First Isaps Course in Russia: a Story of Mutual Admiration

Volume 5 • Number 1

Official Newsletter of the International Society of Aesthetic Plastic Surgery FIRST ISAPS COURSE IN RUSSIA: A STORY OF MUTUAL ADMIRATION Catherine Foss – United States ISAPS Executive Director The Winter Palace, part of the he historic and very beautiful city of St. Petersburg wel- Hermitage Museum complex. The Faculty: comed over 400 plastic surgeons from 29 countries and T Denis Agapov (Russia) 34 exhibiting companies for the first official ISAPS Course Nicolae Antohi (Romania) ever held in Russia. The welcome extended by the local hosts and Mehmet Bayramiçli (Turkey) organizers was overwhelmingly warm and gracious. Those who Alexey Borovikov (Russia) Vadim Bragilev (Russia) were visiting for the first time experienced the magnificent art, Javier de Benito (Spain) architecture, ballet, and food during the mysterious and fascinat- Ewaldo de Souza Pinto (Brazil) ing White Nights. Daylight until nearly midnight and bright sun- Grant A. Fairbanks (USA) Olivier Gerbault (France) light streaming in your window at four o’clock in the morning was V. Golovach (Russia) a new phenomenon for many of us. Mark Jewell (USA) Planned by the ISAPS Education Council, course directors Nazim Cerkes Irina Khrustaleva (Russia) and Renato Saltz worked closely on the program content with Dr. Irina Tim Marten (USA) Khrustaleva, the ISAPS National Secretary for Russia and a native of St. Bryan Mendelson (Australia) Petersburg. We owe a debt of gratitude to Olga Zaseeva of Clovermed and Jan Poell (Switzerland) Igor Bogoroditski of Bio Concept Kirill Pshenisnov (Russia) Company for their superb man- A. Ribakin (Russia) agement of the logistics that made Ricardo Ribeiro (Brazil) this meeting run so smoothly. Dirk Richter (Germany) ISAPS, together with our local Joao Sampaio Goes (Brazil) planning team, were able to bring Cemal Senyuva (Turkey) an outstanding faculty to Russia, Sergey Shvirev (Russia) covering a vast array of aesthetic Henry Spinelli (USA) surgery techniques, and were Tunc Tiryaki (Turkey) rewarded by a most attentive au– Lina Triana (Colombia) dience. We anticipate many new Reha Yavuzer (Turkey) Russian ISAPS members joining Akin Yucel (Turkey) us very soon. Roger Wixtrom (USA) Our hosts provided great hospital- ity, and quite of bit of very good vodka. Resurrection of Christ Church, also known as The Church of The highlights were a memorable eve- Our Savior on Spilled Blood ning at the world famous Mariinsky Theater to see the ballet, Don Quixote, continued on page 11 May – August 2011 www.isaps.org Board of Directors president’s message Message from the Editor PRESIDENT Jan Poëll, MD Jan Poëll, MD – Switzerland J. Peter Rubin, MD – United States St. Gallen, Switzerland [email protected] ISAPS News Editor

PRESIDENT-ELECT Dear ISAPS members, Carlos Uebel, MD, PhD Welcome to this issue of ISAPS News. Our cover story, describ- Also in this issue, ISAPS News is Porto Alegre, RS, Brazil Patient safety is of concern to all of us. The question is: how we can ing our first official ISAPS course in Russia, demonstrates the proud to present a global perspective on [email protected] improve it? The answer is: through improved quality of our work! expanding reach of our wonderful society across the globe. fat grafting. ISAPS representatives from around the world FIRST VICE PRESIDENT Quality is achieved through education and that is where ISAPS steps in. We are doing a Susumu Takayanagi, MD This outstanding educational event featured a diverse faculty provide commentary on practice patterns and attitudes in Osaka, Japan lot to improve the quality of the work of our members. First, they are all handpicked on the from Russia, as well as numerous other accomplished lead- their regions. This informative section shows the scope of [email protected] recommendation of two of our members and of the National Secretary for their country. This ers from Europe, the United States, and South America. This practice as observed by our ISAPS members. SECOND VICE PRESIDENT shows clearly the importance of the National Secretaries to ISAPS. Lina Triana, as their chair, Renato Saltz, MD pioneering meeting held in St. Petersburg represented the Richard H. Read, ISAPS Information Technology Con Salt Lake City, UT, United States is doing a great job trying to make them aware of their importance. Thank you, Lina. true essence of the ISAPS mission: fostering exceptional edu- sultant, United States, presents an interesting piece on [email protected] Quality also means that we all need to be aware of the possible negative influence that our cation and camaraderie among our international members in e-mail spoofing and other malicious internet activity. This is THIRD VICE PRESIDENT treatment could have on our patients. Fat injections to the breast for reconstruction or aug- exciting locations. Complimenting the piece on the meeting a “must read” for all of our ISAPS members. We rely so heav- Jorge Herrera, MD Buenos Aires, Argentina mentation are very popular now. However, are the outcomes truly predictable? Do we know in Russia is a history of aesthetic plastic surgery in Russia, ily on the internet, e-mail, and web-based communication [email protected] enough about what the stem cells are doing to the breast? Can the stem cells stimulate the written by Kirill Pshenisnov, MD, Russian Federation. This that we all need to be aware of methods to protect ourselves SECRETARY GENERAL growth of tumor cells? There are many unanswered questions that should find an answer very interesting piece emphasizes the need for standardizing from viruses and spam. Miodrag Colic, MD Belgrade, Serbia before the method is recommended widely. ASPS and ASAPS are currently creating a joint training requirements for aesthetic plastic surgeons in Russia. On the technical side, Alfonso Barrera, MD, United [email protected] registry to track and evaluate the outcomes of these procedures before they can be recom- Another event that we proudly feature in this issue of States, discusses methods for the correction of sideburn alo- TREASURER mended to everybody. We have to thank ASPS and ASAPS for their pioneering work in this ISAPS News is a report of the very successful 2011 American- pecia secondary to facelift procedures. This outstanding edu- Daniel Knutti, MD Biel, Switzerland area and would be glad to join them as soon as the register is ready. Brazilian Aesthetic Meeting held in Park City, Utah. Renato cational section will be useful to anyone practicing aesthetic [email protected] Other problems might be found with new machines and applications recommended to Saltz, MD, United States, ISAPS 2nd Vice President and facial surgery. ASSISTANT TREASURER us by industry. These must be reviewed closely by our New Product Evaluation Committee. ABAM Chair, reports the details of this event. Friends from Our ISAPS News history piece is presented by Andreas Dirk Richter, MD Wesseling, Germany Some can be dangerous in the wrong hands. Every method is only as good as the surgeon far and wide gathered to discuss new innovations in plastic Gohritz, MD and Peter Vogt, MD, PhD, both from Germany. [email protected] performing it. To do things right, you need training. Don’t use these products until they are surgery and enjoy the “best snow on earth.” They tell us of the life and times of Eugen Hollander, an IMMEDIATE PAST PRESIDENT proven to be safe and all risks and possible complications are known. An awareness of regulations impacting plastic surgery unsung hero of aesthetic surgery, fat injection, and medical Foad Nahai, MD Together with other organizations such as the Am- Atlanta, GA, United States practice is very important among our membership, and art history. As we also read of global perspectives on fat graft- [email protected] CONTENTS erican Society for Aesthetic Plastic Surgery, we should ISAPS News presents a series of pieces addressing this ing, we must recognize the forefathers of fat grafting tech- PARLIAMENTARIAN First ISAPS Course in Russia 1, 11 try to influence what industry does for us instead of issue. Our ISAPS National Secretary from Italy, Gianluca niques. Eugen Hollander played a seminal role in fat grafting, Thomas Davis, MD President’s Message 2, 7, 12 letting them impose on us what they think is right. Campiglio, MD, briefs us on a new law that will regulate Hershey, PA, United States and we thank Drs. Gohritz and Vogt for bringing this history [email protected] Message from the Editor 3 We need a close collaboration with industry that will breast augmentation procedures. This law includes a consid- to the forefront of our newsletter historical section. Feature 4-5 NATIONAL SECRETARIES CHAIR benefit both sides. Without industry support, it would eration of patient age and guidelines for who is qualified to As you can see, the ISAPS membership is working hard Japan Struggling to Recover 6 Lina Triana, MD be impossible for us to finance our great meetings. I perform aesthetic procedures. We also have an interesting to impact plastic surgical care across the globe through Cali, Colombia ISAPS Education Council 7 [email protected] would like to thank them for their highly appreciated piece on regulations in Mexico presented by Jaime O. Salcedo- Legal Reports 8-14 education and the advocacy of patient safety. As I look at contributions. Martinez, MD, ISAPS National Secretary for Mexico. This EDUCATION COUNCIL CHAIR Fat Grafting Perspectives 15-18 these recent accomplishments by our ISAPS members, I Nazim Cerkes, MD Another way to improve quality is EBM (evidence informative story emphasizes changes in Mexico restricting Istanbul, Turkey Practice Management 20 am so proud and honored to be part of this great society. based medicine), a term that is quite well known to all the practice of plastic surgery to those with specialized certifi- [email protected] Aesthetic Education 22 With warm regards to my colleagues, of us, but rarely implemented in our work. Although TRUSTEE – PAST PRESIDENT History ...... 23-25 cation and regulating the practice setting to authorized estab- Bryan C. Mendelson, MD National Secretaries Report 26 it might not be so suitable for our kind of surgery, as lishments. Lina Triana, MD, Chair of National Secretaries, Toorak, VIC, Australia [email protected] Insurance Update 27 every surgeon has his own methods, it is at least of Colombia, briefs us on new Colombian legislation that favors importance in all that surrounds our surgery includ- patient safety, and Elizabeth Hall-Findlay, MD, FRCSC, TRUSTEE – ELECTED ISAPS Survey 28-30 Theodore Voukidis, MD In Memoriam 31 ing medications, facilities, anesthesia and so on. In Canada, informs us about Canadian regulations in aesthetic Athens, Greece Committees 32 the United States, there was a special meeting on this J. Peter Rubin [email protected] surgery. She emphasizes the importance of ISAPS members Calendar 33-36 topic held in Colorado Springs last year and I would getting involved with these efforts. ISAPS News Editor EXECUTIVE DIRECTOR Catherine Foss Mens Sana 36 Hanover, NH, United States New Members 39 continued on page 7 [email protected]

2 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 3 FEATURE

to produce temporary edema (thick- Correction of Sideburn Alopecia ening) of the scalp, which facilitates Secondary to Facelift Procedures graft insertion. I first inject the ante- rior region and proceed posteriorly Alfonso Barrera, MD – United States and cephalically. As fibrinogen turns into fibrin, raditionally facelift incisions can result in a varia- in a single session. the grafts adhere better to the recipi- Figure 1: Sideburn and Temporal ble degree of cephalic and posterior advancement The patient is placed in the supine position and mildly ent slits and we repetitively return Alopecia, secondary to Facelift procedure (before) Tof the temporal hairline and sideburn, creating sedated with Midzolam (Versed) 2 to 10 mg and Subli- anteriorly to insert more grafts plac- an unsightly stigma, a tell tale of a poorly performed maze (fentanyl) 50 to 100 ug, which are titrated for each ing them densely, minimizing the facelift. These stigmas can predictably and consistently be patient. The patient’s vital signs, EKG, and O2 saturation risk of “popping out” of neighboring corrected by the use of modern day hair transplantation are monitored throughout the procedure. grafts. I use 22.5 Sharpoint blades to techniques, specifically follicular unit hair grafting. I use 0.5% bupivacaine with 1:200,000 epinephrine make the recipient sites incisions and It is key to do this in a way that the hair looks natural (approximately 20 ml) to localize both the donor area and immediately my assistant inserts the of course. To accomplish this, we need very small grafts, the recipient sites. A tumescent solution of 0.5% lidocaine graft into each site, using my blade as single and double hair grafts, have them grow in a con- with 1:200,000 epinephrine is then infiltrated as well. a shoe horn. Figure 2: Year after reconstruction with sistent and natural direction, downwards on sideburns, The patient’s head is turned to the left. Using a #10 Very important to incline the Shar- follicular unit hair grafting (right side) perhaps in a slight posterior direction. I initially reported scalpel blade, I harvest the right half of the donor ellipse, point blade to the direction and angle my technique to correct this condition in 1998. incising parallel to the hair shafts. If it is a small case to which you want the hair to grow. This can effectively remove the stigma, the evidence 300-400 grafts. The donor ellipse is 1 cm in width and For dressings I generally use one the patient had a facelift and or forehead lift procedure, what ever length we may need 3-4 cm. If more grafts are or two layers of Adaptic, Kerlex and 3" this way complementing immensely the final aesthetic needed we may harvest a longer ellipse. elastic Ace bandage for the scalp. outcome. The objective of this presentation is to briefly Under a microscope (10x) or 3.5 lope magnification and Problems and Complications describe my personal approach and technique in correct- background lighting, using a #10 scalpel blade, thin slices This is quite a safe procedure, ing this condition. 1.5 to 2.0 mm in thickness parallel to the hair shafts are infection is extremely rare. Hema- We are still unable to create new hair; we can only dissected from the donor ellipse. Then my assistants pre- toma is non-existent as there is no Before redistribute hair from one area to another. pare the final grafts with #10 scalpel blades also under Figure 3: undermining. Often, however we can So for a patient to be a candidate, he or she must have background lighting. encounter ingrown hairs especially enough donor hair to work with. Most commonly the The donor site single is closed in a layer closure with 3 during the first three months post donor hair is harvested from the occipital area. “0” Prolene (continuous running). The ideal grafts have operatively. I learned that simply leav- intact hair shafts all the way from the subcutaneous fatty Patient Selection ing the epidermis of the grafts slightly tissue to the scalp surface, and contain from one to four Most patients have sufficient donor hair to restore the superficial to the epidermis of the hairs. Again they must be handled as atraumatically as sideburns, the temporal and retro-auricular hairline, as it recipient scalp prevents this problem. possible. The harvested scalp and all grafts are kept chilled is not a large area, but make sure the supply and demand When they occur, they are not a major in normal saline until transplanted. ratio is favorable. Make sure the patient has realistic problem, they mature, come to a head Figure 4: After They are lined up in rows on a wet surgical towel. expectations; explain to the patient that it is not uncom- and drain, or you can pop them as a mon to do a second session to obtain sufficient density. Key points to remember in graft dissection are: small pustule and drain them. 1. Maintain the follicular units as intact as feasible. Technique Conclusion 2. In patients with dark hair, 3.5x loupe magnification is References I typically do between 300 and 1500 grafts per ses- The use of follicular unit grafts, sufficient to dissect most grafts as follicular units. 1. Barrera, A: The Use of Micrografts and Minigrafts for the Correction of the Postrhyt- sion depending on the degree of alopecia and the size micrografts and minigrafts technique 3. In patients with light hair or gray hair, surgical micro- idectomy Lost Sideburn Plast. Reconstr. Surg. 102(6) 2237-2240. 1998. of the area to be covered. This labor-intensive procedure as described is safe and predictable, is scopes (10x) and background lighting may be needed 2. Barrera, A.. Correcting the Retroauricular Hairline Deformity After Face Lift. Aesth requires an organized and efficient surgical team. very effective in the correction of scar- for more accurate dissection. Surg. J. 24(2) 176-178, 2004 My surgical team consists of three surgical assistants ring alopecia secondary to facial reju- and myself. I remain in the operating room for the dura- Graft insertion: Infiltration of tumescent solution into venation surgery. It results in great tion of the procedure and insert all grafts personally. Effi- the recipient area is important for several reasons, the patient satisfaction. ciency is key when transplanting a large number of grafts most important of which are to promote hemostasis and

4 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 5 FEATURE EDUCATION COUNCIL

Japan struggling to recover from ISAPS Education Council Plans Multiple the Earthquake and Tsunami Meetings on a Global Scale Susumu Takayanagi, MD – Japan Nazim Cerkes, MD – Turkey ISAPS First Vice President Chair, Education Council

irst of all, I would like to express my sincere mentioned problems on the near future of Japan. Accord- SAPS Courses, Symposia and Endorsed Programs Constantin Stan, Romania; Alfred Traub, Hungary; and gratitude to all ISAPS members in the world for ing to some members of ISAPS who live in Tokyo, the are expanding rapidly around the world, with many Akin Yucel-Turkey. Fsending e-mails of encouragement to us in Japan number of patients has significantly decreased after the Ibeing held in their host countries for the first time. Other official ISAPS Courses planned in the next months in the face of this unprecedented crisis. We are deeply March 11 earthquake, and regulation in the supply of The website www.isaps.org has a current listing of all educa- will be held in Urumqi-China, Prague-Czech Republic, touched by the kind thoughtfulness of many friends and electric power is interfering with surgeries and medical tional programs, with those officially produced, approved, with a special cadaver course in Brno, Sharm El-Sheikh, feel like we are members of a big family of ISAPS. examinations. All kinds of industries have similar prob- or endorsed by ISAPS noted with a special icon. Egypt; Debrecen, Hungary; Beirut, Lebanon; again with When the Tohoku region of Japan was hit by a massive lems and accordingly stagnation of the Japanese economy Our first course in Romania was held on April 26-27 a live surgery component, Goa, India; and Como, Italy. earthquake on March 11, I was very scared by a quite strong is anticipated to be prolonged. I am afraid that interna- in Timisoara, organized by the ISAPS Education Council Several other requests for ISAPS educational programs and long quake in the middle of performing surgery in tional societies’ congresses or meetings will have much and the Romanian Society of Plastic Reconstructive are under consideration by the Education Council Chair Osaka City, which is more than 700 kilometers from the lower participants from Japan for several years to come. Surgery. Course Directors were Nazim Cerkes and Nicolae and the Board of Directors and will be announced when earthquake center. The catastrophic disaster and related problems make Antohi with 145 plastic surgeons attending, including 30 they are finalized. Of course planning for the 21st Biennial Meanwhile in Tokyo, people were frightened by a much us feel as if we had strayed into a long dim tunnel. At from countries outside Romania. Two live surgeries were Congress of ISAPS is well under way in Geneva already. stronger quake. Many surgeons were also in the middle of the same time, however, we believe all people living in performed by Nazim Cerkes (Rhinoplasty) and Richard Mark your calendar to attend on September 4-8, 2012. performing surgery. They say that some surgeons could Japan can get together as a team and help each other for Sadove (Neck Lift). Faculty included: Seyfi Akbay, Turkey; The various levels of ISAPS educational programs are not keep standing and crouched down on the floor and the recovery and reconstruction of this country. Moreover, Nicolae Antohi, Romania; Tiberiu Bratu, Romania; explained on our website under the Education Council some nurses rushed out of the operating room in fear. to our delight, soon after the earthquake and Tsunami, Gianluca Campiglio, Italy; Nazim Cerkes, Turkey; Bernard heading. Members who would like to plan a program The entire public transportation system such as trains, rescue parties from foreign countries came to Japan and Cornette SaintCyr, France; Vakis Kontoes, Greece; Ioan in their country should contact their country’s National subways and buses stopped operation. Many streets were many people around the world sent aid supplies and mon- Lascar, Romania; Csaba Molnár, Hungary; Toma Mugea, Secretary and the Chair of the Education Council, Nazim closed due to destruction, ground liquefaction and power etary donations for the sufferers. We are really encour- Romania; Magnus Noah, Germany; Zsolt Révész, Cerkes. outage. Accordingly, a large number of people could hardly aged and grateful to all the people for their support and Hungary; Richard Sadove, USA; Cemal Senyuva, Turkey; find any means to go home. There was terrible confusion, friendship. as reported in the world media. President’s Message, continued from page 2 The earthquake was the greatest one on record in Japan. Donations to the Red Cross to help with disaster relief It triggered an enormous Tsunami that hit the Pacific like to thank the American Societies Alain Fogli in France is another great job in the preparations for our in Japan are being accepted through their website, Ocean side of Japan. More than 27,000 people were killed for taking the lead in this matter. contributor to our education program. next congress. Thank you, Dirk. www.redcross.org or reported missing, with 18 doctors killed and 166 clin- Education is of great importance As the chairman of the scientific It is important to have a scientifi- ics and hospitals destroyed. However, to my knowledge, and that is where our Education committee of our next biennial con- cally supreme program, but also an no plastic/aesthetic surgeons died. All ISAPS members in Council under the leadership of gress in Geneva in September 2012, unforgettable stay in Geneva and its Japan are safe. Nazim Cerkes comes in. He organizes he will head the program team, as surroundings for all participants is The horrible tsunami brought another crisis to us. It courses all over the world with the Renato Saltz did for our San Francisco the responsibility of our local host, Kai damaged the Fukushima nuclear power plant and caused help of many of our members locally. Congress last year. Alain is on track Uwe Schlaudraff and his wife Anette. a serious radiation problem. Areas within a 30-kilometer All those involved deserve applause. to present to you a magnificent sci- They are working day and night to radius of the plant are completely or conditionally off-lim- We also have many members who entific program. As you all know, the insure that you will enjoy your visit its to the public. At this very moment, the struggle against would welcome other members inter- next ISAPS Congress is always bet- and long remember this Congress on further radioactive contamination is being continued at ested in visiting them. This makes ter than the last one. To help us know the shores of Lake Geneva. the Fukushima NPP. The radiation problem seriously our society so unique. ISAPS does not what our members are interested in Of course our Executive Office staff affected fishery and agriculture in the neighboring areas. only stand for International Society of learning, Dirk Richter in Germany, is already managing the many hidden Furthermore, the damage to the plant gave rise to electric Aesthetic Plastic Surgery, but also for our Assistant Treasurer, has created details involved in the production of power shortages in a wide area including Tokyo. International Society of Amigos Para a questionnaire that will be sent to all any major international congress. We We are concerned about harmful effects of all the above- Siempre. plastic surgeons. He, too, is doing a owe them a word or two of thanks for continued on page 12 6 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 7 LEGAL REPORT – ITALY LEGAL REPORT – RUSSIA

NEW LAW TO BE APPROVED IN ITALY WILL A Short History of Aesthetic Plastic REGULATE BREAST AUGMENTATION Surgery in Russia: A plea for PROCEDURES standardized training requirements Gianluca Campiglio, MD – Italy Kirill Pshenisnov, MD – Russian Federation ISAPS National Secretary he history of cosmetic surgery procedures in the In 1994, the first professional organization of those who former USSR arises from the 1960s when they practiced any form of plastic, reconstructive or aesthetic bout two years ago, the Vice-Minister of Health the data concerns not only the type of breast prosthesis were performed only in Moscow – the capital surgery was created. In 1997, the first medical journal on in the Italian government, Francesca Martini, implanted in the patient (manufacturing data) but will T of the country. The first Institute of Cosmetology there plastic surgery with aesthetic surgery in the title appeared. decided to create a technical committee in also record all the clinical history of the patient including A was under the auspices of the Ministry of Food Industry. Numerous cosmetic surgery courses, master classes and order to institute regional and national registers for breast complications and short and long-term side effects. The second center for aesthetic surgery used to be the meetings were organized. Medical businessmen developed implants and to regulate breast augmentation procedures. Article 2 of the new law prohibits the placement of so called Institute of Beauty. These two facilities covered the attractive concept of aesthetic medicine where surgery This national committee met several times at the breast implants in underage patients for aesthetic pur- nearly all the needs in the field of the communist coun- was “married” to cosmetology and anti-aging. In 2000, a Health Ministry in Rome. Among the participants were poses and sets the penalty at 15,000 Euro. Breast aug- try with the population of 200 million people until the journal of “aesthetic medicine” started to publish papers several ISAPS members: Andrea Grisotti, Roy De Vita and mentation in malformative or reconstructive cases is still 1980s. According to surgeons practicing at that time, the on cosmetic surgery and some of the surgeons joined the Gianluca Campiglio, ISAPS National Secretary for Italy. allowed in underage patients. lines of patients waiting to enter these clinics were equal Society of Specialists in Aesthetic Medicine. It is important The results of these meetings constituted the foun- Another important issue regards obligations to prop- to those at grocery stores and were as long as two stops of to note that in all that time, plastic surgery was not a distin- dation for Law 2515, entitled Institution of National and erly inform patients. Every public or private clinic must the Moscow underground. guished specialty in the Russian Federation. Regional Registers for Breast Implants, Informative Obli- prepare an information card describing the type of pros- Cosmetic surgeons at that time were mostly dental sur- In 2009, plastic surgery finally achieved its place among gations for the Patients, and Prohibition of Breast Aug- thesis, including its supposed duration, the potential com- geons called stomatologists. According to medical practice medical entities in Russia. More than one and a half years mentation in Underage Patients which was approved plications of the procedure, and its short and long-term regulations postulated in 1982, surgical cosmetology pro- after this decision, the Ministry of Health Care did not by one of the two chambers of the Italian Parliament on side effects. This information card does not replace the cedures could be done only by those surgeons who had approve their educational programs and some surgeons December 23, 2010. This law will also be approved by informed consent already collected by surgeons before two years’ experience in facial surgery. Special training in were sure that it was aesthetic surgery recognized as a spe- the second chamber (Senate) in the next few months and the procedure. aesthetic surgery was not required. One could attend one cialty under the name of plastic surgery. Finally in December then will be in effect for all intents and purposes. Finally, Article 3 dictates that aesthetic breast augmen- month of lectures (144 hours) and start his practice in 2010, medical schools got the published program for pro- tations can only be performed by board certified plastic The law deals with four issues: cosmetic surgery. In 1995, maxillo-facial surgery was rec- fessional retraining of general, maxillo-facial, thoracic, surgeons, or by surgeons who can show an equivalent 1. organization of regional and national registers for ognized as an entity and licensing committees started to pediatric and oncology surgeons, urologists and gynecolo- surgical activity in the previous five years, or by board breast prostheses; accept documents only from those who had diplomas as gists after five years of practice in the main specialty to be certified general surgeons, gynecologists or thoracic sur- 2. minimum age to undergo a breast augmentation; maxillo-facial surgeons. At that time, most of them were plastic surgeons. The education process requires 500 to geons. This article is very important as in our country, as 3. informative obligations for patients who are candidates dental surgeons without general surgery training. In spite 720 academic hours (four to five months). In that period, at in many others, every physician can perform an aesthetic for breast implants; of that fact, those surgeons surprisingly performed breast least three quarters of the time is dedicated to aesthetic sur- procedure, including breast augmentation. This law, even 4. definition of surgeons who will be allowed to perform augmentations and reductions without hesitation. Surgical gery. Unfortunately, surgeons must spend all this time in if it does not restrict this procedure to board certified plas- aesthetic augmentation mammaplasty. methods at that time were basically routine without proper the audience during lectures and seminars with no direct tic surgeons, as already established in some countries, instrumentation and with a total lack of modern medi- contact with patients and no on-call overnights. There is no Concerning the registers, the law indicates their pur- represents the first attempt to define surgical competen- cal devices. Most of those who were practicing aesthetic way to check the practical capabilities of the doctors who go poses (clinical and epidemiologic monitoring), the type of cies in aesthetic surgery in Italy. surgery used to pay for five-month courses and could get through these courses. data which will be collected, the physicians authorized to Future issues of ISAPS News will update our members diplomas as maxillo-facial surgeons without attending any At the beginning of specialty recognition, the decision access this data, and penalties (from 500 to 5000 Euro) for about the legislative course of this innovative law and the training program at all. was made by council members of the national plastic sur- public and private clinics that fail to transmit the informa- evolution of the debate about surgical competence in Italy. The collapse of the Soviet Union led to a real boom in gery society that the most experienced plastic surgeons tion to the regional and national data banks. Interestingly, aesthetic surgery in the 1990s. Many new private clin- who teach others as published professors will be “grand- ics were opened. The real possibility to travel and study fathered” and will get their plastic surgery certificates abroad was opened. Internet access also gave new knowl- without additional training. The primary list included no edge about plastic surgery both to physicians and to their more than 20 names. But the newly formed departments patients. Surgeons had to communicate and collaborate. of plastic surgery independently extended this list, without continued on page 10 8 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 9 LEGAL REPORT – MEXICO LEGAL REPORT – COLOMBIA

NEW LAW APPROVED BY MEXICAN SENATE Plastic Surgery Legislation in ESTABLISHES REGULATION OF PLASTIC Colombia SURGERY PROCEDURES Lina Triana, MD – Colombia Chair of National Secretaries Jaime O. Salcedo-Martinez, MD – Mexico

ISAPS National Secretary he Colombian Plastic Surgery Society has made of them; cosmetic surgery is not. We are now working n the last decade, there was an extraordinary increase The Senate of the Republic endorsed changes to several pro- a great effort to educate the public about the with the government health minister to officially define of the number of plastic surgery procedures, inva- visions of the health law to regulate plastic, aesthetic and Thigh risk of some aesthetic/cosmetic procedures competencies and regulate our specialty. We are also Isive and non-invasive, performed by non-plastic reconstructive surgery procedures. This initiative is of enor- in our country. I would like to share with you what the present at the Colombian medical college and association surgeons in Mexico. The number and severity of compli- mous legislative significance because there is no record of Colombian Society’s Board of Directors has been doing. of scientific societies that help define competencies cations related to these procedures was high and there was compulsory Specialty Cedula in any branch of medical prac- We now have an agreement with the Minister of in the medical specialties. Under this new law, all the tice. The Specialty Cedula is an official document given by no legislation to regulate the practice of plastic surgery in Education which allows us to revise and validate the title general doctors who completed medical school but not Educational Institutions when you have finished plastic sur- the country. These bad outcomes were valuable material of plastic surgeon in Colombia. In the past, this was done a residency program and aestheticians who are doing gery residency that officially endorses your practice by the for the media who took advantage of this kind of news, directly by our government that did not verify if these any kind of plastic surgery must stop. The Ministry of Health Department. discrediting all plastic surgeons. titles corresponded to the minimal academic standards Social Protection is helping us comply with this law. We The Mexican Association of Plastic Surgeons (AMCPER) This law has two fundamental features: 1) it is now that our Colombian plastic surgery programs require. are educating our Colombian plastic surgeons to play an decided to participate with our Congress to protect the mandatory to have the Plastic Surgery Specialty Cedula to The Society has recently developed a closer relationship active role in this process by working with the regulatory public from all these persons, doctors and non-doctors, practice Plastic Surgery and 2) it is required that you only with the INVIMA (similar to the FDA in the USA) to agencies we have in Colombia such as the department who, without ethics, without credentials, and mainly with perform surgeries in establishments that are duly author- insure that they verify any new product introduced into health secretaries, secretaria de salud departamental, and commercial means, were practicing plastic surgery. After ized by the Health Department. our country. For example, INVIMA approved silicone gel the health superintendency, superintendencia de salud. several years of hard work, we finally have a law as out- This law may not solve all the problems in the practice and other non-absorbable products that are very popular This new law was to include a recertification process, lined in the following text: of Plastic Surgery in Mexico, but surely it is a great step on and often injected by non-plastic surgeons in spas. Thus, but this part of the law did not pass. The Colombian Plastic the path to protect our specialty. we had a health problem and social risk with these Surgery Society is in the process of changing our By-Laws substances. The INVIMA now understands what can to require recertification every five years. At first it would Legal – Russia, continued from page 9 happen in many of these patients where such products be voluntary, but once our government approves, it will any control, on the basis of their favor- Expensive glossy journals carry adver- surgery as a specialty based on aes- are applied in large quantities. be mandatory and then we hope the government will ites. Education in the courses costs tisements from several “top” doctors thetic surgery knowledge, training and When we speak to the media on aesthetic plastic consider the society as the entity to manage this mandatory approximately five thousand US dol- that present themselves as “one of the successful practice. The situation will surgery procedures by non-plastic surgeons, we refer to recertification process. lars. All the participants get diplomas five best in the world” with “a unique hopefully improve when residency them as “intrusismo medico” meaning invaders of our We are working hard for our specialty in Colombia and and certificates as plastic surgeons in vision of beauty.” Most of them never programs requiring two to five years field. We think this gives a clear message to everyone. hope that by sharing this information with you it will help spite of the results of tests and oral attend professional meetings and with sufficient broad theoretical and We can do this thanks to a new law that regulates to prove that we, as recognized societies, can make big examination. Nobody checks practical have no formal education in plas- clinical training are established and medical specialties in Colombia. Plastic surgery is one changes if we put all our forces together. capabilities of the graduates. There is tic surgery. Their website advertise- short term courses are closed. Only also little attention paid to moral char- ments stimulate medical tourism as professionals can improve the situa- acter and ethical behavior of future the prices for surgery are rather low. tion to protect the brand of our spe- Cover story, continued from page 1 aesthetic surgeons. One should keep in mind that quality cialty. Creation of a national board of and a faculty dinner cruise on the Neva River and the and Peter the Great’s glorious Peterhof Palace surrounded Advertising with pre- and post- and cost of care are the main issues in plastic surgery is one constructive way many canals of the city to see the famous White Nights by the most beautiful gardens and fountains. The history op pictures of patients is legal in aesthetic plastic surgery. At the same to achieve this goal in spite of the fact celebration when the bridges of St. Petersburg are raised of St. Petersburg, a city that seems an architectural cross the Russian Federation. However, time, many less qualified doctors over- that there is no such practice in the and all the palaces on both sides of the river are brilliantly between Paris and Venice, is all around you. And of course, some patients complain that they see charge their patients for no reason. Russian health care system at present. illuminated. the educational value of this meeting was appreciated by Photoshop created images instead of In this situation, it is our obligation ISAPS can help in this regard by real post-op results. There are doc- to protect patients from unqualified prescribing and then requiring proper Several excursions allowed participants to get to know our Russian colleagues throughout the meeting. ISAPS tors who do not hesitate to make pre- doctors even if they have formal diplo- educational requirements and ade- this spectacular city with the Hermitage and Russian looks forward to a renewed and vastly strengthened collab- op pictures without proper lighting mas. Russia is only at the beginning quate training of all their individual Museum housing outstanding collections of fine art, the oration with our friends and colleagues in Russia. and take post-op photos with flash. of the legislative process in plastic members. Church on Spilled Blood with its dramatic interior mosaics, 10 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 11 LEGAL REPORT – CANADA LEGAL Report – European union

Legislative Changes: Disappointing Meeting on European The Canadian Experience Standards By Elizabeth J. Hall-Findlay, MD, FRCSC – Canada Ivar van Heijningen, MD – Belgium ISAPS National Secretary ISAPS National Secretary

ach province (state) in Canada regulates physi- be performed only in an accredited surgical facility or in n earlier articles, I explained the need for regulation of aesthetic proce- on reconstructive surgery and men- cians and this can be quite different from one an approved hospital – and they were not allowed in an dures, facilities and practitioners. A European Standard would help to tioning an interest in aesthetic surgery Epart of the country to another. Plastic surgeons unregulated physician’s office. I accomplish this. On May 6 and 7, stakeholders working on the Euro- is the surest way NOT to get a train- are required to pass exams, both written and oral, from Being involved was hard work and it required a signifi- pean Standards for Aesthetic Surgery Services (ESASS) document met in ing position, so the residents trained the Royal College of Physicians and Surgeons of Canada. cant time commitment – but they listened to my concerns. Graz, Austria for the third plenary session to try to come to a final draft. here are not the ones best prepared Surgeons are given the designation of FRCSC after being We were able to achieve good physician regulation and Comments for aesthetic procedures. Besides that, there are vast differences in training certified and medical specialists are given the designation there is very little surgery now performed by non-plastic In two days, we had to cover a 75-page list of comments which included two throughout Europe. Gynecologists of FRCPC. surgeons. This has not been the case in other provinces tables trying to link procedures to practitioners. It proved to be too much. We in Germany do all breast procedures I practice in the province of Alberta and I have been (such as Ontario where Toronto is located). lost an entire day covering the comments on clauses we had already discussed while in other countries they do none. very involved over the years with the licensing body for We want to ensure that plastic surgery is performed by at the meeting before this one. Although everybody has the right to suggest In addition to that restricting proce- the province: the College of Physicians and Surgeons of well trained plastic surgeons. I did not start out by chairing amendments, in fact parties joining the mirror committees at a later stage dures to certain specialties poses big Alberta. I ended up chairing the committee that set up the committee that had this power, but, because I helped brought up most of the “new” comments on these clauses. To put it another legal problems since some European the standards and guidelines for all surgical facilities in out in other areas, the licensing group listened to me and way, many organizations and societies who were either unaware of or not will- countries (e.g. Germany, the Nether- Alberta. We managed to regulate not only the surgical I was able in the end to achieve what I felt was important. ing to show up at prior meetings now had a lot of comments we needed to lands, Spain) have laws delegating the facility itself, but also the privileges for each physician – My message is to get involved! You may need to start review. which meant that we could insist on proper credentials slowly, but eventually you may be able to achieve similar responsibility for what a doctor does and training for each procedure applied for. A list of pro- results. Specialty and training to the individual doctor; hence, if he/ cedures was then developed and it was required that they Considering the number of comments on the clause related to procedures, she feels competent they are entitled we started the second day with an overview of all the “pros” and “cons” of to do the procedure. specialties versus competence. Traditionally, adequate knowledge and compe- Competencies and knowledge President’s Message, continued from page 7 tency is obtained through the training program of a particular specialty, but with the rapid expansion of the number of aesthetic procedures, as well as PRO their efforts. contri bution. Don’t do operations that you don’t feel com- with the doctors doing these procedures, this becomes less obvious. Other specialties, and especially Control is inevitable to show you where you stand in petent to perform. There is always an ISAPS member you PRO the non-specialist doctors, argue that your education. In golf, you have a handicap, but plastic can ask for help, or even refer your patient to. We don’t competence is particularly important. The advantages of linking/restricting procedures to certain specialties are: surgery is not golf. If you hit a ball into the woods, you just need members that only join us to get the membership They do a restricted number of proce- • the government and European Union of Medical Specialists (UEMS) recog- take a new one. Not so in surgery. certificate and then don’t pay their dues anymore. We will dures, but do these very often. They nize these specialties In the UK, Simon Myers from the University of London be very attentive in this matter and eliminate all from our know everything about these proce- • training centers are controlled both by the government as well as by special- is elaborating a method to measure our education. Foad membership list who do not conform to our ethical rules. dures, so they are better qualified to ist societies Nahai is in contact with him and will further orient us as On the other hand, I would like to thank all those mem- do them than those with a specialist • the content of the training has been established on a European level in the the work goes on. Thank you for your help, Foad! bers who contribute to the prosperity of our society. registration. Because they limit them- UEMS-syllabi. In Europe, we have regular meetings with the CEN I wish you all a wonderful summer (or winter down selves, they deliver better quality, just This makes the specialist verifiable for patients and thus the non-specialists (Centre Européen de Normalisation) where we define stan- under). as the sub-specialization within a spe- have a weak legal position. dards that will eventually govern who is allowed to do what cialty improves the quality. As men- operations in what facilities and on what kinds of patients. CON tioned, this is legally correct in some We need members who are interested in being the On the other hand, not all specialists are competent! Some specialties have countries. And as long as a doctor is best aesthetic plastic surgeons. This requires continuous become so broad that we cannot expect someone concentrating on one end of aware of the importance of the Safety education that involves all of us. We are glad for every Jan Poëll the spectrum for years, say hand surgery, to still be competent in another. Not to Diamond and chooses what proce- ISAPS President mention the fact that the number of procedures has expanded enormously and dure is suited for which patient in an has included a lot of non-surgical procedures such as toxins, fillers, lasers and various devices. If we look at our specialty, some training centers focus mainly continued on page 14 12 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 13 LEGAL REPORT – EU FAT GRAFTING – INTERNATIONAL PERSPECTIVES Legal – EU, continued from page 13 ethical way, and does the procedure cons extensively, it was concluded be a good idea. It would also be good in a safe environment, then it is not that we should not look at the chaotic to recognize “Aesthetic Healthcare” ISAPS News is pleased to present a global perspective on fat important what specialty he/she has. present situation, but at the future. If as part of medicine so that it is taken grafting. With the growing worldwide interest in this proce- CON we want to guarantee patient safety, more seriously. dure, ISAPS representatives from across the globe share their aesthetic procedures should be re We ended the meeting trying to OK, so they concentrate on only thoughts on practices and attitudes in their regions. these procedures, but how did they stricted to specialists with a recog- cover as many comments as possi- learn them? By trial and error? At nized training program. This would ble on the procedure clause. Another the cost of how many complications? make it controllable for patients to meeting is planned in Milano in Sep- And by whom were they trained? By know who is qualified and who is not. tember. the laser industry? Since there is a multitude of aesthetic We as plastic, reconstructive and Without proper, registered training procedures, it would make sense to AESTHETIC surgeons did most of it is difficult to know what the alter- separate aesthetic procedures into the procedures in the past, but espe- US Perspective two areas: aesthetic surgery and aes- cially the non-surgical procedures are natives are, especially if you don’t do J. Peter Rubin, MD – United States these. Not to mention that you must thetic medicine. Those interested rapidly growing both in quantity and be able to treat the complications as should do a sub-specialization with in complexity. If we want to keep our at grafting in the United States has a long his- move away from anecdotal evidence in this area and col- well. The biggest drawback is that a subsequent exam to guarantee ade- position as the experts in this field, tory of practice in facial aesthetic surgery. De- lect stronger clinical evidence to support our practices. this is a self-proclaimed competency quate knowledge and skill. If taught we must improve our training in all Fspite wide-spread use, there is much controversy A newer development in fat grafting in the United States that is NOT controllable by anyone. It in a modular setup, this would allow aspects of aesthetic healthcare and over the best ways to harvest and process fat tissue, and is the concept of stem cell fat grafting. While strongly could be very adequate, but it could all specialties to gain knowledge and not limit ourselves to the surgical much debate about the best techniques for injection. rooted in the rationale that adult stem cells are highly bio- be totally insufficient as well. skill in areas not already covered by part. Those teaching should be made A major challenge is collecting well-quantified data on active and can release growth factors to assist in the heal- their own training programs. Some aware that this should not be taken the outcomes from fat grafting to the face. Surgeons ing process, the actual clinical practices are still poorly Conclusions and suggestions thought that a separate specialization lightly! are using three-dimensional camera systems in an ef- defined and not standardized. Moreover, a Google search After discussing these pros and for aesthetic medicine alone would fort to do this. Beyond facial applications, an emerging of stem cell facelift and stem cell face breast augmenta- trend in the United States is the use of fat grafting for tion returns 200,000 and 300,000 results, respectively. breast augmentation and breast reconstruction. This has Despite this media presence, strong evidence is still been a controversial issue in the United States because needed to show efficacy in aesthetic surgical treatment. sculpt the of strong statements issued by plastic surgery societies Recently, a combined task force of the ASPS and ASAPS against this in the 1980s. However, these positions have released a position statement drawing attention to the dream been softened recently and there is currently much ac- fact that the evidence available to support stem cell thera- tivity in this area of practice. Fat grafting is being used pies in aesthetic surgery does not adequately justify the VECTRA® 3D helps you turn her dream into reality. for both cosmetic breast augmentation and for breast re- widespread marketing that is seen. The position paper With realistic 3D simulations, your patient’s dream takes shape construction, especially lumpectomy defects and for the called for the collection of well-controlled data in this area. right before her eyes. She sees that you understand. You know feathering of implant borders. An interesting develop- While there is great promise for this technology, we are that you will meet her expectations. ment has been the use of external negative pressure in not ready to call stem cell fat grafting a standard of care. Invest with confidence. 80% of VECTRA 3D users increased order to expand the skin envelope and treat the recipi- As one considers the numerous scientific variables their conversion rate—most by over 20%. The top reason? ent site to optimize the results. This technology has been that can impact outcome in fat grafting, we realize that Patients can visualize expected outcomes in 3D.* championed by Dr. Roger Khouri in Miami as well as fat grafting will become an increasingly useful tool as Dr. Dan Del Vecchio in Boston. we continue to improve upon existing technologies and Face, neck, breast or body—VECTRA does it all. The optimization of methods for harvesting, process- make this technique more reliable in the hands of all Call today for a live, on-line demonstration, and see ing and injecting fat grafts is a topic for which much more plastic surgeons. for yourself how VECTRA can sculpt the dream. scientific investigation is needed. It is important that we

www.canfieldsci.com · [email protected] 800.815.4330 *Data from a recent survey of practices using VECTRA 3D. May – August 2011 www.isaps.org 15 FAT GRAFTING – INTERNATIONAL PERSPECTIVES FAT GRAFTING – INTERNATIONAL PERSPECTIVES

“We currently are preparing guide- MIDDLE EAST AND augmentation is becoming more and European Perspective I lines for the safe and responsible use of MEDITERRANEAN more popular in the Mediterranean and Marita Eisenmann-Klein, Prof.h.c., Dr.med. Dr.h.c. – Germany fat grafts. We see an urgent need since Near East. This interest is in part due to more and more patients are request- PERSPECTIVE the guidance document issued by the nnovative plastic surgeons like Jose Guerrerossantos ing these procedures,” states Peter ASAPS Task force in 2009. Despite the in Mexico, Abel Chajchir in Argentina, and Sydney Vogt, President of the German Society Coleman in the US, always were well respected in Eu- Tunc Tiryaki – Turkey popularity, the long-term predictability I of Plastic Reconstructive and Aesthetic rope. Later on, pioneers like Emanuel Delay and his group raditional notions of beauty vary across cultures of volume maintenance remains a limi- Surgeons. in France, Gino Rigotti in Italy, and Michael Scheflan in and generations. While regional stereotypes may tation of fat transfer, especially in cases of high volume This is amazing, since all societies in Israel presented long-term follow-ups with encouraging have held true in the past, globalization of both transplantations. To help overcome the limitations associ- Europe were cautious about informing the public in order T clinical results. Subsequently more and more plastic sur- our patients and our discipline is challenging these be- ated with large volume fat transfers, autologous adipose- not to create unrealistic expectations. Health authorities in geons in Europe became interested in these techniques. Europe usually do not interfere with medical procedures as liefs. As societies place more and more emphasis on an derived regenerative cells (ADRCs) are increasingly used Researchers like Norbert Pallua in Germany prepared the long as the European Tissue Law is respected. Therefore, “international” standard of beauty, the number of people to enhance revascularization, improve survival rate of scientific background. there are no restrictions for application as long as the tis- seeking aesthetic procedures is increasing across popula- grafts, and reduce postoperative atrophy. A break-through occurred after Roger Khouri in the US sue transfer is done in one procedure. For manipulation of tions. To isolate such cells, there are now commercially avail- introduced the combination of fat grafting with the vac- tissue outside the operating room, restrictive requirements In spite of these forces, which are attempting to har- able systems which prepare populations of autologous uum-assisted Bra system. During the past few years many exist. monize our perceptions of beauty, regional variations cells from fat for use within the same surgical proce- national societies of plastic surgery published statements The overwhelming applause for Roger Khouri receiving do indeed influence both patients and surgeons. These dure. Such systems are becoming increasingly popular regarding fat grafting procedures, mostly for the purpose the best paper award at the European Association of Plastic throughout Europe and The Middle East. sometimes subtle and not so subtle anatomical variations of encouraging their members to inform their patients Surgeons (EURAPS) meeting in Mykonos, Greece on June Preliminary results suggest that regenerative cell en- translate into different procedures and emerging trends. about the lack of long-term studies and thus indicating that 2nd, 2011 demonstrates better than anything else that fat riched tissue injections might have advantages compared As an example, populations around the Mediterranean not all potential risks can be judged at present. They also grafting is considered a major asset if not a paradigm shift and the Near East do not have very prominent cheekbones, to traditional fat transplantation. This may be particularly called for long-term studies with larger series. in plastic surgery practice in Europe. resulting in a hollow malar area as well as premature mid- true in vulnerable grafts such as large volume fat trans- facial aging. As a result, fat transfer for facial rejuvenation fers seen in breast augmentation or damaged, radiated or is a very popular procedure and structural fat grafting, as fibrotic tissues. European Perspective II popularized by Coleman, is one of the most common fa- As our discipline continues to expand and we share Kai-Uwe Schlaudraff, MD – Switzerland cial operations in the region. more as colleagues, our regional differences in practice plastic surgeons since risks associated Beyond the face, autologous tissue injection for breast approaches will ultimately make a global impact. ne hundred years after the first report on autol- with autologous fat transplantation are ogous fat transfer in Europe, Sidney Coleman at present considered to be minor. New Odescribed his technique of fat injection thus approaches like cell-enriched fat graft- Australian Perspective defining the starting point of modern fat grafting and ing might offer additional advantages triggering renewed interest for adipose tissue in both and are currently evaluated in several European centers. Craig Layt, MD – Australia research and clinics. Europeans are highly pleased by the concept of a In Europe, the idea of using the patient’s own adipose “natural” treatment using autologous tissue thus avoid- hilst Australia ranks sixth in the world for obe- The last systematic review of the lit- tissue remained controversial for many years – mainly ing foreign bodies and patients are increasingly request- sity rates, not a lot of that fat will be utilized erature performed by the Australian over concerns of its efficacy and safety in particular in the ing fat grafting procedures. However, the experience with Wfor breast augmentation at the moment due to Safety and Efficacy Register of New breast. Initially critically reviewed and banned by plastic the 1992 ban of silicone implants in the USA and parts the current regulatory environment. As the use of fat trans- Interventional Procedures – Surgical surgery societies in the breast, fat grafting would only be of Europe due to a lack of scientific data should motivate us to take proactive measures by (1) formulating best fer for edge defects in breast reconstruction has become (ASERNIP-S) was in September 2010 and reflected the adopted by few European plastic surgeons and limited in practice guidelines for harvesting, injection and follow- mainstream and fat transfer has become a standard part increase in evidence of safety and efficacy from the previ- their use to “safe indications.” up volume measurements, (2) reviewing European tissue of most facial rejuvenation practices, indemnity insurers ous review of 2002. This review, along with the exponen- Today, things have changed: the outstanding work of E. Delay, G. Rigotti, C. Calabrese, M. Eisenmann-Klein, laws regulating adipose tissue banking and (3) establish- are currently reluctant to insure the practice of breast aug- tial increase in research into the area that was evident at M. Scheflan and many others have led to a more refined ing a European register for fat grafting to the breast. mentation using fat. The largest insurer excludes “transfer the recent Boston Breast Workshop and ASAPS 2011 will understanding of the fat and its cellular components like We are witnessing a paradigm shift: the fat, for now or injection of non-vascularized fat into the breast(s) as a hopefully allow the current insurance situation in Austra- adipose derived regenerative cells (ADRCs). Impressive neglected in its functions and unwanted by everybody, cosmetic enhancement procedure, except as part of breast lia to change in the near future. Certainly at the above reconstructive and aesthetic results and positive reviews will soon be broadly discussed as a source of regeneration reconstruction after mastectomy or trauma.” meetings it was “all about the fat!” by most national plastic surgery societies – for example and healing – in plastic surgery and beyond. the German society in 2009 – have encouraged European 16 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 17 FAT GRAFTING – INTERNATIONAL PERSPECTIVES

Asian perspective

Kotaro Yoshimura, MD – Japan

n Asian countries, liposuction is much less fre- Stem cell application is being used by quently performed than in western countries due a limited number of surgeons. Manual Ito the lower number of obese people. However, fat isolation of stromal vascular fraction is grafting is a relatively popular procedure as a facial filler, done in an aseptic cell processing room especially in South Korea. Fat grafting and its application or with a clean-bench isolation system placed in an oper- to the breasts has been getting more attention in Asia ating theater. Full-automatic or semi-automatic machines in the last few years. Although the face is the most fre- provided by Korean or American companies are also used quent site, large volume lipofilling is increasing as spe- by a limited number of clinics and hospitals in South cific devices and machines for large volume processing Korea and Japan. Platelet-rich plasma is also combined by ® and injection become commercially available. Lipofilling some surgeons. to the breasts is still controversial, but some plastic/cos- In Japan and Hong Kong, invasive procedures are less metic surgeons do fat grafting to the breasts as their pre- popular than in other Asian countries. Hyaluronic acid dominant method for breast augmentation. Lipofilling to products are frequently replaced by lipofilling in some the buttock, the hand, and for scarring remains rare. applications of the face and breast in Japan. Centrifugation is the most common processing of The downtime after surgery is always an issue of fat injection fat tissue compared to other procedures such as grafting to the face. If patients do not mind the downtime, gravity precipitation or filtration. Coleman instruments fat is over-injected so that the one session of lipofilling nts and techniques are popular for fat grafting to the face in is sufficient to get a satisfying result. If patients are con- pla t Im many Asian countries, especially in South Korea. Lipokit cerned about post-operative swelling, a relatively small reas is also becoming popular for fat centrifugation in larger volume of fat is injected with delicate and careful tech- B volume such as for the breasts. In general, syringe aspi- niques and multiple sessions are required. ration is used for a small volume, while suction-assisted Même® lipectomy is used for a large volume. Quality made in Germany

South AmericaN PERSPECTIVE

Carlos Oscar Uebel , MD PhD – Brazil

n 1983, Abel Chajchir from Buenos Aires published the first paper on fat graft- Optimam® ing. He opened a new era in South America followed by surgeons, especially Replicon® Ifrom Brazil, were Luiz Toledo, Ronildo Storck, Carlos Uebel, Luiz Haroldo and many others improved continuously this technique using not only in the face, but also in breast and body contouring. In the beginning of the 1990s, with the high fillers marketing promoted by the products of PMMA, Collagens, Hyaluronic acid etc., fat ® grafting suffered a tremendous decline. But now a days, with the appearance of intense Opticon fillers, complications and sequels, fat grafting got again its podium and has become a very common procedure done by almost all plastic surgeons.

POLYTECH Health & Aesthetics GmbH Altheimer Strasse 32 • 64807 Dieburg • Germany  +49 (0)6071 98 63 0 •  +49 (0)6071 98 63 30 © 2011 POLYTECH Health & Aesthetics, Germany. © 2011 POLYTECH [email protected] www.polytech-health-aesthetics.com

18 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org Check product availability for your country with19 us.

ISAPS_SLtxt_US.indd 1 13.07.2011 12:37:29 14730_Hidalgo7.75x10.1.qxd:ISAPS 5/23/11 10:24 AM Page 1

PRACTICE MANAGEMENT ASSI® Hidalgo Lower Email Spoofing and Other Malicious Blepharoplasty Retractor Internet Activity

Richard H. Read – United States ISAPS Information Technology Consultant

We’ve had reports recently from people “owned” by the spammer. The spammer’s malware can do receiving spam emails that appear to be a search of the entire hard disk of this “owned” computer, coming from [email protected]. Our searching address books and other data files for pieces of email system has been carefully audited data that look like email addresses. The spammer’s mal- and we know that these messages do ware might find messages that had been sent by isaps@ not in fact come from our servers or from conmx.net as well as people who had received that mes- ISAPS staff. Still, you should know that we are sage. With this information, the malware could resend aware of this problem. I would like to tell you about a few spam messages apparently originating from conmx.net, common ways that spammers operate. While I cannot pro- but with subject and content of the spammer’s choosing. vide a comprehensive explanation of spam email in one Once this spammer has a list of such addresses, he can short article, I would like to tell you about one method by sell it to other spammers. And on it goes. Symantec, a lead- which you might appear to be receiving spam from conmx. ing anti-spam provider, released a report last month saying net – when in fact we did not send it. that about three quarters of all Internet email is spam. This The content of the recent spoofed malicious messages does not help when we rely so heavily on email to commu- included a link to a malicious web page, which has since nicate with our members. disappeared. This method, called a drive-by download, is a The vast majority of spoofed email simply goes away in ASSI®•AG97326 common way for the spammer to get his malware installed a few days. It can take that long for the spam filters to get on your computer. The web site – and sometimes they are updated, but spoofing attacks do eventually stop. legitimate web sites – has been hacked in such a way as So what to do about this tidal wave of spam that is meant to install the spammer’s software onto the computer if to mislead recipients and get them to click on something the user clicks on a dialog box, or if it is missing security they should not? Here are some tips for safer computing: updates or other protection. • Use an email provider that has built-in anti-spam tools, So where do these messages come from if not from and be sure the tools are turned on. This will keep the ISAPS? This question opens the subject of email spoofing. bulk of spam from getting to your inbox. This happens when someone (generally a spammer) inten- • If the message content does not look like it came from tionally sends email, almost always with malicious intent, the person who sent it, delete it or verify the sender making it look like the message was sent from someone before opening. else. This is possible when there is no authentication (proof • Keep your operating system updated with the latest that the sender is who he says he is) on the Internet. patches and protective software. It benefits the sending spammer to make it look like the • NEVER click on any links in suspected spam messages. message came from a trusted party, in this case isaps@ • Do not click on attachments or pop-ups if they are not conmx.net, since the recipient is more likely to open an Designed by: expected. Doing so will allow the spammer to install David A. Hidalgo, M.D. email from someone they know. malware. Clinical Professor of Surgery So how does the spammer know that you are sometimes Cornell Medical Center, NY, NY These are standard practices for handling any email. We a recipient of legitimate email from conmx.net? There are follow these guidelines in the ISAPS Executive Office, and millions of machines on the Internet that are compro- hope you will, too. Until the spammers are put out of busi- mised. That is, they were not suitably protected or, even ness, it pays to stay alert. ® if they were, the user was tricked into running a program ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS® created by the spammer. Now that machine is said to be For diamond perfect performance® ® accurate surgical & scientific instruments corporation 300 Shames Drive, Westbury, NY 11590 20 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 21

2011 American-Brazilian Aesthetic Eugen Holländer (1867-1932) – Meeting – Park City, Utah a widely forgotten Pioneer of Renato Saltz, MD – United States Aesthetic Surgery, Fat Injection ISAPS 2nd Vice President and ABAM Chair he 3rd American-Brazilian Aesthetic meeting held in Park City, and Medical Art History Utah from March 4-7, 2011 attracted registrants not only from Andreas Gohritz, MD and Peter M. Vogt, MD, PhD – Germany the US and Brazil but also from 15 other countries. We had T I would like to introduce Dr. Andreas Gohritz, a plastic surgeon working at the Medizinische Hochschule in Hannover a record attendance of over 250 including plastic surgeons, residents, nurses and aestheticians – and their families – perhaps the largest (Germany) and keen on the history of our specialty. His paper on Holländer demonstrates the first clinical applica- attendance ever at any ski meeting in the United States. tion of fat injection into the face and breast. —Riccardo Mazzola, MD – Italy – ISAPS Historian Endorsed by ISAPS, ASAPS and ASPS, this year’s ABAM and was Abstract 19th century, ideas and techniques have greatly changed. made possible through the generous support of many exhibitors and Autologous fat grafting has been recently rediscovered During the last decades, autologous fat grafting for tissue sponsors. as a highly versatile method for soft tissue correction or augmentation and reconstruction has attracted renewed The scientific program was quite intense and once again offered a augmentation. Yet little is known about the first mini- interest. Coleman and other authors recommend strict unique opportunity for residents and young colleagues to present their mally invasive fat injections performed as early as 1906 methodology and specific material to reduce reabsorption work at an international educational event. The panels focused on the Program Committee: Mark Jewell, Joca Sampaio Goes, Foad Nahai, Ricardo Ribeiro, and Renato Saltz. by the German surgeon Eugen Holländer (1867-1932) and increase adipocyte survival. Atraumatic liposuction main topics of aesthetic surgery and cosmetic medicine with recog- whose reputation has fallen into oblivion. and centrifugation is combined with the re-injection of nized leaders from the US and abroad debating the same topic and The objective of this article is to remember the life and purified adipocytes placing small amounts in multiple sharing their unique experience with the audience. Three workshops work of this forgotten pioneer who contributed important tunnels to enhance contact and vascular supply between offered by Allergan, Silhouette Lift and Sculptra and a special skin care innovations to aesthetic plastic surgery. transplanted adipocytes and surrounding tissues. panel presented by leaders of the Society of Plastic Surgical Skin Care Holländer invented a method for reconstructive rhino- Curiously, the first minimally invasive fat injections Specialists attracted a lot of participants and enhanced the scientific plasty using breast flaps in 1913 and in 1924 introduced a performed since about 1906 by the German surgeon quality of the meeting. surgical therapy for “pendulous breasts.” In 1910, report- Eugen Holländer have been scarcely mentioned in the lit- With the continued support of a world class faculty and new surgical ing “A case of progressive fat atrophy and its cosmetic erature, although they represent an important milestone and skin care techniques presented at the third ABAM meeting, I am replacement by human fat” he described injecting a mix- in the history of filler materials. sure this annual meeting will continue to attract new (and past) regis- ture of human and ram’s fat using thin cannulas for soft trants and to achieve recognition in the future. Beginning of Fat Grafting tissue correction and later also applied fat injections for a Once again, the program was planned to allow the group to enjoy Beautiful vistas, spectacular skiing. The first reports of the use of free fat grafts date from variety of other reconstructive indications including post- the great outdoors. The “Best Snow on Earth” and the record-breaking the end of the 19th century when Gustav Neuber (1850- mastectomy breast deformities and painful scars. snowfall this year was a nice bonus for all who attended. On our final 1932) in 1893 transplanted walnut-sized fat lumps from He also became a cultural historian, founding the day, nearly half of the group participated in our traditional snowmobile the upper arm to the orbit for scar revision with a “pleas- medical art history movement in Germany. Sadly, his trip in the nearby Uinta Mountains. It was an epic day in the snow. ing” result. Vincenz Czerny (1842-1916) in 1895 restored unique collection of thousands of medically interesting My sincere thanks to my co-chairs, Drs. Foad Nahai, Joca Sampaio the breast contour by lipoma transplantation from the but- art subjects was lost during World War II, but can still be Goes, Mark Jewell and Ricardo Ribeiro for their outstanding work; to tock, reportedly much to the satisfaction of the affected admired in his numerous books. He died in 1932 from a ISAPS, ASAPS and ASPS for endorsing the meeting; to the many com- female dramatic singer. Erich Lexer (1867-1937) dedicated stroke. His fame was suppressed by the Nazis because of panies that exhibited and sponsored this event and who continue to a chapter of more than 280 pages in his famous work The his Jewish origin and his family was forced to emigrate. support the American-Brazilian Aesthetic meetings; and to all the par- Free Transplantations (1919). He applied this technique to Eugen Holländer was a multi-talented physician whose ticipants who came to Utah from around the world. treat facial defects (e.g., hemifacial microsomia), depressed work gives insights into the history of aesthetic plastic Our 2012 meeting is already being planned. The dates are set for or adherent scars, breast asymmetry, reconstruction of surgery and is still an inspiration from a surgical, medico- February 2-5 on the Island of Florianopolis, Brazil. Save the date as eye sockets, prevention of skin adhesions after tendon or historical and cultural point of view. more details will be released soon. Come enjoy this summer paradise in nerve reconstruction and also to fill in wrinkles and folds. Southern Brazil and share your experience in aesthetic surgery and cos- A great day of snowmobiling in the Uinta Mountains. Introduction Interestingly, not even Lexer in his extensive references metic medicine with ISAPS Members from all over the world. Fat tissue transfer is not a new idea in plastic surgery gives credit to Holländer and his contributions, although and since it was reported for the first time at the end of the he worked at the same time as Holländer in Berlin.

22 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 23 HISTORY HISTORY

aesthetic surgery in many famous exact whereabouts are still unknown. patients in Berlin, the cultural and Serendipitiously, great parts of this treasure can at political center of Germany, includ- least be observed in Holländer‘s many beautiful books ing film stars and the Persian Shah like Medicine in Classical Painting (1905), Caricature and numerous women in his harem. and Satire in Medicine (1905) and Plastic and Medicine Early Face Lift Operation (1912). Holländer himself characterized his passion as a Holländer probably performed the “happy activity outside one‘s profession.” His books were first face lift as early as 1901. A Polish acclaimed widely and the judgement of Karl Sudhoff, the aristocrat consulted him with a draw- leading medical historian of the time, remains valid until ing and asked him to remove pieces today: “This work will be for today’s plagued physician a relaxing refreshment, a fresh drink of water, taken from of facial skin in front of the ear to Figure 3a Figure 1 achieve a favorable adjustment of the the deliciously sparkling well of the past.” Figure 4a Figure 4b nasolabial folds and elevation of the Death and Loss of His Fame The Surgeon corners of the mouth. Holländer’s fame was suppressed politically because of Eugen Holländer (figure 1) started At first, he tried to escape the idea of his Jewish origin by the Nazis who came to power only a his medical career as a ship doctor performing such an operation, espe- shows some surprising similarities. He usually harvested few months after his death (1932) in Germany. His wife in 1891, before entering his surgical cially because he would have been fat from hernia, lipoma or grafts, then cooked it for three was forced to write the word “Jew” in red color over the training of 15 years under the guid- probably the first to attempt such an hours before the fat had to rest for two days. After re-cook- name plate of his practice and later she, with two sons ance of James Israel (1848-1926). unknown procedure. However, “as a ing immediately before the planned use, he composed his and one daughter, had to emigrate. Holländer’s ashes Israel is recognized as a world- victim of feminine persuasion,” he special mixture with ram’s fat. Holländer recommended were taken from Berlin in a sarcophagus to Vienna. famous pioneer of renal surgery and finally removed skin at the borders of “homogenous filling” using thin cannulas “without partic- Unfortunately, during the following decades there was plastic surgery, above all facial and the hairline and in the natural aging ular pain” and voluminous over-filling and over-correction no institution or pupils to care for his reputation and his nose reconstruction, at the Jewish skin folds to “freshen up” the wom- to anticipate the partial re-absorption. As he concludes in merits fell largely into oblivion. Figure 3b Hospital in Berlin. an’s wrinkles and drooping cheeks. his case report, the young patient was “very pleased” with Conclusions Holländer himself invented a Not until 1932, probably aware of the the “lasting” correction of the “repulsive skull-like appear- Holländer was a multi-talented physician whose work method for nose reconstruction increasing number of articles deal- ance of the face” and after some months resumed her job. gives insights into the history of our specialty of plastic using a distant flap from the breast ing with face-lifting techniques, did Holländer was obviously also satisfied with his approach, prevent the notorious risks of paraf- and aesthetic surgery. His life and work is still an inspira- (1913w) (figure 2) and a surgical tech- Holländer write that it was actually in as he used fat injections until his death in 1932 and also fin injections, such as painful swell- tion from a medical, cultural, and historic point of view nique to lift up “pendulous breasts” 1901 that he had performed this oper- applied the technique for other indications besides facial ings, migration, infections, blindness and remains a source of and personal pleasure for every (1924). He also devised a now obso- ation for the first time. He judged his defects, for example in breast deformities or painful scars and pulmonary embolism which bibliophile surgeon. lete therapy for lupus using hot air, results in these early cases as “infe- on the chest wall after mastectomy (figure 4). had turned this method, introduced rior,” as they had only little effect on References by Robert Gersuny (1844-1924) and Cultural Historian wrinkles in the lower portions of the Coleman SR, Mazzola FR. Fat Injection from Filling to Regeneration. St Leonhard Corning (1855-1923), from After 1912, Holländer devoted himself intensively Louis, Mo: Quality Medical Publishing, 2009 face. He pointed out, however, that a “miracle” to a catastrophy. to writing several outstanding books that dealt primar- Hofmeier HK. Eugen Holländer, “The founder of the medicine-in-the- the patients were mostly very satis- Holländer stated that after gain- ily with medicine and surgery as depicted in paintings, history-of-art movement in Germany.” Münch Medizin Wochenschr fied and reported a positive “effect on ing experience with fat injections sculptures, illustrations, caricatures, and satire in the (1961) 103: 2238-2240. the soul.” for about four years, he preferred entire historic period from the art of Ancient Greece to his Holländer E. “Über einen Fall von progressiver Fettatrophie und seinen First Fat Injection a mixture of human and ram’s fat. time. Holländer’s unique collection of thousands of medi- kosmetischen Ersatz durch humanes Fett” (About a case of progres- Figure 2 In 1910, Holländer published He regarded this blend as the secret cally interesting art subjects personally assembled on his sive fat atrophy and its cosmetic replacement by human fat) Münch Medizin Wochenschr (1910) 34: 1794-95. “About a case of progressive fat atro- of success to avoid reabsorption and countless travels through Europe became the foundation chinin and iodium. During the First phy and its cosmetic replacement by stabilize the result by some kind of of a permanent exhibition in 1906 at Kaiserin-Friedrich- Holländer, E.: “Plastische (Kosmetische) Operation: Kritische Darstel lung ihres gegenwätrtigen Standes (Plastic (Cosmetic) Operations: World War, Holländer was appointed human fat” in a 21-year-old woman inflammation and resulting “inner Haus for public education in Berlin. He became curator Critical Review of their Current Status).” In Klemperer, G. and as interim chief of surgery at the who, due to her extreme bilateral intumescence.” and a titular professor in 1907. Klemperer, F. (eds.): Neue Deutsche Klinik, vol. 9. Urban and Charité Hospital which enabled him facial lipodystrophy, did not dare to One may observe that his tech- Sadly, the material of this permanent exhibition was Schwarzenberg, Berlin, 1932, pp. 1-17. to perfect his skills in plastic sur- leave her home anymore (figure 3). nique greatly differed from modern almost completely lost in the chaos after the Second World Rogers BO. The development of aesthetic plastic surgery Aesth Plast gery. Later, he dedicated himself to He decided to inject human fat to “atraumatic” techniques, but it also War in 1945. It was probably transported to Russia – the Surg (1976) 1: 3-24.

24 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 25 NATIONAL SECRETARIES INSURANCE UPDATE

Team Work ISAPS Insurance Program: an update Lina Triana, MD – Colombia James Frame, MD and Alison Thornberry – United Kingdom Chair of National Secretaries he ISAPS insurance message is slowly but steadily their home country by another ISAPS member sur- We all know we can work together for our specialty and general public. travelling through our international society with our society as a team. I am convinced that if we share our geon, but only after the original surgeon has given their Look at the Geese: nature’s masters of teamwork Tvery positive results. Managing Director of Sure permission; and experience in our diverse countries, we can help each other, Next autumn when you see the geese flying south for the Insurance, Alison Thornberry, has joined with ISAPS and also strengthen ISAPS. We National Secretaries are the • Patients cannot make a claim, only the surgeon can winter, notice how they fly in a “V” formation. Studies show staff at conferences in Brazil, Romania, the United States, voice of our members. It is important that we communicate decide if remedial work is necessary. that this augments their power by 70%. People who work and Canada to help members understand the program. freely. As Chair of National Secretaries, I am open to Countries with ISAPS members now listed in the new together and share the same direction arrive at their goals faster Her brief and patient one-on-one explanation of how suggestions and appreciate the board’s support that we hold Public Directory of ISAPS surgeons participating in this because they support and strengthen each other. Surgery Shield will help our members and their patients National Secretaries meetings when we gather at major program include: When a goose leaves the formation, he feels the air has gone a long way to clarify how our insurance program international events. Argentina France South Africa resistance, realizes how difficult it is to fly alone, and quickly works. She is looking forward to traveling to more ISAPS We had two National Secretaries meetings in May: one returns to the “V” to regain the power of the group. If we do Brazil Germany Spain during the ASAPS meeting in Boston and the other during Courses and national society meetings in the near future. all we can to go beyond our differences, we can share one direction Canada Israel Tunisia the IPRAS meeting in Vancouver. In total, more than thirty- 00Included here are a few statements, to clarify the and serve with the best of ourselves. Colombia Italy Turkey five members participated. Both of these informal meetings most common misunderstandings. When the leader of the geese gets tired, another goose Costa Rica Lebanon United Arab generated positive input from those National Secretaries who • The insurance can be used for all patients, both at home takes his position. We will get better results if we take turns doing Cyprus Mexico Emirates attended. and abroad; the hard work, instead of letting a few carry all the weight. Ecuador Qatar United Kingdom ISAPS board members at each meeting reinforced the • ISAPS Insurance does not promote medical tourism; Biologists observe that the geese at the back of the “V” Egypt Romania United States of importance of National Secretaries to our organization. Dr. • Surgeons can promote to their patients that they are make special sounds to encourage those in front to maintain Estonia Singapore America Nazim Cerkes, Chair of our Education Council, explained covered by ISAPS insurance and can offer a “patient their speed. One encouraging word can produce big benefits. how educational programs can be organized in any country guarantee”; Please go to www.isapsinsurance.com should you Stimulation motivates and comforts. to meet our goal of offering high quality aesthetic surgery • Should a patient travel to an ISAPS member surgeon wish to join. There is no cost to be included in the Public If a goose gets sick or injured, two other geese leave the courses worldwide. Alison Thornberry, representing our who is covered by the ISAPS insurance and subse- Directory. To request further information, email alison@ formation and follow him to help and protect him. They stay insurance partners in London, explained how the ISAPS quently suffers a complication, they can be treated in with him until he can fly again.National Secretaries can work sureinsurance.com insurance program advances our patient safety initiatives. together to help each other – to help ISAPS – to help our patients. She answered many questions both during and after each meeting, correcting misperceptions, so our National Secretaries understand and appreciate how this program really works. We now have members enrolled in twenty-five participating countries and encourage all National Secretaries to contact Alison for information. Here email is alison@ International Study of Aesthetic Surgery Procedures sureinsurance.com. Thank you to all who have already joined to help create the global public directory of ISAPS surgeons Dear Plastic Surgeon Colleagues, in this program. Our global survey of aesthetic procedures is successfully We addressed each National Secretary’s experiences, attracting many participants. We want to ensure that all problems, and ideas to help grow ISAPS with only the best plastic surgeons have a chance to participate. qualified members making us the largest body of international aesthetic plastic surgeons. We must focus on quality care and I encourage you to complete the 2nd ISAPS study of patient safety and be aware of the non-core doctors doing global aesthetic surgery procedures. Thank you if you have 1 0 0 already submitted your data. cosmetic surgery. We have an increasing number of benefits 9 5 including an excellent journal, high quality educational To participate in this global study, go to www.isaps.org and 7 5 programs, an interesting newsletter, ISAPS insurance that click on the link under NEW: Global Statistics Survey in the strengthens our patient safety program, and are doing our General Info & News column on our homepage. best to gather global statistics on aesthetic surgery. We need 2 5 Joao C. Sampaio Goes, MD, PhD (Brazil) to promote these benefits among our colleagues who can Chair, ISAPS Communications Committee 5 also promote the importance of ISAPS membership to the 0 26 ISAPS News Volume 5 • Number 2 27

1 1 0 0 1 0 - I S A P S N e w s l e t t e r - A d - 3 F I N A L A R T W e d n e s d a y , J u n e 2 2 , 2 0 1 1 1 2 : 4 8 : 3 5 P M ISAPS SURVEY ISAPS SURVEY

Global Survey of Antibiotic Prophylaxis in Aesthetic Surgery

Felmont F. Eaves III, MD – United States

he ISAPS Global Survey series has provided (55.8% of respondents) and highest for breast augmenta- invaluable insights into international trends and tion (97.5%), abdominoplasty (94.0%), and breast reduc- Tperspectives, and the latest survey is no excep- tion/mastopexy (92.8%). Regardless of the procedure, tion, highlighting significant regional differences in the about one fourth (21.9% to 27.5%) of the participants used approach to prophylactic antibiotic utilization. While some a single dose only regimen, and an additional one tenth of the surveys may elucidate differences in personal per- (8.1% to 10.8%, blepharoplasty excluded) used a 24 hours spective, philosophy, or approach of aesthetic surgeons regimen. worldwide, the timing, selection, and duration of antibiotic Totals for regimens following a 24 hour OR LESS pro- utilization should be driven by an evidence-based approach tocol, often advocated by infectious disease specialists, rather than personal preferences. As such, the ISAPS ranged from 27.6% to 38.3%. Individual twenty four hour Global Survey of Antibiotic Prophylaxis in Aesthetic Sur- or less protocols were distributed as follows: gery creates a baseline of current utilization and a bench- • blepharoplasty [382(23.0%)/76 (4.6%)=27.6%] mark against which the impact of evidence-based driven • face/brow/neck lift [448(27.5%)/176(10.8%)=38.3] educational efforts going forward can be measured. • rhinoplasty [408 (25.5%)/149(9.3%)=34.8%] THE SURVEY • breast reduction/mastopexy Over several months, a series of blast emails was sent [421(24.9%)/173(10.2%)=25.1%] to approximately 21,000 addresses with 1,734 responses • augmentation mammaplasty [424(25.1%)/143(8.5%)=33.6%] received as of May 29, 2011. The greatest numbers of • abdominoplasty [372(22.0%)/153(9.0%)=31.0%] respondents were from Europe (547, 31.6%) followed by Figure 1. Responses to the question “Which of the following antibiotic prophylaxis do you routinely use in North America (438, 25.3%), South America (350, 20.2%) • liposuction [456(27.3%)/145(8.%)-36.0%] the following types of elective aesthetic cases?” Results are show for all respondents and are not filtered by and Asia (219, 12.6%). More than half of the respondents, • fat grafting [391(25.1%)/126(8.1%)=33.2%] geographic region, age, membership or practice type. Respondents were instructed to leave blank procedures that they do not perform hence varied totals are present. or 943 (54.4%) were ISAPS members, representing 51% GEOGRAPHIC VARIATION of the total 1,835 Active and Candidate ISAPS member- Of some concern is the finding that more prolonged ship, and 790 non-members. The proportion of members courses of antibiotics were routinely seen in virtually all to non-members varied by region, with the United States geographic regions and procedures, potentially a mecha- longer) was most common in Central having 120/390 (30.8%) members and 270/390 (69.2%) nism of the development of antibiotic resistance. Many and South America followed by Asia non-members and Europe with 355/547 (64.9%) members public health and infectious disease experts warn of the (see Figure 2). Extended antibiotic use and 192/547 (35.1%) non-members as the most varied. A overutilization or underutilization of systemic antibiot- was most common in abdominoplasty, broad range of ages was represented with 23.9% (415) in ics, and in the United States, for example, reimbursement with 66.2% of Central American, practice 1-10 years, 33.3% (578) in practice 11-20 years, and for certain surgical procedures may be denied if antibiotic 52.8% of South Americans, and 53.8% 39.9% (692) in practice more than 20 years. More than prophylaxis is not started on time (recommended 30-60 of Asia surgeons using such a proto- half (n=982, 56.7%) were in solo or small group (up to minutes prior to incision) or is continued past twenty-four col. Extended antibiotic use was also three surgeons) private practice with about a third (n=529, hours. Canadians appeared to have the lowest overall uti- common in augmentation mamma- 30.5%) in institutionally-based academic, university, or lization of antibiotics, with no prophylaxis between 6.3% plasty, with rates ranging from 18.8% hospital practices. (augmentation) and 91.3% (blepharoplasty) of cases, and (Canada) to 64.5% (Central America). Respondents indicated their typical antibiotic prophy- many procedures mid-range (e.g. rhinoplasty 59.1%, lipo- Although varied, all regions had a sig- laxis regimen for eight different types of procedures (no suction 47.9%, and fat grafting 57.1% with no prophylaxis). nificant number of surgeons who uti- antibiotics, single dose, up to 24 hours, etc.) (see Figure 1). European and Asian surgeons were the next most com- lized extended antibiotic prophylaxis. Figure 2. Antibiotic prophylaxis extending five days or longer by case and region, percent Antibiotic use varied significantly among the procedures, mon groups not using prophylaxis. On the other end of of respondents per country with the lowest rate of utilization during blepharoplasty the spectrum, significantly prolonged therapy (five days or

28 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 29 ISAPS SURVEY IN MEMORIAM

patients (52.3%), the same physicians also reported the highest rates of MRSA reports in their commu- Eric Letrosne – France David Ralph Millard, Jr., MD – United States

nity (57.6% numerous reports, 32.5% rare reports, Richard Abs, MD – France Mark Jewell, MD – United States only 9.9% no reports). National Secretary for the United States Antibiotic Selection Most respondents (n=1454, 85.2%) used a cepha- David Ralph Millard, Jr., MD, died on June 19, 2011. losporin as their first choice for antibiotic prophylaxis Dr. Millard was an amazing gentleman who had a life- in non-penicillin allergic patients. In penicillin aller- long dedication to the art and science of plastic surgery. gic patients, cephalosporins were still used in 35.4%, Initially trained in general/pediatric surgery, he was a but the quinolones were used in 40.7%, clindamycin trainee under Sir Harold Gillies and studied with Sir in 28.9%, and vancomycin in 8.1%. Quinolones may Archibald McIndoe and Jack Mustarde and served in both WW II and the have a higher chance of leading to MRSA emergence Korean Conflict as a plastic surgeon. While serving in Korea, he developed and vancomycin is often “held in reserve” for treat- a new type of cleft lip repair that became the standard of the world’s recon- ment of MRSA should it be diagnosed. Respondents structive surgeons. Ultimately, he published his lifework in a 3-volume Figure 3. Have you ever had an elective aesthetic surgical patient develop a were also asked how they would manage a patient This year began with very sad series, Cleft Craft. These books established Millard as one of the greatest postoperative MRSA infection? By region. who developed diarrhea after antibiotic treatment. news. Our friend and colleague, authorities in the world of plastic surgery. Most would discontinue antibiotics and give support- Eric Letrosne, died Sunday, January Dr. Millard was actively involved in leadership positions within ASPRS Initiation of therapy in the prescribed time period (one ive, conservative treatment (n=1130, 66.5%), while 18.9% 2, 2011 – a victim of his passion (now ASPS), the Plastic Surgery Educational Foundation, and the American hour) was the protocol advocated by 68.8% of the respond- (n=322) would continue the antibiotics and only 14.6% for extreme sports. He was swept Board of Plastic Surgery. In 1988, he received the highest award of the ents, while 17.1% began therapy the day before to two hours (n=248) would perform a stool culture which could indi- away by an avalanche in the Alps American Society of Plastic and Reconstructive Surgeons in recognition prior to the procedure and 8.5% began prophylaxis after the cate the presence of C. dificile. while skiing. Many of you did not of “his development of the specialty of plastic surgery and his outstand- procedure. The presence of drains did not alter the course Of note, such a robust data set as generated by the large know him because he was timid, ing scientific contributions to the advancement of its practice.” He received of antibiotics in most (n=1058, 61.6%), although 10.3% response lends itself to some interesting cross-analysis. For but Eric was a very kind friend, and an Honorary Medal from the People’s Republic of China for “his achieve- (n=176) would increase duration of antibiotics if drains instance, those surgeons who used quinolones for routine he will be greatly missed. Aged 54, ments in cleft lip repair which has opened a new era of cleft lip surgery” and were in place and 26.0% (n=448) leave the patient on anti- prophylaxis were more likely to treat for longer (5 days or he lived in Aix en Provence, France was guest lecturer at the Chinese Plastic Surgery Society in Beijing. biotics until the drains are removed. more) periods in all procedures surveyed (e.g. augmenta- where he developed a very good His achievements throughout his career included numerous books, sci- cosmetic and breast surgery prac- entific articles and research studies. He received numerous awards and Methicillin Resistant Staphylococcus Aureus (MRSA) tion mammaplasty 51.7% versus 35.1%, abdominoplasty tice. Eric was an avid sport biker honorary memberships in various plastic surgery societies and medical One of the most common antibiotic resistant organ- 58.8% versus 37.2%, breast reduction/mastopexy 49.7% having raced in the Moroccan Atlas associations for his advancements. Dr. Millard was described as “the most isms is MRSA. Respondents were asked if MRSA had been versus 30.6%). Additional analysis of the data will be per- mountains in November. He loved brilliant and creative plastic surgeon we have alive. His work and publica- reported in their hospital or clinic, and if reported whether formed to look at academic versus private practice, physi- sailing and participated in round- tions speak for themselves.” Dr. Mark Gorney wrote, “Ralph Millard, MD, there were only a small number or numerous reports. cian age, antibiotic selection, and other factors to identify the-world sailing competitions for during my lifetime, is the living personification of what I have always tried Overall 39.5% (n=673) reported no MRSA in their system, trends. more than 20 years – and he loved to impart to all residents I have been privileged to teach; the only difference a similar number (n=660, 38.7%) had a reported a small The way in which we utilize antibiotic prophylaxis for the mountains. He was married between an ordinary plastic surgeon and a truly extraordinary one is the number of reported cases in their area, and 372 (21.8%) the prevention of surgical site infections is particularly with two daughters. degree of imagination he or she brings to the table.” In 2000, Dr. Millard stated that there were numerous reports. Respondents also amenable to the incorporation of evidence based medicine was nominated as one of only ten Plastic Surgeons of the Millennium by indicated whether or not they had ever had an aesthetic principles. Clearly the wide variability in prophylaxis regi- the American Society of Plastic Surgery. His full biography can be accessed patient diagnosed with MRSA (Figure 3). Of course an mens represents a tremendous educational opportunity to at http://calder.med.miami.edu/Ralph_Millard/ individual physician’s antibiotic regimen is only part of the share these principles and incorporate more consistent pat- story in the development of MRSA; there is a significant terns of therapy worldwide, and this survey can function as impact from the overall level of antibiotic use in their coun- a baseline measurement as we assess the effectiveness of try, the location of services (hospital versus outpatient), our educational efforts. tendency to test for MRSA, and the frequency of MRSA The leadership of ISAPS would like to thank all of the in their own community. For example, although the US survey respondents who help provide this important infor- physicians reported the highest rate of MRSA in individual mation for the specialty. Hildebrando LANDAZURI, MD, Peru Paule renault, MD, Canada (1915-2008)

30 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 31 COMMITTEES CALENDAR

Executive Committee Website Committee June 2011 September 2011 Jan Poëll, Switzerland – Chair Alex Verpaele, Belgium – Chair Meetings: 3rd International Eurasian Aesthetic Surgery Dates: 13 September 2011 - 13 September 2011 Carlos Uebel, Brazil Aldo Mottura, Argentina Course Lina Triana, Colombia Meetings: ISAPS Symposium – Sarajevo Foad Nahai, US Location: Istanbul, Turkey Daniel Knutti, Switzerland Rick Zienowicz, US Location: Sarajevo, Bosnia-Herzegovina Venue: Hilton Convention Center Miodrag Colic, Serbia Dennis Von Heimburg, Germany Susumu Takayanagi, Japan Tunc Tiryaki, Turkey Contact: Nazim Cerkes, MD Dates: 23 September 2011 - 27 September 2011 Catherine Foss, US Tel: 90-212-283-9181 Meetings: Plastic Surgery 2011 (ASPS) Finance Committee Fax: 90-212-219-0588 Location: Denver, Colorado Nominating Committee Igor Niechajev, Sweden – Chair e-mail: [email protected] Venue: Hyatt Regency Denver Foad Nahai, US – Chair Miodrag Colic, Serbia – Secretary General HomePage: http://www.eurasian2011.org Contact: American Society of Plastic Surgeons Jan Poëll, Switzerland Daniel Knutti, Switzerland - Treasurer Carlos Uebel, Brazil Dirk Richter, Germany – Assistant Treasurer July 2011 Tel: 1-847-228-9900 Fabio Nahas, Brazil – elected Richard Hamilton, Australia Fax: 1-847-228-9131 Dates: 06 July 2011 - 10 July 2011 Antonio Fuente del Campo, Mexico – elected Olof Poëll, Switerland – Financial Advisor - Ex Officio e-mail: [email protected] Abel Chajchir, Argentina – alternate Meetings: 2011 Plastic Surgery Congress Catherine Foss – Ex Officio Government Relations Committee Location: Queensland, Australia Dates: 30 September 2011 - 03 October 2011 Connie Neuhann-Lorenz, Germany – Chair Venue: The Gold Coast Convention Centre Meetings: ISAPS Course Prague-Czech Republic Membership Committee Contact: Christopher Edwards, MD Location: Prague, Czech Republic Janek Januszkiewicz, NZ – Chair Medical Procedures Abroad Committee Tel: 61-2-9437-9200 Contact: Nazim Cerkes, Bohumil Zalesak Peet van Deventer, South Africa James Frame, UK – Chair e-mail: [email protected], [email protected] James Frame, UK Foad Nahai, US – Deputy Chair Fax: 61-2-9437-9210 Alberto Arguello Choiseul, Costa Rica e-mail: [email protected] HomePage: http://www.isapsprague2011.com Jaffer Khan, UAE By-Laws Committee HomePage: http://www.plasticsurgery.org.au October 2011 Tom Davis, US – Chair Lina Triana, Colombia August 2011 Dates: 21 October 2011 - 22 October 2011 Catherine Foss – Ex Officio David Smith, US Meetings: Third Annual Melbourne Advanced Facial Dates: 18 August 2011 CommunicationS Committee Patient Safety Committee Anatomy Course Meetings: ISAPS Symposium – Urumqi, China Joao Carlos Sampaio Goes, Brazil – Chair Felmont Eaves, US – Chair Location: Melbourne, Australia Alberto Arguello Choiseul, Costa Rica Location: Urumqi, China Jorge Herrera, Argentina Venue: Department of Anatomy, University of Melbourne Florencio Lucero, Phiippines Lina Triana, Colombia Dates: 18 August 2011 - 20 August 2011 Contact: Suzanne Ali, ASAPS Executive Secretary Fabio Nahas, Brazil Luis Perrin, Brazil Meetings: X VEMI – International Course in Video Igor Niechajev, Sweden James Frame, UK – Ex Officio Tel: 61-2-9437-0495 W. Grant Stevens, US Endoscopic Plastic Surgery and Minimal Invasive e-mail: [email protected] Catherine Foss – Ex Officio New Product Evaluation Committee - Ad Hoc Procedures HomePage: http://www.mafac.com.au Henry Delmar, France – Chair Location: Curibita, Brazil Dates: 28 October 2011 - 30 October 2011 Education Council Committee Contact: Ana Zulmira Diniz Badin, MD Nazim Cerkes, Turkey – Chair Journal Advisory Committee Meetings: ISAPS Course – Sharm El Sheikh-Egypt Henry Spinelli – US – Editor & Chair Tel: 55-41-3223-8886 Renato Saltz, US Location: Sharm El Sheikh, Egypt Tom Davis – US Fax: 55-41-3323-1392 Alain Fogli, France Contact: Nazim Cerkes, MD Daniel Kalbermatten, Switzerland Bill Curtis – Springer e-mail: [email protected] e-mail: [email protected] Vakis Kontoes, Greece Victoria Ferrara – Springer Aldo Mottura, Argentina Jan Poëll – Switzerland Dates: 25 August 2011 - 28 August 2011 November 2011 Prado Neto, Brazil Catherine Foss – US Meetings: 3rd European Plastic Surgery Research Council Dates: 04 November 2011 - 06 November 2011 Daehwan Park, South Korea Location: Hamburg Harbor, Germany Newsletter Committee Enrico Robotti, Italy Venue: Freighter MS Cap San Diego Meetings: 9th Annual IFATS Meeting Peter Rubin, US – Editor-in-Chief Sami Saad, Lebanon Location: Miami Beach, Florida Joao Sampaio Goes, Brazil – Contact: Isabelle Laerz Renato Saltz, US Venue: Eden Roc Renaissance Hotel Chair, Communications Committee Tel: 49-3641-311-6320 Susumu Takayanagi, Japan Catherine Foss, US – Managing Editor Fax: 49-234-325-2080 Contact: Catherine Foss Patrick Tonnard, Belgium Tel: 1-603-643-2325 Lina Triana, Colombia Editorial Board e-mail: [email protected] Fax: 1-603-643-1444 Jan Poëll, Switzerland – Ex Officio Haideh Hirmand, US HomePage: http://www.epsrc.eu Carlos Uebel, Brazil – Ex Officio Kirill Pshenisnov, Russia e-mail: [email protected] Catherine Foss, US – Executive Office Ivar van Heijningen, Belgium HomePage: http://www.ifats.org

32 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 33 CALENDAR CALENDAR

Dates: 11 November 2011 - 11 November 2011 Dates: 25 November 2011 - 27 November 2011 Dates: 09 December 2011 - 10 December 2011 June 2012 Meetings: ISAPS Symposium – Goiania Meetings: ISAPS Course – Body Contouring Live Surgery Meetings: International Conference on Aesthetic Surgery of Dates: 01 June 2012 - 03 June 2012 Location: Goiania, Brazil Location: Beirut, Lebanon the Dutch Society for Aesthetic Surgery: Forehead, Brow Meetings: ISAPS Course – Facial Aesthetic Surgery Contact: Prado Neto, MD Venue: Metropolitan Hotel and Periorbital Aesthetic Surgery Location: Como, Italy Tel: 55-14-3621-6206 Contact: Sami Saad, MD Location: Amsterdam, The Netherlands Contact: Enrico Robotti, Gianluca Campiglio Fax: 55-14-3621-6207 Tel: 961-01-754-734 Contact: Ren Nio, MD e-mail: [email protected], info@gianluca- e-mail: [email protected] e-mail: [email protected] Tel: 31-20-510-8670 campiglio.it HomePage: http://www.lspras.com Fax: 31-20-510-8704 Dates: 11 November 2011 - 12 November 2011 e-mail: [email protected] Dates: 06 June 2012 - 08 June 2012 Meetings: ISAPS Course – Hungary Dates: 26 November 2011 - 27 November 2011 HomePage: http://www.nvepc.nl/congress2011 Meetings: Rome Breast Surgery 2012, Reconstruction and Location: Debrecen, Hungary Meetings: CATFAS Asia 2011 Dates: 13 December 2011 - 15 December 2011 Aesthetic: Excellence as the common challenge Venue: Kölcsey Conference Centre Location: Phuket, Thailand Meetings: 2nd International School of Plastic Surgery & Location: Rome, Italy Contact: Czaba Molnar and Vakis Kontoes Venue: Movenpick Hotel and Resort Cosmetology Contact: Organizing Secretariat e-mail: [email protected]; [email protected] Contact: Elien Van Loocke Location: Moscow, Russia Tel: 39-06-3228-2204 e-mail: [email protected] Dates: 12 November 2011 - 12 November 2011 Contact: Natalya Polonskaya Fax: 39-06-322-2038 HomePage: http://doctorseminar.com/catfas2011/catfas.php Meetings: Canadian Laser Aesthetic Surgery Society Annual Tel: 8-499-142-6401 e-mail: [email protected] e-mail: [email protected] Symposium Dates: 27 November 2011 - 28 November 2011 Dates: 06 June 2012 - 09 June 2012 HomePage: http://http://www.pscj.ru Location: Toronto, Ontario Canada Meetings: World Congress of 19th International Society Meetings: XVIII Interntaional Course on Plastic & Aesthetic Venue: Park Hyatt Hotel Toronto of Laser in Surgery and Medicine and Asian Pacific January 2012 Surgery Contact: CLASS Aesthetic Plastic Surgery Symposium 2011 Location: Barcelona, Spain Location: Seoul, Korea Dates: 20 January 2012 - 22 January 2012 Tel: 1-905-837-1124 Venue: Clinical Planas Venue: Baek Beom Musium and KOFST Building. Meetings: ISAPS Course Goa, India Fax: 1-905-831-7248 Contact: Course Secretariat Contact: Prof.Jin Wang Kim Location: Goa, India e-mail: [email protected] Tel: 34-93-203-2812 Tel: 82-2-511-3713 Venue: Grand Hyatt HomePage: http://www.class.ca Fax: 34-93-206-9989 Fax: 82-2-517-3713 Contact: Dr. Lokesh Kumar e-mail: [email protected] Dates: 17 November 2011 - 20 November 2011 e-mail: [email protected] Tel: 91-112-922-8349 Meetings: ASAPS Non Surgical Symposium HomePage: http://www.islsm.kr e-mail: [email protected] Dates: 09 June 2012 - 11 June 2012 Meetings: VII International Plastic Surgery Course Location: Syndey, Australia December 2011 February 2011 Venue: Sydney Hilton Hotel Location: Ekaterinburg, Russia Dates: 02 February 2012 - 05 February 2012 Contact: Suzane Ali Dates: 01 December 2011 - 03 December 2011 Contact: Irina Vlokh, Elena Tselikova Meetings: American-Brazilian Aesthetic Meeting 2012 Tel: 61-29437-0495 Meetings: The Cutting Edge Aesthetic Surgery Symposium Tel: 7-343-371-8802 Location: Florianopolis, Brazil Fax: 61-2-9437-9609 2011. Advanced Body Sculpting Head-To-Foot: Needle, Fax: 7-343-371-8999 Venue: Il Campanario Villaggio Resort e-mail: [email protected] Laser, Cannula, Knife e-mail: [email protected], [email protected] HomePage: http://www.americanbrazilianaestheticmeeting.com HomePage: http://www.asaps.org Location: New York, NY HomePage: http://www.b-med.ru Venue: Waldorf Astoria Hotel March 2012 Dates: 13 June 2012 - 17 June 2012 Dates: 18 November 2011 - 19 November 2011 Contact: Lauren Fishman Dates: 11 March 2012 - 12 March 2012 Meetings: 57th Plastic Surgery Research Council Meetings: Advances in Breast Surgery Tel: 1-212-355-5702 Meetings: Secondary Aesthetic Surgery Location: Ann Arbor, MI Location: Munich, Germany Fax: 1-212-308-5980 Location: Munich, Germany Venue: University of Michigan Contact: Axel Feller, MD e-mail: [email protected] Contact: Axel Feller, MD Contact: Catherine Foss Tel: 49-89-211-1300 HomePage: http://www.aestheticsurgeryny.com e-mail: [email protected] Tel: 49-89-211-1300 Tel: 1-603-643-2325 HomePage: http://www.professor-feller.de e-mail: [email protected] Fax: 1-603-643-1444 HomePage: http://www.professor-feller.de e-mail: [email protected] HomePage: http://www.ps-rc.org Dates: 12 March 2012 - 12 March 2012 Meetings: ISAPS Symposium – Boracay Island Location: Boracay Island, Philippines Contact: Susumu Takayanagi, MD Tel: 81-6-6370-0112 Fax: 81-6-6327-0584 e-mail: [email protected] 34 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 35 CALENDAR

August 2012 Dates: 12 September 2012 - 15 September 2012 Meetings: LaserInnsbruck 2012: Advances and Dates: 23 August 2012 - 26 August 2012 Controversies in Laser and Aesthetic Surgery Meetings: 4th European Plastic Surgery Research Council Location: Innsbruck, Austria Location: Hamburg Harbor, Germany Venue: Faculty of Catholic Theology of the University of Venue: Freighter MS Cap San Diego Innsbruck Contact: Isabelle Laerz the CHOICE Contact: Katharina Russe-Wilflingseder, MD Tel: 49-3641-311-6320 Tel: 43-512-25-2012 Fax: 49-234-325-2080 FOR true LASER Fax: 43-512-25-2737 e-mail: [email protected] e-mail: [email protected] BODY SCULPTING September 2012 HomePage: http://laserinnsbruck.com

Dates: 04 September 2012 - 08 September 2012 October 2012 Congress: 21st Congress of ISAPS Dates: 04 October 2012 - 07 October 2012 Location: Geneva, Switzerland Meetings: IFATS 10th Annual Meeting Venue: Centre International de Conferences Geneve Location: Quebec City, Canada Contact: Catherine Foss Contact: Jordan Carney Tel: 1-603-643-2325 Tel: 1-603-643-2325 Fax: 1-603-643-1444 Fax: 1-603-643-1444 e-mail: [email protected] e-mail: [email protected] “The use of SlimLipo has revitalized SlimLipo is the ﬁ rst laser-assisted lipolysis system HomePage: http://www.isapscongress2012.org HomePage: http://www.ifats.org my practice. Patient satisfaction rate is nearly 100% and their referrals have speciﬁ cally optimized to meet your body sculpting been a major source of new patients needs. Every detail, from the uniquely selective this past year.” 924 nm wavelength to the proprietary treatment tip — Diane Alexander, MD design, was chosen to offer you an ideal solution Mens sana in corpore sano for your patients and your practice. Igor Niechajev, MD, PhD – Sweden

healthy mind in a healthy body, wrote Roman poet The 38th Ski World Cup for Medical Juvenal, expressing what people should desire Doctors, Dentists and Pharmacists Ain life. An excellent way to keep your body and took place during March 23-26, 2011 at soul in good shape is skiing. Alpine racing has many Wolkenstein/ValGardena, South Tyrol in Italy. At the before similarities with surgery. Make an assessment of the same time, the small evening congress Medicine and Ski task, be cool but move speedily forward from gate to gate, was conducted with positive fiscal aspects for the partici- always have an overview of the next three gates ahead, pants. The 140 skiers, men and women from nine coun- and do not stop until you finish. You will be applauded tries, competed in slalom, giant-slalom and Super-G both on the ski race course and in the operating room. with the dramatic scenery of the Dolomites in the back- See how SlimLipo can revitalize your ground. There is a good number of expert skiers among practice at www.slimlipo.com. plastic surgeons – and even more of us think they are experts. I therefore encourage and warmly recommend after Steven Bloch, MD Steven Bloch, to our colleagues to join in and challenge the others. The Individual results may vary and are not guaranteed. details about last and next year’s program can be seen at the site: http://www.med-skiworldcup.de/ Finally a hint about the most effective training: keep torturing your body, or your body will torture you! ©2011 Palomar Medical Technologies, Inc. Palomar and is a registered trademark and SlimLipo is a trademark of Palomar Medical Technologies, Inc. ALL RIGHTS RESERVED. Palomar Medical Technologies, Inc. 15 Network Drive, Burlington, MA 01803 USA from light comes beauty Palomar Medical Technologies BV, Kleine Gartmanplantsoen 21 (5th Floor), 1017 RP Amsterdam, The Netherlands www.palomarmedical.com | USA: 1-800-PALOMAR | EUROPE: +31 20 624 6159 36 ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 37 ISAPS NEW MEMBERS

Admitted in May 2011 Austria Romania: Helmut HOFLEHNER, MD Sorin Adrian ADETU, MD Johann UMSCHADEN, MD Nicolae ANTOHI, MD, PhD Ileana BOIANGIU, MD, PhD Belgium Maria FILIPESCU, MD Joan VANDEPUTTE, MD Cornelia PANCHICI, MD Brazil Russia ISAPS Executive Office Carlos Alberto GOMEZ VALDIVIESO, MD* Valery PAVLOV, MD Eduardo LANGE HENTSCHEL, MD EXECUTIVE DIRECTOR Avelino MONTEIRO DE ABREU, MD Saudi Arabia Catherine Foss 9th Annual Symposium on FATS Luis Fernando SALET, MD Maher AL-AHDAB, MD* [email protected] I Roberto SEBASTI á PEIXOTO, MD Adipose Stem Cells and 2011 M AM Spain DIRECTOR OF ACCOUNTING I I Chinese Taipei Carmen HIGUERAS SUNE, MD, PhD Becky Cook Clinical Applications of Chang-chien YANG, MD [email protected] Tunisia Adipose Tissue Colombia Atef MAHERZI, MD DIRECTOR OF MARKETING Martin Alberto GOMEZ RUEDA, MD Jodie Ambrose Eden Roc Hotel Turkey Maria Cristina JAIMES PLATA, MD [email protected] Ismail KURAN, MD IFATS provides a premier international Axel VARGAS, MD Miami Beach Özay ÖZKAYA, MD MEMBERSHIP SERVICES MANAGER venue for leading basic science, clinical, and Egypt Cemal Tg SENYUVA, MD Jordan Carney Florida Heba HUSSEIN, MD Ahmet SEYHAN, MD [email protected] Murat TOPALAN, MD translational investigators from academia France SPECIAL PROJECTS MANAGER Osman Akin YUCEL, MD November 4-6, 2011 Thierry VAN HEMELRYCK, MD Gael de Beaumont United Kingdom [email protected] and biotech to exchange state of the art Germany Rozina ALI, MD Volker ALT, MD ISAPS EXECUTIVE OFFICE Amer DURRANI, MD information on the development and use Andreas DACHO, MD, PhD Peter HODGKINSON, MD, PhD 45 Lyme Road, Suite 304 Stephan GUENTHER, MD Richard PRICE, MD Hanover, NH, USA 03755 of adipose tissue and cells for cosmetic and Massud HOSSEINI, MD Peter SAXBY, MD Christoph JETHON, MD Phone: 1-603-643-2325 Geoff WILSON, MD reconstructive surgery and therapy. The Society Torsten KANTELHARDT, MD, PhD Fax: 1-603-643-1444 Irini PANTELI, MD United States is dedicated to an open exchange of ideas Ulrich ROHDE, MD Michael DIAZ, MD Email: [email protected] Lisa DIFRANCESCO, MD Website: www.isaps.org Iceland Leonard HOCHSTEIN, MD and concepts based on sound science and Thordis KJARTANSDÓTTIR, MD, PhD Jeffrey KENKEL, MD Iran Gregory MACKAY, MD international standards of ethical patient and www.ifats.org Hossein ARAB, MD Nina NAIDU, MD animal care. Italy Venezuela Franco BASSETTO, MD Henry SAUD BARRIOS, MD Giovanni FERRANDO, MD Patrizia GILARDINO, MD *Candidate Gianmario PRINZIVALLI, MD Egidio RIGGIO, MD ISAPS news Management DISCLAIMER: Luca SILIPRANDI, MD Vincenzo VINDIGNI, MD, PhD Editor-in-Chief ISAPS News is not responsible for facts as presented by the authors or advertisers. This newsletter presents current J. Peter Rubin, MD (United States) Japan scientific information and opinion pertinent to medical Hideo IIDA, MD, PhD Chair, Communications Committee professionals. It does not provide advice concerning specific diagnosis and treatment of individual cases and is not Taro MAKINO, MD João Carlos Sampaio Góes, MD, PhD (Brazil) intended for use by the layperson. The International Society Shinsuke TANAKA, MD, PhD of Aesthetic Plastic Surgery, Inc. (ISAPS), the editors, con- Managing Editor tributors, have as much as possible, taken care to ensure Lebanon Catherine B. Foss (United States) that the information published in this newsletter is accu- Hussein HASHIM, MD, FACS rate and up to date. However, readers are strongly advised Editorial Board Roland TOHME, MD to confirm that the information complies with the latest leg- Haideh Hirmand, MD (United States) islation and standards of practice. ISAPS, the editors, the Mexico Kirill Pshenisnov, MD (Russia) authors, and the publisher will not be responsible for any errors or liable for actions taken as a result of information Alejandro ENRIQUEZ DE RIVERA CAMPERO, Ivar van Heijningen, MD (Belgium) or opinions expressed in this newsletter. ©Copyright 2011 MD by the International Society of Aesthetic Plastic Surgery, Nashielli TORRES ESPINOSA CHIU, MD Inc. All rights reserved. Contents may not be reproduced in whole or in part without written permission of ISAPS.

ISAPS News Volume 5 • Number 2 May – August 2011 www.isaps.org 39 GENEVA ISAPS INTERNATIONAL SOCIETY OF 2012 AESTHETIC PLASTIC SURGERY

st 21 CONGRESS September 4-7, 2012 Geneva, Switzerland Centre International de Conférences Genève