IPRAS JOURNAL 9th ISSUE by MARIA PETSA

ISSN: 1792-1275

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CONTENTS • President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 5 • General Secretary’s Message . . . . . . . . . . . . . . . . . . 7 • Editor-in-Chief’s Message. . . . . . . . . . . . . . . . . . . . . 9 • IPRAS Management office Report . . . . . . . . . . .

• Pioneers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• Rising Star . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• Senior Ambassador . . . . . . . . . . . . . . . . . . . . . . . .

• Humanitarian Works . . . . . . . . . . . . . . . . . . . . . . .

• ISPRES Section . . . . . . . . . . . . . . . . . . . . . . . . . . .

• ISPRES Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dr Reinaldo Kube , FILACP Presidential Change

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• Globalization in Plastic Surgery East versus West – Beijing 2011 . . . . . . . . . . . . . .

• National Associations’ & Plastic surgery organizations’ News . . . . . . . . . . . . . . . . . . . . . . . .

• Historical Accounts . . . . . . . . . . . . . . . . . . . . . . . .

• Hyperguide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 17th IPRAS world congress . . . . . . . . . . . . . . . . .

• IPRAS website . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• National & co-opted societies future events . . . .

• Industry news . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• Certificate of Membership . . . . . . . . . . . . . . . . . .

• IPRAS past General Secretaries . . . . . . . . . . . . .

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

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Dr. Marijan Novakovic

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3rd CAPS Congress Local Organizing Committee

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First European Congress of Plastic Surgery in Brussels (2 th and 3 th October 1936), from left to right, Gillies, Esser, Coelst, Kilner, Sanvenero-Rosselli

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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 relieve 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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PRESIDENTâ&#x20AC;&#x2122;S MESSAGE

Prof. Marita Eisemann-Klein President of IPRAS

Dear colleagues, We are thrilled by the astounding response to our invitations for your active participation in our world congress 2013 in Chile. The acceptance rate comes close to 100%! Plus, we have received a sensational amount of top-quality abstracts. IPRAS 2013 will be an outstanding event due to the tireless efforts of our wonderful team, composed of local colleagues and professionals from the venue, the staff members of Zita Congress and our Executive Office team, with a lot of support from Andreas Yiacoumettis, Petros Palmos and last but not least, our General Secretary Nelson Piccolo. During our site visit to Santiago in May, we were enchanted by the charm of the city and its inhabitants, as well as the friendliness and professionalism of the congress venue team.

Board of Directors President Marita Eisenmann-Klein - Germany General Secretary Nelson Piccolo - Brazil Treasurer Bruce Cunningham - USA Deputy General Secretary Yi Lin Cao - China Deputy General Secretary Brian Kinney - USA Deputy General Secretary Ahmed Noureldin - Egypt Deputy General Secretary Andreas Yiacoumettis - Greece Parliamentarian Norbert Pallua - Germany Executive Director Zacharias Kaplanidis - Greece

And now we need YOU to make it YOUR congress! We want to optimize and expand our services for you. Please send us your suggestions for the improvement of our services, - whatever you have on your mind and whatever moves you. We are so much more than a scientific confederation: we are your support group, your scout for new techniques and devices (IQUAM Athens November 1- 4, 2012 will be the place for that), your contact for involvement with humanitarian services, your promoters, your networkers, your FAMILY. We want to benefit from the global innovative competence of our members, the innovative competence that Plastic Surgeons are famous for, as well as from the experience of the members of our Board of Trustees and the enthusiasm of our trainees. Hurry up and register, we want YOU to be a part of it and experience the spirit of a splendid innovation!

Cordially yours

Marita Eisenmann-Klein IPRAS President

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GENERAL SECRETARY’S MESSAGE

Dr. Nelson Piccolo IPRAS General Secretary

As we have been participating on some of numerous Plastic Surgery and Plastic Surgery-Related Congresses in Brazil and around the world, we continue to realize how important this exchange of information will always be. We recently attended the Jornada Paulista de Cirurgia Plástica, in Sao Paulo, one of the major regional events in Plastic Surgery in Brazil. This event is attended by hundreds of practicing Plastic Surgeons as well as tens of trainees, who come to update knowledge and know-how, with a massive presence of members of most training services in the country, in a very friendly environment. This year, attendance was over 1,700 people. We also went to the FILACP congress in Medellin, where almost 1,500 Surgeons discussed old and new techniques while clearly showing a more obvious concern with the patient as a complete person. Within the same spectrum, we also went to the 17th Meeting of the Mediterranean Burn Club, in Sicily, which commemorated 25 years of its foundation. This meeting was held in the state-of-theart Burn Care, indicating the several aspects where the presence of the Plastic Surgeon is fundamental for the treatment of these patients.

Over the past several years I have noticed that the Plastic Surgeon has become more and more aware of the patient as a whole. Care for the patient’s psychological integrity and well being has become as important as the preoperative exams, the actual procedure itself and its postoperative care. Also, new technologies have brought us closer to our patients, since, besides our efforts to comprehend them, we also must make sure that the patient and his or her relatives are also oriented and informed about their possible beneﬁts and these discussions and conversations have also become opportunities for us to know our patients better. All these facts, this continuum of knowledge exchange, these technologies which are rapidly consolidating themselves in our everyday practice, our closer relation to a more content, stable patient, as well as several other aspects of our practice add to our excitement with the current arrangements for the 17th IPRAS World Plastic Surgery Congress to be held in Santiago de Chile, from February 24th to March 1st, 2013. We are most happy with the smooth and progressive evolution of the organization of this Congress – as this goes to print, we have almost 1,500 programmed presentations – it will be a Congress as no other before. Surgeons from all over the world will be there, presenting their everyday concepts as well as what they have recently discovered. Plastic Surgery at its Best – IPRAS welcoming members from its 102 country Societies to the only event where every member has a voice – our Congress and its sessions!!! As I said before, in previous issues of this Journal, we are very much looking forward to meeting you and seeing what you have to tell us in Santiago de Chile, next February. See you there,

Dr Jose Tariki, presidential discourse. Dr. Nelson Piccolo on the panel.

Dr. Nelson Piccolo IPRAS General Secretary

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

Scientific Presentations

EDITORIAL

Dr. Thomas M. Biggs, M.D. Editor-In-Chief

Our bi-annual Congress, this year held in Santiago, Chile, is soon approaching. There will be Master Classes, Keynote Lectures, panels and assorted independent lectures. Because of my good fortune to have been involved with Plastic Surgery for so long (fifty-four years) and because of the rapid escalation of Plastic Surgery meetings, I suspect that I am among the few who have heard more Plastic Surgery lectures than anyone…living or dead. With this introduction I want to say that I’ve gotten something (occasionally little….but something) from all of them. Could I have gotten more…and taken home more? Yes. How? I could have gotten more if the presenter had understood that scientific presentations are different from scientific papers. The latter are a contribution to the immortal archives and can be read and reread. They can have complicated charts and diagrams that require meticulous studying to comprehend but are essential to substantiate the veracity of the paper. They follow a specific structural outline with Patients and Methods, Results, Conclusion and Summary being traditional. They form the foundation for our pursuit of Evidence Based Medicine. They are not the same as scientific presentations. Scientific presentations are the “coming together” of a scientific conclusion with a listening body. This “coming together” is enabled by the presenter, otherwise referred to in my mind as a “performer” Like a performer in any other endeavor, he must attract the attention of the audience and maintain it. If he drifts off into the minutiae essential in a scientific paper, he most assuredly will lose some, or much, of his audience. He needs to recognize the traditional structure as mentioned above, but this must be done in an inconspicuous way. Large charts, graphs and minutiae-filled pictures may be pivotal in a presentation but should be reduced to one or two points. The use of images is always beneficial in a presentation, especially demonstrating “before and after”, but should be used to keep the audience with him, rather than drive them away. If making a point, it is unnecessary to show more than two cases, if there is only one point to be made. Too many words on an image also cause the listener to drift away. No more than ten words per image are encouraged, fewer is better. The images are the background music whereas the presenter is the singer….and the singer never wants to be drowned out by the background music. It is highly important never to read to the audience. It is extremely difficult to read with the verve that comes naturally when speaking of a subject of great interest to oneself. The presenter must remember that parents have employed for centuries “reading to” as a mechanism to put the baby to sleep. Regardless of the size of the audience, speak as if you’re speaking to only one person….whether it be 5,000 strangers or a group of five friends. As the presenter wishes to maintain contact with the audience, he should never turn away from them. Therefore he should never look at the screen. He may quite subtly place a monitor on the floor before him to which he can, for a brief moment, refer to assure that his speaking and the image being shown are in concert. Rather than use a laser pointer he can employ a series of duplicate images with appropriately placed marks to replace the laser pointer. Like any other performance, it’s best if there can be an order to the flow of the presentation….one point leads to the next…and then to the next; it is always effective if the finishing image (or images) return in some way to the opening ones, with all putting the pieces together, so that the listener is told, reminded, then told again the points the presenter wishes to impart. These are but a few points to future presenters to help me, in my future listening, to get more,and take home more, of what he has to say. . Thomas M. Biggs, M.D. Editor-In-Chief

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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

April 2012 – July 2012

Mr. Zacharias Kaplanidis IPRAS Executive Director

Since the previous IPRAS Journal edition, in April, a large number of Plastic Surgery events have occurred, on both a National Association level and internationally. Without a doubt, one of the most important events was the 19th International Congress of FILACP that took place during May 22nd to 26th in Medellin, a tremendously interesting city of Colombia. Approximately 1300 Plastic Surgeons from all over South America and other countries of Europe & America, gathered in order to attend the biannual congress of the Ibero-latin Section of IPRAS. It was an undoubtedly successful scientiﬁc event, in which IPRAS was ofﬁcially represented by its President, Dr. Marita Eisenmann-

Klein, its General Secretary, Dr. Nelson Piccolo and its Executive Director, Mr. Zacharias Kaplanidis. We would like to congratulate and thank for their hospitality, the President of FILACP, Dr. Jose Tariki, the Congress President, Dr. Juan Hernando Santamaria Duran and the entire Colombian Society who contributed signiﬁcantly to the success of the organization. A more extensive report on the Colombian FILACP Congress can be found in another section of this edition. Furthermore, in May, the IPRAS Management Ofﬁce, traveled to the beautiful city of Tashkent, Uzbekistan, in order to participate in the 3rd Central Asian

Dr Reinaldo Kube , FILACP Presidential Change

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Plastic Surgery Conference. A considerable number of Plastic Surgeons from Central Asia participated in this Congress and there was also a substantial number of international faculty members, such as: Sheng Lai Chung (Taiwan), Mimis Cohen (USA), Franklyn Elliott (USA), Daniel Marchac (France), Sumit Singhal (India) and Paul Ling Tai (USA). The Minister of Health of Uzbekistan, Mr. Botir Daminov, “opened” the congress in a packed congress hall. The IPRAS Executive Director, Mr. Zacharias Kaplanidi presented the work and progress of IPRAS during the opening ceremony and delivered the last edition of the IPRAS Journal (April) to Mr. Daminov. The Minister showed his utmost respect for IPRAS’s work and thanked Mr. Zacharias Kaplanidis for the confederation’s support to the fieldofPlasticSurgery in Uzbekistan. It should also be noted that IPRAS supported the Congress financially with the amount of 15000 € as it was included in the 2012 IPRAS budget. We would like to thank the Health Minister, Mr. Botir Daminov and the President of the Congress, Dr. Murod Jafarov as well as all the members of the local Association for their warm hospitality. We would also like to thank all the faculty members for their scientific contribution. We have already arranged to meet again in Athens for the 10th IPRAS/IQUAM

Congress and in Chile for the 17th IPRAS World Congress in 2013. Moreover, the IPRAS Management Office has continued, during this period, with its significant work in the support of important Scientific Events, such as the 12th Congress of the Romanian Association of Plastic Surgeons to be held in Sinaia, Romania, from September 9th to September 10th 2012, the 2nd International Pan African Congress of Plastic and Reconstructive Surgery to be held in Egypt in October 2013, the 4th Congress of the Armenian Association of Plastic, Reconstructive and Aesthetic Surgeons: Technology Innovation in Plastic Surgery, to be held in Yerevan, Armenia, in October 2013 and of course the 10th IPRAS/IQUAM Congress and Consensus Conference, in Athens from November 1st to 4th 2012, during which the 1st IPRAS International Trainees Meeting on November 1st will take place, and, finally, the 17th World Congress of IPRAS, in Santiago, Chile, from February 24th to March 1st 2013. For this reason, Mr. Zacharias Kaplanidis, travelled to Romania, Egypt and Chile, where he collaborated with local organizing committees to assure the perfect organization of these scientific events.

From the left: Dr. Mimis Cohen, Dr. Daniel Marchac, Dr. Galina Smirnova, Dr. Adkham Ikramov, Mr. Botir Daminov (Health Minister of Uzbekistan) , Prof. Murod Jafarov, Mr. Zacharias Kaplanidis

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In September, the IPRAS Management Office and the IPRAS Officials will participate in the important event of the 21st ISAPS Congress in Geneva, the 12th Congress of the Romanian Association of Plastic Surgeons in Romania and the LaserInnsbruck Congress in Austria. Finally, we would like to thank all the IPRAS & ISPRES Board of Directors members for their excellent cooperation with the management office and to wish you all a beautiful summer season.

Interview on Uzbekistan TV Channel of IPRAS Executive Director Mr. Zacharias Kaplanidis during 3rd central Asian Plastic Surgeons Conference (3 - 5 May 2012)

Furthermore, the 2nd ISPRES Congress in Berlin, in June 2013, is already on its way, due to the efforts of the ISPRES President, Dr. Gino Rigotti, the Secretary General, Dr. Sydney Coleman and the Treasurer, Dr. Norbert Pallua. This congress is expected to surpass the number of participants and the success of the 1st ISPRES Congress in Rome. Additionally, IPRAS was also represented during the ASAPS Aesthetic Meeting in Vancouver, in May 2012. During this congress, the humanitarian project “WomenForWomen” was comprehensively promoted and for this reason we would like to thank Mrs. Christine Grogan for all her effort and Mr. Julian Klein for his volunteer work.

Let us “renew our appointment” for the following autumn, although we shall be at your disposal throughout the summer, since ZITA … does not take vacations.

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PIONEERS

Dr. Gaith Shubailat

Dr. Biggs: Welcome, Gaith, and congratulations for being chosen as PIONEER for this issue of the IPRAS JOURNAL I have reviewed your extensive CV and I will give the readers a brief summary: you are a native Jordanian and received your early education and medical education in Jordan, but traveled to the UK for your training in General Surgery, then to Washington, D.C. and Georgetown University for you specialty training in Plastic Surgery. Please give the readers your assessment of your career and don’t be shy about your many accomplishments. Dr. Shubailat: Thanks Tom. I’m quite honored to be here. I completed my residency in Plastic Surgery at Georgetown University in 1973. That year, being a Fellow of the Royal College of Surgeons (FRCS), the American Board of Plastic Surgery recognized my General Surgical training in England and much to the joy of Dr. Albert Fleury, director of the program, I became qualiﬁed to sit for the American Board examination. I passed both parts of the board by 1975. Until the present time, I am the only holder of the Board in the Arab Middle East. A couple of Jordanians who have done all their General and Plastic Surgery training in the USA are sitting for their Boards and plan to stay in the U.S. In 1973, the newly established King Hussein Medical Center was inaugurated and I started the division of Plastic Surgery with one senior rotating resident. With two operating sessions we did over 20 procedures per week. At the end of the year, it occurred to me that I should start a post-graduate two-year fellowship training program in Plastic Surgery for already qualiﬁed and practicing general surgeons. Having obtained permission to do that, I picked one of my General Surgery colleagues to join me. Each year I would choose an applicant to my program. Upon completing the two years of fellowship, each fellow continued as a member of the staff. I had a big problem with severe burns patients who were dumped by the surgical department onto the Plastic Surgery division. Treating these cases in open general surgical wards created an immense burden on our staff.

Luckily, in 1974, the late second wife of King Hussein, Queen Alia, was invited by Empress Farah, wife of the Shah of Iran Mohammad Riza Pahlavi to show her children centers and rehabilitation institutes. She picked a team of senior Army surgeons to accompany her. I was a member of that delegation. It was a very memorable visit to dine and wine with the Shah and Shahbanu for 3 days and nights. During an informal gathering I mentioned to her Imperial Majesty my problem with treating and rehabilitating burns patients and ventured to ask her (after two gin tonics!) to help. Immediately she changed her schedule for the following morning and took us on a tour of the brand new burns hospital in Tehran. She told me “You will get your burn unit within a new rehabilitation center as a gift to Jordan”. Three weeks later, hospital planners from Malibu dropped into my office and we started planning for a 17000 square-meter rehabilitation center that incorporated a self-contained 14 bed burn unit, complete with its operating room and physiotherapy, specially designed according to my specifications as an open ICU with Clinitron beds and special climate control of humidity and temperature. Along with that, a state of the art auditorium with audiovisual connections to relay live surgery from all the operating rooms of the center. I was appointed first director of the Farah, Royal Rehabilitation and Burns Center in 1983. I sent the medical, nursing, physiotherapy and occupational therapy staff on training missions to Brooke Army Medical Center Burn Unit in Fort Sam Houston in San Antonio, Texas. I am especially proud that 30 years hence, this burn unit is still considered to be one of the leading burn centers in the World, for I had visited the best like the Shriners in America and Upsala in Sweden where Skoog made his fame. The 70’s was the decade of musculo-cutaneous pedicled flaps. As we had an ample supply of paraplegic patients with decubitus ulcers, we proceeded to clear the physical rehabilitation wards of decubitus ulcers performing every flap described in the books of John McCraw and the Atlas of the late Stephen J. Mathes . Our extensive experience in MC flaps led me to perform the first microvascular free flap in 1980 and the first reIssue 8

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plantation of index finger in the Middle East and Western Asia. With the help of my friend, the late Charles E. Horten, I sent our specialists for formal training in microsurgical animal labs and attachments to great names like Donald Serafin and Harry Buncke Sr. Since then, hundreds of replantations and free flaps have been successfully performed by our burgeoning staff. The most personally agonizing but successful was the replantation of a severed arm by a boat propeller that that was driven by my son, who jumped , swam and saved the unfortunate 16-year-old girl whose amputated limb sank to bottom of the Red Sea in Aqaba. The arm was retrieved and I had to replant it in a field army hospital. The late King Hussein who was vacationing in Aqaba offered me all the help I needed and his private jet shuttled back and forth to Amman with my surgical team of residents and nurses and all the equipment I needed to make it a success story that was well chronicled in the book “ Plastic Surgery Tales” written by Robert N. Cooper M.D. Craniofacial surgery was on my mind next, so I sent one of our fellows to spend a year with Paul Tessier and Daniel Marchac in Paris. On his return the specialty of Cranio-facial surgery was established in 1984, in collaboration with neurosurgery. The Jordan Board of Medical Specialties Residents who had completed 4 years of training in General Surgery, Internal Medicine and OBGYN were sent to England to obtain the Fellowship of the Royal Colleges. As Chief of the Surgery Department in 1977 and later as Chief of Professional Services, I realized our need to create the Jordanian Board of Medical Specialties as securing positions abroad was becoming increasingly difficult. With the collaboration of the Minister of Health, the Army Royal Medical Services and the young Medical Schools of Jordan University and Jordan University of Technology I was given the job of heading the team that would put together the rules and regulations that were drafted into law of the Jordan Medical Council and passed by Parliament in 1982. I served as Chairman of the Executive Board of the Jordan Medical Council from 1984-1991 after I had retired from 30 years of military service. Further specialties and subspecialties were included as their training programs became accredited to the Board. The fellowship program I started at KHMC in 1974 became and still is the only accredited training program in Plastic Reconstructive Surgery to qualify for the Board of Plastic Surgery examinations. I served as Chairman of the Jordan Board of Plastic Surgery from

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1982-1995 and I am very proud to see that program produce over 35 qualified plastic surgeons since. The Jordanian Society of Plastic Reconstructive Surgeons was established in 1988 and I served as its President from 1990-1992. I have been active in private practice since 1984. I was the first to introduce LIPOSUCTION in 1984, LASER surgery in 1995 and ULTRASONIC LIPOPLASTY in 1997 with the help of my good friend Michele Zocchi. In the past 15 years I have limited my practice to Aesthetic Surgery. I still do cleft palate surgery for underprivileged children pro bono. My pet subject is RHINOPLASTY which constitutes 30% of my total practice. One third of rhinoplasties are secondary reconstruction following 1-11 previous surgeries. My wife Zein and I travel at least 3 times a year to partake in International conferences and workshops as I am a member of ASPS, IPRAS, ISAPS and ICAPS. Last April I was particularly honored to be invited to join Rollin Daniel on the teaching faculty of the 20th Anniversary of The Advanced Course in Rhinoplasty conducted by my friend and fellow traveler Wolfgang Gubisch in Stuttgart, Germany. The Future of Plastic Surgery in Jordan continues to be bright, as we have the only board eligible training program in the Arab World. Many surgeons from neighboring countries continue to apply to join our 40-year-old training program crowning it with the certification of the Jordan Board of Plastic Surgery. My advice to the young generations has always been to be prepared for a lifetime of very hard work operating and studying; improving one’s skills and results can only be obtained by honest self-criticism. I always mention what I said to my beautiful wife to be when I proposed to her. I told her “Zein, you will always be number 2”. Astonished she asked: “Who is number 1 ?”. I answered: “Surgery”. We have been happily married for 43 years on the 4th of July. Dr. Biggs: Thank you for that…but before we finish I want to remind you of the live surgery you performed in Mumbai at one of our Tutorials. It was a very difficult secondary rhinoplasty (but aren’t ALL secondary rhinoplasties “very difficult”?) but the skillful management of that case was probably the smoothest rhinoplasty I’ve ever seen done….and…live in front of 300 people! We’re proud to have you as our “PIONEER”.

RISING STAR

An interview with Dr. Hisham El Minawi

Dr. Biggs: Hisham, it gives me great pleasure to have you as the recipient of the honor of being our “Rising Star” for this issue of the IPRAS Journal. Looking through your CV, it is apparent that you are an heir to a significant family dedication to education and, in general, to making people’s lives better. Of course this is our main purpose as Plastic Surgeons…making people’s lives better. Please tell us, in your own words, the story of your career and what you wish for in the future. Dr. El Minawi: I am honored to be seen by you as a rising star in my practice. I will try to summarize my journey. I was born on the 28th of January 1971 in Columbia, Missouri, USA, while my father was studying for his American boards in OBGYN and my mom for her boards in Rheumatology and Rehabilitation. I was then sent to Egypt, to be raised by my grandfather, who was the Minister of Education in Egypt at that time. I received my General certificate of Education from London and entered Kasr El Aini School Of Medicine in 1987, at the age of 16. I graduated from the faculty of medicine in 1993, followed by a year as an intern. In 1995 I started my residency in Plastic Surgery, which was part of the General Surgery department. I received my Msc degree in 1998 and my thesis at that time was about the use of tattoo in Plastic Surgery. I was appointed Assistant Lecturer in 1998 and in 2001 I received my MD degree in Surgery. My thesis was on reduction mammoplasty in huge breast hypertrophy and I was appointed Lecturer at the department. In 2006 I was appointed Assistant Professor and in 2011 as Professor of Surgery at Cairo University. I was appointed as the deputy director of the Emergency Department for three years, from 2002 to 2005. During my journey, I started with a lot of Reconstructive Surgery, Microsurgery and Hand Surgery. I did a successful hand replantation and finger replantations during my senior year of residency under the guidance of my late professor Shawki Kamal . During those years, I worked a lot on perforator-based adipofacial flaps and published papers on the adipofacial radial forearm flaps and the reversed sural flaps.

Wandering around in the world, I attended a lot of workshops and conferences and stayed for a couple of weeks in 2001 visiting at Emory in Atlanta and West Paces with Mark Codner. In 2005 I visited Dr. Tom Biggs and Dr. Don Collins in Houston, where I learned a lot and started a long friendship with my god-father in Plastic Surgery, Tom Biggs. I also had the pleasure to be taught the secrets of rhinoplasty from a giant like Gilbert Aiach, whom I visited in France in 2009. Through my journey I have been honored for being one of the people who fought hard for the separation of Plastic Surgery from General Surgery in our department. I am happy to be one of the founders of the Facial Aesthetic Conference of Egypt (FACE) which is the ﬁrst live surgery and video aesthetic meeting in the region and has been seen by many as a great success. Plastic Surgery in our part of the world is booming and Egypt, along with Lebanon and Jordan is turning to be the hub of Plastic Surgery in the region. My dream is to spread education of Plastic Surgery in Africa, the forgotten continent. Humanitarian missions to Congo began this kind of work and then came the Flying Doctors in Kenya and other countries. I want to continue this work. I am writing a book on the history of Plastic Surgery and Surgery in our region as our Faculty is celebrating its 185th birthday. I am married to Malak El Shazly, Lecturer of Opthalmology at Cairo University and I have three sons, Mahmoud, 10, Ismail, 8 and Omar, 4. I wish that everyone could have a chance to come and visit Egypt after things settle here. I hope for a better future for my country and my profession after the revolution of the 25th of January. Dr. Biggs: Thank you, Hisham. My faith in the future of Plastic Surgery and its place in our medical world is enhanced greatly when I hear you speak. All of us look forward to what we know will be signiﬁcant contributions coming from you and your ongoing efforts in the pursuit of excellence for the well being of our family of mankind. Issue 8

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SENIOR AMBASSADOR

An interview with Dr. Luis Vasconez

Dr. Biggs: Luis, we are pleased to honor you as our “Senior Ambassador”. This represents our opinion that you have made a great contribution to Plastic Surgery and are continuing to do so by your ongoing relationship with residents and your presence at academic meetings around the globe. It has been my pleasure to be with you at some of these meetings and I have been eager to have you as our honoree. Let’s begin by your giving us some of your educational background. Dr. Vasconez: I was born in Ambato, Ecuador, and was fortunate to emigrate to the USA at the age of 18. I entered University of Miami and was promptly given an academic scholarship. After 3 years of college I was admitted to Washington University Medical School in St. Louis, Missouri, and also given a tuition scholarship. I received room and board while in Medical School working as a “diener” in the Pathology Department. I recently attended my 50 year Reunion of Medical School. (May 2012) Dr. Biggs: How about your residency life? Dr. Vasconez: I trained at the University of Rochester and University of Florida in General Surgery and Plastic Surgery and had the privilege of having two excellent role models: Dr. Robert McCormack from Rochester and Dr. MJ Jurkiewicz from Florida and later Emory. Dr. Biggs: What did you do after you finished your training? Dr. Vasconez: After completing my training I spent my entire life in academic positions. I was first at the University of Florida; then moved to Emory to start the program there with Dr. Jurkiewicz; then I went to San Francisco as chief of Plastic Surgery at the University of California San Francisco. (1978-85) and have been here at the University of Alabama since 1985. 18

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Dr. Biggs: Why did you leave the University of California to come to Alabama? Dr. Vasconez: Why did I leave UCSF? I left because of the opportunity to start a new program at the University of Alabama. I was given all of the support to accomplish that mission. I have trained 72 residents and over 100 post-graduate fellows from throughout the USA and the world. I continue practicing and operating and contributing to the education of medical students and the training of residents in Surgery and Plastic Surgery. Dr. Biggs: Tell us about your career. What do you feel have been your more significant accomplishments? Dr. Vasconez: I think my greatest accomplishment has been to have the good fortune to work with, to teach and learn with many young Plastic Surgeons. Many of them have become nationally and internationally renowned. I was also fortunate enough to work on the development of muscle and musculocutaneous flaps with John McCraw and others. I had the opportunity to get in early on the work of breast reconstruction, with the introduction of the latissimus dorsi flap and then make contributions to the development of the TRAM flap. I was fortunate enough to be one of the early proponents of the use of the endoscope in Plastic Surgery. In the field of facial rejuvenation I was one of the first to work on the development of the anatomical basis and technique for mid-face improvement; I worked on a better understanding of the anatomy of the SMAS and what it does in improving the neck and was worked with local anesthesia with sedation in cases of facial rejuvenation. Dr. Biggs: After five decades of active Plastic Surgery what do you feel about our specialty?

Dr. Vasconez: I feel Plastic Surgery is the most personalized of all the specialties in surgery. It is innovative and creative and represents a way of thinking rather than following the “cook book”. The specialty allows us to find possible new solutions to existing problems. It brings forth all of the previous surgical knowledge and experience. Plastic Surgery is anatomically based and thus the need to do cadaver studies. Dr. Biggs: What about our future? Dr. Vasconez: I see a need for more translational studies. For example: fat transplantation. We need to do basic science studies to confirm or discard “opinions”. We need to expand the broad field of our specialty. For example, we understand back pain, at least part way as being do to changes in the lumbar lordosis. We should study some more.

a multidisciplinary way. We need to develop and get involved in the clinical applications of robot technology. I do not see why a breast reduction can not be done with the aid of a robot. We need to continue to emphasize Reconstructive Surgery. The need for reconstruction due to trauma or extirpation of tumors is actually increasing. A Plastic Surgeon is the most adept of all specialists to solve those problems. Cosmetic surgery will remain part of Plastic Surgery and will expand. The best Reconstructive Surgeon may also become a good Aesthetic Surgeon. The reverse may not happen. We need to be more involved in the education of medical students. That way we may attract the finest candidates.

We need to be involved with IRB approved protocols for wound healing in proper “Wound Healing Centers” directed by Plastic Surgeons.

Plastic Surgery has been good to us and we need to thank our communities for what they give us by offering our services to all patients who may benefit from our expertise, regardless of the ability to pay.

We need to set up Extremity Centers to manage patients with severe upper and lower extremity injuries in

Dr. Biggs: Dr. Luis Vasconez, thank you very much. You honor us by being our honoree.

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HUMANITARIAN WORKS

WfW is good news! In 2007 the IPRAS ExCo agreed to form the humanitarian project WomenforWomen with the WomenforWomen Committee. Since then quite a lot has happened within this project, as is documented in various and regular reports of the committee and of the individual missions. Originally meant and designed to be funded by the IPRAS budget, WFW turned out to be, at least at the moment and for the past 2 years, self-financed. After the first 3 missions in Jalandhar, Kullu and Palampur in 2008 and 2009, we have been able to raise enough sponsor funds to cover all the following mission expenses until now. To give you only an idea about our greater donations and sponsors: In 2008 we received the first donation explicitly for the WFW move by BBraun, Melsungen, and ever since, BBraun has very generously donated various smaller money sums, together with vast amounts of medical supplies for the individual missions –even Aesculap instruments – as well as other smaller companies. Donations through personal contacts by the IPRAS President Dr. Eisenmann-Klein reach the sum of 30000.-€. Via Dr.Andrea Pusic, who organized a hilarious Gallery Fundraising Event last autumn, $40000 (30000.-€,) were collected; 20000.-€ were donated via Dr.Sarah Lorenz´s intervention by Germany’s largest Media group- she also initially had motivated the BBraun´s donations. And my personal contacts, friends and patients spontaneously donated around 50000.-€. , Dr.Debbie Reilly has initiated various donations with quite a constant flow, as well as Dr. Nancy Vanlaeken. All the media and organizational work, internet presentation etc has been donated until now. And in spite of this non-professional work, WFW experienced vast media coverage. Johanna Braun of Germany has donated lots of time in helping with the organizational tasks and PR work. The Digital Media Office “zum Kuckuck” from Germany has set up and maintained our website pro bono. Mrs. Marieluise Briza from Germany donated her time, shipping the WFW Namaste pendants and Christmas Cards. Christine Grogan and her office, in the USA and Julian Klein, in the USA and in Germany have offered their time and expertise, as well as in presenting WomenforWomen pendants at various occasions. The WFW Mailing list up to now includes about 60 Plastic Surgeons opting to participate in future camps, as well as 20 Anesthesiologists and 20 physiotherapists and nurses. These numbers of supporters and donors is growing steadily – WomenforWomen by IPRAS is very good news! Dr. Constance Neuhann-Lorenz, MD

Plastic and Aesthetic Surgery President IQUAM President «Women for Women» - IPRAS Humanitarian Project ISAPS Chairperson Committee Government Relations DGPRAEC (German Society of Plastic, Reconstructive and Aesthetic Surgeons)

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INTERNATIONAL SOCIETY OF PLASTIC REGENERATIVE SURGERY (ISPRES) SECTION

Letter from the Board Dear colleagues, We are pleased to announce that the second congress of the International Society of Plastic Regenerative Surgery (ISPRES) will be held June 7-9, 2013 at the Steigenberger Hotel, in Berlin, Germany. The ﬁrst Congress was held in Rome March 13-15, 2012 (http:// www.ispresrome2012.com/) and was an unprecedented success, attended by plastic surgeons from 55 countries and selling out three months before the meeting. ISPRES was founded to stimulate the study and discussion of those forms of plastic surgery that utilize fatty tissue, stromal vascular fraction, growth factors and adipose derived stem cells to repair, remodel and enhance the human body. FORMAT: The format for the upcoming Berlin 2013 Congress will be similar to the previous meeting in Rome 2012. Plastic surgery scientists will review our rapidly expanding knowledge of the science of fat and the components of adipose tissue. We will highlight the elements of translational research, which allow us to better understand what is happening in clinical applications. While understanding the science of adipose tissue is important, the ultimate goal is to use the knowledge obtained from the Congress to improve surgical clinical practices. Sessions will highlight the use of transplanted adipose tissue, stromal vascular fraction, growth factors, and adipose derived stem cells in the following clinical situations: • Treatment of aging & sun damaged skin • Facial aesthetic surgery • Maxillofacial surgery • Craniofacial surgery • Extremity reconstruction • Aesthetic extremity enhancement • Therapeutic radiation damage • Acute open wounds and burns • Chronic wounds & ﬁstulas • Surface and deep scarring • Iatrogenic liposuction deformities • Buttock augmentation • Breast augmentation • Breast reconstruction • Tuberous breasts • Uses of stromal vascular fraction • Reverse expansion (BRAVA) • Uses of platelet rich plasma • Growth factors • Engineered adipose tissue • Storage of fat grafts and SVF • Unusual problems and applications

Standard and alternative methods of processing fat grafts will be presented throughout the meeting. Of course, safety issues will be emphasized throughout the sessions. Discussion of the standardization of nomenclature for this new branch of plastic surgery will take place. Finally, we will discuss the regulatory aspects of adipose tissue, growth factors and stem cells, and the role of our professional societies and governments world-wide. ABSTRACTS: During the Rome 2012 ISPRES Congress, abstracts of unprecedented quality were accepted and presented throughout the meeting in almost every session. We plan to use the same format to encourage introduction of new ideas and speakers in Berlin 2013. Please start planning your contribution to ISPRES 2013, and submit your abstract before our deadline, December 15, 2012. HOTEL VENUE: The Steigenberger Hotel has been chosen as the ofﬁcial hotel and the meeting venue for the ISPRES Berlin 2013 Congress. The Steigenberger Hotel is ideally situated in Berlin, and is a modern, luxurious but affordable hotel. Please register early. Our Rome 2012 meeting hotel was sold out meeting three months before the meeting. MEMBERSHIP IN ISPRES: It is important for you to be part of this exciting new society by joining us not only in ISPRES Berlin Congress in June, 2013, but also as a member of ISPRES. The ISPRES membership dues for 2012 is 100€. The 2013 ISPRES dues will be 130€. Candidates and associates can become members for 70€ in 2012 and 90€ for 2013. If you are not already a member of ISPRES, please initiate your application. Send the membership application, a one-page curriculum vitae and a copy of your board certiﬁcation to m.pe@zita-congress.gr. We look forward to seeing you in Berlin, June 2013. Please register early as we sold out three months before the Rome 2012. Respectfully,

Sydney Coleman Secretary General ISPRES

Gino Rigotti President ISPRES

HOW TO APPLY FOR ISPRES MEMBERSHIP: You may apply for membership by visiting www.ispres-ipras.org “How to become a member” section. Please send us your application together with your short CV (not more than one page) and you will be informed shortly about your membership status and membership fee. For more information you may send your requests at Mrs. Maria Petsa (m.pe@zita-congress.gr).

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ISPRES SURVEYS

Pilot Study Using RF Assisted Tissue Tightening for Nonexcisional Breast Lifting Diane I. Duncan M.D., FACS Sagging, deflated breasts are a complaint of women worldwide following childbirth, weight loss or aging. This problem can be corrected in some women with implant placement, but not all women want larger breasts. Even fewer want the scars associated with traditional mastopexy, especially those women with darker skin types. With 9 out of 10 patients choosing nonsurgical options for aesthetic treatment, a procedure where skin is not excised is deemed preferable by the majority of patients seeking correction of droopy breasts. Recent studies showing tissue tightening with subsequent skin surface area reduction following treatment with radiofrequency assisted devices indicated a minimally invasive

The radiofrequency heating device targets the fibroseptal network or collagen matrix surrounding adipocytes.

pathway towards treating breast ptosis. Questions regarding this type of treatment include longevity of correction, changes within the breast parenchyma over time and the degree of improvement possible with this minimally invasive technique.

Methods: Twenty patient volunteers aged 17-65 underwent treatment for breast ptosis. Three patients had grade I ptosis; two of these were treated for asymmetry. Eleven patients had grade II ptosis, and six had severe grade III glandular ptosis. Preoperative mammograms and high resolution ultrasound examinations were performed on all study patients. The patients were treated with the InvasixBodyTite platform using the FaceTite handpiece. IRB oversight was provided by the Essex IRB. Indications for treatment included mastopexy with breast augmentation, correction of asymmetry, mastopexy alone, mastopexy following implant removal and modest breast reduction in combination with lipoaspiration. Six patients were treated under local anesthesia and fourteen underwent general anesthesia. 200-300 cc of tumescent fluid was infused into the subcutaneous and the subglandular tissue of each breast. Radiofrequency heating of these regions was then performed using the FaceTite handpiece with settings of 45 watts and 38 degrees maximum skin temperature. An average of 21.6 kilojoules of energy was used in each breast. The device has a solid 1.4 mm probe which was inserted through an intra-areolar access puncture; heating was 24

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performed upon withdrawal of the device, which was inserted and withdrawn in a radial manner. Endpoints of treatment were visible and measurable lift of the nipple-areola complex by 1 to 1.5 cm and visible correction of lateral glandular pendulosity in the supine position. Following ptosis correction, the remainder of treatment, if any, was performed.

Results: All patients had measurable nipple-areolar lift, as well as improvement in the elongated, tubular appearance in those patients with severe ptosis. Measurements with Canfield Vectra 3D computerized imaging showed an improvement of 1.6 to 5.1 cm of lift in the sternal notch to nipple measurement at 3 to 5 months. Five out of six patients with grade III ptosis improved to grade II ptosis at 6 weeks post-treatment, with ongoing improvement to grade I or grade 0 ptosis at 3 months. Early results have persisted in 10 patients at 5 months post-treatment. Complications include one patient with a blister at the access port that healed within 5 days and one older patient with less than hoped for improvement. This nonexcisional option for treating breast ptosis has become popular with patients due to the very minimal scarring, 24 hour down time and high level of patient satisfaction with results. Patients report full retention of sensation. To date, no changes have been noted in the breast parenchyma on mammogram or on high resolution ultrasound examinations as the breast tissue itself is avoided during treatment. No lumps, seromas, oil cysts or calcifications have been noted, but it is early in the follow-up period and some of these could occur with time. Patients will continue to follow up for a one year period. Ongoing studies are being conducted to verify the longevity of lift plus the degree of long term improvement possible. Mechanism of action is the contraction of collagen strands located within the adipose stroma. The fibroseptal network which surrounds adipocytes is uniquely heat sensitive in the presence of tumescent fluid; many reports show contraction of the subdermal tissue matrix with subsequent accommodation and shrinkage of surface area of overlying skin.

17 year old before RF assisted breast reduction 2 months postop. Size reduction was from 34 DDD to 34 C.

Presented in the 1st International Society of Plastic Regenerative Surgery (ISPRES) Congress, Rome, Italy

Influential Factors in Autologous Fat Transplantation - Focusing on the Lumen Size of Injection Needle and the Injecting Volume Chih-Kang Chou, MD1, Tsai-Ming Lin, MD, PhD2,3, Jian-Hao Chiou2, Chun-Ying Wu3, I-Hua Chen3, Chung-Sheng Lai MD, PhD3, Sin-Daw Lin, MD3 1) Department of Plastic Surgery, Yuan’s General Hospital 2) Charming Plastic Institute 3) Kaohsiung Medical University Kaohsiung, Taiwan

Introduction Fat graft survival depends on the delicate handling during fat harvesting, processing and, most importantly, precise fat placement. Dr. Coleman emphasized that the key to successful fat grafting placement is to maximize the contact surface area between the fat parcel and the recipient tissue. To achieve this goal, especially to make fat survive in the face without potential complications such as lump and irregularity, it is suggested that at least 30 parcels in 1 mL fat1 be delivered. Moreover, when fat grafting is done in the peri-orbital areas (like sunken eyelid, nasojugal groove/palpebro-malar junction), each fat parcel should be tiny and even less than 1/50 mL1. Technically, it is quite difficult for an inexperienced surgeon to perform the procedure. Many kinds of needles/cannulas have been used in fat injection for decades. In the book “Complementary fat grafting”, the authors suggested 3 kinds of cannulas for different facial areas. The usual amount of fat injected per pass was suggested to 1/10 cc. In the superficial area such as the orbital rim and around the eyelids, the amount per pass was 3 to 5 per 1/10 cc, compatible with Dr. Coleman’s2 concept. Regarding these injection techniques and choice of different needles/cannulas, fat placement becomes even more technique-demanding. Nonetheless, another important variable, injecting pressure, is less addressed in literature.

Purpose The aim of this study was to monitor the pressure produced during harvesting and injection (placement) of fat and to demonstrate the pressure difference between the variable sizes of cannula (diameter) and volume of fat parcel per pass.

Materials and Methods First we measured the aspiration pressure during fat harvesting. Aspiration pressure was recorded respectively, in a 10 cc and a 60 cc syringe connected to a real-time

Three injection needles, 18G, 16G and 14G were tested. X-axis is the injecting frequency and Y-Axis is the accumulated pressure accordingly.

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pressure meter. While pulling back the plunger at different volume levels, the negative pressures were produced and recorded (Fig. 1). With a 10 cc syringe, we checked the negative pressure for every 1 cc of 10 cc; however in the 60 cc syringe, negative pressure for every 10 cc out of 60 cc was monitored. Then using the MAFT Gun速, the injection, the pressure of 3 different sizes of needles with variable injecting volume per triggering (volume of

Setting of the experiment

The negative pressure while pulling back of the plunger of a 10 cc syringe was shown during liposuction procedure.

fat parcel per pass) were detected accordingly. Injection pressure was recorded with monitoring of the MAFTGun速 loaded with 1 cc medical gel-filled syringe, which transduced the same pressure to a real-time pressure meter. The injecting volume of each triggering could be

Table 1. Negative pressure during harvestin og fat (liposuction) by a 10 cc syringe

Table 2. Negative pressure during harvestin og fat (liposuction) by a 60 cc syringe

Table 3. Accumulated pressure at the end of 1cc fat injection by different size of injection needle vs. fat parcel delivered per triggering

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adjusted by the switch button on the handle of MAFTGun®. The injecting volume was adjusted from 1/10, 1/30, 1/60, 1/90, 1/120, 1/150, 1/180, to 1/240 cc per-triggering (Fig. 2). Three injection needles, 18G, 16G and 14G were tested and the injection pressures were recorded separately.

Results Aspiration pressure: Since most surgeons agree to keep a 2 cc volume out of a 10 cc syringe while performing the liposuction, our data showed the negative pressure to be around -270 mmHg (Table 1). The negative pressures of different 10 cc intervals out of a 60 cc syringe were shown to be relatively high (Table 2). Injection pressure: In Figure 3, the X-axis is the injection frequencies (passes) and the Y-axis is the accumulated injecting pressure accordingly. These two variables showed a linear progression. Different color lines stand for different injecting volume per triggering from 1/10 cc to 1/240 cc. With 14- & 16G needles, the injection pressures at the end of 1 cc injected are all under 200 mmHg. However, with the 18 gauge needle, after pulling the trigger for 6 times (�), the injection pressure rises over 270 mmHg (reaching around 300 mmHg) which is the pressure limit which should not be surpassed while performing lipo-aspiration in fat harvesting(Fig. 3). Comparing the three different needles at the end of 1cc gel injection, (not just pulling the trigger 10 times), when using 18-G needle, the pressure of 1/10cc and 1/30 cc per-triggering were both over 270 mmHg. Therefore, while 18-G needle is chosen for fat placement, the perpass volume of fat parcel is suggested to be less than 1/60 cc per-triggering (Table 3).

Discussion The medical gel used in this study is a reliable material for conducting fat graft related experiments. The homogenous character of the medical gel makes the data show regression/progression in a linear way, though the processed human lipoaspirates may be not totally the same in viscosity and homogeneity. With the inhomogeneity and higher viscosity of grafted human fat tissue, the injection pressure is expected to be higher than the data shown in this study. The concept of Micro-Autologous Fat Transplantation (MAFT) proposed the senior authors, Lin et al. in 2006, with a central dogma that each fat parcel be smaller than 1/100 mL, is further documented in this study.

Conclusion In this study, the pressure generated by 2 cc back-pulling of the plunger out of a 10 cc syringe during fat harvesting is about -270 mmHg (0.36 atm). Using the MAFT Gun® filled with medical gel, the injection pressures of both 14and 16-G needles are below 270 mmHg, no matter the injecting volume per triggering. However, with the 18-G needle, injecting a volume greater than 1/60 cc per-trigger will induce a higher pressure of over 270 mmHg. In human fat tissue with higher viscosity and tissue resistance, a higher injection pressure could be expected and encountered consequently. The fact injecting technique during placement is advised to deliver at least 60 passes for each 1 cc fat volume when a 18-G needle is used.

References 1. Structural fat grafting. SR Coleman. Quality medical publishing ( 2004). 2. Complementary fat grafting. SM Lam, MJ Glasgold, RA Glasgold. Lippincott Williams & Wilkins ( 2006).

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Presented in the 1st International Society of Plastic Regenerative Surgery (ISPRES) Congress, Rome, Italy

Micro-Autologous Fat Transplantation (MAFT) for the Correction of Sunken Temporal Fossa - Long Term Follow up Chieh Chou, MD1, Tsai-Ming Lin, MD, PhD1,2 Chih-Kang Chou, MD1,3, Tsung-Ying Lin, MD1,2 Chung-Sheng Lai, MD, PhD1, Sin-Daw Lin, MD1 1) Department of Plastic Surgery, Kaohsiung Medical University Hospital 2) Charming Plastic Institute 3) Yuan General Hospitalc Kaohsiung, Taiwan

Instruction Sunken/hollow appearance in temporal fossa is sometimes seen in Asian people. Most of them present this phenomenon without any preceding events like trauma history, congenital anomaly or malnutrition. Due to physiognomic considerations, they want to re-contour the hollow look and obtain a fuller shape. Various strategies to construct the depressed area were reported in the literature, including soft tissue fillers, auto-/allo-dermal graft and silicone implants or flap surgeries. However, little was known about the use of autologous fat transplantation in this reconstruction, in order to produce a better camouflage effect and the long-term follow-up was also unsatisfactory.

Purpose We reported the experience of the application of the concept of Micro-Autologous Fat Transplantation (MAFT) to re-contour the hollowed temporal fossa, discussed the long term results and reviewed the surgical techniques. Materials and Methods: Micro- Autologous Fat Transplantation (MAFT) was performed on 58 patients from March 2006 to March 2010. Patients received MAFT under total intra-venous anesthesia. Follow up was regularly done with photography taken for comparison thereof.

Comparisons of a 52-year-old female receiving MAFT to re-contour the hollow appearance of her temporal area. At one year follow-up after MAFT by 4.5 cc and 5.0 cc fat grafting to the right and left side respectively, the effect was satisfactory. The sunken upper eyelid was also grafted with good results.

Results

MAFT-Gun速 is applied to deliver the fat parcel precisely and accurately in the sunken/hollow temporal area.

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Each injected parcel between 1/120 ~ 1/150 cc was evenly and precisely delivered with the assistance of MAFTGun速. Total injected fat volume of each area ranged from 4.5 to 12.5 ml (average 6.6 ml).All patients undergoing MAFT for hollow temporal were post-operatively uneventful. No major complications, such as neurovascular injury or infection were recorded. During the longterm follow up (> 6 months) period, most patients were satisfied with the results.

Panorama of MAFT-Gun速 (Fig. 2-A). The pre-determined fat parcel volume delivered by pulling the trigger can be chosen according to different recipient areas. For re-contouring of the sunken temporal fossa, the insertion site of injection needle is the pivot-point of the temporal fossa along the hair-line as shown in the picture (Fig. 2-B).

Conclusion In conclusion, the concept of MAFT was proven to be of value for the correction of sunken/hollow temporal fossa. The patented micro-controlling system of the instrument, MAFT-Gun速, provides an innovative concept

which enables surgeons to perform fat transplantation in an accurate and precise way and achieve higher satisfaction. With the understanding of the anatomy of the temporal area and the application the MAFT-Gun速, good long term clinical results should be anticipated.

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GLOBALIZATION IN PLASTIC SURGERY EAST VERSUS WEST – BEIJING 2011 Gregory R.D. Evans, MD, FACS, Philip Blondeel, MD, Lee L.Q.Pu, MD, Ph.D., Jenny Kyriopoulos, MD, Ruhong Zhang, MD, PhD, Bruce Cunningham, MD, Malcolm Roth, MD, Brian Kinney, MD Correspondence: Gregory R.D. Evans, MD, Professor of Surgery and Biomedical Engineering Chief, Aesthetic and Plastic Surgery Institute 200 S Manchester Ave, Suite 650, Orange, CA 92868 7144565253, gevans@uci.edu In October 2011, the International Confederation for Plastic, Reconstructive and Aesthetic Surgery (ISPRAS) along with the Chinese Society of Plastic Surgeons and the American Society of Plastic Surgeons met in Beijing, for several days of educational opportunities. This meeting, themed with innovation and comparison of East versus West, brought thought leaders, academics, physicians and residents together for a variety of topics, the latest in surgical techniques and panel discussions. The fourday meeting developed new collaborations and brought to the center common issues related to Plastic Surgery worldwide. One of the panels discussed globalization and business issues in Plastic Surgery, with a focus on medical tourism and how each country should deal with legal and patient care issues. Medical tourism involves patients that leave their particular country to access medical care abroad. From a historical standpoint, Greek pilgrims traveled to Epidauria, the sanctuary of the healing God Asklepios for treatment of diseases. Often, patients from high income countries travel to low or moderate income countries for the favorable exchange rate. This, however, is not always the case and some patients come to higher income countries for a perceived increased level of care. Approximately 40 percent of all global travelers seeking medical care come to the US. This could be called “Quality or Time-based Medical Tourism.” This is because of the long-standing reputation and the “global brand” of medical institutions such as Johns Hopkins, Mayo and others. One major motivation is to avoid potentially long waiting times and obtain medical care not available at home. Typically, this includes patients from the Middle East, Canada and South America. In recent years, because of more restrictive border security, more patients have stayed in the Middle East; however, many American Institutions have established medical branches in locations like Dubai, Qatar, Abu Dhabi and Singapore, to mention a few. The roots of “Cost- Based Medical Tourism” stem from patients who seek inexpensive cosmetic or dental procedures while vacationing. Plastic Surgery was one of the ﬁrst surgical specialties to be inﬂuenced by the global marketplace. In 2010 approximately $10.1 billion were spent

on cosmetic procedures within the US. Global medical travel was a $40 billion per year industry in 2010 and is expected to increase to $100 billion by 2012. Over the next several years, Deloitte has projected growth at 35 percent annually and it is estimated that the number of American traveling overseas by 2012 may approach 1.6 million. The obvious motivation for this travel includes lower cost, but also potential therapy that is not yet available in the US, including Stem Cell Therapy and some Cancer treatments. It is well known that the US regulatory process often proceeds at a significantly slower pace than in other countries, often leading to approval times several years slower than in Europe, Asia or elsewhere. While this is a major drawback, there appears to be a general perception that if the FDA warns against or restricts against a device, their investigation is of high scientific quality. So what are some healthcare trends that are influencing medical tourism outside the US? These include an increased demand for outpatient surgery and sophistication of operations including perioperative care, risk management and safety. There has been a large increase in hospitals targeting this market, with labor and operational costs lower than the US and comparable state-of-the-art technology driving the appeal. Many hospitals are accredited by the Joint Commission International, which has seen a dramatic rise in the number of hospitals they accredit. More foreign-born, US trained and Board Certified physicians are returning home and higher quality medicine is therefore being practiced in recent years. What are the advantages of medical tourism for US patients? One is potential cost savings of 30-90% depending on the procedure and location. This “healthy competition” may encourage greater efficiency of health care delivery in the US. What are some disadvantages? Questionable quality, safety and adequacy of provider credentialing. Potential loss of revenue for hospitals and physicians and potential spreading of disease globally. There are significant consequences of long travel on physiologic functions and the increased risk of pulmonary embolism remains a great concern. It will expose the patient to disparities in informed consent laws. Continuity of care is disrupted, with challenges in medium and long-term follow-up. Serious complications can ocIssue 8

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cur such as infection, contour abnormalities, wound healing problems, hematoma, scarring and even death. There is limited recourse for malpractice or HIPAA violations outside the US and those patients who undergo surgery in other countries may be unable to ﬁnd a surgeon in the US when returning to treat complications due to potential legal issues, among other problems.

a non-proﬁt trade group consisting of international hospitals, healthcare providers, medical travel facilitators and insurance companies, who raise awareness for medical tourism. The HealthCare Tourism International (HTI) is a non-proﬁt organization complementary to the Joint Commission International Accreditation group that raises awareness for medical tourism.

What about the countries themselves? Certainly there is an inﬂux of foreign capital which generates revenue. It stimulates the development of the healthcare infrastructure and promotes retention of medical graduates in their native countries. Conversely, it diverts resources for the local population from public to private facilities and it entices local health professionals to leave the public facilities for private practice. It may also expose the population to novel or unfamiliar diseases.

What about China? Plastic Surgery is blooming in China. The demands have increased rapidly, even in the public hospitals, where Plastic Surgery cosmetic centers have expanded. There is government support for medical tourism with websites and advertisements. Perhaps the big attraction in China is the low cost for Cosmetic Surgery especially for US patients of Asian descent. It is the responsibility of the Chinese Society of Plastic Surgeons to regulate training and provide CME for physicians serving the cosmetic market. In a system without a formal system of board certiﬁcation, a key challenge is to identify those physicians who are, and who are not, properly trained.

What are the effects of medical tourism on the European Union? By 2012 medical tourism is projected to be a $21 billion industry in Europe. As in the US, cosmetic surgery accounts for a major proportion of medical tourism. Similar reasons for travel are found in the US and Europe. This has reversed a longstanding trend - that of patients traveling to Western Europe for high quality care (“Quality Based Medical Tourism”). Instead, more Western European patients are seeking bargains in Eastern Europe and Asia. In Europe the data on medical tourism is limited. Many of these organizations hide information to maintain a competitive advantage. Furthermore, because of increasing emphasis on patient confidentiality, it has become more difficult to find information. Missing uniform accreditation systems and knowledge gaps among the different entities in the market, including Ministries of Health, legal experts, travel agents and others add to the lack of data. The most common countries for patients coming to Western Europe are the Czech Republic, Poland, Estonia, Cyprus, Switzerland and Spain. For those outbound patients from Europe, the most common destinations include Dubai, India, Malaysia, Philippines, Singapore, Thailand, Turkey and Northwest Africa. The Philippines have 17% of European tourism and Thailand is more common for gender reassignment. Outside of the US, the UK has the 2nd most frequent outbound medical tourism flow, again for many of the same reasons, including reduced waiting times, cost savings, availability of treatments and increased international cooperation between UK based companies and foreign medical facilities. What about European regulations? EU Law E112 enables authorization to travel abroad in order to receive medical treatment. The EU Directive for Cross-Border Health Care allows patients to go to another country for treatment as long as they clear it with their insurers and pay the costs upfront. The European Committee for Standardization is looking at Aesthetic Surgery services aiming to establish consistent standards in Aesthetic Surgery throughout Europe. The Medical Tourism Association is 32

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Whether we are discussing medical tourism in China, the EU or the US, safety considerations are critical for all surgery centers. In the US and EU, physicians are certified by either the American Board of Plastic Surgery or its European equivalent. As previously discussed, many of these foreign facilities have no board certified physicians on staff. Many of the standards for outpatient facilities in the US are also not aligned with foreign facilities. These include proper patient selection (ASA I or II), provider qualifications, and accreditation of the facility by a national or state recognized agency and surgical safety checklist (time-out) to name a few. Two critical practices for all facilities should be guidelines for volume aspirated in liposuction and DVT/PE Prophylaxis. Whether surgery is performed within the US, EU or China, what do you do if a patient sues? Although more common in the US and EU, China is continuing to see an increase in patient complaints and suits. In the United States, neurosurgery has the highest malpractice rates and payments for claims to plaintiffs. Plastic Surgery comes in about fifth, depending on the malpractice carrier. What can we do to prevent potential suits? Learn to listen to the patient. Avoid operating on high risk patients. Communicate effectively and recognize the unhappy patient. Emphasize precision, quality and long-term outcomes; de-emphasize speed, low cost, aggressive use of fantastic imagery. Spend more time listening and less time marketing. The globalization of Plastic Surgery will continue. These conferences allow enhanced communication, advance the state of the art and develop common means of collaboration for patient care and safety. The American Society of Plastic Surgeons will continue to work with IRPAS and the Chinese Society of Plastic Surgeons on international efforts to further these goals, promote Plastic Surgery and share common ideals.

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NATIONAL ASSOCIATIONS’ & PLASTIC SURGERY ORGANIZATIONS’ NEWS

Plastic Surgery Congress 2013 Melbourne Australia IPRAS Journal Submission 15 June 2012

The Australian Society of Plastic Surgeons (ASPS) and the New Zealand Association of Plastic Surgeons (NZAPS) will jointly host a Plastic Surgery congress from 24-26 April 2013 in Melbourne, Australia. The 2013 Congress follows two successful congresses in 2008 and 2011. Now planned to run biannually, the Plastic Surgery Congress has an international focus on world’s best practice in Plastic Surgery and cutting edge technology and innovation. The biannual Plastic Surgery Congress brings the two societies, ASPS and NZAPS, into closer partnership and provides the opportunity to take the meeting to an international scale. Australia is famous for its sunshine and beaches and the Gold Coast, Queensland, in July 2011 was no exception. Over 500 Plastic Surgeons from 13 countries were in attendance for the four day Congress. Renowned international speakers were present, including keynote addresses from Dr. David Coleman, Professor Wolfgang Gubisch, Dr. Phillip C Haeck, Dr. Moustapha Hamdi, Dr. Vincent R Hentz and Dr. Glenn Jelks. In 2013, we will stay on the East Coast of Australia but move south from the Gold Coast to cosmopolitan Melbourne and the state of the art Melbourne Convention and Exhibition Centre is the ideal setting to attract international visitors. Known for its style and sophistication, the city exudes a distinct bohemian charm with its maze of hidden laneways, opulent bars, exclusive restaurants, charming gardens and off-the-beaten-track boutiques. It’s also a cultural hub of museums, galleries and music venues. The upcoming Congress will continue the tradition of hosting high quality international and local speakers on a range of reconstructive and aesthetic topics, focusing on cutting edge technology and practice. The Organising Committee welcomes all Plastic, Reconstructive and Aesthetic Surgeons from around the world to participate in the 2013 Plastic Surgery Congress which facilitates both continuing professional development and extensive networking. More information about the Congress will be made available shortly. For more information, please visit the Congress website: www.plasticsurgerycongress.org.au, or by contact the PSC Secretariat at psc2013@conferenceaction.com.au or on +61 2 9431 8638. 34

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The National Congress of Plastic Surgeons Held in Belgrade

The 11th National Congress of the Serbian Society of Plastic, Reconstructive and Aesthetic Surgery – SRBPRAS, with international participation, was held in Belgrade, on May 15th -18th , 2012. It was the second National Congress held after Serbia had become an independent state and the Society changed its name YUPRAS into SRBPRAS. The first Congress, which took place two years ago, was equally successful as the latest one. Present at the Official Opening Ceremony taking place in the ‘Odbrana’ Media Center were Dr. Slavica Đukić Dejanović, President of the National Assembly of the Republic of Serbia and Acting President of the Republic of Serbia, Dr. Zoran Jeftić, State Secretary, the heads of the MMA’s Clinics and Congress participants. The participant and guests were addressed by Brig. Gen. Prof. Dr. Marijan Novaković, the head of the Military Medical Academy and president of the Serbian Society of Plastic, Reconstructive and Aesthetic Surgery. He pointed out that the main objective of the Congress was to take, within the three working days, a retrospective look at the most important trends in the field of Plastic, Reconstructive and Aesthetic Surgery over the last two years. “This Congress will also cover the largest areas of Plastic

Surgery, thus keeping the 8-year long tradition of Surgery in this area. That is actually the most efficient way of staying in touch and getting new friends, since our profession is a continuing quality”, the MMA’s Head said. This year’s Congress was opened by Dr. Slavica Đukić Dejanović, President of the National Assembly of the Republic of Serbia and Acting President of the Republic of Serbia. Having expressed her pleasure for being given the privilege to open this event, she said that Plastic Surgery is a branch of Medicine which creates a higher quality of life for our patients and the Military Medical Academy, more precisely, the Clinic for Plastic Surgery of that institution is a maker of such an atmosphere in the field of Plastic Surgery here in Serbia. Plastic Surgery has its roots deep in the past and when something lasts, it is, surely, of great value. In the future, Plastic Surgery will see various improvements in terms of both knowledge and skills, that will, first of all, benefit the patients. Fill your working hours with your knowledge and skills, work as a team and share your experiences, for that will bring you a great satisfaction. The great number of participants and the international character of this event as well confirm the fact that there is a need for learning and experince sharing among our experts, who

Sessions of the Congress in the Crystal Hall of the Hotel Hyatt. Issue 8

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should become educators, not only at a national but an international level in the near future. The Congress was organized under the auspices of the Republic of Serbia Ministry of Health. During the ﬁrst two days, the Congress venue was the hotel Hyatt Regency and the topics of the scientiﬁc program ranged from the breast aesthetic surgery, breast reconstruction, reconstructive surgery, body aesthetic surgery, tumors, head and neck reconstructive surgery, face aesthetic surgery to rhinoplasty and hand surgery. The international lecturers at the Congress were Jan Jernbeck (Sweden), Marco Klinger (Italy), Giovani Botti (Italy), Gusztav Gulyas (Hungary), Ionac Mihai (Romania), Luiz S. Toledo (UAE), Marco Margaritoni (Croatia), Csaba Kunos (Hungary), Lucian Jiga (Romania), Zoltan Matrai (Hungary), Uros Ahcan (Slovenia), Franc Planinsek (Slovenia), Mario Zambelli (Croatia), Sonja Cerovac (UK), Nebojsa Rajacic (Kuwait). Among the national lectureres there were Marijan Novakovic, Zlata Janic, Jefta Kozarski, Nenad Stepic, Boban Djordjevic, Nebojsa Jovic, Lidija Kandolf-Sekulovic and Zeljko Mijuskovic. On the 16th and 17th of May, 62 oral presentations were delivered by 130 lecturers. Dr Giovani Salti’s presentation on ‘’Non-surgical face lift’,’ presented at the Restylane Symposium, was followed by a work-shop. The poster presentations exhibited during these two days

included 25 very interesting and professional posters. There were about 15 sponsors in the exibition room during those two days in the Hyatt hotel. On the 18th of May, the venue of the Congress activities was the Military Medical Academy. The Participants could take part in a live interactive broadcast of two surgeries performed at the same time in two operating rooms and in an extensive Q/A discussion. The ﬁrst surgery, which involved a breast reconstruction with a latissimus dorsi myocutaneous ﬂap and Polytech anatomical shape silicone implant after a previous mastectomy, was performed by Prof. Marijan Novakovic. The second one, relating to a beast augmentation by Natrelle was performed by Asst. Prof. Nenad Stepić. The Juvederm and Vistabel workshop that followed was

Dr. Nenad Stepic, Dr. Marko Margaritoni, Dr. Marijan Novakovic and Dr. Gusztav Gulyas

Dr. Marijan Novakovic 36

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moderated by Dr Mario Zambelli. Dr Milica Rajovic conducted the Pharma Swiss mini symposium on the ‘’Beriplast P application in Surgery’’. The Health Council of the Republic of Serbia has accredited the program of continuing medical education with 15 CME points for lecturers by rendering the decision numbered A-1-1875/12. The SRBPRAS is an acronym for the Serbian Society of Plastic, Reconstructive and Aesthetic Surgery. It is a professional organization established with the aim of better professional and organizational co-operation in the ﬁeld of Plastic, Reconstructive and Aesthetic surgery, as well as in the interdisciplinary areas. Its goal is to provide continuous education and training of experts in that ﬁeld through various forms of work, in order to be able to apply the latest achievements in both their clinical practice and research. The physicians of this Society are well-educated, actively involved in international congresses, members of a great many world societies of Plastic, Reconstructive and Aesthetic Surgeons, often seen as lecturers at medical events, and practically do not lag behind their international colleagues in almost all areas of Plastic Surgery.

Colombian Society of Aesthetic Plastic Surgery and Reconstructive In today’s world, South America is getting stronger every day and we, Colombia, being part of South America, are there on the front row. Our Colombian Plastic Surgery Society (SCCP) has been the leader of Plastic Surgery in our country for more than 50 years. The main objectives of our society are: • To contribute to the progress and quality of our specialty with diffusion and up to date information to our members, • To stimulate scientiﬁc papers and investigation by giving special mentions and prizes, • To ensure that the teaching faculties for Medicine and Plastic Surgery give quality education, • To promote the University hospitals open programs where Plastic Surgery is present, • To look after ethical conduct and quality performance of our specialty and profession in general, • To serve as an advisory entity for public and private organizations when academic, scientiﬁc and ethical problems related with our specialty arise, • To endorse the practice of Aesthetic and Reconstructive Plastic Surgery in our country,

worldwide, where we have non- qualified doctors doing Aesthetic Plastic Surgery. With this media campaign we have been educate with our people why they should do an Aesthetic Plastic Surgery procedure with a real Plastic Surgeon; we have also been able to make the Colombian Plastic Surgery Society visible to the general public. We have received thousands of calls and inquiries from the general public and potential patients asking if their doctor is or not a member of our society. Colombians know us and, more importantly, they know we are there to give the best to our patients always focusing on patient safety. We have also been working hard toward maintaining and enhancing higher scientific standards among our members every day. That is why this last May we had the last FILACP meeting, FILACP2012, where we enjoyed a huge scientific program of excellent quality. We hosted more than 1200 Plastic Surgeons from all over the world. Last May we held the elections for our Board of Directors and we are very proud to say that we are still working hand by hand towards reducing the social risk that Aesthetic Plastic Surgery in the wrong hands has turned to our country, Colombia. We are working towards the legalization of our specialty, Aesthetic Plastic Surgery. Several attempts have been done in our country in the past to this purpose. Today we have opened our minds and we

• To ensure that the professionals in charge of the Plastic Surgery programs are qualiﬁed and have the credentials as specialists in Plastic Surgery, • To promote the unity of Plastic Surgeons in our national territory and to be in favor of scientiﬁc interchange between its members and the medical groups of Colombian and internationally. Having these principles in mind, we can see how we have been active in projecting to Colombia who we are. In the last years we have been promoting a campaign named: Don’t be the body of evidence yourself. Why? Because we are in a situation, like many other countries

Vow of the new president

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Νew board: Νew President Dr. Carlos E. Hoyos, Vice president : Lina M Triana . Other members of the board: Dr. Ricardo Galàn, Dr. Juan Santamaria, Dr. Emilio Aun, Dr. Boris Henriquez, Dr. Ovidio Alarcòn

are working together with other surgical specialties that overlap in certain areas with aesthetic procedures, such as ORL, to have more strength together. We have started this path and hope other countries follow us because in the end we are there for patient safety, we

Carlos E. Hoyos S. President

are there to work hand by hand with our government to guarantee public health to our nations. The new board of Directors of the Colombian Plastic Surgery Society (2012 – 2014 ) SCCP comprises of the following members :

Lina M. Triana Vice-president

Ricardo Galàn Executive Secretary

Ovidio Alarcòn General Secretary

Emilio Aun Treasurer

Boris Henriquez Fiscal

Juan Santamarìa Past President

Adress: 2012 Colombian Society of Aesthetic Plastic Surgery and Reconstructive Avenida Calle 127 # 16A - 76 Of. Edificio 304 Pizano - Phone 6279136 - Fax: 6279247 Bogotá - Colombia, South América. Website: www.cirugiaplastica.org.co

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6th International Congress on Plastic, Reconstructive, Aesthetic Surgery and Cosmetology, Batumi, Georgia, July 6-8, 2012 The 6th International congress on Plastic, Reconstructive, Aesthetic Surgery and Cosmetology was held in Batumi, Georgia on July 6th - 8th. Such meetings are alternately organized either in Tbilisi or in Yerevan and are usually timed to coincide with the conventions of the respective National Societies (GeoPRAS and AAPRAS). World known Plastic Surgeons are usually invited to these meetings. They give lectures and make presentations with novel approaches in Plastic, Reconstructive and Aesthetic Surgery and dermatocosmetology. Georgian and Armenian surgeons also share their experience; they demonstrate interesting cases from their practice. Such exchange of information allows the colleagues to learn new methods and approaches and to introduce them in their practical activity. This year the meeting was crowded ever more. The con-

As at previous meetings, master-courses and video sessions on minimally invasive methods of Aesthetic Medicine (Z. Saylan, A. Tenenbaum, and others) were carried out.

Dr. Marlen Sulamanidze, Congress President

Conference Hall of Intourist Hotel ference hall of Intourist Hotel was full, doctors listened attentively to the speakers, asked questions and took part in discussions. Lectures on Reconstructive Surgery, mammoplasty, surgical and dermatological treatment of age aesthetic manifestations were innovative and interesting; complications and problematic situations were particularly emphasized.

For the ďŹ rst time this year, Aptos set up a live broadcasting from the Congress venue. You can watch the Congress even now on www.aptos.ru/reg/ Participants noted with satisfaction the high professional level of both the theoretical and practical studies, as well as the good organization of the meeting and the social program as well. The Congress was held in the resort town of Batumi, which has recently become a pilgrimage center for tourists of all over the world. It is located in the picturesque Adjara region on the shore of the Black Sea. The town is practically totally reconstructed â&#x20AC;&#x201C; old buildings are restored and new ones are built; the entire necessary infrastructure is developed for recreation and entertainment. The hospitable land of Georgia will be glad to welcome the colleagues to such meetings again.

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IPRAS report The Euro-Mediterranean Council for Burns and Fire Disasters (MBC) celebrated its 25th anniversary in Palermo, the City of its birthplace, on June 6-8, 2012, with the ofﬁcial participation of the European Burn

states gathered, joined by a large number of speakers and participants, despite the economic, political and security turmoil affecting the Mediterranean basin at present. The opening ceremony was held in parallel to Forum Mediterraneo in Sanità 2012 at Teatro Politeama, a

Group picture of the speakers

Association (EBA) and the Società Italiana Ustioni – SIUst. Under the title “Palermo, a bridge between centuries, cultures, civilizations and continents”, National Representatives of most Mediterranean MBC member

MBC General Assembly after the election of a new MBC Executive Committee. From left to right: Bishara Atiyeh, MBC New President, Michele Masellis, MBC Past President and present Director General, S. William A. Gunn, MBC Honorary President, (sitting) Matilda Costa, MBC Treasurer

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historical cultural landmark in downtown Palermo. Following a welcome address by Prof. S. William, A. Gunn, Honorary MBC President, G. Rockenschaub, WHO-Europe Adviser for Disaster Preparedness and Response Program, M. Russo, Regional Councilor for Health and G. Ruocco, Director of Politics of International Cooperation of Health Ministry addressed the audience. The opening ceremony was followed by a focus topic session on Burn Prevention & Education, then by a Special EBA session. Speakers were J.P. Fauville, L. Klein, G. Beerthuizen and P. Vogt. Subsequently, a special SIUst session was held with G. Caputo, G. Stracuzzi, B. Azzena, M. Stella and L. Marasco as speakers. Finally, a reception took place around the roof top pool of San Paolo Hotel, the main venue of the conference, overlooking the beautiful skyline of Palermo. Over the following two days, scientiﬁc sessions about various aspects of burn prevention and management were held. Guest speakers were D. Mackie, ISBI President, E. Van der Merwe, recipient of the latest Whitaker prize, Nelson Piccolo, IPRAS General Secretary and Naiem Moiemen from the UK, who participated in a special round table about wound coverage. On the second day of the conference, the MBC General Assembly was held. Reports of the President, General Secretary and Treasurer were reviewed. The General

direct link between MBC and the Italian and Sicilian Authorities. The Assembly then moved to unanimously elect Prof. Bishara Atiyeh as new MBC President, Prof. Michele Masellis as MBC General Director, Prof. Maurizio Stella as MBC General Secretary and Prof. Matilda Costa as Treasurer. The Assembly then approved the nominations to the various MBC committees and endorsed the application of Croatia to become an MBC member country.

Michele Masellis, MBC President, speaking at the opening ceremony held in parallel with the Forum Mediterraneo in Sanità 2012 at Teatro Politeama

The General Assembly was followed by a Gala Dinner at a beautiful seaside resort in Mondello, on the western outskirts of Palermo. With traditional Sicilian food, wine and music, the dinner ended with a spectacular ﬁrework display, marking 25 years of MBC’s existence.

Assembly, in the presence of Mr. Francesco Paolo Castellana, public Notary from Palermo, approved changes to MBC charter to include action in Third World and Developing Countries in MBC’s activities and to institute the position of MBC General Director to be the

The Mediterranean Burn Club 17th Congress took place in Palermo, Sicily, in the first weekend of June this year. It gathered specialists from the Mediterranean countries, as well as from several other countries. This year the MBC commemorated 25 years of its inception and the meeting was especially interesting in the sense that its content was very broad. Plastic Surgery principles, techniques and technologies were thouroughly discussed during the three days of the meeting, analyzing procedures for a very wide variety of reconstructive challenges, as well as common procedures on the burn patients The evolution of plastic surgical procedures in the care of the burn sequellae patient was especially discussed with great detail, pointing out the advantages and disadvantages of a very large spectrum of techniques, by Prof. Michel Coastagliola, from France. With his vast experience, he confirmed what is the state-of-the-art in Burn Reconstruction today. Similarly, Prof. Peter Vogt from Germany presented us several aspects of today’s options in burn care and reconstruction, also defining the current trends for best results. Profs Michelle Maselli and Bishara Atiyeh are to be congratulated again for a very successful meeting, which presented a most rich scientific content.

Dr. Nelson Piccolo IPRAS General Secretary

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Seoul Rhinoplasty Forum 2012 (SRF 2012) Man Koon Suh, M.D. Executive director of SRF 2012

The first Seoul Rhinoplasty Forum 2012 (SRF 2012) took place from 16th to17th June this year in “Seoul Saint Mary’s Hospital” in Seoul, Korea. This forum was hosted by the Korean Society of Rhinoplasty Surgeons, comprised of board-certified Plastic Surgeons and sponsored by the Korean Society of Plastic and Reconstructive Surgeons and IPRAS. The forum lasted two full days in two separate rooms. The official languages were Korean and English. Participants were provided with simultaneous translation. The two-day forum consisted of 14 panels, 5 instructional courses, 2 video sessions, 3 current opinion sessions, 3 invited lecture sessions and 2 free paper sessions. The panels covered most fields ofAsian rhinoplasty, including nasal reconstruction, functional septorhinoplasty, and secondary cleft lip nose as well as aesthetic rhinoplasty. Five instructional courses covered the practical operative techniques, including the closed rhinoplasty, open structure rhinoplasty, tip-plasty using ear, septal and rib cartilage, providing the detailed techniques and useful tips for the beginners to step in the fascinating rhinoplasty fields and for the mid-level surgeons to proceed into more advanced levels. Forty speakers from Korea and 14 speakers from abroad gave their excellent lectures. Over 400 participants from our country and abroad had a valuable experience exchanging the most advanced knowledge of Asian rhinoplasty and engaging in discussions. The first day focused on the primary rhinoplasty and the second day emphasized secondary rhinoplasty.

The ﬁrst day began with Panel 1: Asian beauty (Practical analysis in rhinoplasty) in room A and instructional course 1 (Becoming a rhinoplasty surgeon) in room B. Panel 2 dealt with the low proﬁle nose management. Each panelist presented their special techniques and opinions about

Choon Ho Ye, M.D., Eun Sang Dhong (program council chair), M.D., Se Whee Hwang (director of PR), M.D., Yong Ju Jang, M.D., Man Koon Suh, M.D(executive director), .Jae Goo Kang, M.D., Moo Hyun Paik, M.D.(new elected president of Korean society of rhinoplasty surgeons), Hyun Soo Kim, M.D., Dong Chul Lee, M.D.(from left)

implant use and tip-plasty. The following sessions included the nasal reconstruction (ﬂap and framework), deviated nose, functional aspects in septorhinoplasty, Asian septorhinoplasty and Asian tip-plasty. Panelists from Korea and abroad explained their experiences and knowledge and there were

Faculty members and some speakers

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Standing person for greeting is Prof. Cenk Sen, M.D.(Turkey). Dinner Hotel is Palace Hotel.

many interesting questions and comments from the audience. The first day in room B focused on two instructional courses, including closed rhinoplasty, etc, current opinion sessions and free papers. Participants had the pleasant opportunity to see many personal techniques and current opinions on the Asian update rhinoplasty, such as implant-related topics, ala base surgery, hump-related subjects and filler-related complications. The second day explored more difficult fields of rhinoplasty. First session (panel 9) started with the practical analysis and preparation of secondary rhinoplasty. Septal modifications for the tip and secondary cleft lip nose deformity followed. Even though the second day of the forum was a Sunday of good weather, leading to the temptation of going for a picnic or playing with one’s family, nobody abandoned their seat all day long. The second day forum concluded with panel 12 – 14 (problem solving 1,2 and my difficult patients) Masters dealt with difficult and challenging subjects of Asian rhinoplasty. Foreshortened nose correction, ala shape change after jaw surgery, alar retraction were included. Also, Panel 14 had the most serious topic; “My difficult patients: Over tertiary operated”. Panelists with extended experience and a high level of skill presented their various cases of endangered nose or problematic nose due to previous frequent operations. The second day in room B consisted of three instructional courses and two sessions of invited lectures. We had a rich social program, a clinic tour, a welcome reception and a presidential dinner. On Friday, the day before the beginning of the forum, a clinic tour was held. Twelve doctors from abroad, who had reserved the clinic tour, visited the private Plastic Surgery clinics in Seoul. They were grouped into two teams and each team visited JW Plastic Surgery center and April 31 Plastic Surgery clinic for the observation of Korean Aesthetic Plastic Surgery. Visitors observed the operations during the half day before noon and had a pleasant lunch time with clinic doctors. We held a welcome reception Friday evening in JW Marriott Hotel.

All the participants and their accompanying persons could freely join the reception and enjoy the delicious cuisine and beautiful atmosphere of the night of Seoul. There was a presidential dinner on Saturday evening in the Palace Hotel. Panelists, committee members, national chairs, chairs of the Plastic Surgery-related societies of Korea and many participants enjoyed the delicious foods and wine and had a joyful friendship with each other. Each faculty members of the forum were introduced to the participants. “Danbi’, a group performing the fusion style of Korean traditional music and dance, gave a cheerful time to all the participants. The forum was successful, giving all the participants valuable feeling of acquiring the most advanced knowledge of Asian rhinoplasty and changing their experiences. The forum will create opportunities for the Surgeons in the Asia-Paciﬁc region to exchange knowledge and engage in discussions about rhinoplasty and will be a venue for them to promote friendly relations. It will also promote the worldclass level of Asian rhinoplasty and hopefully establish itself as the most widely recognized forum on rhinoplasty in the Asia-Paciﬁc region as an organization of true rhinoplasty experts.

From the left Prof. Ki Il Uhm, M.D.(Korea), Prof. Lun Jou Lo, M.D.(Taiwan), Prof. Kyung Suck Koh, M.D.(Korea)

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Report by the 3rd Central Asian Conference on Plastic Surgery (3rd - 5th MAY 2012) Murod M. Jafarov, MD, PhD Associative Professor Head of Plastic Surgery Department Tashkent Pediatric medical Institute President of SPRAS of Uzbekistan Member of ExCO of IPRAS Member of American Society of Plastic Surgeon

The Society of Plastic, Reconstructive and Aesthetic Surgeons of Uzbekistan (SPRASU), the Tashkent Pediatric Medical Institute, in conjunction with the Republican Public Children’s Fund “SEN YOLG’IZ EMASSAN” and the International Confederation for Plastic Reconstructive and Aesthetic Surgery organized the 3rd Central Asian Conference on Plastic Surgery, which was held on 3rd – 5th of May, 2012 at the International Business Center in Tashkent. The Minister of Health of the Republic of Uzbekistan, Prof. Adkham Ikramov, opened this conference. At the opening ceremony, addresses were made by the Director of the Republican Public Children’s Fund “SEN YOLG’IZ EMASSAN”, Galina Smirnova, Executive

Prof. Murod Jafarov (President of Uzbekistan Society of Plastic, Reconstructive and Aesthetic Surgeons), Dr. Vladimir Kan (Taiwan), Dr. Chung Sheng Lai (Taiwan), Mr. Zacharias Kaplanidis (IPRAS Executive Director), Dr. Lin-Sin Dan (Taiwan)

director of the International Confederation for Plastic Reconstructive and Aesthetic Surgery, Mr. Z. Kaplanidis (Greece) and two of the world’s leading Plastic Surgeons, Prof. Daniel Marchac (France) and Prof. Cohen (USA). The conference addressed a wide range of issues relat46

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ed to Plastic and Reconstructive Surgery, Maxillofacial Surgery, Traumatology and Orthopedics, Oral Surgery, Ophthalmology and Otorhinolaryngology, Dermatology and Cosmetology, Anesthesiology and general issues of post-operative patient care. The Central Asian Conference on Plastic Surgery was held for the third time, the previous ones being in 2008 and 2010. In the first conference in 2008 there were 17 foreign guests from five countries and in 2010 40 foreign guests from 14 countries worldwide participated. This year, more than 60 foreign surgeons expressed the wish to participate in the conference, of which 45 actually did. They were all leading Plastic Surgeons from 22 countries worldwide. For the first time the conference was first held in conjunction with the International Confederation for Plastic Reconstructive and Aesthetic Surgery. Through the help of the Confederation, we had guests from Austria, Australia, Armenia, Brazil, Germany, Greece, Egypt, India, Spain, China (Taiwan), Korea, Malaysia, Mexico, Pakistan, Russia, Singapore, USA, France, Turkey and Ukraine, also from our close neighbors, Kazakhstan and Kyrgyzstan. One of the most active organizers of this Conference was the Republican Public Children’s Fund “Sen yolg’iz emassan.” This fund is a partner of the Society of Plastic Reconstructive and Aesthetic Surgeons of Uzbekistan, who co-hosted several charity events, aimed at the rehabilitation of children with congenital malformations such as cleft lip and palate and took action to improve the health of the children population. One of the recent successful campaigns of the project was “Smile for the Children”, which is based on foreign campaigns and was conducted for the first time in April in the city of Andijan, on the eve of World Health Day. According to reputable Plastic Surgeons Uzbekistan occupies a leading position in Central Asia as far as Plastic Surgery is concerned. This is evident in International

Photo from Myanmar mission of Uzbekistan team. Among others Prof. Murod Jafarov.

Conferences, the participation of foreign guests and joint actions. Thus, the International Organization Operation Smile annually invites Plastic Surgeons from Uzbekistan to participate in international actions carried out by the Fund. In 2009, an Uzbek team of Surgeons participated in the mission in Indonesia (operations were performed on more than 20 children), in 2011 in Cambodia (27 children were operated on) and Indonesia (22 children were operated on). In February 2012 the group participated in the Myanmar mission, where they operated on 26 children. All these events show the recognition of the high skills of the Uzbek Plastic Surgeons by the international organizations. These results were

Opening Ceremony

discussed at the conference with leading experts from around the world. On the first day of the conference excellent lectures were made by Prof. Daniel Marchac and Prof. Aleksey Borovikov, which focused on face-lifting and mammoplasty. Local doctors, Prof. M. Azimov and Dr. M. Nigmanov delivered a presentation dedicated to cleft lip and palate. A presentation on aesthetic mammoplasty was made by Russian Surgeons Andrew Guryanov and Eugeniy Jukov. The second day began with a master class on rhinoplasty (Cohen Mimis) and otoplasty (Gomaa Raouf). There were many lectures on Oral and Maxillofacial Surgery and Microsurgery, as well as a good presentation on Extremity Surgery by Prof. Shahob Khamraev and Dr. Ravshan Irismetov. Dr. Alisher Madazimov made a presentation on post-burn surgery. On the last day of the Conference interesting presentations were delivered by Lai Chung Sheng and Ivan Krainik on new advances in Plastic Surgery. Dr. Natalya Ligay presented an excellent report on the use of lasers in cosmetology. We believe that this Conference was successful and served as an excellent opportunity for exchange of information between medical professionals and experts in the field of medicine; it also helped to raise the level of provision of skilled care in the field of Plastic Reconstructive and Aesthetic Surgery by local doctors. Issue 8

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14 March 2012 Prof Adkham I Ikramov Minister of Health 12, A. Navoi Street Tashkent, Uzbekistan 100011 THROUGH: His Excellency Mr Alisher Kurmanov, Ambassador of Uzbekistan to Singapore Dear Prof Ikramov THANK YOU FOR SENDING UZBEKISTAN MEDICAL VOLUNTEERS IN OPERATION SMILE MISSIONS On behalf of Operation Smile, I thank the Ministry of Health for facilitating the participation of nine Uzbekistan medical professionals in three Operation Smile international medical missions in Cambodia, Indonesia and Myanmar, resulting in a total of 315 free surgeries. The following are the list of participation of Uzbekistan volunteers. Mission in Takeo, Cambodia (May 2011) 164 screenings and 105 surgeries i) Dr Bakhtiyor Gaziev - Anaesthesiologist ii) Dr Mavlon Meliboev - Paediatric Anaesthesiologist Mission in Batam, Indonesia (July 2011) 180 screenings and 104 surgeries i) Dr Murod Nigmanov - Plastic Surgeon ii) Dr Otabek Fayziev - Anaesthesiologist iii) Ms Umida Umarova - Operating Room Nurse Mission in Mandalay, Myanmar (February 2012) 154 screenings, 106 surgeries i) Dr Murod Jafarov - Plastic Surgeon ii) Dr Mavlon Meliboe - Paediatric Anaesthesiologist iii) Dr Bakhtiyor Gaziev - Anaesthesiologist iv) Ms Umida Umarova - Operating Room Nurse Operation Smile is happy that Uzbekistan medical professionals have started playing a key role in international medical missions throughout Asia.

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HISTORICAL ACCOUNTS

Royal Belgian Society for Plastic Surgery I. THE EARLY HISTORY OF PLASTIC SURGERY IN BELGIUM The period of birth (1922-1946). The history of “modern” Plastic Surgery in Belgium started when a young restless ENT specialist, Dr. Maurice Coelst (1894-1963), who graduated in 1922 from the Free University of Brussels and trained in ENT in Brussels and Paris with Prof. P. Sébileau (1860-1953), got aware of the shortcomings of his specialty and other connected specialties and left Dr. M. Coelst for Berlin to specialize with Professor Dr. J. Joseph (18651935), who was at the apogee of his career, performing not only rhinoplasties but also general reconstructive procedures. By that time, M. Coelst became fascinated by Plastic Surgery, which was to be the dominant interest of his life. Back in Brussels, he had to restrict his activities to private practice, because he could not get any official university or hospital appointment; it was generally felt there was no need for this kind of surgery. In spite of this, it did not take him long to prove himself a practitioner of extraordinary talent, who drew patients from all over the country and became the real pioneer of this type of surgery in his country. He could easily have allowed his creativity to be consumed solely by his large practice, but his scientific eagerness prompted him to join his fellow pioneers in various countries of Europe and the USA, who also had to face many challenges in this newly established specialty. For almost twenty years, he would practically be the only Surgeon in Belgium restricting his practice to Plastic Surgery. From 1931 on, he extended his scientific activities, presenting models of new nasal saws and making pictorial records of his patients and strips of films of his operations; he tried to gather with other Plastic Surgeons to establish what he called a “filmothèque”. As a clinical scientist, he made many contributions to Plastic Surgery, 50

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Prof. Em. Dr. Paul Wylock Former Head of the Department of Plastic Surgery University Hospital Brussels, Belgium

constantly improving the techniques in the fields of cleft palate, angiomas, skin grafts, rhinoplasty, etc. The year 1931 is, in fact, outstanding in the history of Plastic Surgery in Belgium and all over the world. A man of vision and far-sighted imagination, M. Coelst realized that the separated and personal efforts and publications of so many pioneers, scattered all over the world, would be lost if not gathered in a scientific journal devoted solely to Plastic Surgery for the benefit of all. This brought him to the idea of establishing, at his own initiative, the first international journal of Plastic Surgery ever published: “Revue de Chirurgie Plastique”, fifteen years before the USA journal “Plastic and Reconstructive Surgery”. The International Board of this journal included the names of G. Sanvenero-Rosselli, L. Dufourmentel, Eastman-Sheehan, Ferris-Smith, Lexer, Pierre-Robin, Portman, Dartigues, etc. This “Revue” was promptly accepted as the leading Journal of Plastic Surgery and all the internationally known Plastic Surgeons of that time contributed to it with scientific papers that are of great value even today. At the suggestion of Esser, who thought that the term “Plastic” was not appropriate to define that new specialty and owing to the fact that many less stalwart colleagues disliked the term “Plastic”, Coelst wanted to dissociate the true Reconstructive Surgeons from those bad actors who were often pure charlatans with low ethical and deontological practices, totally disapproved by the medical profession. This degradation could be ill afforded by Coelst and in 1936, the name of the journal was modified to “Revue de Chirurgie Structive». Papers were published in whatever language was preferred by the authors (French, English, German, Italian and Spanish) with summaries in French, English and German. A restless organizer, heartened by the success of his journal and perceiving the importance of interpersonal relations in the development of the new specialty, he established the first European Society of “Structive Surgery” in October 1936 and organized the “First International Congress of Structive Surgery” in Brussels on the 3rd and 4th of October 1936, nineteen years before the so-called “First” meeting of the International Society of Plastic Surgeons, organized in Stockholm by T. Skoog. The aim of the meeting was to exchange personal experiences, confront the various methods utilized and resolve the problems and challenges the new specialty was confronted with.

First European Congress of Plastic Surgery in Brussels (2 th and 3 th October 1936), from left to right, Gillies, Esser, Coelst, Kilner, Sanvenero-Rosselli

The ofﬁcers of this Congress were: F.S. Esser (President), H. Gillies (Vice-President), M. Coelst, T.P. Kilner and G. Sanvenero-Rosselli. This meeting met with a very sympathetic reception and could count on an international participation, 44 papers being delivered. At this Congress the principles were laid down for a tribune for common investigations and for a stronger confraternity among those who were pursuing the same ideal. Finding a venue for this historical congress was also not straightforward, with the choice ﬁnally being The Marble Hall at the Palace of the Academies in Brussels, near the Royal Palace. Further meetings of this European Society were held in 1937 in London (Dr. T.P. Kilner: President) and in Milan in 1938 (Dr. G. Sanvenero-Rosselli: President), where 140 representatives of 16 nations came together. Unfortunately, WWII interrupted the organization of these congresses and the publication of the Revue de Chirurgie Structive as well. These international congresses of the European Society of Structive Surgery represented the highpoint of development of Plastic Surgery prior to World War II. The contribution of these congresses was of very high quality and represented milestones of progress towards the recognition of this new branch of surgery. Dr. M. Coelst reached another climax in his brilliant career by founding the Belgian Society of Plastic Surgery in 1955. He passed away in 1963. The period of infancy: (1946-1955) Immediately after WW II, only two fully trained Plastic Surgeons dominated the scene in Belgium: Drs M. Coelst and W. Cowell, a British Maxillofacial Surgeon who came with the British troops and who had been responsible for a British Maxillofacial Unit in the army of the Rhine. After the war he decided to settle down in Antwerp and soon

started an important private practice of Plastic Surgery, mainly covering the Dutch-speaking part of the country, while Dr. M. Coelst attracted mostly the French-speaking part of our country. In the meantime, Dr. A. Steenebruggen, an Oral Surgeon at the University of Liège working in the department of Stomatology, showed a great interest in cleft lips and palates. At the time, the organization of training in various specialties was in a real chaos, due to the total lack of basic organization and of criteria of recognition. As far as Plastic Surgery was concerned, the situation was even more dramatic, since the public opinion towards Plastic Surgery was not very favourable. This kind of surgery was considered as purely aesthetic and restricted to rich people and did not benefit from the consideration of the medical profession, the Universities and the lay people. All these elements did not contribute to the early development of Plastic Surgery in our country. No Certification Boards existed and the Surgeon who wanted to specialize had to apply either to the Ordre des Médecins (Orde der Geneesheren) or to some of the existing Professional Associations, which represented, at the time, the two only “legal” authorities. There was a lack of specific regulations as far as quantity and quality of training and a total absence of “official” training centres, except the two private practices of Drs. Coelst and Cowell. However, the magnificent job done mainly in the UK and the USA during and after the war became gradually known to a rather limited group of young doctors and a number of them applied, mainly to the UK centres of H. Gillies, A. McIndoe, R. Mowlem and others, to get acquainted with the possibilities and the techniques of this new specialty; new, because the lessons of WWI seemed to be forgotten by most of the surgical profession. Only in a few countries who had been involved directly in the First World War like the UK, France, Italy and the USA, one could find Issue 8

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a few Plastic Surgeons practicing Plastic Surgery, but they remained unknown by the largest part of the medical profession. Nevertheless, a few newly graduated Belgian physicians started to show interest in Plastic Surgery in Belgium and, after having spent a number of years in General Surgery, they started their training either overseas, in France or in Belgium with Dr. Coelst. Jacques Polus, who graduated in 1945, started as a trainee in General Surgery with Dr. G. Cahen, a wellknown and outstanding General Surgeon, but got interested in facial surgery and soon went to France for 6 months to watch some famous surgeons like Drs. V. Veau, Léon Dufourmentel, Ginestet and Dr. J. Polus Virenque. Back in Belgium, he trained in ENT with Prof. P. Hennebert. In 1947, he went to observe H. Gillies for 3 months at Basingstoke and in 1948, he managed to become an assistant in the service of Dr. H. Gillies for 18 months; meanwhile, he observed operations by Drs. P. Kilner, R. Mowlem and A. McIndoe. In 1949, he was appointed Head of the newly created unit of Plastic Surgery at the Gailly Hospital in Charleroi and in 1962 he was appointed Head of the Plastic Surgery Service at the Policlinique de Bruxelles, where he operated until his retirement. Although he did not publish a lot of scientific papers, he gave a huge amount of conferences and lectures of General Plastic Surgery of interest to ENT specialists, Dermatologists and Urologists in Belgium, France and the UK He became a founding member of our Society and remained at the Directory Board for 14 years, as Treasurer, Secretary, President and Councillor. He was appointed member and President of the French speaking Chamber of Certification of Plastic Surgery for many years. The second important figure of this period is Dr. Albert de Coninck, who started his full-time training in General Surgery at UCL and became the private assistant of Dr. M. Coelst from 1950 to 1955. At the end of 1955, he Prof. A. de Coninck Prof. R. Vanwijck spent two months with Dr. 52

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H.Gillies in the U.K. In 1956, he started his private practice at the Clinique des Deux Alices, where he was appointed Chief of the Department of Plastic Surgery. He joined the UCL in 1957 and was appointed successively assistant in Plastic Surgery, Maître de Conférences in 1958, Lecturer in 1972 and Professor of Plastic Surgery in 1974. His collaboration with Dr. W. Boeckx is well known and they both contributed to the early literature on Microsurgery in Plastic Surgery in Belgium. He became a founder of our Society in 1955 and held the President’s chair of our Society after Coelst’s resignation. We want to give credit to the outstanding efforts and dedication of these two men who contributed so much to Plastic Surgery in our country. They mothered and cared for the infancy of Plastic Surgery in our country, preserving it from drifting away aimlessly and observed the preservation of the high principles and standards of our specialty. Their planning and wisdom have been unexpectedly farsighted; their very action gave the necessary confidence – at that time- to the puny child. After the establishment of the Belgian Society of Plastic Surgery, they remained the pillars of the young society for a long time and they contributed immensely to the scientific and professional success of our Society. Their continuous efforts and stimulation of their young colleagues have left permanent marks and enabled the continuous growth of our Society and made it possible to celebrate our 50th anniversary in May 2005, since they preserved the vitality of the limited Society which started with five Surgeons and which now includes more than 200 Plastic Surgeons. We also have to mention other young Plastic Surgeons who started training and practicing Plastic Surgery during these early days of infancy : Dr. A. Fardeau, who practiced in the Hôpital Longchamp and the Hôpital Français after a stay in the UK; a General Surgeon, Dr. L. Switters, who completed a full training program in Plastic Surgery in Sweden with Dr.R. Ragnell and started his private practice in la Clinique du Solbosch in Brussels, without forgetting Dr. H. Smet who started his private practice some years later in Antwerp, after a full-time training in the Netherlands with Dr. C.A. Honig and G. Bovy, who had partially trained with Dr. M. Coelst In the late 1950’s and early 1960’s, a certain number of Surgeons in Belgium, concerned with the deficient training standards and opportunities in our country and realizing the necessity of a specific full-time training in Plastic Surgery, left our country to get a full training either in the USA or in Great Britain, in France, in Germany, in Canada etc. In the USA, Drs J. Vrebos, G. Matton, J. Vandeput, R. Peeters, C.C. Dupuis passed the examinations for Certification as Diplomats of the

American Board of Plastic Surgery (Foreign Certificate). In Great Britain, Drs A. Castermans, N. Robbe and G. Monballiu. In France, Dr. M. de Thibault. In Germany, Dr. R. Van Lierde. In Germany and France: Dr. F. Segers. These men fulfilled their complete training in recognized units of Plastic Surgery. In 1970 Guido Matton and André Castermans were appointed Professors at the University of Gent and of Liège, respectively. They developed the first University Departments of Plastic Surgery, where they started official training programs in Plastic Surgery.

II. FOUNDATION AND HISTORY OF THE BELGIAN SOCIETY OF PLASTIC SURGERY The story officially dates back to November, 17, 1955, when Dr.Maurice Coelst and four enthusiastic Plastic Surgeons decided to establish a Society for Plastic Surgery in Belgium. (Moniteur-Staatsblad n°3430, December 10, 1955). The genesis of this Society was the issue of a dynamic union between the surgical status quo of the time and a handful of Surgeons who, perceiving the signs, the importance and the future of Plastic Surgery, met and founded this Society. At the Constituting Assembly of November 17, 1955, the Directory Board consisted of the five founders: Drs. M. Coelst, J. Polus, A.de Coninck, A. Steenebruggen and A. Fardeau with following officers: President: Dr. M. Coelst; Secretary: Dr. A. Fardeau and Treasurer: Dr. A. de Coninck. Dr. M. Coelst was host and President of the first session of scientific meetings he organized at the Maison des Médecins in Brussels on June 26th, 1956, June 26th, 1958, October 24th, 1958, April 29th, 1959, November 25th, 1960 and June 16th, 1961. At this last meeting, he resigned for health reasons and was elected Honorary President of the Belgian Society of Plastic Surgery. Unfortunately, there are no records left of the meetings Dr. Coelst organized. After the resignation of Dr. Coelst, Albert de Coninck became President and Jacques Polus Secretary. Dr. M. Coelst passed away on April 2, 1963. His international reputation is confirmed by his memberships at the time of his death: the American Society of Plastic and Reconstructive Surgery and the British Association of Plastic Surgeons. From 1962 on, Drs A. de Coninck and J. Polus took over the organization of meetings. There are no records left, but from 1963 on, the authors of this chapter remember that they took place at the Policlinique de Bruxelles, where Jacques Polus worked. Those were very informal meetings, usually on Friday evenings, with no predetermined programs. All those present, usually not more than 10 or 12 colleagues, were asked to spontaneously present an interesting subject or to report on a scientific meeting they had attended. This system assured that the meetings

did not last very long and all the participants went to a nearby café, where André Fardeau excelled at telling juicy jokes. But these informal meetings contributed to creating an atmosphere of camaraderie and friendship, which over the years and up the present time have been cultivated in the Belgian Society of Plastic Surgery. An important event happened on May 25th, 1963. The secretaries of the Dutch and Belgian Societies of Plastic Surgery, Jacobus (Jaco) Hage and Jacques Polus had somehow met each other and organized the first Joint Meeting of both Societies at the “Economische Hogeschool” in Tilburg. There was a visit to this Hogeschool (College), a programme for the ladies and a scientific programme with 8 papers. Mr. A. B. Wallace of Edinburgh (Scotland) was the guest of honour. This was the first occasion on which Dutch and Belgian Plastic Surgeons got to know each other and the start of two yearly joint meetings, and were held alternatively in Belgium and the Netherlands, which continued until a few years ago. In 1963 the membership fee for the Belgian Society of Plastic Surgery was 300 Belgian francs: about 7, 50 Euros. From April 22nd to 24th, 1964, the British Association of Plastic Surgeons organized its spring meeting in Leiden (The Netherlands) upon invitation of the Dutch Society and the members of the Belgian Society of Plastic Surgeons were also invited. A second joint meeting of the Belgian and Dutch Societies of Plastic Surgery which had been planned for April 25th, 1964, in Brussels had to be postponed for October 24th, 1964, due to a strike of the Belgian doctors,. A ladies programme was organized and 11 scientific communications were given. Mr. John Barron of Salisbury (UK) and Mr. Tom Gibson of Glasgow (Scotland) were the guests of honour. For the first time, an evening dinner for all participants and partners was organized. From around that time, the Belgian Society regularly organized two meetings every year; In the meantime, some important achievements were obtained: Plastic Surgery was officially recognized by the Ministry of Health and by the U.E.M.S (Union Européenne des Médecins Spécialistes). In May 1967, Albert de Coninck ended his six year term as President and was replaced by Jacques Polus. Guido Matton was elected Secretary Since its foundation, the Belgian Society had organized all its activities in French. As a growing number of young Dutch speaking Plastic Surgeons had become members and were active in the Society, is was decided at the general Assembly of February 16th, 1968, that the Society should become bilingual and the name became “Société Belge de Chirurgie Plastique – Belgische Vereniging voor Plastische Chirurgie”. From then on, communications in meetings could be given in French or Dutch. The statutes and bylaws were published in Dutch in the Moniteur – Staatsblad on December 2nd, 1971. In 1968, the National Meeting of the French Society of Issue 8

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Plastic Surgery could not take place as scheduled and the members of this Society were invited to attend the Joint Meeting of the Belgian and Dutch Societies, which took place in Brussels on May 24th and 25th. The French Surgeons came in great numbers, notwithstanding the fact that especially in France, it was the time of the student’s revolt and public life had practically came to a standstill. Some French Surgeons drove into Italy or Switzerland and took a train or a plane. The meeting was a great success scientifically, but on May 25th, the Heads of the most important French Plastic Surgery Departments were ordered to return to their posts immediately. The meeting of the Belgian Society in Louvain on December 7th, 1968 also marked an important turning point: is was the first full day meeting with a ladies’ programme and an informal dinner for all participants and their partners, a tradition which has been continued up to the present day. Up to then, at the Universities, Plastic Surgery was still part of the Department of General Surgery, but in 1970 training programmes of Plastic Surgery were started at the Universities Gent and Liège, in independent departments of Plastic Surgery. The Heads were Prof. G. Matton and Prof. A. Castermans. Although the law at that moment only required “4 years of full-time training in Surgery and Plastic Surgery”, without specification of how much time had to be devoted to Plastic Surgery, the required training in these programmes was from the beginning set at a minimum of 3 years of General Surgery and 3 years in a “polyvalent” Plastic Surgery centre. Over the years other training centres were created at University Hospitals and peripheral hospitals. In 1973 “The Prize of the Belgian Society of Plastic Surgery” was established. In 1975 the statutes and bylaws of the Society were modified. The main modifications were that the terms of President, Secretary and Treasurer were reduced from six to three years and a new category of membership was created: candidate members, mainly aimed at accepting assistants-in-training and recently established Plastic Surgeons until they qualified to become full members. On April 26th , 1975, the Society celebrated its 20th anniversary by organizing a congress in Gent ( Prof. G. Matton), which was attended by foreign colleagues: Morel-Fatio (France), Huffstadt (The Netherlands) and Hartwell (USA). In 1980, the 25th anniversary of the Society was celebrated during the first two-day Congress, organized by J.Vrebos in Brussels on May 30th 31st . It was also the 10th Joint Meeting with the Dutch Society of Plastic Surgeons. Several foreign Plastic Surgeons attended the Congress, during which Honorary Fellowship of the Society was granted to Drs. J. Polus, A. de Coninck, J.K. Masson (USA), C.A. Honig (The Netherlands), R. Mouly (France) and R. Sandon (U.K). The 30th anniversary of the Society was celebrated in 1985, with a congress in Liège, organized by Prof. A Castermans and Dr. R. Vanwijck. On May 5th, 1990, Prof. G. Matton organized the National 54

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Congress in Gent on the occasion of the 20th anniversary of the Gent Department of Plastic Surgery. In 1991, the statutes and by-laws of the Society were again modified on the initiative of the then president, Dr. E. Van Calster. On June 8th -10th , 1992, a Joined Congress with the British Association of Plastic Surgeons was held in Glasgow, UK, under the presidency of Mr. W H. Read and Prof. R. Vanwijck. The 40th anniversary of the society was celebrated by a scientific meeting organized on June 6th, 1995 by Dr. A. Vanhaesebrouck in Sint Niklaas. Also in 1995, the name of The Belgian Society of Plastic Surgery was changed into the Belgian Society of Plastic, Reconstructive and Aesthetic Surgery. On October 18th -19th, 1996, the Joint meeting of the Belgian and Dutch Societies was organized outside Belgium and The Netherlands for the first time: in Mondorf-les-bains in Luxembourg, by Dr. N. Calteux. In 2005 the Belgian Society of Plastic, Reconstructive and Aesthetic Surgery celebrated its 50th anniversary, an important milestone in the history of our society. The name of our society became Royal Belgian Society for Plastic Surgery The Board of the Society had decided that this happy event should not pass unnoticed. Besides the organization of a two-day congress on May 6th and 7th, 2005, at the Cinquantenaire in Brussels, it was decided to publish a commemorative book. Several foreign Plastic Surgeons attended the congress: B. Haeseker, M. Kon, J. van der Meulen (The Netherlands), D. Marchac (France), G. McGrouther (U.K.), and Dr Nhat (Hue, Vietnam). The organization of the 2005 Congress (Co-chairman: Prof. A. De Mey and Prof. P. Wylock) and festivities was entrusted to an organizing committee (Prof. Ph. Blondeel, Prof. A. De Mey, Dr C.C. Dupuis, Prof. G. Matton, Dr. J. Vrebos, Prof. P. Wylock). This committee was also responsible for writing the lustrum book: a formidable task. The collaboration between the members, however, was pleasant and stimulating. On May 8th, 2010, Prof. Wylock, of the University Hospital Brussels, organized the last congress of his active career, before his retirement at the end of 2010. The place of venue was the Square in Brussels. Guests of honour: Aly Al (USA), S. Hovius (Rotterdam), McGrouther (U.K)

THE COLLEGIUM CHIRURGICUM PLASTICUM BELGICUM The Collegium Chirurgicum Plasticum Belgicum was founded in 1988. It all started with an initiative of Prof. Madeleine Lejour and Prof. Guido Matton. Prof. Lejour invited all the training chiefs of that time at her home for two meetings in 1988.

Prof Dr. Madeleine Lejour

Those present were: Prof. Madeleine Lejour (ULB), Prof. Dr Guido Matton (Gent), Prof. J. Fissette (Liège), Prof. W. Boeckx (Leuven), Prof. Romain Vanwijck (UCL), Prof. Paul Wylock (VUB), Dr. Norbert Robbe (Roeselare), Dr.Guy Monballiu (Brugge) Reunion of the chiefs of training at M. Lejour’s house, July 1988 for planning the foundation of the

Collegium Chirurgicum Plasticum. During these meetings, it was decided that - four full teaching days should be organized every academic year. - the teaching should be spread over cycles of three years, the length of the specialist Plastic Surgery training at that time. - the entire spectrum of Plastic Surgery should be covered in those 12 teaching days. - a yearly evaluation should be organized for all candidates in training. Prof. Matton was elected to be the co-ordinator of “The Collegium Chirurgicum Plasticum Belgicum” or CCP, a task that he fulﬁlled up to July 2004, when Prof. Wylock took over as co-ordinator. At the beginning the trainees were furious. More courses

Prof Guido Matton

and more interrogations! However, over the years, their attitude changed. Although there are still some trainees who consider it a pain in the neck, the majority now appreciates it. They realize that it makes them study and gives a more solid scientiﬁc basis to their training of cutting and stitching. Recently, even the ones who spend a year in research

J. Vranckx, M. Vandorpe, S. Monstey, M. Mertens, D. Jacquemin, M. Hamdi, M. Depoorter, P. Wylock Chiefs of the trainings centres, aug. 2010 Absent: R. Vanwijck, A. De Mey, S. de Fontaine, N. Calteux

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before entering the training program have asked to be allowed to participate, a request which has been granted enthusiastically. The entire system had another unexpected benefit. For years now the trainees of the different training centres know each other and when they go into practice, they know their young neighbours. The two essential elements of the system are: • The teaching days • The evaluation The teaching days. They are always organized and held at one of the training centres. At the present time, there are nine training centres in Belgium and one in Luxembourg. In alphabetic order: Antwerpen: Universiteit Antwerpen Brugge: St Jan’s Hospital Brussels: Université Libre de Bruxelles (ULB) Brussels: Vrije Universiteit Brussel (VUB) Gent : Universiteit Gent (UG) Kortrijk: Groeninge Campus Leuven : Katholieke Universiteit Leuven (KUL) Liège : Université de Liège (ULg) Louvain : Université Catholique de Louvain (UCL) Luxembourg: Centre Hospitalier de Luxembourg From the preceding list, it can be seen that, from the beginning, there was a language problem (not amazing in Belgium): there are French speaking and Dutch speaking training centres. In the beginning it was tried to solve the problem by letting all lecturers teach in their own language. It did not work. Some trainees were not fluent enough in the other national language…regrettable, but a fact. So now, since many years, all the teaching and correspondence is done in English. An essential part of the teaching days is that the trainees are not only allowed but are requested to evaluate the lecturers and give them points. This has allowed eliminating some lecturers who might be outstanding Surgeons but poor teachers and these bright young men and women, who train in Plastic Surgery have the right to get didactic teachers. In principle, the majority of the lectures are given by staff members of the teaching centres, but also colleagues who are in private practice but have acquired a special expertise in a certain field are invited to lecture. This is a good occasion to tell them how much their collaboration is appreciated: they give some of their valuable time to teach young colleagues and this without any financial compensation. The Collegium has no money and no treasurer. There are no membership fees and at the teaching sessions trainees only pay for their lunch. It is the Royal Belgian Society 56

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of Plastic Surgery which sponsors the activities of the CCP and the Board members of the Collegium are very grateful for this. One problem which was encountered, is when it was considered desirable to incorporate a lecture on embryology, genetics or pathology in a teaching day. Colleagues in these disciplines were called upon and their willingness to collaborate to a teaching for which they had no obligation whatsoever was very much appreciated. But it was not always an undivided success: they knew too much about their subject and their lectures sometimes were too complicated for a Plastic Surgeon in training. So now a Plastic Surgeon is called upon to teach the essentials of these disciplines in a more simple way. After several years of teaching, the question was raised in 2001 whether we were not falling into an easy routine. And thinking of the adagio “to make your trainees learn, make them teach”, it was decided to have the courses given by the trainees themselves. It was hoped that this formula would lead to livelier discussions among trainees. It did not work. At the end of that academic year, an opinion poll was held and a clear majority of the trainees rejected the new formula, mainly because they thought their younger colleagues did not have enough experience to answer questions and had to be rescued by their training chiefs. So the old formula was reinstituted. Recently, the training in Plastic Surgery has been changed from three years General Surgery and three years Plastic Surgery to two years general surgery and four years Plastic Surgery. So, from 2004 on the teaching sessions will be spread over four years. Reunion of the chiefs of training at P. Wylock’s house, August 2010. The evaluations. An evaluation is organized at the end of each academic year. The first and second year Plastic Surgery trainees and from now on also the third year Plastic Surgery trainees appear consecutively before two out of three juries, determined by a drawing of lots. Each examiner has prepared written questions on the subjects taught that year. The candidates blindly draw a question from each examiner and are given an hour to prepare their answers for the 2 juries, before which they appear for half an hour each. The candidates are each given their score in the week following the evaluation, but not the score of the other candidates. If they fail, their attention is drawn upon their deficiencies, so that they can study that field. But there are no other consequences, except that their score is reported to the Certification Board, instituted by the National Ministry of Health and consisting of two chambers: a Dutch and a French speaking chamber. For the final candidates, the evaluation system is different. They each have to write 5 case reports in English of

personally operated cases in such a form that they should be publishable. Their case reports are evaluated by 2 examiners who take into account: - the difficulty of the case - the quality of the result - the presentation - the discussion - the diversity of the cases. A few weeks later, the final candidates sit for an oral evaluation before three juries of each two or three examiners, in such a way that all candidates each appear before every chief of a training centre. They are given slides of clinical cases in a haphazard way but covering the entire domain of Plastic Surgery. They do not get preparation time but are allowed to answer in their native language. After all, it is a Plastic Surgery examination, not a language examination. Each evaluation lasts half an hour, making for a total of one and a half hours. At this point it should made clear that there are two separate bodies: - the CCP, which organizes the teaching and the evaluation and which gives a favourable or an unfavourable advice to - the Certification Board, consisting of a Dutch speaking and a French speaking Chamber ( Erkenningscommissie Commision d’ Agréation) both installed in and appointed by the Ministry of Health. These chambers control whether: - the candidate has an approved training program. - the training chief gives a yearly favourable evaluation of the candidate - the candidate has performed a sufficient number of operations of increasing complexity. Both Chambers of the Certification Board have agreed that successfully passing the final examination of the CCP is a conditio sine qua non before they propose the candidate to the Minister of Health, who is the final authority for granting the title of “Specialist in Plastic, Reconstructive and Aesthetic Surgery” but who, up to now, has always followed the advice of the Certification Board. If a candidate fails in the finalexamination,heis notproposed to the Minister of Health for certification. Fortunately, in the past, this has happened only a few times. In those cases, the candidate is either allowed to sit again for the examination a few months later or is requested to fulfil another 6 to 12 months of training. In summary, the CCP has no legal authority but a strong moral authority. It cannot substitute for the practical training to become a Plastic Surgeon. The practical skills of a trainee can only be evaluated by his training chief, who has the responsibility to either let the trainee continue his training or to stop him/her from becoming a Plastic Surgeon. The CCP has greatly contributed to make our young Plastic Surgeons not just cutters and stitchers but scientifically interested surgeons.

European Board Examination. The Educational and Exchange Program Committee of the European Board of Plastic, Reconstructive and Aesthetic Surgery (EBOPRAS) is responsible for organizing the examination. Only Plastic Surgeons who have been fully accredited in one of the member countries of the European Union or are full members of the European Union of Medical Specialists are eligible to take this examination. The examination is a combination of 100 multiple choice questions and discussion of 5 clinical cases through slides demonstration in the applicant’s own language provided this is one of the ofﬁcial European Union languages. The candidate is eligible to sit the oral examination after he has passed successfully the written one. The ﬁrst examination took place in Brussels on November 14th and 15th, 1994 with the following Belgian examiners: T. Lahaye, G. Monballiu, N. Calteux and W. Boeckx, D. Goldschmidt. R. Vanwijck. The following Belgian Plastic Surgeons successfully passed the examination and were elected Fellows of the Board : J.Ph. Adant, Ph.Blondeel, H. Cools, Cornil, R. De Mulder , M. Haway, B. Lengelé, S. Monstrey, G. Mullie, P. Vico.

Royal Belgian Society for Plastic Surgery RBSPS Board Members (2011) President (2011-2013): J.L. Nizet President Elect: F. Missotten Treasurer: P. Blondeel Secretary: M. Depoorter Advisors: A. De Mey, G. Willemart Advisor Aesthetics: A. Verpaele Advisor Microsurgery: M. Hamdi Advisor Third World: P. Wylock Past President (2009-2011): S. Monstrey Past President (2007-2009): D. Goldschmidt Number of members: 175 full members 11 juniors (reduced fee) 2 from Luxembourg 6 foreign members 18 retired 9 honorary Total: 221 members

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Colombian Society of Aesthetic Plastic Surgery and Reconstructive The Colombian Society of Plastic Surgery was founded on May 15, 1956 by Drs Guillermo Nieto Cano, Jose Ignacio Mantilla, Nestor Godoy, Leon Hernandez, Alvaro Londono, Juan Ruiz Mora, Gerardo Obonaga, Guillermo Rojas, Hernando Castro, Delfin Borrero Duran, Humberto Dorado Garces, Luis Gonzalez Torres, and Felipe Coiffman in the doctors’ clubhouse in the city of Bogota. The foundation of the Colombian Society of Plastic Surgery was an initiative led by Dr Felipe Coiffman, who had returned from his studies with Professor Arthur J. Barsky in New York, and was convinced of the necessity of founding a company to group Plastic Surgeons in this emerging specialty in Colombia (there Dr. Felipe Coiffman who founded The SCCP society were 16 Plastic Surgeons in the country at that time), to develop the teaching of Plastic Surgery across the country and to extend the practice of the specialty to all capital cities. Dr. Guillermo Cano Nieto was the first president of the SCCP, who had the opportunity to offer the services of its members to the use of the victims of a dynamite explosion in the city of Cali in the year 1956. Arguably the founding of Colombian Society of Plastic Surgery occurred at a time when it was necessary to expand the specialty across the country. At that point, at the National University of Colombia with San Juan de Dios Hospital in Bogota, Plastic Surgeons began to train residents in Olastic Surgery, training lasting 4 years. The first Plastic Surgeons trained were Miguel Amezquita Rincon and Guillermo Marin. At that time National University in coordination with the SCCP doctors arranged visits Plastic Surgeons from around the world, such as Sir Harold Gilles, Richard Stark, Ralph Millard, Marc Iselin, Raoul Tubiana, Antonio Fuentes del Campo, Hector Marino and Ivo Pitanguy. The first congress of the Colombian Society of Plastic Surgery was held in Bogota between 19th and 22nd June 1957. Under the chairmanship of Dr. Delfin Borrero, the second National Congress of Plastic Surgery was held in Medellin in 1958. The third congress of the SCCP was held in the city of Cali, with the participation of renowned international Surgeons like Dr. Harold Gilles, Richard

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Stark, G. Barro, Guy Pulvertaft, James Barrett, Frank Mac Douwell, Daniel Fatio- Morel, Marc Iselin and Arthur Barsky. National scientiﬁc meetings were conducted ever since and now the society performs an annual national conference, which alternates with an International course in Cosmetic Surgery every year. Some important International Congresses of that have been held in Colombia by the SCCP are: First Latin American Congress Northern Zone 1962. Bogota. XI Latin American Congress 1969. Cartagena de Indias. VII Ibero-Latin American Congress. 1988 Cartagena de Indias. Ibero-Latin American Congress XIX. 2012. Medellin. Today the society performs an annual national scientiﬁc meeting that alternates with an International course on Cosmetic Surgery.

Politics The society is subdivided into 9 sections that cover the whole country and act as branches in the different regions of the country.

Awards: During the Congress, awards were given to Arcadio Forero Prize, award to the best work from a resident, Leon Hernandez for the best paper in the category of clinical practice, Guillermo Nieto Cano for the best work in class experimentation and research in technology and basic sciences and Felipe Coiffman for the best aesthetic art work.

Publications: Since the founding of the SCCP, members have had a vocation for the publication of books and magazine articles. Dr Leon Hernandez. Book of plastic surgery. Principles and Techniques in Plastic Surgery. Dr Guillermo Cano Nieto: Atlas of incisions and sutures. Emergency surgery Plastic Surgery chapter. Authors Guillermo Cano Nieto, Rafael Caballero, Ortegon Samuel, Felipe Coiffmann, Christopher Sastoque, Abraham Cuperman. Text of Cosmetic and Reconstructive Plastic Surgery. Dr Philip Coiffman. Currently in its fourth edition. The most extensive work in Spanish-speaking. 1986 to 2012. General Plastic Surgery. University of Antioquia. Editor: Dr. Alberto Kurzer.

Integrated management of burns. Ricardo Manzur 2011 Photographic Atlas of burns. Ricardo Manzur 2011. Craniofacial Surgery. Authors. Jorge Cantini, Rolando Prada. 2012. Plastic surgery for general practice. Dr. Francisco Villegas. CIB. 2012 The 4 Seasons of the breast. Manuela Berrocal. 2012.

Scientiﬁc Magazine, COLOMBIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY Edition by . Dr. Jorge Arturo Diaz, with 2 annual publications The Colombian society currently has 780 members and is preparing for the XXXIV Congress of Plastic Surgery and the XVII Cosmetic Surgery Course. Through its board of education, the society maintains contact and supports the graduate programs in Plastic and Reconstructive Surgery in the country. Below you can ﬁnd a list of the Graduate training educational centers in Cosmetic and Reconstructive

Plastic Surgery in Colombia, followed by the respective responsible director. University of Antioquia. Dr. German Wolff Idarraga. National University. Dr. Oswaldo Gomez Diaz. University of Rosario. Dr Juan Camilo Norena. Javeriana University. Dr. Juan Carlos Leyva. Health Sciences Foundation. Dr. Jorge Ernesto Cantini. Military University. Dr Oscar Martin Gomez. El Bosque University. Dr Celso Bohorquez Escobar. Universidad del Valle. Dr Jaime Roberto Arias. Esculela de Medicina JohJuan N Corpas. . Dr. Olga Lucia Mardach. Fundacion Universitaria San Martin. Fundacion Dr Fernando Arango. Upcoming events to be organized by the SCCP are the XIX Congress and the seventeenth FILACP and Aesthetic Surgery Course of the SCCP, in the city of Medellin, May 22nd -26th , 2012, and the VIII Bolivarian Congress of Plastic Surgery and XXXIV National Congress of the SCCP in the city of Santa Martha, on April 17th -20th , 2013.

National Board, from left to right: Dr Emilio Aun Dau, Vocal ex- president, Dr Lina Triana ﬁscal , Dr. Juan H. Santamaria President, Dr. Maria Esther Castillo, Executive Secretary, Dr. Carlos Enrique Hoyos Vice President, General Secretary Dr. Manuela Berrocal, Dr Ovidio Alarcón Treasurer.

Website. www.cirugiaplastica.org.co Adress: 2012 Colombian Society of Aesthetic Plastic Surgery and Reconstructive Avenida Calle 127 # 16A - 76 Of. Ediﬁcio 304 Pizano Phone 6279136 - Fax: 6279247 - Bogota- Colombia. South America.

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Plastic Surgery in Latvia Ansis Gilis, MD Clinic of Plastic Surgery, Riga, Latvia

History The first operations in the field of Plastic Surgery were performed by the legendary Russian surgeon Nikolay Pirogov, who performed his first rhinoplasty in Riga. It was in 1835 that he came to Riga to perform complicated operations, consult patients and to teach doctors and other medical staff. Since the beginning of the 20th century, Surgeons treated cleft palates and performed oesophagoplasties in the Latvian Paediatric Hospital and later in the Institute of Dentistry. The first operations were performed by Reinholds Girgensons and Aleksands Biezins, who invented the cleft palate surgery techniques Biezins I and Biezins II. In the 1960s Viktors Kalnberzs, an Orthopedic Surgeon, performed the first breast surgeries, including breast augmentations, with allogenic fat transplantations. In 1970 he performed the first complete sex reassignment surgery (from female to male) in Latvia, as well as extracavernosal penis prosthesis implantations. From the 1980s on, Plastic Surgery developed in two separate ways. Oral and maxillofacial surgeons, including Baiba Klucane, Andrejs Skagers and Valentina Kandaurova (the

Krumins came as Orthopedic or General Surgeons and specialized in Reconstructive Surgery and Microsurgery. Furthermore Olafs Libermanis, Janis Gilis and Janis Zarzeckis started practicing Reconstructive Surgery and Microsurgery right after their internship. During the Soviet period, Plastic Surgeons acquired knowledge in Reconstructive Surgery in major hospitals in Russia. The First Latvian Congress of Physicians took place in Latvia in 1989. Surgeons working in Latvia came in contact to Latvian Plastic Surgeons who were living and practicing in other countries: Arnis Freibergs (Canada), Gunars Graudins (USA), Uldis Bite (USA), Juris Bunkis (USA), John Briedis (Australia) and that gave a great impact in the education and development of the industry and surgeons.

Association In 1992, when Latvia’s independence was restored, new training possibilities appeared. Many doctors visited clinics in western countries – Canada, USA, Germany, Norway etc., to get new experience and knowledge. Some Surgeons founded their private clinics and practices. The same year the Latvian Association of Plastic Surgeons was ofﬁcially founded. Since the beginning, there have been 4 Presidents of the Association – Haralds Adovics, Talivaldis Krumins, Martins Kapickis and since 2006 the President is Peteris Laucis. At the moment there are 28 active members, 3 honored members and 3 candidates in the Association. Three commissions are working: the Commission of Certiﬁcation, the Commission of Ethics and the Commission of Revision. Meetings of the Association are held on a regular basis. There are delegates and members in international organizations like IPRAS, IQUAM, IFATS and ISAPS.

Education 1989: Doctors from Department of Microsurgery T.Krumins, O.Libermanis, anesthetist V.Deksnis, H.Adovics, A.Dalmatovs, J.Gilis, G.Bite, J.Zarzeckis

latter two later joined the Latvian Association of Plastic Surgeons) continued performing different facial surgeries, otoplasties and rhinoplasties and, occasionally abdominoplasties and aesthetic breast operations in the Institute of Dentistry. At the same time Guntis Bite, an Orthopedic Surgeon, became the Head of the recently founded Department of Microsurgery in Riga Hospital No.7, which was the ﬁrst department of Plastic and Reconstructive Surgery in Latvia. Besides him, 6 other doctors started working in the department: Aldis Dalmatovs, Haralds Adovics, Talivaldis 60

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A residency program was started in 1992. The first resident was Gundars Krauklis, who is now the manager of the Plastic Surgery residency program. Residency is organized by the Stradins University in Riga, with a total duration of 5 years, which consist of 2 years which correspond to a General Surgery program with rotation cycles in General Surgery and other specialties, and 3 years of training in Plastic and Reconstructive Surgery and Microsurgery departments. After these 5 years the resident has to present his scientific research and pass a number of theoretical and practical exams to receive the Plastic Surgeon’s certificate and become a member of the Latvian Association of Plastic Surgeons. There is a re-certification every 5 years for the already- certified Plastic Surgeons, which is administered by the Latvian Medical Association.

Plastic Surgery Hyperguide: An Interactive Continuing Medical Education Web Site

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IPRAS WEBSITE

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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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NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS 20 - 22 Jul 2012 Aesthetic Plastic Surgery / Anti-Aging Medicine: The next generation Location: New York, USA Venue: Conrad Hotel URL: http://www.NextGenMTG.org 04 - 08 September 2012 ISAPS 21st Congress Location: Geneve, Switzerland - Venue: CICG URL: http://www.isapscongress2012.org/ 09 - 10 September 2012 IPRAS Course - “State of the Art” of Fat Transplantation in Regenerative Plastic Surgery & Microsurgery Location: Sinaia, Romania - Venue: Casino Sinaia, Romania Contact: Nikos Antonopoulos - Telephone: +30 2111001782 - Fax: +30 2106642116 E-mail: n.an@zita-congress.gr - URL: http://www.roaps2012.com 11-12 September 2012 The XIIth Congress of the Romanian Association of Plastic Surgeons with Co-organization of Hungarian Association of Plastic, Reconstructive and Aesthetic Surgery Location: Sinaia, Romania - Contact: Nikos Antonopoulos E-mail: n.an@zita-congress.gr - URL: http://www.roaps2012.com 12 – 15 September 2012 LaserInnsbruck 2012 Location: Innsbruck, Austria - Venue: Faculty of Catholic Theology of the University of Innsbruck Contact: Mrs. Mina Ploumpi - Telephone: +30 2111001781 - Fax: +30 2106642116 E-mail: a.pl@zita-congress.gr - URL: http://www.laserinnsbruck.com/ 12 - 16 September 2012 10th National Congress of the Northern Cyprus Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons Location: Girne, Cyprus - Venue: Merit Crystal Cove Hotel - Telephone: 0090 3124661466 E-mail: kongre@bilkonturizm.com - URL: http://www.kktcplastik2012.org 13 - 15 September 2012 43. Jahrestagung der DGPRÄC / 17. Jahrestagung der VDÄPC Location: Bremen, Germany - URL: http://www.dgpraec2012.de 10 - 13 October 2012 2nd World Congress of Plastic Surgeons of Lebanese Descent Location: Cancun, Mexico - Venue: Convention Center Cancun URL: http://www.congressmexico.com/LSPRAS2012

NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS 26 – 30 October 2012 Plastic Surgery THE MEETING Location: New Orleans, USA - E-mail: registration@plasticsurgery.org URL: http://www.plasticsurgerythemeeting.com/

1st November 2012 The 1st IPRAS International Trainees’ Meeting Location: Athens, Greece - Venue: Royal Olympic Hotel Contact: Mr Nikos Antonopoulos - E-mail: n.an@zita-congress.gr - URL: www.iquam2012.com

01 - 04 November 2012 10th IQUAM CONSENSUS CONFERENCE Location: Athens, Greece - Venue: Royal Olympic Hotel Contact: Nikos Antonopoulos - Telephone: +302111001782 - Fax: +302106642116 E-mail: nikos.antonopoulos@zita-congress.gr - URL: www.iquam2012.com

4 - 8 November 2012 47 Annual Conference of the Association of Plastic Surgeons of India (APSICON 2012) Location: Lucknow, India - URL: http://www.apsicon2012.com/

08 - 10 November 2012 Marrakesh World Aesthetic Conference Location: Marrakesh, Morocco - Venue: Palmaraie Palace URL: http://www.mwac2012.com/

14 – 18 November 2013 49th Brazilian Congress of Plastic Surgery Location: Porto Alegre - URL: http://www.cirurgiaplastica.org.br/

29 - 01 Dec 2012 The Cutting Edge 2012: Advanced Sculpting of the Nose Location: New York, USA - Venue: The Waldorf Astoria Hotel URL: http://www.aestheticsurgeryny.com

INDUSTRY NEWS

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IPRAS PAST GENERAL SECRETARIES

Tord Skoog (Sweden) 1955 - 1959

David N. Matthews (U.K.) 1959 - 1963

Thomas Ray Broadbent (USA) 1963 - 1967

William M. Manchester (N. Zealand) 1967 - 1971

John Watson (U.K.) 1971 - 1975

Roger Mouly (France) 1975 - 1983

Jean-Paul BossĂŠ" (Canada) 1983 - 1992

Ulrich T. Hinderer (Spain) 1992 - 1999

James G. Hoehn (USA) 1999 - 2006

Marita Eisemann-Klein (Germany) 2006 - 2011

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International Confederation for Plastic Reconstuctive and Aesthetic Surgery

IPRAS BENEFITS FOR INDIVIDUAL MEMBERS AND NATIONAL ASSOCIATIONS • Immediate information about safety warnings on devices, drugs and procedures • Information regarding the proper use of all materials, substances and techniques related to Plastic, Reconstructive and Aesthetic Surgery through IQUAM (the International Committee of Quality Assurance and Medical Devices in Plastic Surgery) General Consensus statement, with an update every 2 years • Free electronic receipt of the IPRAS JOURNAL • Information regarding harmonization of training • Information regarding accreditation of Plastic Surgery Units • Promotion of Patient Safety and Quality Management (in cooperation with WHO) • Protection of the Specialty and Promotion of its image world-wide • Promotion of Individual Members of National Associations by uploading their scientific profile on the IPRAS website • Exchange of ideas, views, thoughts and proposals though the IPRAS website and its FORUM section • Certificate for Individual Members to display their IPRAS Membership • Right to participate in all events organized by National Societies and IPRAS • Strengthening ties of professional cooperation and friendship with colleagues beyond national borders all over the world • Information regarding the developments of plastic surgery worldwide • Association support for educational and research purposes • Association legal & ethical advice according to international law and practices and assistance with crisis management • Promotion of local or regional news and Historical Accounts of IPRAS National Associations through the Journal • Information, promotion and reports of local or regional events, organized by other National Societies and IPRAS, through the official IPRAS management office

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IPRAS Journal Management Editor: Editor-in-Chief: Editorial Board:

Page Layout: E-mail: Post Editing: Photographer: 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 IPRAS Media Office: Christina Georgiou E-mail: c.ge@zita-congress.gr Commercial Director: Gerasimos Kouloumpis E-mail: gerasimos.kouloumpis@zita-congress.gr

Next issue: October 2012

IPRAS Thomas Biggs, MD Marita Eisenmann - Klein, MD Andreas Yiacoumettis, MD Christian Echinard, MD Constance Neuhann-Lorenz, MD Zacharias Kaplanidis, Economist Diastasi info@diastasi-print.gr Athena Spanou, MD Julian Klein

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. Not for sale. Distributed for free.