operated upon by them and she was able to find New York-based plastic surgeon Andrea Pusic was in employment in a factory. Her hand was burnt when she the city for the second time to work with a team of other tried to protect her face from the hot “rasam” that her plastic surgeons at Salaja Hospital here. Dr. Pusic, fellow ex-husband threw on her face. New York-based surgeon Alexes Hazen, Canadian

surgeon Nancy Van Laeken, city-based cosmetic and plastic surgeons Lakshmi and her husband Saleem performed 70 procedures on 26 patients since they arrived here a couple of days ago, at a free surgery camp.

The visiting plastic surgeons lauded the service being rendered to the poor by the Salaja Hospitals and the high standards that were being maintained in it. Article of the Hindu Issue 4

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BIOGRAPHIES

Ali Nihat Ulgen, President of the Society of Plastic, Reconstructive and Aesthetic Surgeons of Northern Cyprus

n 1948, I entered the Medical School of the University of Istanbul, whose teaching cadres in that era were comprised of prominent German Jewish scientists who had fled the Nazi Germany before the war and had found refuge in Turkey. In 1956, I began to work as an Assistant at the Department of General Surgery of Cerrahpasa Hospital of the Istanbul University, where the German surgeon Prof. Rudolf Nissen had worked for a long time. In 1960, I completed my residency as a General Surgeon and went to United Kingdom. I worked in various Plastic and Maxillofacial Surgery Units of both England and Scotland as Registrar. After having been specialized in Plastic and Reconstructive Surgery, Burns, Maxillofacial and Hand Surgery, I returned to Turkey and received my Plastic Surgery diploma in 1966. I began to work in the Department of Plastic Surgery of the Cerrahpasa Medical School (of Istanbul University), which had just been founded. In 1971, I became Associate Professor, and in 1978, Professor. The last 15 years of my career were devoted to the research and practice on Craniofacial Surgery. In 1982, after the Craniofacial Surgery Symposium in Rome, I established the necessary discipline required by this field in my Department. Some of our research was published in the PRS and European Journal of Plastic Surgery. A new syndrome that we named as 46

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“Craniorhiny” got published in PRS in 1991 (Plastic and Reconstructive Surgery, 88:699-702). Until the year I retired (1997), my last name was “Mindikoglu” . Around 150 publications of mine carry this last name. Selected publications of mine on Craniofacial Surgery can be listed as follows: - Surgical treatment of exophthalmos which was caused craniofacial malformations. First Hellenic-Turkish Joint Meeting for Plast.Reconstr.Surg., Abstract, p.17, 22-24 Sept. 1998, Athens. - Surgical treatment of an extensive basal cell carcinoma of the scalp infiltrating the superior sagittal sinus. Eur. J. Plast. Surg. P.50-52, 1995. - Total and subtotal petrosectomi : 30 Cases. Turkish J. Plast.Reconstr.Aesth.Surg., 5:69-77,1997. After my retirement, I regarded it as my duty to contribute to the advance of Plastic Surgery in Northern Cyprus, the birthplace of my mother and father. The Northern Cyprus Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons, founded in 2001, is consistently growing and now has 23 members. We applied to IPRAS for the first time in 2002. After years of arduous struggles, we are finally proud to be a part of IPRAS as a Regional Association. Our 9th National Congress will take place in Girne of Northern Cyprus between July 14th and 18th 2011.

WORLD HEALTH ORGANIZATION

www.who.int/patientsafety

No 6, January 2011

WHO Patient Safety Newsletter

In this edition: How patient safety improvements can help achieve Millennium Development Goals Editorial by Sir Liam Donaldson Can improving health-care safety help us reach MDGs? It is unacceptable that health care kills and harms. WHO Patient Safety delivers tools and support to aid and advance achievement of the new Global Strategy for Women and Children's Health.

Feature by guest writer Carla AbouZahr Integrating safety in Millennium Development Goals Integrating safety into care for women and children must be a core component of renewed efforts to attain the health-related MDGs.

News in brief SAVE LIVES: Clean Your Hands 5 May 2011 campaign This year's global annual hand hygiene campaign SAVE LIVES: Clean Your Hands is focused on knowing where your health-care facility stands on hand hygiene sustainability.

New online research courses in French

Patients for Patient Safety

In January 2011, the WHO Patient

A patient-held tool for mothers The Patients for Patient Safety team is creating a patient-held safety tool that will help increase safety for mothers and their newborn babies during the first seven days after birth, considered a high-risk period.

Safety Research team launched the French version of free online courses to introduce the basic elements of patient safety research.

African Partnerships for Patient Safety

APPS: A powerful catalyst to address MDGs Through a new approach and by addressing patient safety issues in innovative ways, the African Partnerships for Patient Safety Programme is a powerful catalyst for addressing MDGs within the African Region.

Research and Knowledge Management

Understanding safety in surgical robotics The SAFROS Project works at understanding patient safety in robotic surgery through the development of technologies and procedures to assist surgeons.

Understanding problems and building capacity are key

Recent WHO Patient Safety News Alerts

Understanding the nature of unsafe care in low- and middle-income countries and building capacity at the local level are key steps towards achieving MDGs.

Health care-associated infections Surgical Safety Checklist

Checklists

Updates

Safe Childbirth Checklist: a tool to help achieve MDGs The Safe Childbirth Checklist aims to help frontline health workers prevent avoidable childbirth-related deaths and illnesses. Developed by WHO Patient Safety and international experts in maternalnewborn health, it is currently being pilot tested in Karnataka, India.

Articles Events

www.who.int/patientsafety

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PROCEDURES AND SAFETY Dear colleagues, On January 26, 2011 the American Health Authorities have released a safety signal on Anaplastic Large Cell Lymphoma (ALCL) in women with breast implants. Our colleagues in the American Society of Plastic Surgeons, chaired by their President Phillip Haeck, are working closely with the FDA to evaluate this issue further. Although the number of patients who developed the disease is extremely small (34 identified cases out of an estimated number of 5 to 10 million women with breast implants), we should inform our patients and follow the recommendations of the FDA closely:

Recommended Actions for Health Care Providers and Patients Health Care Providers: If you have patients with breast implants, you should continue to provide them routine care and support. ALCL is a very rare condition; when it occurs, it has been identified most frequently in patients undergoing implant revision operations for late onset, persistent seroma. Because it has generally only been identified in patients with late onset of symptoms such as pain, lumps, swelling, or asymmetry, prophylactic breast implant removal in patients without symptoms or other abnormality is not recommended. Current recommendations include the steps below. As the FDA learns more about ALCL in patients with breast implants, these recommendations may change. • Consider the possibility of ALCL when you have a patient with late onset, persistent peri-implant seroma. In some cases, patients presented with capsular contracture or masses adjacent to the breast implant. If you have a patient with suspected ALCL, refer her to an appropriate specialist for evaluation. When testing for ALCL, collect fresh seroma fluid and representative portions of the capsule and send for pathology tests to rule out ALCL. Diagnostic evaluation should include cytological evaluation of seroma fluid with Wright Giemsa stained smears and cell block immunohistochemistry testing for cluster of differentiation (CD) and Anaplastic Lymphoma Kinase (ALK) markers. • Report all confirmed cases of ALCL in women with breast implants to the FDA. Link to how to report In some cases, the FDA may contact you for additional information. The FDA will keep the identities of the reporter and the patient confidential. • Develop an individualized treatment plan in coordination with the patient’s multi-disciplinary care team. Because of the small number of cases worldwide and variety of available treatment options, there is no single defined consensus treatment regimen. 48

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Patients: If you have breast implants, there is no need to change your routine medical care and follow-up. ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants. Although not specific to ALCL, you should follow standard medical recommendations including:

• Monitoring your breast implants. If you notice any changes, contact your health care provider

promptly to schedule an appointment. For more information on self breast exams, visit Medline Plus: Breast Self Exam. • Getting routine mammography screening. • If you have silicone gel-filled breast implants, getting periodic magnetic resonance imaging (MRI) to detect ruptures as recommended by your health care provider. The FDA-approved product labeling for silicone gel-ﬁlled breast implants states that the ﬁrst MRI should occur three years after implant surgery and every two years thereafter. If you do not currently have breast implants but are considering breast implant surgery, discuss the risks and benefits with your health care provider. You may also visit FDA’s Breast Implants website for additional information. Please inform us if one of your patients develops ALCL or will develop in the future. Please send the information to us first in order to avoid double reporting. We are going to forward your information to ASPS and FDA accordingly. Please do not hesitate to approach us if you have questions or if you need our support. For sure there is no reason to get into a panic but we need to be proactive and inform our patients and the media in a well balanced fashion. Sincerely yours Marita Eisenmann-Klein IPRAS General Secretary Zacharias Kaplanidis IPRAS Executive Director Please visit www.ipras.org in order to download the following: -American Society of Plastic Surgeons to MOU Partners, letter Phillip C. Haeck, President ASPS, Statement Philipp Haeck, “FDA to issue safety signal on ALCL & breast implants” -Plastic Surgery News, Special Bulletin, January 26, 2011 -FDA Medical Device Safety Communication: Report of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants (Clean Version) -Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants:”Preliminary FDA Findings and Analyses” (White Paper Clean Version)

IPRAS WEBSITE

www.ipras.org

JOIN YOUR COLLEAGUES The first website that gives you the opportunity to upload your scientific profile for free!!

Now it is very simple to upload your scientific profile and gain the benefits of being under the IPRAS umbrella. Try it…!! Sign up on www.ipras.org and follow the following steps: 1. Create an account by clicking “Member’s login” on the top right-hand corner and then select the “Create new account” tab. 2. Fill out your “Username”, “Email” and “Password”, as required. 3. Select the option “Doctor” and your country, under the section “If you are a doctor, complete the following”. 4. Once all account details have been added, click on “Create new account” button. Then you click on “EDIT” and then on “DOCTOR PROFILE”. This is the section where all the information of your scientific profile can be uploaded. You may complete the fields with the information that you prefer such us: Personal Picture, Hospital Position, Affiliation, Special Field of Interest, Contact Details, Memberships, Topics of Special Interest, Publications etc. At the “EDIT” section you may proceed to the appropriate corrections at your account such us to change your password or to update personal information. When you complete the aforementioned steps there will be one last step remaining for your details to be uploaded on the IPRAS website. The application must be approved by the National Association you are a member. The application will

be sent at the Association of the country that you have declared, ensuring that only IPRAS members of good standing and high ethical principles are able to upload their personal details. As soon as your Association verifies you as a member, your profile will automatically be uploaded at the website’s, “Find a doctor” option in the “Members”section. It is also up to you to decide whether your profile will be classified as “private” or visible to all visitors of the IPRAS webpage. Our aim, besides facilitating communication among colleagues, expands to allowing patients to verify the good standing and high ethical principles of the doctors’ profiles hosted, allowing them to choose qualified IPRAS members for needed procedures. In conclusion, I want to emphasize the usefulness of the IPRAS website FORUM. A section you will gain access to, as soon as your profile has been accepted and uploaded. Only verified plastic surgeons can use it and read its contents. Therefore, you will have the opportunity to exchange ideas, news regarding plastic surgery techniques, news from your National Association, alerts and all other information you would like to share with your peers. Don’t miss the opportunity to make the IPRAS website twice as useful to you! If you face any difficulties please do not hesitate to contact me at: maria.petsa@iprasmanagement. com . Always at your disposal! Maria Petsa IPRAS Assistant Executive Director

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IPRAS Journal

UP - COMING CONFERENCES

Preliminary Program Topics Preventive, Regenerative and Anti-Aging Medicine Non-Invasive facial Rejuvenation

• Bioengineering • Stem Cell Research • Composite Tissue Transplantation • Innovations - Materials & Devices • Wound Healing & Wound Management • Congenital Anomalies • Hand Surgery • Burns • Pediatric Plastic Surgery • Innovations in Microsurgery • Management of Malignant tumors and post Oncologic Reconstruction • Trauma Management & Reconstruction • Breast Aesthetic & Reconstructive Surgery • Liability Issues and Malpractice • Fat Graft Workshop • Aesthetic Surgery • Body Contouring • Set up of a Successful Plastic Surgery Practice • Optimizing Internet Representation

• • • • • • • • • • • • • • • • • • •

Biotechnology and Human Aging Biology and Genetics of Age Related Skin Disorders Glycation and Aging of the Cardiovascular System Human Myoblasts in Regeneration of Post - Infarction heart Common Ageing Associated Bone & Joint Diseases and their Treatment Brains & Skin Aging: A Common Molecular approach? Ageing of Immune System Macula Degeneration - a Progressive, Ageing Associated Ocular Disease New Frontiers in the Management of Chronic Disease Prevention and Treatment of Prostate Cancer Prevention and Treatment of Kidney Stones Testosterone and PDE5 Inhibitors in the Aging Male The Dialectic Role of Hormones in the Prevention and Female Health New Cosmetic Approaches for the Ageing Skin Elastic Fibres , Skin Scarring and Phytocosmetology Can Aging be delayed? Lessons from Centenarians IPRAS / ESAAM cooperation: A Futuristic picture of Preventive, Regenerative and Anti-Aging Medicine Holistic Medicine.

Presidents of the congress:

Presidents of the Supporting Societies:

Marita Eisenmann-Klein, General Secretary IPRAS Yi Lin Cao, Congress President President of the Chinese Association of Plastics & Aesthetics Andreas Yiacoumettis, President ESPRAS

Haeck Phillip, US (President of the American Society of Plastic Surgeons) Sebastiγo Nelson Edy Guerra, Brazil (President of the Brazilian Society of Plastic Surgeons) Poell Jan, Switzerland (President of the International Society of Aesthetic Plastic Surgery) Zouboulis Christos, Germany/Greece (President of the European Society of Anti-Aging Medicine) Kontoes Paraskevas, Greece (President of the European Society of Laser Aesthetic Surgery)

IPRAS Journal

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Organizing Committee & Scientific Committee Chinese Scientific Committee & Faculty Chairman of Scientific Program Committee: Lan Mu M. D. Secretary: Nanping Chen Yilin Cao Shuzhong Guo Zuoliang Qi Lai Gui Jianhua Gao Wei Liu Xia Wang Yuxin Wang Jinlong Ning Qun Qiao Jianning Li Chuanxun Yi

Huiqing Jiang Qingfeng Li Xin Xing Shirong Li Lancheng Zhang Senkai Li Nian Wu Zhenmin Zhao Yangqun Li Qiang Li Ningbei Yin Zhiyong Zhang

Jiaqi Wang Mingyong Yang Qingguo Zhang Guie Ma Li Teng Yuanbo Liu Haiyue Jiang Jie Luan Fei Fan Jincai Fan Jinglong Cai Ran Xiao Lan Mu

International Organizing committee: Chairman: Yiacoumettis Andreas, Greece Co-Chairman: Pallua Norbert, Germany Cerkes Nazim, Turkey Colic Miodrag, Serbia Echinard Christian,France Elberg Jens-Jorgen, Denmark Enescu Dan, Romania Fedeles Jozef, Slovakia Filho, Pericles, Brazil Guerra Sebastiao, Brazil Haeck Philipp, US Kaplanidis Zacharias, Greece Kim Suk Wah, Korea

Kontoes Paraskevas, Greece Le Louarn Claude, France Mazzola Riccardo, Italy Mugea Toma,Romania Neuhann-Lorenz Constance, Germany Palmos Petros, Greece Piccolo Nelson, Brazil Poell Jan, Switzerland Scharnagl Erwin, Austria Takayanagi Susumu, Japan Uebel Carlos, Brazil Yianu Dana, Romania

Chinese Organizing Committee Congress Chairman: Yilin Cao M.D. Honor Chairman: Disheng Zhang M.D. Yilin Cao Jianguo Wang Nian Wu Weiping Zhao Zhenmin Zhao Nanping Chen Meng Li Xia Hong Wei Liu Changsheng Lv

Hong Hu Danni Li Lu Xu Ping Wang Bo Cui Hong Huang Baoxiu Ma Kang aGao Zhigang Bi Xiaoming He

International Scientiﬁc Committee: Chairman Marchac Daniel, France Banic Andrej, Switzerland

Molea Guido, Italy

Brody Garry, US

Ninkovic Milomir, Germany

Chung Kevin, US

Noureldin Ahmed, Egypt

Coleman Sydney, US

Park Choul, Korea

De May Albert, Belgium

Rigotti Gino, Italy

Evans Gregory, US

Saldanha Osvaldo, Brazil

Ferreira Lydia, Brazil

Tariki Josι, Brazil

Gόrsu Gόler, Turkey

Vogt Peter, Germany

Kinney Brian, US

Yoshimura Kotaro, Japan

Magalon Guy, France

Zouboulis Christos, Germany/Greece

Mandrekas Apostolos, Greece

www.china-europe2011.com

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IPRAS Journal

Canadian Society of Plastic Surgeons (CSPS) appreciative of the opportunity we have been given and of the assistance we have received.

Dear Colleagues and Friends: Welcome! Welcome! Welcome! The Organizing Committee for IPRAS 2011 Vancouver is joined by the Canadian Society of Plastic Surgeons in extending a warm Canadian welcome to the world of Plastic and Reconstructive surgery. We have tried our absolute best to provide you with an amazing venue, a stimulating scientific program, easy access to the best of the best in our field, as well as, fun filled events. We are honored that you have come to Vancouver and hope you will take away life long positive memories of this fabulous city and Canadian hospitality. After six years of discussions, negotiations and planning, we are finally here. We sincerely thank all those people who have contributed to this wonderful project – our Scientific Program Committee, the unwavering support of our Canadian Society and the Plastic and Reconstructive Surgeons of Canada, as well as the leadership and staff of IPRAS. This is a true team effort and we are sincerely

Welcome to Vancouver! Enjoy nature’s wonders and devour the amazing advances of our specialty. Become inspired! We hope you will return home with new ideas, refreshed enthusiasm and a reborn dedication to do the best possible for your patients, who have placed their trust in you. Canada is a proud yet humble nation. We stand united in welcoming our world colleagues in our eagerness to share our accomplishments and discoveries and in our genuine desire to make this conference a success for everyone. 250 faculty from 40 countries with over 1000 abstracts submitted, 450 podium presentations, over 500 e-posters, 5 major keynote and almost 80 mini-keynote lectures, over 25 panels and 50 master classes so we are extremely confident that this will be a great meeting!!

Ronald M. Zuker, MD, FRCSC Chair, IPRAS 2011 Vancouver

IPRAS Journal

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Donald H. Lalonde, MD, FRCSC Chair, Organizing Committee IPRAS 2011 Vancouver

Jean-Paul Bossé, MD, FRCSC Honorary Chair IPRAS 2011 Vancouver

IPRAS 2011 VANCOUVER Conﬁrmed Faculty (as of March 2011)

ARGENTINA Claudio Angrigiani Aldo Mottura AUSTRALIA Gerard Bayley Peter Callan Niamh Corduff Daniel Kennedy Warren Rozen Howard Webster AUSTRIA Manfred Frey Helmut Hoﬂehner Peter Kompatscher Christian Papp Gerhard Pierer Erwin Scharnagl Anton Schwabegger BELGIUM Phillip Blondeel Paul Guelinckx Moustapha Hamdi Stan Mostrey Nathalie Roche Koen VanLanduyt Paul Wylock BRAZIL Marcus Castro Ferreira Ewaldo DeSouza Pinto Patricia Erazo Paulo Leal Sebastiao Nelson Salustiano Pessoa Nelson Piccolo Péricles Seraﬁm José Tariki CANADA Dimitri Anastakis Oleh Antonyshyn James Bain Tom Bell Trevor Born Patricia Bortoluzzi Erin Brown Mitchell Brown Edward Buchel Kevin Bush Louise Caouette-Laberge Wayne Carman Nicholas Carr Howard Clarke Douglas Courtemanche David Fisher Christopher Forrest Bing Siang Gan Nick Guay Betsy Hall-Findlay Patrick Harris

Tom Hayakawa Stefan Hofer David Jewer Leila Kasrai Donald Lalonde Peter Lennox Lucie Lessard Joan Lipa Frank Lista James Mahoney Damir Matic Michael Morhart Steven Morris Kenneth Murray Melinda Musgrave Peter Neligan James O’Brien Justin Paletz Gloria Rockwell Douglas Ross John Semple Claire Temple Achilleas Thoma Edward Tredget Nancy VanLaeken Cynthia Verchere Richard Warren Gordon Wilkes Bruce Williams Scott Williamson Kenneth Wilson Ronald Zuker CHINA Yilin Cao Shuzhong Guo Xiaoxi Lin Yuanbo Liu Jie Luan Shengkang Luo Maolin Tang Xing Xin Ru-Hong Zhang Yixin Zhang COLOMBIA Manuela Berrocal EGYPT Ahmed Adel Noreldin Mohamed Sobhi Zaki FINLAND Sinikka Suominen FRANCE Éric Arnaud Fred Kolb Daniel Labbé Laurent Lantieri Daniel Marchac GERMANY Marita Eisenmann-Klein

Gunter Germann Milomir Nincovic Dirk Richter Michael Sauerbier GREECE Apostolos Mandrekas Andreas Yiacoumettis INDIA Rajeev Ahuja Rakesh Khazanchi Mathangi Ramakrishnan Gosla Reddy Raja Sabapathy Arun Kumar Singh INDONESIA Teddy Prasetyono IRELAND Michael Early ISRAEL Aharon Amir Eyal Gur ITALY Cristina Garusi Miahcel Masellis Riccardo Mazzola Gino Rigotti JAPAN Hidekazu Fukamizu Hiroshi Furukawa Ichiro Hashimoto Masao Kakibushi Katsuhico Kashiwa Katsuya Kawai Kyoichi Matsuzaki Shintaro Matsuura Takashi Nakatsuka Yuzaburo Namba Rei Ogawa Hideaki Rikimaru Hiroyuki Sakurai Hideaki Sato Kenichi Shimada Katsuhico Takushima Katsumi Tanaka Takatoshi Yotsuyanagi KOREA Jong Woo Choi Jeong-Tae Kim Kyung Suck Koh Yoon Hoo Lee Chul Park

LIBYA Mustafa Zaidi

UNITED KINGDOM Jonathon Britto David Evans Donald Sammut Brian Sommerlad TC Teo

MALAYSIA Sukari Halim MEXICO Fernando Molina Eric Santamaria NETHERLANDS Marc Mureau OMAN C Thomas PERU Julio Daniel Kirschbaum SAUDI ARABIA Manaf AlAzzawi SINGAPORE Colin Song SOUTH AFRICA Anil Madaree SPAIN J. Enriquez deSalamanca Jaume Masia SWEDEN Håkan Brorson Per Heden Sven-Olof Wikström SWITZERLAND William Gunn Daniel Kalbermatten Dirk Schaefer TAIWAN Hung Chi Chen Chung-Sheng Lai Lee-Wei Chen Philip Chen Yu-Ray Chen Ming-Huei Cheng David Chuang Chung-Sheng Lai Chih-Hung Lin Jean-Yin Lin Sin Daw Lin Lun-Jou Lo Jeff (TB) Sun Fu Chan Wei Jung Wu Jiu-Yung Yang

KYRGYZSTAN Musa Mateev

TURKEY Nazim Cerkes Reha Yavuzer

LEBANON Bishara Atiyeh

URUGUAY Gonzale Fossati

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UNITED STATES Amy Alderman Al Aly Elisabeth Beahm Thomas Biggs Brian Boyd Garry Brody Charles Butler David Chang Kevin Chung Sydney Coleman Richard D’Amico Greg Evans Jeffrey Friedrich Bryan Gamble Larry Gottlieb Joe Gruss Geoff Gurtner Bahman Guyuron Phil Haeck Geoff Hallock Richard Hopper Ian Jackson Jeff Janis Glen Jelks Glyn Jones Carolyn Kerrigan Roger Khouri Brian Kinney Matt Klein William Kuzon Scott Levin Bill Magee Samir Mardini David Mathes Mike McGuire Tom Mustoe Mike Neumeister Barry Noone Malcolm Paul Julian Pribaz Lee Pu Andrea Pusic Debra Ann Reilly Peter Rubin Hakim Said Michel Saint-Cyr Kenneth Salyer Maria Siemionow David Song Aldona Spiegel Stephen Sullivan Helena Taylor Nicholas Vedder Robert Walton Steve Warren Peirong Yu

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Congress Organizer

Dear Friends and Colleagues, The 14th Annual Congress of the European Society for Laser Aesthetic Surgery (ESLAS) that will be held in Mykonos, Greece on 5th and 6th of June in Saint John Hotel will present an interesting scientiﬁc program with new techniques and highlights regarding Lasers in Aesthetic Surgery.

Convened by

In order to organize a successful meeting and define the main scientific topics we will need your active participation. Your personal experience and your knowledge will help us to accomplish our goals regarding laser technologies in the various fields of Aesthetic Surgery and Medicine. ESLAS has been organising successful meetings for the past 13 years and our aim is that the 14th Annual Congress will follow this strong tradition.

Supported by

So seize the opportunity and participate in the 14th ESLAS congress. Mykonos is a great venue and will generously offer the best location for excellent and expert medisoscientiﬁc content, a diverse and entertaining social programme, and a excellent opportunity to meet new friends and cement old friendships, all in a friendly atmosphere. We are looking forward to welcome you in Mykonos!

HELLENIC SOCIETY OF PLASTIC RECONSTUCTIVE & AESTHETIC SURGERY HE.S.P.R.A.S.

Sincerely, Paraskevas Kontoes, MD PhD Plastic Surgeon President ESLAS Athens-Greece When: June 5th - 6th 2011 Where: Mykonos, Greece Congress Venue: Saint John Hotel

Congress Secretariat

Mrs. Maria Petsa ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116 E: maria.petsa@zita-congress.gr www.zita-congress.gr

IPRAS Journal

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Issue 4

• Laser Biophysics • Laser Safety • Patient administration and patient selection for laser treatments • Lasers in Aesthetic Surgery • Lasers in Epilation, vascular and pigmented lesions • Lasers in combination with conventional Aesthetic Plastic Surgery • Adjuvant techniques in Aesthetic Plastic Surgery • Lasers in Dermatology • Lasers in combination with injectables • How to avoid and treat complications in Laser applications

Join us to this important meeting.

At a Glance

Scientific Topics

• What is new in Lasers • New technologies and laser treatments

Important Date

April 25th, 2011 Abstract Submission Deadline April 30th, 2011 Last Day for Early Registration

• Photodynamic Therapy (PDT) • The role of the phototherapy in Aesthetic Surgery • How to built and integrate a laser practice

www.aapras2011.com

Congress Organizer

Congress Co-Organizer

Deadline for abstracts submission: April 15th, 2011

At a Glance

Abstracts should be submitted online or via e-mail at abstracts@aapras2011.com All abstracts must have an indication on the right top corner according to the scientific topics indication list which is at the official web page here. Abstract Guidelines Authors are kindly requested to adhere to the following guidelines: 1. The abstract must be written in English.

When: 28-30 of June 2011 Where: Yerevan, Armenia

Congress Venue: Yerevan State Medical University

2. The presenting author’s name should be first.

Under the endorsement of

3. Refer to authors’ name according to institution with an asterisk. e.g. Name A. Surname*, Name B. Surname**, Name C. Surname* * Institution A ** Institution B Do not use superscripts.

Important Date June 24th, 2011 Last Day for Late Registration

4. The title of the article should be written in capitals, be concise and contain the main contents of the abstract. 5. The allowed maximum characters are 2500 (about 250-300 words). Do not include any blank lines, and do not give subheadings in the text. Do not include tables or figures. Do not underline, italicize or embolden any word.

Organizing Committee

Media sponsors

Set Kazaryan, Chairman Zacharias Kaplanidis, Co-Chairman Ara Nazaryan Argine Azatyan Arthur Arutunian Hrachya Arshakyan Lilit Nersisyan Lilit Sakoyan Termine Asatryan Tatevik Babayan Alina Karapetyan Gevorg Aloyan

Scientiﬁc Topics • Face • Rhinoplasty • Breast

Scientific Committee

• Body Contouring

Gevorg V. Yaghjyan, Congress President

Iva Kuzanov Marlen Sulamanidze

• Reconstruction / Microsurgery

Armen R. Hovhanesyan, Scientific Committee Chairman

Russia Arnold Adamyan Alexei Borovikov Igor Reshetov Nikolay Milanov Ruben Adamyan

• Hand / Peripheral Nerve Surgery

Marita Eisenmann Klein Andreas Yiacoumettis Scientific Committee Co-Chairmen Armenia Artavazd B. Sahakyan Gagik G. Stambultsyan Garegin Babloyan Karen Danielyan Leon A. Torosyan France Daniel Marchac, Georgia

• Tissue Engineering • Burns

To Be Confirmed Kamal-Seyed Forootan, Iran Murad Jaravov, Uzbekistan Phil Haeck, USA Suk Wha Kim, Korea Vasiliy Hrapach, Ukraine Yilin Cao, China

Issue 4

• Skin Tumors / Melanoma • Plastic Surgery Training • Innovation in Plastic Surgery • Satellite symposium in Dermatocosmetology

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IPRAS Journal

Invited Faculty www.aapras2011.com Aiach Gilbert, France Antohi Nicolae, Romania Ariyan Stepan, USA Atiyeh Bishara, Lebanon Badran Hassan, Egypt Banic Andrej, Switzerland Baudet Jacques, France Bey Eric, France Binder Jean-Philippe, France Cao Yi Lin, China Cariou Jean Luc, France Cerkes Nazim, Turkey Colic Miodrag, Serbia Constantian Mark, USA Costa Horacio, Costagliola Michel, France

Delay Emmanuel, France Demey Albert, Belgium Eadie Patricia, Ireland Echinard Christian, France Eisenmann-Klein Marita, Germany Enescu Dan, Romania Evstatiev Dimitre, Bulgaria Ferreira Lydia Massako, Brazil Filho Pericles, Brazil Foyatier Jean Luc, France Haeck Phil, USA Khoo Chris, UK Khouri Roger, USA Kim Suk Wha, Korea Knoll Bianca, USA Kompatscher Peter, Austria

Kotikian Armond, USA LabbĂŠ Daniel, France Lantieri Laurent, France Lascar Ioan, Romania Le Louarn Claude, France Malcolm Paul, USA Marchac Daniel, France Milanov Nikolai, Russia Mitz Vladimir, France Molea Guido, Italy Nour El-Din Ahmed Adel, Egypt Outi Kaarela, Finland Park Chul, Korea Park David, Korea Pascal Jean Claude, France Persing John, USA

Piccolo Nelson, Brazil Rimdeika Rytis, Lithuania Saldanha Osvaldo, Brazil Scharnagl Erwin, Austria Schoofs Michel, France Scuderi Nicolo, Italy Servant Jean-Marie, France Sherman Randy, USA Stricker Michel, France Suominen Sinikka, Finland Vinzenz Kurt, Austria Yiacoumettis Andreas, Greece Zaky Mohamed Sobhi, Egypt Zic Rado Zins James, USA

Preliminary Program

June 28th, 2011 08.30-10.00: Registrations 10.00-10.30: Welcome 10.30-13.15: Face 13.15-14.00: Lunch 14.00-16.45: Rhinoplasty 16.45-17.00: Coffee break 17.00-18.00: Residents Abstracts Presentations

June 29th, 2011 08.30-11.15: Breast 11.15-11.30: Coffee break 11.30-14.15: Body Contouring 14.15-15.15: Lunch 15.15-18.00: Reconstruction/Microsurgery

June 30th, 2011 08.30-11.15: Hand/Peripheral Nerve Surgery 11.15-11.30: Coffee break 11.30-11.50: Skin Tumors/Melanoma 14.15-15.15: Lunch 15.15-15.35: Innovation In Plastic Surgery 16.45-17.00: Coffee break 17.00-18.30: Public day 18.30-19.00: Closing Ceremony/Award for residents Congress Secretariat

Mrs. Chrysa Kontololi ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116

E: chrysa.kontololi@zita-congress.gr www.zita-congress.gr

IPRAS Journal

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2nd International Meeting on Aesthetic and Reconstructive Facial Surgery

www.imafr2011.org

www.imafr2011.org Dear Colleagues, ORGANIZED BY THE

HELLENIC SOCIETY OF PLASTIC RECONSTUCTIVE & AESTHETIC SURGERY

HELLENIC ASSOCIATION FOR THE TREATMENT OF MAXILLOFACIAL CANCER

SPONSORS

IPRAS Journal

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Dear colleagues, The preliminary program for the 22nd Annual EURAPS Meeting is now available on the website. We have received a total of 331 abstracts and our 18 reviewers (three for each category) had a heavy task to score all those abstracts. The Scientific Program Committee compiled the Preliminary Program based on the scores of the reviewers and we were able to include 89 abstracts and the best AAPS and ECSAPS papers. Because there was a large number of abstracts dealing with breast reconstruction we decided to make two breast reconstruction sessions. As you know the 22nd Annual Meeting of EURAPS will be held June 2-4, 2011 on the island of Mykonos, Greece, with Othon PAPADOPOULOS as our local host. On Thursday, June 2nd, 2011, we will start with a Refresher Course: “Refinements in Aesthetic Rhinoplasty and Secondary Rhinoplasty”. The late start of the Course at 13.00 hours enables you to arrive on the island in the morning and participate in the afternoon. On Thursday evening, June 2nd, 2011 the Opening Ceremony will take place in the Auditorium of the Royal Mykonian Hotel (congress venue) and will be followed by a welcome reception with buffet on the Pelagos Veranda of the hotel. The two days Scientific Meeting will also take place in the Auditorium of the Royal Mykonian Hotel. As always, the main purpose of the annual EURAPS meeting is to provide a platform for high level plastic surgical presentations and discussions in a single auditorium. The annual EURAPS meeting is considered the most competitive meeting in Europe! Our president Julia Terzis is doing her utmost to provide you with an interesting Panel on Facial Aesthetic Surgery: Pearls and Pitfalls with world renowned speakers. Social events include our Congress Dinner on Friday evening, June 3rd, 2011, which will take place around the swimming pool of the hotel and the traditional Farewell Dinner on Saturday evening, June 4th, 2011 at the Sea Satin Market near the famous windmills of Mykonos in the Little Venice area. All information about the meeting is available at our website: www.euraps. org/meetings . Be aware of the fact that flights to Mykonos are limited, so it is important not to wait too long before making your reservations. Olympic and Aegean airlines have 30 minutes flights between Athens and Mykonos and several European countries also have direct charter flights. Another option is to take the boat (Seajet 2) from Rafina port to Mykonos, which is a two hours and twenty minutes crossing (www.ferries.gr/sea-jets/ferries.htm ). The port of Rafina is a 40 minutes taxi drive from Athens airport. Hotel rooms in the Royal Mykonian (venue) and surrounding hotels are reserved for our participants till April 1st, 2011. If you want to profit from the special congress prices please book your accommodation in time using www.euraps.org/meetings/hotel-reservation which leads you to the hotelregistration site of ZITA. Together with our local host Othon PAPADOPOULOS and his wife Katia I am looking forward to welcoming all of you at the Mykonos 2011 EURAPS Meeting. Remember that the entire EURAPS meeting is open to non-members as well. Let’s make Mykonos an unforgettable experience with the largest attendance ever and don’t hesitate to bring your family along! It is really a great place to spend some extra days with your dear ones. Best regards, Moshe KON, M.D., Ph.D. EURAPS Secretary General

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SESSION CHAIRMEN Moustapha HAMDI Belgium Christoph HEITMANN Germany A. Lee DELLON USA Efterpi DEMIRI Greece Eric ARNAUD France Irene MATHIJSSEN the Netherlands Adriana CORDOVA Italy Adriaan GROBBELAAR UK Pietro BERRINO Italy Ingrid SCHLENZ Austria Fabio SANTANELLI Italy Marie WICKMAN CHANTEREAU Sweden Rafic KUZBARI Austria Peter M. VOGT Germany Johannes BRUCK Germany Françoise FIRMzIN France,

Congress Secretariat

Mrs. Chrysa Kontololi ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116 E: euraps2011@zita-congress.gr http://www.euraps2011.gr/

www.hespras2011.gr

HELLENIC SOCIETY OF PLASTIC RECONSTUCTIVE & AESTHETIC SURGERY HE.S.P.R.A.S.

At a Glance

Dates: August 29th-30th 2011 Place: Kos Congress Venue: Kypriotis Conference Centre

Important Dates

Last Day For Low Cost Registration: May 31st 2011 Last Day For Abstract Submission: April 29th 2011 Abstract Acceptance Date: May 16th 2011

Dear Colleagues, The Board of Directors of the Hellenic Society of Plastic, Reconstructive and Aesthetic Surgery (HE.S.P.R.A.S.) and the Organizing Committee, are very glad to announce the organization of the 9th Pan-Hellenic Congress of Plastic, Reconstructive and Aesthetic Surgery that, as decided by the HE.S.P.R.A.S. Board of Directors, will take place at the beautiful island of Kos, in the Congress facilities of the Kipriotis Hotels, from August 29th to August 31st 2011. The large success of all past congresses challenges and urges the HESPRAS Board of Directors to make every possible effort to organize one more successful congress. The Scientific and Organizing Committee aspire to cover a large variety of subjects such as Trauma and Rehabilitation, Hand Surgery, Burns, Microsurgery Techniques, Breast Surgery, Aesthetic Surgery and many more, in order to boost the contemporary scientific knowledge in the field of Plastic, Reconstructive and Aesthetic Surgery and also of Health in general. Our target is for all participants to benefit by expanding their knowledge through a high standard scientific programme in all fields of contemporary Plastic Surgery. For this reason we anticipate you to participate actively by submitting your abstracts in order to exchange opinions and reports on scientific achievements. The island of Kos, besides the scientific presentations during the congress, offers large potential to all participants for additional cultural activities and recreation possibilities. Being confident that your presence will be dynamic, we send you our warmest regards and look forward to seeing you in Kos for the most important event of our Society. The President of the Congress Dimosthenis Tsoutsos Sponsors

Congress Secretariat

Mrs. Maria Petsa ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116 E: maria.petsa@zita-congress.gr www.zita-congress.gr

Issue 4

Topics: • Trauma & Rehabilitation • Skin & Soft tissue Oncology • Hand Surgery • Burns • Congenital Malformations • Chronic Ulsers • Microsurgery Techniques • Breast Surgery • Aesthetic Surgery • Fat Grafting • Tissue Transplantation • Biotechnology – New Methods in Plastic Surgery • Training in Plastic Surgery • Medical Responsibility in Plastic Surgery

The Congress will Include: • • • • •

Round Tables Oral Presentations Posters Lectures Educational Courses

Invited Speakers Phillip Blondeel Mimis Cohen Sydney Coleman Peter Cordeiro Michel Costagliola Marita Eisenmann-Klein Ralph William Gilbert Mutaz Habal Brian Kinney Milomir Nincovic Peter Neligan Nelson Piccolo Julian Pribaz Julia Terzis Spero Theodorou Patrick Tonnard

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IPRAS Journal

17th Congress of the International Confederation for Plastic Reconstructive and Aesthetic Surgery

February 24th â&#x20AC;&#x201C; March 1st 2013 Santiago, Chile

International Confederation for Plastic Reconstuctive and Aesthetic Surgery

Convention Centre ESPACIO RIESCO Organizational Support IPRAS management ofďŹ ce Contact Person Maria Petsa Tel: 0030 211 100 1787 E-mail: maria.petsa@iprasmanagement.com

IPRAS Journal

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Issue 4

NATIONAL & CO-OPTED SOCIETIES FUTURE EVENTS 2 - 4 June 2011

22nd Annual EURAPS Meeting Location: Mykonos, Greece Venue: Royal Myconian Hotel E-mail: euraps2011@zita-congress.gr URL: http://www.euraps2011.gr/

29 - 02 Jul 2011

WSRM 2011 Congress Location: Helsinki, Finland Venue: Marina Congress Center Telephone: +358 9 4542 190 Fax: +358 9 4542 1930 E-mail: info@congcreator.com URL: http://www.wsrm2011.org

8-10 September 2011

Sociedad Paraguaya de Cirugía Plástica Reconstructiva y Estética (SPACPRE) Location: Asunción, Paraguay Venue: Granados Park

14 - 18 September 2011

33rd National Congress of the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons Location: Sheraton Hotel, Çeşme, İzmir E-mail: info@plastikcerrahikurultayi.org (Scientific Correspondence) URL: http://www.plastikcerrahikurultayi.org/ Phone: +90 212 381 46 00, Fax: +90 212 258 60 78, E-mail: tpcd@figur.net (Organization Secretariat)

14 - 17 Oct 2011

Association of Plastic and Reconstructive Surgeons of Southern Africa (APRSSA) Location: Spier Wine Estate, Cape Town

04 - 05 Nov 2011

International Education Symposium: «Esthetic Surgery and Cosmetology for Face and Periorbital Rejuvenescense» Location: Institute of Surgery n.a. A.Vyshevsky, B. Serpukhovskaya, 27 E-mail: info@plastickafedra.com URL: http://www.plastickafedra.com/

7 - 10 May 2011

15th Annual Scientific Meeting of Indonesian Association of Plastic Surgeons (IAPS) “Creating Anew and Harmony through Plastic Surgery-The Comprehensive Approach from Basics to Recent Advances” Location: Semarang - Indonesia Venue: Gumaya Tower Hotel Phone. / Fax. +62 24 8443443 URL: http://www.pitperapi2011.com E-mail: secretariat@pitperapi2011.com / pitperapi2011@yahoo.com

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NATIONAL ASSOCIATIONS & PLASTIC SURGERY ORGANIZATIONS NEWS

Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (Ă Ă PRAS) AAPRAS (www.aapras.org) was founded in 2005. At the 14th International Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery of IPRAS, AAPRAS became a member of both the European and the International Societies. Our association has 34 members. The scientific sessions take place in our country four times a year. During those sessions we discuss current scientific, clinical and organizational problems which need our attention. AAPRAS has secured a partnership agreement with the Yerevan State Medical University under Mkhitar Heratsi and the National Institute of Health. This partnership allows us to provide high quality health services in our country and also offer a residency program especially in CME and fellowships of our members and young doctors.

Every year, an International Congress of Plastic, Reconstructive and Aesthetic Surgery is being held either in Armenia under the organization of AAPRAS or in Georgia under the organization of GeoPRAS. We will have our annual International Congress soon, from 28th to 30th of June. The Congress will be devoted to Unfavorable Results and Complications in Plastic, Reconstructive and Aesthetic Surgery. These problems are very important for our young association. Plastic Surgery has a history of over 30 years and the analysis of the reasons for these problems should be very useful for practicing doctors. We are inviting all surgeons with experience in this field, who would like to share their practical skills, to join us. It will be a great honor for us to discuss our points of view with our colleagues. The organizer of this meeting is Zita Congress. You can find more information on our website www. aapras2011.org

THE AMIC NEWSLETTER I. News from Armenians Third International Medical Conference In its November, 2010, issue Info-Flash had already given information about the Conference to be held from July 7 to July 9, 2011. We would like now to inform our readers that the website address (http://www.3imca.com) is currently functioning and only a few of its sub-sections are under construction. The sections necessary for your

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Registration, Accommodation and Abstract Submission, are ready and functioning. By the time you receive this bulletin, the remaining four sections will most likely be active. However, please note that: 1- If you encounter any problems when submitting your abstract, click on the blue contact button at the bottom of the format for further instructions. 2- Under the “Contacts” button at the top of the welcoming page, you can find the email addresses of the members of the Organizing Committee, as well as a “Technical Assistance Unit” e-mail address. You may also use that button for any further technical assistance. 3- If your computer is equipped with an older browser version, an animated logo with red bold letters will appear on the first page. That message contains instructions on how to upgrade your web browser in order to see the website correctly. For any other question or problem, you may contact and write to the AMIC office (amic@amic.ca or aida@amic. ca) and we will do our utmost in order to help you quickly. You may also contact directly hrachmd@plasticsurgery. am in Armenia explaining your problems. You also have of course the “help buttons” indicated above.

whom the analysis and the best possible solutions of the above mentioned complications will serve as groundwork for future treatment procedures. We hope that plastic surgeons from the USA, Russia, Georgia and the Eastern European countries will attend and participate in this important event, including the representatives of the Armenian Diaspora Plastic Surgeons. The Congress is being organized during one of the best periods of the year in Armenia. Usually, this time of the year is excellent to explore the city and visit the sights around it. The Congress social program includes sightseeing and many other opportunities for enlarging the scope of knowledge pertaining to Armenian cultural values. We are looking forward to meeting you in Yerevan.” Congress President, Gevorg V. Yaghjyan Scientific Committee Chairman, Armen R. Hovhanesyan Scientific Committee Co-Chairmen, Marita Eisenmann Klein, Andreas Yiacoumettis

II- Information for the Armenian Plastic Surgeons of the World 3rd Congress of the Armenian Association of Plastic Reconstructive and Aesthetic Surgeons. If you are a plastic surgeon, you will be interested by the announcement below. The event will take place from June 28th to June 30th, 2011, just a week before the Third International Medical Congress. This way you can attend both events and have the time to visit Armenia. What a great opportunity! Please read below the announcement sent by Dr. Gevorg Yaghjyan:

Armenia

“Dear colleagues, honourable guests, and friends, We have the great pleasure of welcoming you to the 3rd Congress of the Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (AAPRAS) being organized under the auspices of the IPRAS and ESPRAS. This is a scientific event called “Unfavourable Results and Complications in Plastic Surgery”; its main objective is to avoid the mentioned complications. The Congress will take place from June 28th to June 30th, 2011, in Yerevan State Medical University, Yerevan, Armenia. We anticipate the participation of renowned plastic surgeons, as well as of students and clinical residents for

Georgia

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Artavazd B. Sahakyan Gagik G. Stambultsyan Garegin Babloyan Karen Danielyan Leon A. Torosyan Russia Arnold Adamyan Alexei Borovikov Ivan Reshetov Nikolay Milanov Ruben Adamyan Iva Kuzanov Marlen Sulamanidze To Be Confirmed: Kamal-Seyed Forootan, Iran Murad Jaravov, Uzbekistan Phil Haeck, USA Suk Wha Kim, Korea Sincerely yours, Dr. Yaghjyan Gevorg MD, PhD , President of 3rd Congress of AAPRAS For Further Information, please visit www.aapras2011.com

III- The past year’s (2010) AAHPO Achievements at a Glance After organizing the memorable 10th Armenian Medical World Congress in 2009, the Armenian American Health Professionals Organization (AAHPO), representing health professionals in New York, New Jersey and Connecticut, had a busy year in 2010 with the organization and the initiation of the following events: • An affiliation with the North Hudson Community Action Corporation, a non-profit organization dedicated to providing healthcare to the underserved and uninsured in three northern New Jersey counties with a significant Armenian population. • A continuation of the telemedicine collaboration with Armenia Fund USA/HyeBridge Telehealth to provide medical care and continuing medical education to Armenia via live electronic telecommunications. AAHPO also joined the American Telemedicine Association. • AAHPO’s website (www.aahpo.org) was expanded, thus including additional medical resources. The website has produced a record number of hits for information. • A bi-weekly health show on the Armenian TV Station Ardzagang. • A monthly email, AAHPO Medical Alerts, on contemporary medical topics. This also is available at www.aahpo.org • A bone-marrow donor initiative, in conjunction with other organizations, which has thus far logged 1,500 new registrants. • AAHPO held its second annual diabetes community workshop in November, in New Milford, New Jersey. • A TV program on diabetes awareness that reached a television audience of more than 200,000 people. This TV program is now available on www.aahpo.org • A charity event in conjunction with the Armenian Eye Care Project, which has provided eye care to an impressive 20% of Armenia’s poorest. • AAHPO also provided a medical support for participants in the AGBU (Armenian General Benevolent Union) New York Summer Intern Program AAHPO held ongoing health and medical education workshops throughout the year in the tri-state area. Dr. Lawrence Najarian, President of AAHPO, wants the Info-Flash readers, and especially the Armenian community living in the tri-state region, to know that

they can, without hesitation, contact the Association by: Calling the Hotline (201) 546-6166 and/or Emailing to: info@aahpo.org AAHPO has been active for the past 17 years and will continue its mission with dedication in the years to come!

What is AMIC? The Armenian Medical International Committee (AMIC) was created 21 years ago. It is an umbrella organization that unites and promotes Armenian medical associations throughout the Diaspora, creating thus a large network through which information and data are exchanged. AMIC organizes Armenian Medical Congresses. So far, ten congresses have been held in different cities of the Diaspora, the latest being the one held in New York from July 1 to July 4, 2009. In 2007, the “Second International Medical Congress of Armenia” organized by Armenia, was held in Yerevan (June 28 to June 30). The third one is to be held from July 7 to July 9, 2011. See http://www.3imca.com Since 1998 AMIC has published an online newsletter which is sent free of charge to all Armenian Health Care Professionals. If you are a health care professional and are interested in receiving Info-Flash, please send us your e-mail address (aida@amic.ca, or amic@amic.ca). To all those who already receive the Info, please do not forget to send us your new e-mail address when you change it. InfoFlash is posted on GROONG, but with a different format, and often with less data and graphics, due to GROONG’s rules. To receive it individually in full size and content, please contact AMIC’s office (aida@amic.ca, amic@amic.ca). For further information, visit our website: www. amic.ca As of 2005, AMIC in collaboration with Regimedia, publishes a scientific journal, the “Armenian Medical Review”. The fourth issue is out. To subscribe please visit www.amic-review.com Useful information to remember: You can send medical equipment/medicine, free of charge from wherever you are located, through the services of the United Armenian Fund: Contact: U.A.F. President Mr. Harout Sassounian (sassoun@pacbell.net)

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Australian Society of Plastic Surgeons (ASPS)

In Australia the medical supply and service industry has opted for self-regulation. As a result, new Codes of Practice and Codes of Ethics, incorporating stricter compliance regimes, are emerging. Medical device and pharmaceutical manufacturers are particularly From 6 to 10 July 201 I the Australian Society of Plastic conscious of the pressure for greater transparency, Surgeons jointly with the New Zealand Association of disclosure and a stricter compliance environment and Plastic Surgeons will host their biannual major Scientific the need to apply more rigorous processes for the Congress on the Gold Coast, Queensland Australia. 6-10 July 2011, Gold Coast, Queensland, Australiadistribution of their marketing and sponsorship spend. The Australasian Society of Aesthetic Plastic Surgery, Australian Society of Plastic Surgeons welcomes sensible Australia and New Zealand Society of Ophthalmic change and is committed to align our activities with a ogether with the New Zealandand Association of Plastic Plastic Surgeons Australian HandSurgeons Surgery(NZAPS), Society Australian shiftand to greater accountability in relation to the funding ociety of Plastic Surgeons will hosttoanour outstanding up of international are also major(ASPS) contributors scientificline program. weand seek from industry for our activities. cal speakers and cover that will enhance professional development There is antopics outstanding line upyour of international and We reviewed our ‘Professional Code of Conduct’ and ontinuing medical education. local speakers with a special focus on rhinoplasty, breast, after lengthy consultation with all stakeholders replaced oculoplastic and hand surgery. Medico-legal topics will with a new Code of Practice which incorporates the We also welcome participation Australasian Society Aesthetic Plastic itSurgery; also bethecovered and aof“President’s Panel”ofwill examine principles associated with the stricter industry standards. real-life their impactand on Australian the lives Hand ustralia andseveral New Zealand of scenarios Ophthalmicand Plastic Surgeons; andwho careers of thecontributors surgeons concerned. This promises urgery Society are major to our scientific program. to Collaborating with industry partners in anticipation of the pressures the medical industry now faces, the be a frank and revealing session with lessons to be learnt Governing Councils of Australian Society of Plastic for all ofprogram us. he comprehensive will include a special focus on rhinoplasty, breast and hand Surgeons and New Zealand Association of Plastic rgery. We welcome you to the Gold Coast, Surgeons will launch the Australasian Plastic Surgery www.plasticsurgerycongress.org.au. Education and Research Foundation at the July 201 I nternational speakers includeCodes Congress. This Foundation is committed to provide Medical Industry � Dr Glenn Jelks M.D, Seattle, Washington quality lifelong learning opportunities for our members In many parts of the world, the medical industry sector and to encourage and promote research in our Specialty. � Dr Phil Seattle, Washington is Haeck, facing M.D, mounting pressure from consumers and � Dr Wolfgang Gubishch, M.D, Stuttgart, Germany For enquiries regarding the Foundation, please contact governments to disclose the details of its marketing costs � Dr Rod M.D, Redwood, Californiasponsorship for medical the Chairman of the Foundation at: chairman(5)plastics andHentz educational and promotional organisations associations, � Dr David Coleman, and M.D,professional Oxford, United Kingdom medical trials urgeryfoundation.org.au. and research and individual medical � Prof. Moustapha Hamdi, M.D, Gent, Belgiumpractitioners. Mr Peter Callan MBBS FRACS, President ASPS

2011 Plastic Surgery Congress

� Dr Venkat Ramakrishnan, M.D, Essex, United Kingdom

Bulgarian Association of Plastic, Reconstructive and Aesthetic Surgery (BULAPRAS)

all for Abstracts uthors of research papers who wish to have their abstracts considered for inclusion in e scientific program must submit their abstract(s) via the website Second National Conference on Plastic, Reconstructive and Aesthetic Surgery www.plasticsurgerycongress.org.au) by the close of business Monday, 28 February with international participation. Endorsed by ESPRAS 011. April 8th-10th 2011 – Riu Pravets Resort, Pravets, BG ubmission details and abstract guidelines are available via the website The Second National Conference on Plastic, of ISAPS 2000-2002; Prof. Andreas Yiacoumettis, MD, . ww.plasticsurgerycongress.org.au

Reconstructive and Aesthetic Surgery was held in 8th PhD - President of ESPRAS; Prof. Toma T. Mugea, MD 10th April 2011 in Pravets, Bulgaria, organized by The President of the Romanian Aesthetic Surgery Society he 2011 PSC Organizing Committee looks forward to seeing you at the Gold- Coast! Bulgarian Association of Plastic, Reconstructive and – RASS; Prof. Ivan V. Krainik, MD, PhD, Russia; Prof. Aesthetic Surgery. 120 participants took part in the Michel Costagliola, MD, France; Assoc. Prof. George conference, including plastic surgeons, dermatologist, Koliakos, MD, Greece; Dr. Joseph Fedeles, MD, Slovakia; orthopedists, maxillofacial and oral surgeons. Dr. Darina Krastinova-Lolov, France. Official guest speakers of the conference were – Prof. The Second National Conference on Plastic, Reconstructive h. c. Marita Eisenmann-Klein, MD, Dr. h. c. - General and Aesthetic Surgery offered attendees a chance to Secretary of IPRAS; Zacharias Kaplanidis - Executive network with one another, preview products and listen to Director of IPRAS; Prof. K. Güler Gürsu, MD - President lectures by experts who provided information on up-to66

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date trends and innovations in the field of breast plastic surgery, Rhinoplastics, Head Plastic Surgery, Lipofilling, Stem Cells, Reconstructive Surgery. The Conference hosted 18 regional and international exhibitors, showcasing brands and innovations from around the world. The exhibition and conference embraces all areas of aesthetic, plastic and reconstructive surgery,

dermatology, anti-aging technologies and medical spa. The scientific works, of high level, touched on the various field of activity of the specialties’ involved, showing quality of content and presenting the most innovative techniques. The high-level scientific aspect was matched by social program that allowed the participants of the conference to have useful contacts. Organizing Committee

Czech Society for Plastic Surgery (SPCH) The President, Dr. Lubos Drazan reported on the most important information concerning the Czech Society for Plastic Surgery. The official title of society for the Society is “Society for Plastic Surgery of the Czech Medical Association of J.E. Purkyne”. The Society has 125 registered members, 13 of whom are also members of ISAPS. Its Committee, empowered with its management and direction, consists of the following Officials: Dr. Lubos Drazan - President Dr. Bohuslav Zalesak – Vice President Dr. Ales Nejedly – Scientific Secretary Dr. Danes Raska - Treasurer Among other very important activities, the Society believes that the most important event of 2011, will be the Instructional ISAPS Course, taking place in Prague from September 30th to October 3rd 2011, at

the Prague, Corinthia Tower Hotel. The Instructional Course includes important subjects with the Cadaver heads dissection being an exceptional opportunity for colleagues to participate in. The Institutional Course Confirmed Faculty Members are the following esteemed Colleagues: Woffles Wu, Singapore Nazim Cerkes, Tur Renato Saltz, USA Nuri Celik, Tur Daniel Baker, USA Henry Spinelli, USA Julius Few, USA James Grotting, USA Gaith Shubailat, Jordan The Contact Person for more information on the Event is Dr. B.Zalesak (bzalesak@gmail.com)

German Association of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAC) The German Association of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAC) is the largest association of plastic surgeons in the German speaking countries. Next to board certified plastic surgeons with full membership, residents in plastic surgical training programs are also represented as associate members. A representative of the associate members is elected every two years and serves as a member of the extended executive committee.

Since 2008 all associate members have evaluated their trainers regarding theoretical, practical and scientific education. Furthermore, the working conditions are also taken into account. The evaluation is performed online with a website developed especially for this purpose (http://www.weiterbildungs-offensive.de).

Results are then divided into “institutions up to three associate members” and “institutions with four or more members”. The winner The promotion of up-and-coming talent obtains receives a prize in line with the gala dinner special priority at the DGPRAC. Full members at the annual DGPRAC meeting. Using organize more than 80 training courses every the DGPRAC website (www.dgpraec.de) year to support and refine the associate members associate members can search for full members in their speciality. These courses are available at who are authorised to teach according to a nominal charge and are limited to a number of board certification standards (e.g. common A. Arkudas four to six participants per course. All courses trunk, plastic surgery, hand surgery). They are classified into five categories: reconstructive surgery, also have the opportunity to rotate to another hospital, aesthetic surgery, hand surgery, burn surgery and varia. exchanging places with other associate members, in order to learn about specialized branches of plastic After each seminar, the participants evaluate the courses, surgery. regarding theoretical and practical learning effects. Issue 4

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Iranian Society of Plastic, Reconstructive and Aesthetic Surgeons (ISPRAS) The Iranian Society of Plastic, Reconstructive and Aesthetic Surgeons was established about fifty years ago and at the moment has 188 members, who are Board Certified General Surgeons with three more years of training in the field of Plastic and Reconstructive surgery. In the last 10 months we have organized 4 national and international congresses in different fields of plastic surgery. The 34th Annual General Plastic Surgery Congress was held on May 1st, 2010 and continued for four days. This event was part of the National Gathering of the Iranian Society of Surgeons which was held in the Television and Radio Convention Center. In this meeting 37 papers were presented by fellow plastic surgeons and 10 panel discussions were held, different subjects such as aesthetic, reconstructive, microscopic, congenital anomalies and craniofacial surgeries were covered and about 140 surgeons participated. The second meeting was held on 14th October 2010 in St. Fatima Hospital. In this one-day workshop, fat injection rich with platelet derived stem cell technique was demonstrated. One hundred and twenty surgeons

participated in this meeting. Three live surgeries were performed during this session. The 3rd Congress for Advanced Rhinoplasty, an annual meeting, was held on October 21st, in the Milad Hospital Conference Hall and continued for 3 days. Internationally known speakers in this field were invited. Dr. Sam Hamra, Dr. Hamid Masiha and Dr. Sajadian from USA, Dr. Shobeilat from Jordan and Dr. Cerkes Apaaydin from Turkey presented their ideas in this 3 day meeting. Forty five papers, 4 round tables of 4 live surgeries for primary and secondary rhinoplasty were performed during these sessions. We had 130 participants in this meeting. Body contouring and facial rejuvenation was the title of 4th Iranian Society Meeting, held in St. Fatima Hospital Conference Hall on 20th and 21st of June, 2010. Twelve scientific papers were presented and 7 round table sessions were held on new advances in this field. Kamal S. Forootan, MD. President of Iranian Society of Plastic Surgeons

Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) The Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) organized the 1st Annual Congress of the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery and the World Congress of Plastic Surgeons of Lebanese Descent in Beirut together with the 3rd Conference of Professor Illouz Association, on October 14-17, 2010. This congress has been officially endorsed by ISAPS and the Euro-Mediterranean Council for Burns and Fire Disasters (MBC). Colleagues from North, Central, and South America as well as Europe, Australia, North Africa and the Middle East attended this congress and enjoyed 4 days full of science, pleasure, history and culture. With 110 speakers, 190 presentations, and about 350 participants, this congress was undoubtedly 68

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one of the greatest scientific events of our specialty in the Middle East in 2010. An attractive social program including dining and dancing as well as trips and visits to the most interesting sites of Lebanon, including a visit to the newly renovated and rebuilt Beirut Downtown, Jeita Grotto, the new world wonder, and a visit to the old Phoenician port of Byblos, city of the Alphabet, and the most ancient continuously inhabited city of the world, added to the excitement. At the conclusion of this congress, the Association of Plastic Surgeons of Lebanese Descent (APSLD) was founded headed by Dr. Ricardo Baroudi with Dr. Bishara Atiyeh as General Secretary. The Association has decided to organize the 2nd World Congress of

Plastic Surgeons of Lebanese Descent, on October 1013, 2012, in Cancun, Mexico, with Dr Jose Luis Haddad as President and local host. Preparations for this great event are well underway, with the participation of world renowned plastic surgeons already confirmed. The 2nd Annual Congress of the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery, will be organized in Beirut later this year. Plans for live surgery transmission have been made and hopefully will be as successful as last year’s congress. Already confirmed faculty are Drs. Sam Hamra and Fabio Nahas.

Information about the 2011 and 2012 congresses will be available soon on line at www.lspras.com B. Atiyeh, MD, FACS President, the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) General Secretary, Euro-Mediterranean Council for Burns and Fire Disasters (MBC) Executive Editor, Annals of Burns and Fire Disasters Professor, Plastic and Reconstructive Surgery e-mail: batiyeh@terra.net.lb Tel: +961-3-340032

Nicaraguan Society of Plastic Surgery (SNCP) During this year, the Nicaraguan Society of Plastic Surgery has begun its activities with monthly meetings, in which 90% of its members attend. Some of the objectives we are working on this year are: 1. To promote the ethical code of FILACP among all of its members. 2. To continue the development of the internal rules of SNCP, which began last year. 3. To continue working in order to obtain jurisdiction for the SNCP. During 2010 we met all the prerequisites; we are now legally constituted under the Constitutional Act and presented our request of jurisdiction to the Congress in Nicaragua, so that finally, after more than twenty years of existence, the SNCP can have legal rights. We are awaiting the

response of the Nicaraguan Congress 4. To support continuous education, we are promoting the active participation of our members in the next FILACP Congress, which will be held in the Dominican Republic in September 2011. 5. We are currently working to organize the 3rd Volunteer Surgical Mission for Mothers and Fathers of low income in Nicaragua. This event will be held in May, in honor of the International Mother’s Day. 6. Keep on working together. Dr. Sandra Gutierrez President, Nicaraguan Society of Plastic Surgery (SNCP)

Sociedad Paraguaya de Cirugía Plástica Reconstructiva y Estetica (SPACPRE) SPACPRE in the process of organizing its upcoming annual meeting that will be in Asunción, Paraguay, from the 8th to the 10th of September, 2011. A great scientific event allowing colleagues to share important information. At the same time the Society is working closely with the Organization “Circulo Paraguayo de Médicos” (http:// www.cpm.org.py) and the Paraguay Ministry of Health on several important issues. Among those issues we are especially proud about a program with several different topics on reconstructive and aesthetic surgery and relevant informative sessions. This is currently on its last preparation

stages and will be launched no later than April 2011. SPACPRE maintains bonds with many other Societies dealing with Plastic Surgery and keeps plenty of communication links with the world of plastic surgery. Through the SPACPRE website, all interested Societies and colleagues can find important information about the work being done and the SPACPRE future plans. For more details please visit http://www.cirugiaplastica.org.py FILACP (Federation Ibero Latinoamericana de Cirugia Plastica Y Reconstruiva: http://filacp.org) is another Organization SPACPRE is a member of and in close cooperation with. Issue 4

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Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons, INC (PAPRAS) The Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons (PAPRAS) will be celebrating its Golden Anniversary this year. Formally established March 21, 1961, the PAPRAS is the only nationally recognized Plastic Surgery Society in the Philippines. It is also affiliated with the IPRAS and the Oriental Society of Aesthetic Plastic Surgery (OSAPS). The celebrations will kick off with a Golden Anniversary Dinner Symposium, wherein lifetime achievement awards will be handed to the following members of the PAPRAS in recognition of their unparalleled achievements in Plastic Surgery, both locally and internationally: 1. Dr. Gil C. Fernandez 2. Dr. Ponciano D. Manalo 3. Dr. Jorge B. Neri 4. Dr. Sia Tiong Gam 5. Dr. Teresita I. Tongson

The symposium will also be graced by the presence of Dr Darryl Hodgkinson, who will be giving a talk on “Body Implants Including Calves, Buttocks, Upper Limbs & Chest Walls Indications”. The year-long celebrations will culminate in the biggest regional meeting of Plastic Surgeons, the 16th Asian Congress of Plastic Surgery on March 11 -14, 2012, at the world famous Boracay Island in the central Philippines. This congress will feature a day long ISAPS symposium and a comprehensive cleft symposium, together with other interesting and controversial topics. Numerous well known Plastic Surgeons have already confirmed their availability to participate in the faculty of the congress. The PAPRAS Board of Directors headed by President Alexander De Leon is cordially inviting all of you to come and learn from the sessions and at the same time bask in the glorious sun and frolic in the powdery white sand beaches of Boracay. We will launch the Congress website soon for more information on the Congress. See you all!!

Portuguese Society of Plastic, Reconstructive and Aesthetic Surgery (SPCPRE) A BRIEF HISTORY; THE PORTUGUESE SOCIETY OF RECONSTRUCTIVE AND AESTHETIC PLASTIC SURGERY The Portuguese Society of Plastic, Reconstructive and Aesthetic Surgery (SPCPRE), an Association that congregates the large majority of Portuguese Plastic Surgeons, celebrates its 50th anniversary this year. It was on the 16th of April 1961, that a group of 12 surgeons, proposed to the prestigious and centenary Society of Medical Sciences of Lisbon (SCML - Sociedade das CiênciasMédicas de Lisboa) to set up a new, independent division to represent the small number of Plastic Surgeons in Portugal at that time. The SPCPRE was approved unanimously on the 18th of April 1961 and elected its first Board of Directors on the 2nd of May: President - Carlos Elias da Costa; General Secretary - Elias DamiãoPires and Assistant Secretary - António Pinto Teixeira. Its founding members were surgeons that developed a special interest for Reconstructive Plastic Surgery, having come from several other specialties including Stomatology, Oral and Maxillofacial Surgery, Otorhinolaryngology, General Surgery, Pediatric Surgery, Head and Neck Surgery and Orthopedics. During the 1950´s (post World War II) many of them obtained professional training in plastic surgery in the USA, United Kingdom and France, as these were countries where surgeons from all over 70

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the world congregated to seek proficiency in this new and upcoming specialty. Renowned names in Portuguese Plastic Surgery, such as A. BaptistaFernandes, Elias DamiãoPires, Guimarães e Sousa, Gentil Martins were responsible, amongst others, for the creation of this society. The first SPCPRE scientific meeting was held in Lisbon on the 18th of July 1961, with Professor Ivo Pitanguy as the guest of honor. Since then, the SPCPRE has organized several scientific events and its annual meeting, which began in 1971, traditionally takes place in October. In 1960, the first plastic surgery hospital service was established at St. António Hospital in Oporto, with Guimarães e Sousa as its director. In 1965, A. BaptistaFernandes, developed the first Plastic Surgery Unit at St. Maria Hospital, the largest University Hospital in Lisbon, initially used as the Stomatology and Maxillofacial Surgery Unit. During the end of the 1960’s and throughout the 1970´s, other Units emerged across the cities of Lisbon, Oporto and Coimbra, with links to the University Hospitals as well as large Civil Hospitals. (In Lisbon at HCL - São José Hospital with DamiãoPires and at Egas Moniz Hospital with J. Boleo Tomé; In Oporto at São JoãoUniversityHospital with FlávioGuimarães and at

PreladaHospital with Antonello Ferraro; In Coimbra at the HUC - University Hospitals of Coimbra with Veiga Vieira) During the Portuguese Colonial War (1960 – 1974) there were great medical advancements in the areas of treatment for patients with burns and severe injuries resulting from the war. During the war years it wasn’t only young plastic surgeons that contributed to these advancements, it was also many other professionals from a non-military background, that played a vital role in the evolution of the main Military Hospital in Lisbon. Today, the Portuguese Military Hospitals in Lisbon and Oporto have Plastic Surgery services. Presently, there are five Burn Units in Portugal; two in Lisbon, one in Coimbra and two in Oporto. There is also a burn treatment unit for children at the Pediatric Hospital of Lisbon. The 1980s mark the beginning of the dispersion of the PRAS’s Specialty Services throughout the capital districts of Portugal. Before then, only the three main cities in Portugal provided this service. Today, there are 26 units (service and small divisions) of PRAS in Portugal, of which 16 are located in the district capitals’ main hospitals, offering the country a wide covering of these specialty services. Nowadays, many plastic surgeons also work for private or insurance companies’ hospitals. The 1980s also marked progress in the restructuring of the residency as well as the training of new specialists. Once the potential plastic surgeons graduate, they must then participate in the Reconstructive and Aesthetic Plastic Surgery Training Program, which is basically known as a post-graduate program. In Portugal, this involves a six year residency in various reliable and recognized institutions and includes training in several areas of the specialty. The resident only becomes a practicing plastic surgeon after continuous and rigorous evaluation and a final exam with a national jury. Maxillofacial Surgery, although it has become an independent specialty in Portugal, is part of the Plastic Surgery’s curriculum and is practiced by plastic surgeons, especially in the bigger hospitals. (Emergency Services and Scheduled Surgery). Hand Surgery is another specialty kept under the Plastic Surgery field and learning it is part of the Specialty’s curriculum training. Hand Surgery is also practiced by Orthopedic Surgeons, who, in conjunction with the Plastic Surgeons, alternate in the Director’s position at the Portuguese Society of Hand Surgery (SPOCMA – Sociedade Portuguesa de Cirurgia da Mão). Since the beginning, the PRAS Portuguese Society has the mission to bring plastic surgeons together (Portuguese and other nationalities), stimulate the specialty study, and promote the Post-Graduate National Training Program. This is an annual program mainly organized for residents and includes four modules, each of them dedicated to a sub-specialty - Hand Surgery, Aesthetic Surgery, Burns and Head and Neck Surgery. As usual, in October of this year, 2011, the 41stAnnual Reunion of SPCPRE will take place in Oporto. Various national and international guests have been invited, as well as internationally renowned specialists. Their attendance will be a great honor for the Portuguese plastic surgeons.

Organizing courses, conferences, symposiums and the annual meetings, are the activities of the society uses to maintain a strong bond with several International Societies where it is represented. Throughout the years, SPCPRE has been represented or invited to participate at various international meetings, some of which took place in Portugal, and were co-organized by SPCPRE. The SPCPRE has always been committed to spreading the ethical principles and deontological codes through its members. The SPCPRE count on its Board, elected at the general assembly for a two year period; President; two Vice Presidents; General Secretary, Assistant Secretary and Treasurer, and a permanent Consultative Board consisting of all its previous presidents (the author is the 17th President of SPCPRE). Each Board of Directors invites a team of specialists from the different areas of the specialty to serve Unit Advisors. These specialists, during their time, are encouraged to propose activities to boost their relevant units (Hand Surgery; Aesthetic Surgery; Maxillofacial and Cranio-Maxillofacial Surgery; Burns; Oncologic Plastic Surgery). SPCPRE has a total of 180 members. It is a small society, but it has been able to make Plastic and Reconstructive Surgery more prestigious and recognized from the Portuguese Medical Community. On the special occasion of our 50th Anniversary, I would like, as SPCPRE’s President, to salute the 37 thousand members of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, by addressing my best wishes to IPRAS’ Board of Directors.

F.Ribeiro de Carvalho, President of Portuguese Plastic, Reconstructive and Aesthetic Surgery

Board of Directors Presidente :

Dr. F. Ribeiro de Carvalho (ribeirocarv@gmail.com) Vice Presidents: Prof. Dr. J. Rosa de Almeida Dr. Manuel Maia Secretary (general) Dr. J. Videira e Castro (videiracastro@netcabo.pt) Secretary (Adjunct) Dr. Paulo Monteiro Treasurer Dr. Júlio Matias (contacto@juliomatias.com) This year, the Portuguese Society of Plastic, Reconstructive and Aesthetic Surgery (SPCPRE) celebrates its 50th anniversary, which is a reason of joy for all its members. The SPCPRE annual meeting takes place in October. This Year the Plastic and Reconstructive Surgery Service of Hospital da Prelada in Oporto City will host the meeting, lead by Dr. Manuel Maia. manuelmaiacorreia@gmail.com

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Asociatia Chirurgilor Plastici din Romania (ACPR) ACPR has schedules the following events for 2011:

dedicated to the subjects of:

• The Pre-WSRM (World Society for Reconstructive Microsurgery) held in Bucharest, Romania at Radisson Hotel on June 25th-27th 2011, organized by ACPR and WSRM;

- Aesthetic and Reconstructive Surgery of the Face

• The Annual Romanian Plastic Surgery Association Conference, held in Sinaia, Romania, between 5th8th of October. • The Annual Romanian-Hungarian Congress in Debrecen, Hungary on November10th-11th. • The first International Plastic Surgery Conference for the Eastern Europe during the 12th ACPR Annual Congress, in October 2011, preceded by an International Aesthetic Plastic Surgery Course

- Aesthetic and Reconstructive Surgery of the Breasts. ACPR would appreciate all support and feedback on the “International Aesthetic Plastic Surgery Course” initiative and hope that many IPRAS members will be able to attend the Conferences. The new ACPR website has also been presented and it can be found following the www.asociatiachirurgilor plastici.ro link. It is intended to be an interactive and modern tool to maintain communication with all ACPR members and patients. In order to contact ACPR you can address your emails to office@asociatiachirurgilorp lastici.ro.

Tunisian Society of Plastic, Reconstructive and Aesthetic Surgery (STCPRE) Yes, we did it!! It was just impossible for me to go over this historic moment that we lived in Tunisia during last December and January. Obama said “Yes we can” and as a Tunisian citizen I’m so proud to say “Yes, we did it”. This great Tunisian revolution deserves more her popular and juvenile identity than a simple scented floral allegory like Jasmine! Yes, the Young forced, for the first time, one of the Arab world’s most entrenched leaders to flee after 23 years of authoritarian rule! And even if some diplomatic pressure helped “this flower to open” this remains only the pride of an incredible solidarity between the Tunisian people from the unemployed to the rich young investor and from the illiterate to the high graduate genious who stand up all together for their rights during an interminable and rude month of unrest and protest!! A new country of freedom is born and things are going to change for the better. During this month, it was amazing to see that plastic surgery and aesthetic surgery procedures have continued to be in the clinics even for 72

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foreign patients. Obviously, when I was asking some colleagues about this, I reported a notable decrease of the activity during this period and an important one during the peak of the crisis but things were restored to normal step by step for the most of the colleagues which shows a great confidence in the quality of the surgeons from Tunisian and foreign patients. I was wondering to think Professor Marita EisenmannKlein for her kind words on the IPRAS website and also all my colleagues from Italy, Algeria, Russia, Norway and specially from France who supported me during this very difficult situation that we lived recently in Tunisia and a great think particularly to my French friend Dr Claude Lassus who mailed me every day to encourage me and by the way to support all this revolution by giving me good vibes and good advices. We are so proud and I really hope that this small country who showed his great energy will shine nowadays more and more with his scientific, artistic, intellectual and cultural talents. Sincerely, Bouraoui KOTTI, MD. Tunisian ISAPS NS

Plastic Surgery Society Emirates Medical Association (PSSEMA) Board of Directors update Dr. Ali Al Numairy – President Dr. Najm Khan – Vice president

Dr. Zahra Al Refae – Scientific committee in charge Dr. Safwat Mohammed – general Secretary Dr. B Venkata Ratnam – Cultural committee in charge

American Society of Plastic Surgeon (ASPS) An amazing, interactive and customizable educational program is being prepared for the ASPS, PSF, ASMS annual meeting. Plastic Surgery 2011, September 23-27 in Denver Colorado, will allow attendees to personalize their educational experience, target their needs and get the most out of their time. Some of this year’s highlights include: • Evidence-based medicine and performance improvement strategies • Use of Acellular Dermal Matrices in Breast Surgery: An Evidence-Based Review • Avoiding the Wrongs: Using Checklists to Avoid Errors and Wrong Site Surgery • Engaging panels covering revisions and complications management • Controversies and Complications in Fat Grafting for the Face and Breast • Revisional Breast Augmentation: Dealing with Capsular Contracture, Fold Asymmetries and Nipple Malposition • Complications with Lower Lid and Lid-Cheek Junction Surgery • Handling Problems after Carpal Tunnel Release • After the Flap Dies: Now What – Is It Still Microsurgery? • Panels exploring controversies in reconstructive and aesthetic plastic surgery • Controversies in Ear Reconstruction • Controversies in SMAS Management in Face-lifting: Why I Don’t Do Now What I Did Then • Long-term Outcomes in Augmentation/Mastopexy: Consecutive Cases

• Controversies in Oncoplastic Surgery – Patient Selection, Timing, and Politics • Dupuytren’s Contracture: Different Approaches • Interactive surgical video presentations • Networking opportunities with peers in your same career path Exhibit enhancements include: • Industry Expert Theater - Showcasing new products and services • Commons Area - Relax and discuss the day’s programming with other residents ASPS Resource Center – ASPS staff will be on hand to answer questions, offer product specials and more Extended dedicated exhibit hours – Shop for the latest plastic surgery products and services Denver, an outdoor-lover’s paradise, has many exciting activities for attendees to participate in after classes

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Texas man receives first full face transplant in U.S. A Brigham and Women’s Hospital (BWH) plastic surgery team, led by ASPS member Bohdan Pomahac, MD, performed the first full face transplant in the country last week, the second face transplant procedure performed by Dr. Pomahac. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 15 hours to replace the facial area of Dallas Wiens, a 25-year-old from Ft. Worth, Texas, who had suffered severe electrical burns in November 2008. (Weins was featured in the March 2011 issue of Plastic Surgery News.) Wiens received a new nose, lips, facial skin, muscles of facial animation and the nerves that power them and provide sensation. “Today’s tremendous news marks a new milestone in Brigham and Women’s legacy in transplant surgery. The pioneering achievement accomplished by the entire transplant team is a gift made possible by the most selfless act one human being

can do for another, organ donation,” said Betsy Nabel, MD, president of Brigham and Women’s Hospital. “This remarkable, anonymous gift is another example of

adjourn. Explore all Denver has to offer before and after the meeting, including biking, hiking, golf, fishing, rafting, and more. To learn more about Denver and to plan your trip, visit www.denver.org. For the latest information on Plastic Surgery 2011,

including updates on the program and social events, visit www.plasticsurgery2011.org. Registration will open Mid-May 2011. Register by June 27 for the best selection of courses and savings.

the life-affirming power of organ and tissue donation,” said Richard S. Luskin, president and CEO of New England Organ Bank. “As always, we are immensely grateful to the donor and the donor family for their generosity.” The world’s first full-face transplant was performed in March 2010 in Barcelona, Spain, by a team led by plastic surgeon Joan Perre Barrett.

Samba evening in Iguazu

Aldo Mottura (IPRAS EXCO member) Marita Eisenmann-Klein (IPRAS General Secretary) Samba evening in Iguazu during Argentinian Society Congress, Dr. Mottura had his birthday and we wish him all the Best!!

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INDUSTRY NEWS

Exciting happenings in 2011 are moving forward at ClearPoint Medical, a Montreal, Qc based developer and marketer of post-surgical compression wear to plastic surgery professionals and their patients worldwide since 2000. In addition to its Canadian facility, ClearPoint Medical also operates facilities in the United States and in Thailand to serve its diverse international client base more effectively. With new products slated for introduction during the course of the year, ClearPoint Medical is looking forward once again to exhibiting its complete line of compression wear at the American Society for Aesthetic Plastic Surgery meeting in Boston Massachusetts, May 7-10 as well as the American Society for Plastic Surgeons meeting, September 24 through 26 in Denver, Colorado. The company is also planning to exhibit at regional and international meetings.

patented breast sizing kit - including a prosthesis bra - developed by a well-respected ASPS board certified plastic surgeon from Chicago. The B4Bra Kit is a tool for surgeons and patients to achieve the desired outcome of an implant procedure by simulating the desired size and shape before surgery. Included in the new product offering for 2011 is the affordable micro power mesh Arm-Sleeve with Velcro closure now available in Beige, sizes S thru XL. On the marketing front, ClearPoint Medical will be showing off the new colours of its booth (#432) at the Boston aesthetic meeting in harmony with the companyâ&#x20AC;&#x2122;s packaging and other product information materials.

ClearPoint Medical is exclusively licensed to manufacture and market the B4Bra Breast Sizing Kit, the only

ClearPoint Medical products are now CE certified and the company is actively pursuing partnerships with distributors in the Euro zone. For more information about the company and its products, please contact Michael Zinay, Executive Vice-President at mzinay@clearpointmd.com or at www.clearpointmd.com.

ADODERM represents the innovation and development of various dermatological products and surgical implants in the field of Aesthetic-Plastic Surgery and Dermatology. With more than 25 years of ongoing research and development, Adoderm has introduced numerous and patented products to the market and has achieved a worldwide product distribution in more than 50 countries. With a long lasting professional responsability, the customers of Adoderm benefit from sophisticated and effective products.

VARIODERM product line (Meso-Lift, Fineline, Lips&Medium, Basic, Plus, Subdermal) is a new generation of cross-linked hyaluronic acid filler with a wide-range of wrinkle filling and volume creation solutions. The previous manufacturing methods generate hyaluronic acids of various qualities: more or less diluted monophasic solutions or suspension of particles. However, the traditional processes for obtaining hyaluronic acid do not achieve optimal durability after injection in the skin. Varioderm was developed as a new generation of hyaluronic acid with a longer durability. Issue 4

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Varioderm product line was extended in July 2010 with Variofill® Body Contour: A cross-linked hyaluronic acid filler with highest cross linking grade up to 80% without dilution. Designed for various indications like increasing volume and contours of the body surface, high tolerance and giving aesthetic and long lasting clinical results. With a high visco-elasticity, Variofill® Body Contour is injected with a blunt cannula between 16G / 18G / 19G / 20G, into hypodermis or supraperiostally, providing an high volume effect with sufficient amount of product. Featuring a 10ml syringe per box and 33mg/ml concentration, presented as a ready to use syringe and box assembled. Thanks to the highest concentration in available hyaluronic acid products worldwide, Variofill® Body Contour sets a new standard in the market of soft-

tissue augmentation and body contouring by offering a biocompatible, efficient and long-lasting solution. The new innovative technology of Variofill® Body Contour has been developed by ADODERM GmbH. Name of company: Adoderm GmbH Address: Elisabeth-Selbert-Str. 5, D-40764 Langenfeld, Germany Phone: 0049 (0)2173-1019180 Fax: 0049 - (0)2173-1019182 Email: info@adoderm.com Web: www.adoderm.com Legal representative: Mr. Dr. Aydin Dogan (Managing Director)

Crisalix releases the new version of its revolutionary 3D breast augmentation simulator Get a free trial for 2 patients on www.crisalix.com // No hardware required

Her everyday life in 3D After developing the first 3D physical simulator for breast augmentation, Crisalix takes the consultation to a new level. With e-Stetix 3D Mammo, patients can, not only see their new breasts when naked, but also visualize themselves dressed for any occasion, wearing a turtleneck, a décolleté, bikinis, casual clothes, etc. With this unique feature, every plastic surgeon can help the patient project herself into her new life, thereby stimulating greater interest in the upcoming surgery.

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The first 3D physical simulator Crisalix’s state-of-the-art tissue elastic model (TEM) accurately re-constructs in 3D the internal organs of the body using volumetric slices called voxels. These voxels are given the properties of the muscle, skin, fat and glandular parts of the patient’s body at a level of cell groupings and tissue boundaries never achieved until now. Those exclusive developments are a result of

Crisalix’s unique integration of two of the world’s most renowned university research institutes in biomechanics, 3D imaging and information technology based in Switzerland. Using the latest technologies of web server applications and employing sophisticated calculations on high performance hardware and software based in Swiss data centers, every surgeon can generate during the consultation unlimited, instantaneous 3D simulations of the patient’s new body. The surgeon can position any

shared social media features. This unique website service will be supported by Crisalix’s web marketing experts to permanently improve the surgeon’s internet visibility via Search Engine Optimization and the latest digital marketing techniques. This new service will also allow for active interaction with potential patients through major social networks and provide them with a direct and easy contact form to obtain a consultation with the plastic surgeon.

implant from all major manufacturers, specifying the surgical technique and indicating the skin’s elasticity. This in turn allows the most precise simulations, taking into account the individualities of each patient.

Testimonial

Communicate through Facebook In order to provide plastic surgeons with higher visibility to patients on the internet, Crisalix releases a new web service included for free in all subscriptions. In just a few minutes every e-Stetix user is now able to create a dynamically designed personal website containing all

“To demonstrate on the patient’s own body in 3D how she will look like after the operation without expensive equipment and through an online program is most exciting.” Foad Nahai, Past President of the ISAPS. Crisalix SA Parc Scientifique –A Ecole Polytechnique Fédérale de Lausanne 1015 Lausanne Switzerland info@crisalix.com

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CEREFORM® Breast implants

CEREPLAS is a recognized leader in the aesthetic and reconstructive surgery field thanks to a considerable innovation and the development of the CEREFORM ® breast implants range. Its excellent positioning and the large variety of models reflect the seriousness and the demand for quality that are characteristic of CEREPLAS. CEREFORM® breast implants are made of a silicone elastomer shell, pre-filled with silicone gel. We solely use medical grade silicone and have obtained ISO 13485 and CE mark for our complete range. CEREFORM® breast implants are available in round (smooth or intermediate textured shell) and anatomical (intermediate textured shell only) shapes. Thanks to it technical properties, the shell offers great resistance to wear and tear and ensures maximum safety. A group of barrier layers integrated in the shell prevents gel perspiration through the shell. The CEREFORM® implants offer an intermediate texture for best compromise between smooth and macro-texture. The inversed texture is directly realized on the made-in-house mould (316L biocompatible inox) offering approximately 50µm depth pores. The irregularity of the surface prevents at best the capsular contracture. The specific formulation of the silicone gel makes it feel similar to a natural breast. The gel rheology ensures the implant retains its shape and increases the safety of the product. Also, thanks to its self-reticulating seal, CEREFORM® offers full security. The implants are sterilised with ethylene oxide, following a validated cycle. CEREFORM® is supplied in double packaging to ensure an optimum microbiological barrier until implantation and each implant bears a unique identification number engraved on the occlusion patch to allow perfect traceability. CEREFORM® breast implants are available in round and anatomical shapes: • The round shape provides increased cleavage. CEREFORM® round breast implants exists in 4 profiles (low, medium, high, very high). The round range is available with two gels: The standard range

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suggests a natural aspect to the touch thanks to an adapted cohesivity rate. The Aptima range offers a higher filling level and a more

cohesive silicone gel. This model enables the surgeon to benefit from a higher projection for the same implant diameter as the standard CEREFORM® round range. • The anatomical shape very closely resembles the dimensions and distribution of the natural breast volume. They follow the bust line smoothly keeping breast and chest wall in one uninterrupted flow. Moreover, prefilled or inflatable sizers are available as a complementary tool helping to choose the perfect breast implant corresponding to the patient wishes. Our commitment is expressed by our constant desire to offer products that are always more reliable and more efficient in combination with impeccable service. With this in mind we offer our customers a lifetime guarantee program on CEREFORM® breast implants. This direct access program is applicable to the whole CEREFORM® range and consists in replacing the implant for life in case of rupture. Flexibility and adaptability clearly became the Cereplas footprints. Indeed, through a massive R&D investment, the company keeps on innovating and offering new ranges. For more information about our CEREFORM® range and availability in your area, feel free to contact us at export@cereplas.com. Our dedicated international team will be glad to help you. CEREPLAS Actipôle 2 - Avenue de la Solette 59554 Sailly lez Cambrai – FR t : +33(0)3 27 83 69 57, f : +33(0)3 27 83 70 42 www.cereplas.com, export@cereplas.com

LETTERS TO THE EDITOR

Antonio Grazi osi, MD, of Sao Paulo, Brazil, “for a long ti informed us th me, I’ve been at lo o ki n allow u g for 3D

s to do a qual software that ity pre- and p would augmentation ost-op evaluat , and, if poss io n fo r breast ible, for masto well. Some pro pexy and red grams have ar u ct io n as rived on the m too expensive, arket, but som and others, sim e were ply not practic it is finally po al to use. With ssible to create eStetix, a 3D simulatio both me and m n that can be y patients, in useful to predicting a re pre- and post sult, and in ca -op volumes. lc ulating This is particu with asymmet larly evident in ries. This soft patients ware is being and improved continually up , giving us the graded ability to overc problems enco ome earlier te untered with 3D ch nical .”

“e-Stetix aulo, says that P ao S f o so jo, MD, al tation, and it Ricardo Maru the volume for breast augmen ionals, but ea of us profess gives us an id , not just for ty ri ves cu se f o l t dea whole team lo y m , it ve lo I gives us a grea , love it tions of ts. My patients curate calcula ac d an s for our patien n o ti mula chosen. We very lifelike si my patient has at h it. It gives us w d an t use it g what I wan r arsenal, beca u o in l o to volume, showin is e th easier to satisfied to hav rity. It’s much cu se f are extremely o t lo a s s, and l ¯ it brings u with the other an th e ar w isn’t just a too ft is so ferences patients with th cases, with dif s u o ri se show photos to re o m the ps us in our easy cases. In lt breasts, it hel cu fi not just in the if d re o m e know metries, th ho didn’t really w ts n ie at p in volume, asym h it t, w ut in, there nts. In the pas sure what to p ’t en er choice of impla w o h w . Our ted, for doctors that insecurity e m o rc ve o what they wan w can no certainty. We was a lot of un t good.” been nothing bu experience has

“The Editor welcomes letters and will publish all those deemed prescient while reserving the right to publish only a part or parts of a letter”

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International

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Confederation for Plastic Rec onstuctive and Aesthetic Surgery

IPR AS BENE F I TS FOR NATION A L A S SO C I A TIONS & INDI V IDU A L M E M BE R S Ass

ociation suppo rt for educatio nal and resear • Association ch purposes legal & ethical advices accord international la ing to the w and practices • Promotion of local or regi onal events thro IPRAS manag ugh the officia ement office l • Immediate information ab out safety warn drugs, procedu ings of devices res , • Informatio n regarding th e use of mater etc related to P ials, devices, d lastic, Reconst rugs, ructive and Aes through IQUA thetic Surgery M (The Internatio nal Committee of Quality Ass Medical Devic urance and es in Plastic Su rgery) • Free receip t of the IPRAS JOURNAL • Informatio n regarding har monization of accreditation o training and f Plastic Surger y U n it s • Promotion of Patient Safet y and Quality M cooperation w anagement (in ith WHO) • Protection of the Specialt y and Promoti world-wide on of its image • Promotion of Individual m embers of soci scientific profi eties with their le through IPR AS website • Certificate for Individual members • Right of par ticipating in al l events organiz Societies and IP ed by National RAS

4th Issue April 2011

IPRAS Journal Management Editor: IPRAS Editor-in-Chief: Thomas Biggs, MD Editorial Board: Marita Eisenmann - Klein, MD Andreas Yiacoumettis, MD Constance Neuhann-Lorenz, MD Zacharias Kaplanidis, Economist Page Layout: “In Tempo” Athens Greece E-mail: panos@intempo.gr Post Editing: Athena Spanou, MD IPRAS Management Ofﬁce ZITA CONGRESS SA 1st km Peanias Markopoulou Ave P.O BOX 155, 190 02 Peania Attica, Greece Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216 URL: www.ipras.org • E-mail: zita@iprasmanagement.com Executive Director: Zacharias Kaplanidis E-mail: zacharias.kaplanidis@iprasmanagement.com Assistant Executive Director: Maria Petsa E-mail: maria.petsa@iprasmanagement.com Accounting Director: George Panagiotou E-mail: george.panagiotou@zita-congress.gr Sales Manager: Gerasimos Kouloumpis E-mail: gerasimos.kouloumpis@zita-congress.gr Congress & Events Manager: Yannis Liolios E-mail: yannis.liolios@zita-congress.gr Associations Management Director: Dimitris Synodinos E-mail: dimitris.synodinos@zita-congress.gr Marketing Director: Kostas Chamalidis E-mail: kostas.chamalidis@zita-congress.gr

Next issue: July 2011

DISCLAIMER: IPRAS journal is published by IPRAS. IPRAS and IPRAS Management Office, its staff, editors authors and contributors do not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this journal. The information provided on the IPRAS JOURNAL is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on this journal is for general information purposes only. IPRAS, IPRAS Management Office and its staff, editors, contributors and authors ARE NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS JOURNAL. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS JOURNAL. While every effort has been made to ensure accuracy, neither the publisher, IPRAS, IPRAS Management Office and its staff, editors, authors and or contributors shall have any liability for errors and/or omissions. Readers should always consult with their doctors before any course of treatment. ©Copywright 2010 by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery. All rights reserved. Contents may not be reproduced in whole or in part without written permission of IPRAS.