Volume 9 • Number 1

Official Newsletter of the International Society of Aesthetic Plastic Surgery

From the Office of the President: ISAPS’s Survey and Results – Towards a New Future

he ISAPS board has always discussed what is beneficial The ISAPS board recognized that there are conflicts in some to ISAPS members and what ISAPS should do for the countries and we therefore decided to ask the opinion of T safety of our members’ patients and uses these discus- ISAPS members around the world directly. This resulted in sions to review its policies for the future. the recently implemented ISAPS survey which proved that the issues with other core specialists are more serious than During the board meeting held in Rome last November, the we imagined. following points were raised: as our daily clinical statistics have made clear, and as any member from around the world It is our mission to serve all ISAPS members. Our mem- would admit, the number of non-surgical treatments is bers are like a family and it is important that we listen to increasing. At the same time, the number of participants in their opinions carefully. The survey results, although small ISAPS courses and symposia has been declining. in number, are clear, with more than half of the respondents from around the world being against establishing a new Based on the aforementioned circumstances, it is our opin- affiliate membership category and to allow other core ion that we can learn techniques and increase our knowl- specialists to attend our meetings. However, the majority edge about other clinical fields important to our practice and agree that core specialists should be invited as faculty to teach patients by inviting core specialists to present at our meet- at our meetings. ings. We also discussed whether we should admit leaders in the fields of aesthetic surgery and non-surgical aesthetic pro- This ISAPS survey was very valuable. We learned that there is cedures as members in order for ISAPS to become a leader a variety of issues in each country and that the magnitude of in both fields. Furthermore, we discussed how we can expect the issues varies. Consequently, we announce the following: discussion and interactions at meetings at a higher level than 1. ISAPS will not establish an affiliate member category. before by allowing board-certified dermatologists, board- certified oculoplastic surgeons, and board-certified facial 2. ISAPS will not allow other core specialists to attend our plastic surgeons to enter into the academic meeting sites. meetings except by special invitation of the President. As a result of discussions and voting at the board meeting, as 3. ISAPS will invite excellent core specialists from other you know, proposals were made to ISAPS members. fields to teach at our courses, symposia, and congresses. ISAPS board members then received many opinions from ISAPS will evaluate them and will not invite them back if ISAPS members throughout the world, including opinions they have a bad evaluation—the same process we use for that agreed with our proposals. However, many doctors, in the plastic surgery faculty. particular, those in South America, told us that they have As President of ISAPS, I deeply appreciate your comments always been in conflict with doctors in other fields and that it and valuable opinions. is a serious issue for them if these doctors enter into the field of plastic surgery in their countries.

In particular, we received many opinions that were seriously Susumu Takayanagi, MD against the affiliate members we proposed. ISAPS President 2014-2016 BOARD OF DIRECTORS

PRESIDENT MESSAGE FROM THE EDITOR Susumu Takayanagi, MD Osaka, JAPAN [email protected]

PRESIDENT-ELECT Renato Saltz, MD Salt Lake City, Utah, UNITED STATES [email protected]

t is my pleasure to welcome you to this issue 16372) that encompasses all aspects of practice. FIRST VICE PRESIDENT of ISAPS News. In this edition, you will learn Dr. Lina Triana, Chair of the Education Council, Dirk Richter, MD Köln, GERMANY Iabout our society’s efforts to survey and listen gives a wonderful update on all of the exciting [email protected] to our members regarding proposed changes as educational plans for ISAPS. We also present a SECOND VICE PRESIDENT described by Dr. Takayanagi in his message to report from our journal editor, Dr. Henry Spinelli, Nazim Cerkes, MD, PhD the membership. highlighting the successful growth of our jour- Istanbul, TURKEY [email protected] Consistent with our mission of patient nal, Aesthetic Plastic Surgery. safety and excellent standards of care, Ivar van Our Global Perspectives Series in this issue THIRD VICE PRESIDENT W. Grant Stevens, MD Heijningen reports on the new European Stan- focuses on trends in non-invasive treatments. Marina del Rey, California dard in relation to Aesthetic Surgery services (EN This is a great opportunity to read about practice UNITED STATES [email protected] patterns in different regions of the globe as pre- SECRETARY sented by our members. This global perspectives Gianluca Campiglio, MD, PhD CONTENTS topic is complemented by an informative article Milan, ITALY [email protected] Letter from the President 1 on the psychosocial aspects of minimally invasi- European Standards – CEN Update 6 ve procedures by Dr. David Sarwer. Our regular TREASURER Kai-Uwe Schlaudraff, MD Education Expansion Plans 5 history section this time focuses on the fascina- Geneva, SWITZERLAND [email protected] OSAPS 8 ting story of Jaques Riverdin, a pioneer in skin grafting, presented by Dr. Denys Montandon. WAPSCD 9 ASSISTANT TREASURER I hope you enjoy this issue of ISAPS News Eric Michael Auclair, MD National Secretaries 10 Paris, FRANCE where you can read about these topics, as well as Global and Patient Safety Surveys 11 [email protected] several humanitarian efforts, past and upcoming Membership Committee Report 12 PARLIAMENTARIAN educational programs, and much, much more. Thomas S. Davis, MD Affiliate membership 12 Warmest regards, Hershey, Pennsylvania, UNITED STATES Public Relations 14 [email protected] Insurance Committee 15 NATIONAL SECRETARIES CHAIR Peter Desmond Scott, MD Fellowships 16 Benmore, SOUTH AFRICA Congress 2016 – Kyoto 18 J. Peter Rubin, MD, FACS [email protected] Visiting Professor 20 ISAPS News Editor EDUCATION COUNCIL CHAIR Lina Triana, MD ISAPS Establishes Alliance 21 Cali, COLOMBIA Psychology 22 [email protected] Journal Reports 24 PAST PRESIDENT Global Perspectives 26 Carlos Oscar Uebel, MD, PhD Porto Alegre, BRAZIL Skin Care Specialists 33 [email protected] ISAPS-LEAP Update 34 TRUSTEE Italian Humanitarian Program 37 Lokesh Kumar, MD New Delhi, INDIA History: Jaques Reverdin 38 [email protected]

Members Write 41 TRUSTEE In Memoriam 42 Sami Saad, MD Beirut, LEBANON Calendar of Courses 48 [email protected]

New Members 50 EXECUTIVE DIRECTOR Catherine Foss photo Bruce D. Jones, 1957 Hanover, New Hampshire UNITED STATES [email protected] 2 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 3 16728_Trepsat_8.5x11.pdf 10/30/14 10:52:14 AM

EDUCATION COUNCIL Trepsatp ISAPS EDUCATION EXPANSION PLANS Lina Triana, MD – Colombia Chair, Education Council

Facial Flap e are living today in a global- gery universe. Today we have the respon- Finally, since we are all connected, the ized world where strategic sibility to lead in this globalized world of ISAPS EC team would like to encourage Walliances are very important aesthetic procedures. those who present at our meetings to fur- Dissector to stay on board in any business. We see Following this new ISAPS trend that ther share their knowledge by submitting this in different industries and now it is has been mandated by our Board of Direc- papers to our ISAPS journal, Aesthetic time for us as plastic surgeons to catch up tors led by our president, Dr. Takayanagi, Plastic Surgery. We invite you to become with this flow. the EC team has a big responsibility and ISAPS ambassadors not only during Scissors ISAPS members have read in my past will play an active role in these changes. ISAPS scientific meetings, but at any articles in this newsletter and in a recent We are now open to learn from those in meeting you attend. Be open to recruiting letter sent by our president, Dr. Takayan- the core specialties by including them as interesting new information and concepts Dissecting the lower eyelids. agi, how ISAPS is expanding its mission faculty in our scientific programs. to be submitted to our journal. in education. The EC team and our ISAPS National The ISAPS leadership is demonstrat- Now I want to once more bring to you Secretaries are still working according ing a straightforward message and offer- our updated ISAPS goals. We are expand- to the high standards established by ing an open invitation for us as members ing from our initial mission of surgical Dr. Nazim Cerkes for our ISAPS courses, to take an active role in plastic surgery education only to even more compre- symposia and meeting endorsements expansion to include all aesthetic pro- ASIM121626ASIM121626 ASIM121426ASIM121426 ASIM12M121526 hensive aesthetic procedure education throughout the world. Recent courses cedures worldwide that will ultimately worldwide. in Pattaya, Thailand and Liege, Belgium enhance our practices and allow us all To pursue and achieve these goals, have been very successful and I invite you to grow. we must extend our strategic alliances to to maintain this good energy so that we I want to thank my EC Team and our include core specialties that perform both can continue with what past ISAPS EC National Secretaries, and especially to our aesthetic surgical and non-surgical proce- Chairs had achieved — providing educa- Board of Directors for their efforts to help dures. By doing so, we will become a more tion in plastic surgery worldwide, but now ISAPS grow and maintain our excellence inclusive society sharing and enriching expanded to all aesthetic procedures. in education into the future. each other in our areas of expertise. We must always keep in mind that this can only be done with those who have true, formal education in aesthetic procedures. This includes only those specialists who Show your have completed their residency and advanced training and who have experi- patients that ence in the specific surgical or non-surgi- you are an cal aesthetic procedure they claim to do. These are the core specialists with whom ISAPS member. we truly share competencies in aesthetic procedures. We must never forget why we are here: for our patients. If we want to offer them ® Our distinguished member plaques have silver or gold metal on highly- ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS® the best in aesthetic procedures, we must ® polished piano finish wood and are 8 by 10 inches (20 by 25 cm) or 12 by For diamond perfect performance become an inclusive society where we accurate surgical & scientific instruments corporation 15 inches (30.5 by 38 cm). The order form can be downloaded from the ALL work together and learn from each 300 Shames Drive, Westbury, NY 11590 Member Area of our website. Each plaque costs $300 for 8 by 10 and other. The times when isolation was best 800.645.3569 516.333.2570 fax: 516.997.4948 west coast: 800.255.9378 $500 for 12 by 15 including the cost of shipping. Info: [email protected] • Orders: [email protected] have changed. ISAPS is stepping in with www.accuratesurgical.com these alliances to expand our plastic sur-

4 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 5 EUROPEAN STANDARDS

CEN UPDATE ème th Ivar van Heijningen, MD – Belgium Congrès ISAPS National Secretary for Belgium and Membership Committee Chair sofcep Congress It is with great joy that I welcome the CEN press release on the European Standard for Aesthetic Surgery Services. My membership in ISAPS helped me a lot with this standard. Société Française The ISAPS safety diamond was taken as the basis and the AAAASF-I accreditation manual des Chirurgiens was also used as a base for discussion. In this sense ISAPS contributed a lot to this standard Esthétiques Plasticiens which finally took form thanks to the input of numerous people in the standard institutes of most European countries whom I thank for this. —Ivan van Heijningen French Society of Aesthetic CEN publishes standard on Aesthetic Surgery services est), this standard will be published at national level by CEN Mem- Plastic Surgeons Brussels, 20 January 2015 — CEN is pleased to announce the bers in 33 European countries. publication of a new European Standard in relation to Aesthetic The Project Committee CEN/TC 403 is chaired by Dr Johann Surgery services (EN 16372). It is expected that this standard will Umschaden from Vienna (Austria), who is a Specialist in Plastic, help to improve the quality of these services, enhance the safety Aesthetic and Reconstructive Surgery. Dr Umschaden states: “The and satisfaction of patients, and reduce the risk of complications. new European Standard defines a high level of quality for aesthetic Traduction surgery services and provides the basis for optimal patient safety". 4 JUIN / JUNE 4 simultanée he market for aesthetic surgery interventions has grown over The Belgian Plastic Surgeon Ivar van Heijningen was one of ISAPS SYMPOSIUM the last few years. The increased availability of affordable those who initiated the project to develop a European Standard for - T travel and the internet mean that medical tourism in relation Aesthetic Surgery services, alongside Dr Umschaden. According Simultaneous to aesthetic surgery has become a reality. There is a rising need to Dr van Heijningen: “This European Standard is a landmark for 5-6 JUIN / JUNE 5-6 translation to ensure that patients are fully informed and able to rely on safe health care services, especially considering the cross-border mo- aesthetic surgery interventions, whether at home or abroad. bility of patients in Europe.” CONGRÈS SOFCEP The new European Standard (EN 16372) addresses require- “Whether they are being treated in their own country or abroad, SOFCEP CONGRESS ments for surgical services provided to patients who wish to patients expect to be treated by competent practitioners in a safe change their physical appearance. This new voluntary Standard environment and to be informed about relevant issues related to provides requirements and recommendations in relation to ser- their treatment, including risks. These expectations are addressed NICE vices provided by aesthetic surgery practitioners. These recom- by the new European Standard for aesthetic surgery services," mendations concern various aspects such as: ethics and mar- continues Dr van Heijningen. HÔTEL keting, information provided to patients, competencies of the “Some EU member states have specific regulations on aesthetic NEGRESCO surgery, but most countries don’t have. This gap can now be 2015 surgeons, the consultation procedure, requirements for clinical facilities and post-operative follow-up. closed by the voluntary European Standard for the mutual benefit The new European Standard (EN 16372) was developed by of practitioners and patients,” adds Dr van Heijningen, who is Organisation générale Inscriptions, Informations générales Informations partenaires, CEN’s Project Committee on “Aesthetic Surgery and Aesthetic the National Secretary ofISAPS (International Society of Aesthetic General Organisation Registration, general information programme scientifique, logistique Non-surgical Medical services” (CEN/TC 403), which was set up Plastic Surgery) in Belgium. Partners, Scientific Programme, Logistics Président/President: www.sofcep.org in 2010. This Committee includes practitioners nominated by CEN According to the chair of CEN/TC 403, Dr Johann Umschaden: Charles VOLPEI Members as well as other stakeholders including ANEC, which "Even if there are specific regulations in some EU Member States 12 Rue Nazareth - 31000 Toulouse 44 Bd. Périer - 13008 Marseille represents consumer interests in standardization. on aesthetic surgery, some of them are lacking in terms of hygien- Tel :+33 (0)5 34 31 01 34 Tel : +33 (0)4 95 05 30 67 The new European Standard (EN 16372) was formally approved ic, technical issues, or they don't include a risk analysis. Recent www.congres-sofcep.org [email protected] [email protected] by CEN in October 2014 and the final version of the standard was reports on incidents in the context of Aesthetic Surgery emphasize made available to all CEN Members (National Standardization Bodies) on 17 December. Before the end of June 2015 (at the lat- continued on page 23

6 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 7 EDUCATION COUNCIL EDUCATION COUNCIL

14TH OSAPS MEETS IN THAILAND THE FOURTH CONGRESS OF THE COMBINED WITH ISAPS SYMPOSIUM WORLD ASSOCIATION FOR PLASTIC Kamol Wattanakrai, MD – Thailand Sanguan Kunaporn, MD – Thailand SURGEONS OF CHINESE DESCENT National Secretary for Thailand Past National Secretary for Thailand David S.Y. Wong, MBBS, FRCS, LLB – Hong Kong and Lee L.Q. Pu, MD, PhD, FACS – United States

n October 27-29, 2014, and Dr. Sacit Karademir from he Fourth Congress of pedic counterpart has joined the the 14th International Turkey, Dr. Kotaro Yoshimura and the World Association for effort to develop their specialty to Congress of the Oriental Dr. Kunihiko Nohira from Japan. O Plastic Surgeons of Chinese greater heights and to deliver better Society of Aesthetic Plastic Surgery The topics covered were breast T Descent (WAPSCD) took place care for patients. (OSAPS) met in Pattaya, Thailand surgery, hair restoration, rhino- at the Hong Kong Academy Professor Foad Nahai came as with 262 local delegates and 194 plasty and facial transplantation. of Medicine with its ISAPS- an ISAPS Visiting Professor. He international participants. In all, Free papers were presented Endorsed scientific program from arrived before the meeting to teach 24 countries were represented. in the areas of mammaplasty, November 6th to 8th. This was in the two university hospitals and Scientific sessions covered 10 rhinoplasty, breast, facial, eyelid, preceded by four workshops on then at the Hong Kong Society of topic areas with Live Surgery and cosmetic surgery with 25 oral aspects of aesthetic surgery. Plastic, Reconstructive & Aesthetic demonstrations on Mammaplasty presentations and eight posters. The opening ceremony adopted Fig. 2 Group photo 4th Congress WAPSCD Surgeons (HKSPRAS). At the Con- the favorite Chinese customary eye-dot- gress, he traced the origin and develop- and Rhinoplasty. The opening There were 27 faculty members sions took place in two adjoining theatres. ting and lion dance. It is a traditional ment of plastic surgery and illustrated the address was the Seiichi Ohmori from nine countries. Twenty panel sessions were interspersed belief that the awakened lion scares importance of innovation in its further Memorial lecture given by US Prof. Gordon H. Sasaki from Social events included a welcome reception at the beautiful with nine plenary sessions with speakers away bad elements to ensure good luck evolution (Figure 3). USA. infinity-edge swimming pool of The Royal Cliff Beach Resort of extraordinary caliber. There were 82 (Figure 1). An ISAPS Symposium was included and the opening remarks Hotel, a presidential dinner for faculty and speakers, a banquet invited speakers, 86 oral paper abstracts were given by Dr. Susumu Takayanagi, president of ISAPS. The for all delegates, and private tours to Nongnuj botanical garden and 22 posters, and 27 sponsor booths. faculty included Dr. Selahattin Ozmen, Dr. Mehmet Bayramicli for ISAPS speakers. Each mid-day there was a sponsored lunch symposium. One could easily feel excited being a part of this meeting because we saw leg- endary authorities everywhere, speaking, passing by, talking to someone, having a cup of coffee or visiting the exhibition booths. Notable examples were Profes- sors Fu-Chan Wei, Yu-Ray Chen, Yilin Fig. 3 ISAPS Visiting Professor Foad Fig. 1 Lion Dance and eye-dotting at the Cao, Lee L.Q. Pu, David T.W. Chiu, and Nahai was giving his lecture during the opening ceremony Dae-Hwan Park, and too many others to congress mention. Several specially invited speakers Some 300 delegates came from Main- added extra highlights. Sir Gordon Wu, The Faculty and Congress Dinners land China, Taiwan, USA, Singapore, UK, an entrepreneur, philanthropist, and suc- took place off the coastline aboard the Canada, Ireland, Korea, Australia, France, cessful engineer delivered a speech on Lantau and the Jumbo. Both involved a India, Israel, Macau, Malaysia, New Zea- China’s role in the world. That stimulated boat cruise to allow participants to experi- land in addition to Hong Kong (Figure 2). a lot of views from the audience. Profes- ence the autumn breeze. The former was The scientific program included com- sor KM Chan, founding Secretary General a special restaurant next to the waters prehensive coverage of all current and (1994-2006) and president (2006-2009) and the latter a floating marine vessel. important aspects of plastic surgery. Con- of the Chinese Speaking Orthopedic Soci- Deliciously cooked fresh seafood and fine current reconstructive and aesthetic ses- ety, generously shared how our ortho- wine helped wash away the tension of the continued on page 14

8 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 9 NATIONAL SECRETARIES SURVEY COMMITTEE

MESSAGE FROM GLOBAL SURVEY REPORT THE CHAIR OF NATIONAL SECRETARIES David Daehwan Park, MD – Korea Chair, Ad Hoc Survey Committee, ISAPS Assistant Chair of National Secretaries Peter Scott, MD – South Africa Chair of National Secretaries ollection of data for the ISAPS however, these were omitted in previous very strong in cosmetic surgery with Global Statistics Study for proce- surveys and have been added. Chin aug- many patients and procedures. China, reetings to all our National Secretaries from a very Several National Secretary elections will take place in 2015 as C dures in 2014 began on January mentation is also included under facial Japan and Korea could be in the top ten in warm and sunny South Africa. ISAPS is entering into terms expire. Since my last message, we have had elections in 8, 2015. We expect to have results ready bone contouring procedures. the world in the number of cosmetic sur- G a very exciting phase under the leadership of Susumu Bahrain, Luxembourg, Bolivia, Brazil and Denmark. by June. The information generated from A very important issue is how to gical procedures; however, China, Japan Takayanagi. His message in this issue describes changes in One of the continual gripes of the chair of NS is the poor these annual surveys is important to all increase participation. Our survey ana- and Korea were excluded from last year’s future course content and faculty that will allow our society to response to emails sent specifically to the NS by the ISAPS plastic surgeons, the international press, lysts tell us that 30 responses per country survey because their response rate was grow from strength to strength and keep at the cutting edge of Board. I have found that the same NS always reply promptly industry and the public. The international is sufficient for the data to be statistically too low to provide valid statistics. our speciality. and the same reply to a second email, but about 70% of our NS media eagerly awaits our results. valid. In some countries, surgeons cus- Survey Committee members will con- Over the Christmas period, the ISAPS office under the capa- ignore emails. The ISAPS Board does realize that we are all run- Our committee is composed of eight tomarily under report their procedural tact via telephone or e-mail our friends, ble leadership of Catherine Foss, continued to work away quietly ning busy practices; however, you take on this four-year position members including me. They include: the information to their government which colleagues, graduates, and fellows in in the background with Jordan Carney keeping a very active role representing your country to improve the standard of aesthetic chair of the Communications Commit- means that they simply ignore our survey. Korea, Japan and China and in other Asian in sorting out membership applications. surgery to ensure successful transfer of skills to the younger sur- tee, Arturo Ramirez-Montana (Mexico); Group emails from ISAPS are systemati- countries using our network to encourage As a member of the Membership Committee, I have noted geons in training. We realise that circumstances change and that ISAPS Board Member Sami Saad (Leba- cally blocked by powerful spam filters in participation. We urge all national secre- that we have attracted new members who may well be the only various NS may have personal health issues or become too busy non); two members of the Industry Rela- some countries. taries and survey committee members to ISAPS members in their country and we have encouraged them or disinterested in the position. If this is the case, you are wel- tions Committee, Grant Stevens (USA) Our committee encourages sending all help us generate much higher response to get involved in regional meetings. In particular for instance, come to approach Catherine Foss or myself to organize an early and Wayne Perron (Canada); and Asian plastic surgeons e-mails in their country rates in their respective countries. as the NS for South Africa, we have two active members in Mau- election in your country. members Yuzo Komuro (Japan), Sufan to ISAPS where this is permitted. We also Finally, our committee wants all ritius who have fallen under the umbrella of ISAPS South Africa For ISAPS to function effectively as a world leader we need Wu (China), and Yong-ho Shin (Korea). encourage national secretaries to send the ISAPS members to use personal e-mail and have been invited to our local meetings. The membership your active involvement. The company charged with collection survey again to ISAPS members in their and telephone to encourage their friends, numbers in Bolivia have grown to the stage where we now have I wish you all a prosperous, successful and healthy 2015 and and analysis of the data, Industry Insights, countries from their own email address to colleagues, graduates, fellows and all plas- recently appointed Maria Theresa Rojas as the first National Sec- I look forward to meeting up with you at one of the upcoming is the same. They have refined the survey avoid these distribution problems. Asking tic surgeons in their country, including retary for Bolivia. I would encourage NS who are neighbors of meetings this year. questions based on what we learned last national societies to forward the survey to non-members, to respond to the ISAPS countries where there is no or poor representation to take them New National Secretaries year. In head and neck cosmetic surgery, their members will also help us. survey. The link to the one page survey under your wing and to grow the foot print of ISAPS in their for example, fat grafting and facial bone We will focus on East Asian countries is: www.iisecure.com/ISAPS/survey.asp We welcome newly-elected National Secretaries: country. contouring are important procedures; this year as China, Japan and Korea are Thank you very much. As part of my role on the Education Council, I would like Bahrain Rajesh Gawai, MD to compliment Lina Triana on stepping into the very big shoes Brazil Antonio Graziosi, MD of Nazim Cerkes and tirelessly working on faculty members Bolivia Maria Theresa Rojas, MD for upcoming meetings. In the course of being involved as the Denmark Andreas Printzlau, MD ISAPS PATIENT SAFETY SURVEY ISAPS Course Director for the October Australian meeting, Luxembourg Serge Schmitz, MD Lokesh Kumar, MD – India I have enjoyed the efficiency with which Lina has been able to We thank the outgoing NSs for all their hard work over the ISAPS Board Trustee, Acting Chair, ISAPS Patient Safety Committee put a group of expert lecturers on the “fat transfer” focus of this last four years. one-day symposium. SAPS recently circulated a survey to all National Secretar- π 26 responded that malpractice insurance ies asking their opinion about issues pertaining to patient is required as a condition of licensure, Have you submitted your data yet? Isafety in their country. Sixty-one (75%) National Secretaries while 34 said it was not. Global statistics on the number of aesthetic procedures performed responded. The results are included here. π 48 said that hospital privileges are not required as a condition of practicing plastic surgery; 13 said that they are required. are difficult to determine — and requested all the time. ISAPS is the π 54 report that plastic surgeons are required to be board certi- only organization in the world that undertakes an annual study of this fied in their countries.7 said no. π The majority reported that surgeons practice in private surgi- information. Please send us your data and help us provide the most cal clinics, while half mentioned that surgeons in their country π 43 said that re-certification is not required, 17 said that it is. accurate information we can. also practiced in third-party surgical clinics. Frequency of re-certification varied from 1-10 years, with The link to the one-page survey is: www.iisecure.com/ISAPS/survey.asp the majority reporting that recertification is required every π 35 reported that surgeons must operate in an accredited five years. facility. 24 said that this is not required. continued on page 47 10 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 11 MEMBERSHIP COMMITTEE MEMBERSHIP COMMITTEE

We have already let go of option 1 and said that we will allow From my work on the European Standard for Aesthetic MEMBERSHIP COMMITTEE REPORT other specialties to teach us. So will it just be that (option 2), or Surgery Services, I have learned that we are not the only ones Ivar van Heijningen, MD – Belgium are we opening our doors wider? doing good aesthetic procedures. I still think we are best placed, Let us consider option 3 seriously for a moment.: but our number is limited, especially where non-core doctors ISAPS National Secretary for Belgium and Membership Committee Chair Ω We can attract the best from other specialties as faculty; are concerned, so we might be better off to join forces with core-specialists who at least had well defined and proper train- Ω We gain knowledge in areas that are less core plastic sur- ing. We can form a front with them and still hold the key posi- gery: i.e., non-surgical medical treatments and teach that ince meeting during the Congress 2,473 are Active, 178 are Associate, 186 A survey on the issue of affiliate mem- tion if we start it. better; in Rio in September, we have cre- are Life and 6 are Honorary. The growth bership showed that members welcome In fact some of our members are non-plastic surgeons doing Sated a Membership Committee was steady over the last months with an presenters from other specialties, but Ω We will have more submissions for our journal, Aesthetic only aesthetic plastic surgery; some of them are double and Team to address all issues with respect average of 35 new members per month. prefer to reserve membership for plastic Plastic Surgery; triple-boarded; and some of them are faculty in our courses and to membership. We organized the team The procedure has been improved to surgeons. Growth of our membership Ω We can continue to lead the way in aesthetic procedures; very well respected. in such a way that each of us oversees a admit applicants on a monthly basis and should come more from the younger Considering all these arguments, the board issued a survey Ω We can emphasize Patient Safety and Ethics across spe- continent. James Grotting (US) was kind we now archive applications that have generation, so promoting Associate to consult its members. The majority opted for option 2. cialties; enough to oversee North America; Maria not been finished within a year. The fast Membership for those in training and Isabel Cadena (Colombia), South Amer- track procedure allows countries to admit just finished is a priority. Internet mod- Ω We will have more reach for our courses and congresses; ica; Sufan Wu (China) addresses issues larger groups of pre-selected members of ules for e-learning (e.g., webinars, video Ω We will stand stronger when creating Standards and in Asia and Australia; and Bouraoui Kotti an Aesthetic Plastic Surgery Society sav- streaming of courses) need to be devel- negotiating with governments. (Tunisia) covers Africa and the Middle ing the cost of the application fee. This oped and senior members are encour- East. As Chair, I will cover Europe. Ex has worked well. aged to be open to contacts from the officio members Catherine Foss, our After discussion in the board meeting, younger generation. Executive Director, and Peter Scott (South it was decided that membership in mul- CME accreditation of ISAPS courses Africa), the Chair of National Secretaries, tiple countries is not allowed. Members and the ISAPS biennial congress is a goal complete the team. are free to work in more than one coun- for the future so we can offer these credit During the board meeting held in try, but they must choose under which points to surgeons from countries that Rome in November, changes over the last country they want to be listed and pay need them to maintain their registration. year and current membership status were only one membership fee. reported. Of 2,843 current members,

Membership changes? SAPS has been a plastic surgeons’ society from the begin- surgeons do good rhinoplasties, and that there are maxillofacial ning. But 44 years ago we were basically the only specialty surgeons who achieve amazing aesthetic results with midface Idoing procedures to enhance the aesthetics of the human advancements. body. We have devoted ourselves to training plastic surgeons to be the best aesthetic surgeons in the most ethical way possible Having said that, what are our options? with a focus on patient safety. 1. Remain a plastic surgeons only society, with teaching done Things have changed, whether we like it or not. Other spe- by plastic surgeons only; cialties have embraced aesthetic procedures and the majority of these procedures are no longer surgical. Besides, other spe- 2. Remain a plastic surgeons society only, but allow some cialties’ non-core doctors are doing aesthetic procedures and experts from other specialties to teach us; even a lot of non-doctors, nurses being the best of these. We 3. Allow other specialties to become members of our society; may not like it, but it is the reality. 4. Allow everybody with an interest in aesthetic treatments to Now, we can hang on to the fond memories of the good join our society. old times and hope that they return, or we can face reality and acknowledge that others are out there and embrace the best Now option 4 is clearly unacceptable, with worldwide endan- of them. gering of patient safety as the result of non-core doctors who do If we wish to continue to lead in the field of aesthetic proce- procedures without any training and we are clearly not going to dures, then we must acknowledge that dermatologists in gen- teach them. But we do want to be the gold standard—a society eral do better Laser treatments then most of us, that many ENT that the best aesthetic surgeons aspire to join.

12 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 13 PUBLIC RELATIONS COMMITTEE INSURANCE COMMITTEE

REPORT OF THE AD HOC COMMITTEE ON ISAPS INSURANCE CHANGES ARE COMING! PUBLIC RELATIONS Jose Carlos Parreira, MD – Portugal Dirk Richter, MD, PhD – Germany Chair, ISAPS Insurance Committee ISAPS 1st Vice President very year, the ISAPS Insurance scheme ISAPS Cross Border Revision Cover he ad hoc public relations committee was inaugurated at As an international society, the requirements for public rela- has seen positive changes and this year Similar to the scheme outlined above, this version has the added benefit that the the last meeting of the Board of Directors in Rome, Decem- tions are challenging and need to be addressed. Social media has is no exception. The insurance is being patient may be treated once back in their own country by another ISAPS surgeon ber 2014. been identified as a promising tool especially to maintain contact E T split into two types of cover as shown below: if remedial treatment is necessary The aim of this committee is to analyze the current situation with the younger generation of plastic surgeons and to inform following a complication. The of ISAPS in terms of public relations, marketing, branding and patients about ISAPS activities and aesthetic surgery in general ISAPS Revision Cover insurance premium for this cover corporate identity to be sure that it meets the needs of our mem- in order to increase the visibility of our society. Revision cover is for any ISAPS member sur- will be higher than the basic revi- bership. Currently, we are analyzing the experiences of our national geon to use and no application is necessary. sion cover due to the additional societies and what has worked best for them. With these results We already completed a detailed survey among the committee Each surgeon will be contacted to ask if they benefits being offered. we will implement potentially good ideas into new concepts of members asking about the past, present and the possible future would like to use the scheme. The launch of these new types our marketing strategy. situation. Following a surgical procedure, if the of cover will be within the next few months and each member surgeon will be pro- patient needs a revision procedure, this will vided with all the necessary information. be available at no extra cost to them. The In the meantime, should you have an enquiry or wish to cover a patient, please patient and premium amount chosen must contact [email protected] or telephone 0044 207 374 4022 in our be declared for cover before any complications London office. have been diagnosed. The ISAPS member WAPSCD, continued from page 9 surgeon will then be invoiced for the premi- ISAPS Insurance Committee Jose Carlos Parreira, Portugal – Chair day. Everyone was exhilarated The two-yearly Congresses ums. The cost of this cover may be passed on Gianluca Campiglio, Italy and chatting joyfully and hav- of the WAPSCD have evolved to the patient and a personalized guarantee Alison Thornberry, UK – Ex officio ing fun going around shaking into regular opportunities is created for each ISAPS member surgeon. hands and proposing toasts for re-union of brothers and This guarantee is for the surgeon to present ISAPS Insurance is managed by our partners at Sure Insurance in London and is under- (Figure 4). sisters of Chinese descent to the patient so that the patient knows they written by certain underwriters at Lloyd’s. New in the organization of and friends and colleagues of are covered for up to 24 months post surgery. this 4th Congress was that it other races. The warm friend- The insurance premium for this cover is was no longer hospital based. ship and sincere atmosphere being reduced as the claims on the current The then president of the are aspects distinct to these scheme have been below expected levels. Where in the World? society, Dr. David SY Wong, meetings and have certainly now Chief of Plastic Surgery given participants a sense of at the Chinese University of homecoming and reunion. Hong Kong, decided that the The next Congress will be Fig. 4 Delegates celebrating at the Faculty Dinner HKSPRAS would draw on held in Chengdu in conjunc- more people with capabili- international advisory committee. This tion with the annual meeting ties and foster a stronger sense of unity consisted of Professors Yilin Cao, David of the Chinese Society of Plastic Surgeons amongst local colleagues. The call was T.W. Chiu, Shuzhong Guo, Lee L.Q. Pu from October 13 to 16, 2016. We are further extended to the Hong Kong Asso- and Fu-Chan Wei. Professor Pu, from the planning to invite another ISAPS profes- ciation of Cosmetic Surgery, the surgical University of California, Davis, in particu- sor to our congress and welcome plastic departments of the two universities, and lar, deserves credit for being instrumental surgeons of Chinese descent or all races the College of Surgeons of Hong Kong as in helping with the contacts of many sur- from all over the world to attend another co-sponsors. That laid the foundation for geons, arrangements with societies and magnificent scientific forum of interna- the organization of an event truly on an publishers, and advising on marketing tional plastic surgery. Please stay tuned international scale. strategies. for updates. Coordination and liaison went to the See page 51 for the answer.

14 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 15 FELLOWSHIPS

9. Abdominoplasty either from the candidate’s own remain- Provided that no 48% per competency MCH (AESTHETIC PLASTIC 10. Thigh Lift ing cases or cases introduced by the scores are recorded, then an average of 11. Inner Arm Reduction examiners. These could include the man- 50% for competency subjects must be SURGERY PRACTICE) 12. Autologous Fat Transfer agement of complications. achieved for a pass. A certificate is awarded 13. Rhinoplasty to successful candidates. Further credits Professor James D. Frame, FRCS, FRCS(Plast) The 2014 Examinations 14. Non-Surgical Aesthetics – i.e., Botuli- are required for the award of a diploma, Consultant Plastic Surgeon, Anglia Ruskin University, Chelmsford, UK This year there have been two certifica- num Toxin, Fillers, Skin rejuvenation but this can often be achieved from previ- tion Viva examinations held at the Post- Dr. Ruth Jackson and injection liposculpture ous academic study. The MCh is awarded graduate Medical Institute, Anglia Ruskin to candidates that submit an academic This is a validated university course Pro Vice Chancellor and Dean of Faculty of Medical Science University in Chelmsford. dissertation on a related aesthetic subject. and candidates are assessed on their abil- Director of Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK The examiners on these occasions Topics selected to date include aesthetic ity to analyze a patient’s psychology and were Professor Neil McLean, Consultant procedures to hands, capsular contracture perceptions before deciding upon a course Plastic Surgeon, Hexham, Newcastle; Mr. and problems related to breast implants. of action, then proceeding to supervised ully-trained and accredited plastic surgeons are able to It is precisely for reasons of patient safety that UKAAPS, Niri Niranjan, Consultant Plastic Sur- The Anglia Ruskin University is proud surgery, and finally reflecting on the out- practice aesthetic surgery within the independent sector ISAPS and the Anglia Ruskin University have recognized the geon, Anglia Ruskin University; Profes- to have developed this program. It is come. This evidence is recorded in a stan- with medical indemnity insurance, but are increasingly importance of tailoring a qualification in aesthetic surgery with a sor David Smith, Chief of Surgery, Plastic reflective of good aesthetic working prac- F dard form that is reviewed by a university aware in the early period of their consultancy of a need for plastic surgeon’s ambition to develop aesthetic surgery skills and Surgeon, Florida; and Professor James tice and by certification, allows patients appointed panel of expert academic plas- supervised specialist training in aesthetic and cosmetic surgery. marketable practice. A plastic surgeon declaring a qualification Frame, Plastic Surgeon, Anglia Ruskin the means to identify that a plastic sur- tic surgeons. The program is designed to The majority of aesthetic procedures performed in the UK in a super-specialty interest gives the patient the opportunity to University. The candidate’s training geon has undergone additional voluntary demonstrate and train plastic surgeons to now occur in the private sector. There is therefore an obvious identify practitioners that demonstrate evidence of prolonged instructor is permitted to observe the Viva training and passed a rigorous assess- perform safe, low risk surgery, but great deficiency in aesthetic surgery exposure during basic plastic sur- pro-active hands-on training specifically in cosmetic surgery and examination, but is not permitted to ask ment in cosmetic surgery, putting them- importance is placed on careful patient gery training within the National Health Service. This has also non-surgical procedures. questions. Mr. Paul Levick, Consultant selves above others. This program is also selection and being able to say no. The been recognized in the United States, but many other countries Whilst plastic surgeons can specialize in cleft, burn, hand, or Plastic Surgeon, Birmingham, attended already working in Dubai with UKAAPS examiner’s role is not just to assess their have had a similar experience. It is difficult for newly-qualified oncoplastic breast surgery to the exclusion of others, then it is the most recent Viva in this capacity. and ISAPS member plastic surgeon Jaffer ability and understanding of the common surgeons to fully understand the needs and demands of patient interesting that the ‘super-specialty’ of aesthetic surgery is not Both candidates succeeded in passing the Khan as training instructor and it is likely aesthetic procedures, but to also look for groups to which they have had limited exposure. Whilst many similarly recognized and supported. This is an integral limb of examination. to be offered in Mumbai in 2015 with evidence of: of the skills in their surgical training programs are transferable, the ISAPS Patient Safety Diamond that was so elegantly pre- The examination process has adapted UKAAPS/ISAPS member plastic surgeon there are distinct differences which must be acknowledged. sented to the ISAPS membership by our esteemed Past Presi- 1. The trainee’s concept of informed con- to lessons learned from previous exam- Shailesh Vadodaria as training instruc- For example closing a DIEP flap donor is unlike closing a dent, Professor Foad Nahai. Certification with validated evidence sent for surgery; inations. It is important to note that the tor. These surgeons are members of the faculty of the Anglia Ruskin University. Brazilian abdominoplasty where the seroma complication rate of supervised practical hands-on training and oral examination 2. Identifying the relevance of proper final examiners have no responsibility as The ambition is that this course be suffi- should approximate zero percent, but sadly it is nearer 20%. in 14 aesthetic competencies is a module within the Masters in photographic consent; preceptors in the training or ‘signing off’ ciently internationally flexible to develop Similarly, removing a basal cell carcinoma from a lower eyelid or Aesthetic Surgery Training program (MCh) developed from the 3. Careful patient selection; on the trainee’s competency portfolios. in any ISAPS member country in associ- nose and closing a related wound would not necessarily impart collaborative efforts of the UK Association of Aesthetic Plastic 4. The ability to seek advice and support The examiners were therefore also in a ation with Anglia Ruskin University. Of the full skill set required to understand a blepharoplasty or rhi- Surgeons (UKAAPS) and the Department of Allied Health and from colleagues. position to critically review the trainers course EU qualified plastic surgeons have noplasty. Medicine at the Anglia Ruskin University. The full MCh training “sign off” for the fourteen competencies. A main attraction to the plastic sur- a right to practice in the UK and thence Medical indemnity insurance companies have been very program of 180 credits has Fellowship Program Endorsement The exam is two hours in total and geon participating in this course is the join the UK training program, but for slow to demand evidence of training in cosmetic surgery and by the Education Council of the International Society of Aes- with fourteen competencies, each subject exposure to a complete range of aesthetic non-EU plastic surgeons and those from the resultant collective legal framework of risk assessment is thetic Plastic Surgery (ISAPS). is discussed in just under nine minutes. procedures with demonstrations, assisted more remote countries, the course can be important in their overall calculation of premiums for surgeons. The Fourteen Compulsory Aesthetic Procedures Are: and supervised independent surgery and A pre-Viva discussion of over two hours adapted to run from their home country. Consequently plastic surgeons pay premiums calculated on a 1. Breast Augmentation critical review by appointed preceptors. between the examiners on the presenta- The facility, care pathways and trainer collective risk that includes non-plastic surgeons who may pay 2. Mastopexy Both the supervised surgeon and indi- tion of the candidate’s workbook assists surgeons must be thoroughly assessed very low premiums because they don’t necessarily declare their 3. Mastopexy/Augmentation rectly the training preceptor are ultimately in the process by honing in on specifically by prior visits from the university before whole practice. The difficulty is that plastic surgeons can’t prove 4. Breast Reduction examined at the oral Viva examination related questions. The candidate’s name granting training status. A British univer- that they are any more trained or get better outcomes with lower 5. Liposuction after sign off from the competencies. The has been omitted and the closed marking sity degree still has value and respect. complications than other specialties or indeed non-medical peo- 6. Blepharoplasty oral Viva exam is split into two one-hour system per competency examined is: 50% Plastic Surgeons interested in partic- ple who have attended weekend workshops and gained certif- 7. Facelift sessions describing cases representing is a pass, 51% is a good pass, 49% is a fail ipating in the scheme, either as trainees icates of competency in injectable fillers and botulinum toxin. 8. Innovative Procedures – e.g. I-Guide Neck Suture Suspen- each of the fourteen competencies. The mark that can be neutralized by a good or as preceptors, may contact Mr. Roger This quite simply is because plastic surgeons rarely generate sion, Suture Suspension, Browlift, Gynaecomastia, and But- first seven competencies being assessed pass on another competency and 48% is Acres, Course Supervisor and Lead, data on comparative outcomes nor routinely provide data on tock Implants are preselected by the examinee and the a straight fail that cannot be compensated Anglia Ruskin University, Roger.Acres@ complications or outcomes to the public. final seven competencies are assessed and a retake exam may be offered. anglia.ac.uk

16 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 17 CONGRESS 2016 ISAPS 2016 THE ROAD TO KYOTO: KYOTO JAPAN TWO FESTIVALS ON OCTOBER 22ND Susumu Takayanagi, MD – Japan INTERNATIONAL SOCIETY OF ISAPS President AESTHETIC PLASTIC SURGERY

n October 22nd you will find Kyoto tremendously ary women are represented. Roles of renowned beauties such crowded having two well-known festivals on the same as Yodo-gimi and Shizuka-gozen are played mainly by apprentice O day: Jidai Matsuri during the day and Kurama-no-Hi- geisha girls (Maiko) from the entertainment quarters of Kyoto. matsuri (Fire Festival) in the evening. The ISAPS Congress will They fascinate the audience with their beauty in the proudest begin immediately after these festivals. If you are interested in moment of their lives. www.heianjingu.or.jp/english/0301.html taking this opportunity to enjoy them, you are strongly advised Kurama Fire Festival to make your hotel reservations early. Our headquarters hotel To attend the Kurama Fire will be the Westin Miyako Hotel. Festival, you are advised Please note that both festivals will be held on the next day if it to take a train of the Eizan rains. For inquiries, contact the JTB Western Japan Corporation Electric Railway ahead of ISAPS 2016 desk at [email protected] time. Toward the end of Jidai Matsuri Jidai Matsuri, there will be a This festival includes several related events of which the most growing crowd around sev- famous is the costume parade. Approximately 2,000 people eral Eizan-train stations. in ancient Japanese This is a solemn shrine costumes, beginning ritual performed on a with the late 8th cen- mountain that is about tury and ending with 50 minutes by train from the late 19th century, the center of Kyoto City. parade in the streets Despite the inconvenience and danger often found at this event, in Kyoto City. Paid the Kurama Fire Festival attracts a lot of tourists every year, per- seats for the audi- haps because of the mysterious wooden torches blazing up in ence are provided, the darkness. but these are no There is a series of movies called Kurama Tengu including more than plain fold- a film titled Kurama-no-Himatsuri in the last eight minutes of ing chairs that allow people to secure a place to seat themselves which the Kurama Fire Festival is featured. The film was pro- among a huge crowd. The seats are supposed to be in Kyoto Gyoen duced over 60 years ago and Kurama Tengu, a masked swords- National Garden (Kyoto Imperial Palace), Oike Street and Heian man, became a very popular hero. You can find a short video Jingu-michi, where the beginning of the extracted from the film on the internet, using costume parade is expected around 12:00, search words: Kurama Tengu and Himatsuri. 13:00 and 14:20 respectively. The entire At 18:00, a bonfire called Eji is built parade takes about two hours. The paid in front of each house in Kurama. About in conjunction seats are all reserved with advance booking 21:00, people with wooden torches gather with required. To make a reservation, contact around the gate of Yuki Shrine leading to a http://www.jtb.co.jp/shop/itdw/info/e/ ritual called Shimenawa-kiri (cutting of Shi- The parade consists of twenty groups menawa, a sacred straw rope). This is the representing different eras in the history highlight of the festival which tourists don’t of Japan. The group representing the lat- want to miss. After this, visitors get ready to October 23-27, 2016 est era is in the lead, and the oldest era is go home. However, it is after the end of this at the end. The two most popular groups part that two sacred palanquins (Mikoshi) are the medieval ladies and the ladies of the show up to be carried around the festival area. Venue: Miyakomesse, Kyoto, JAPAN Heian period in which a number of legend- continued on page 21 18 ISAPS News Volume 9 • Number 1 www.isapscongress.orgJanuary – April 2015 www.isaps.org 19 VISITING PROFESSOR PROGRAM

ISAPS VISITING PROFESSOR IN HONG KONG Congress, continued from page 18 ISAPS ESTABLISHES Around 23:15, the sacred palanquins arrive at Otabisho, the des- Foad Nahai, MD, FACS – United States tination of the Mikoshi procession. This arrival is called Miya-iri GLOBAL ALLIANCE ISAPS Past President — Mikoshi’s entrance into precincts of a shrine — and followed by a performance of Kagura (music and dance in dedication to PARTNERSHIP Shinto Gods). At the Kurama station, after 22:30 you can get on n an effort to unite all Aesthetic Plastic Surgery Societies a train without a long wait. The last train leaves from the station into an international working group, ISAPS has begun the was deeply honored and delighted to be invited to Hong the magnificent view from the patients’ rooms, with the green around 0:20. process of inviting our colleagues to work together on com- Kong as a plenary lecturer for the 4th Congress of the World mountains on one side and the sea on the other. After the “ward Kurama is a very I mon issues. Association for Plastic Surgeons of Chinese Descent and as rounds” I presented a formal lecture on “Contemporary Blepha- small town and its main I Agreements have been signed by six societies already, while ISAPS Visiting Professor at both the University of Hong Kong roplasty.” After the discussion that followed the lecture, the fac- road is quite narrow. On others are waiting for their boards to approve. Benefits to our and the Chinese University of Hong Kong. ulty and I left for lunch at the Hong Kong club hosted by Dr. this road, people with Alliance Partners include public relations collaboration, mutu- After a very long, almost 24-hour, but pleasant journey from Gordon Ma where we were joined by our ISAPS National Secre- more than 100 wooden ally planned and implemented educational programs, affili- Atlanta I arrived in Hong Kong at 10 pm on a Monday night. tary Dr. Ming Shiaw Cheng. After lunch, Dr. Wong and I left for torches go back and ation with Aesthetic Plastic Surgery, visibility in ISAPS News, Even at that time of night, during the ride to the hotel I was the Prince of Wales hospital across town, a long drive through forth on the night of the fast track group admission of new members, and a forum of introduced to Hong Kong traffic. Wide awake and looking for- Hong Kong’s traffic which was heavier than expected due to the festival, and over 10,000 alliance partners at each biennial ISAPS Congress. Additional ward to my stay, I saw evidence of the amazing growth since students’ “occupy central” activities. tourists are expected to benefits and strategies to benefit all members of the group will my last visit several years ago. Arriving later than planned come to see them. As it emerge over time. New construction of high rises, at the Prince of Wales, we went is more than 5°C colder Alliance member logos will appear on the ISAPS website roads, and the new under- straight into the conference in Kurama than in Kyoto soon. ground train system were all room. The afternoon was spent City, you should wear too evident. To my surprise, on case presentations in aes- something warm, but so were Christmas decora- thetic surgery. I was impressed make sure to choose flameproof clothes. Also, be aware that tions in early November! The and pleased to see the level of your clothes may get soot-blackened during the festival. Another vitality and hustle and bustle interest in the aesthetic cases thing to note is that it is hard to find restroom facilities in the ISAPS Global Alliance Participating Societies of Hong Kong we all love was that were presented. festival area. π Associazione Italiana di Chirurgia Plastica Estetica unchanged and all around. That evening’s lecture and Although there are both spas and Japanese inns in Kurama, (AICPE) After a comfortable first dinner was held at the Hong it is difficult to make a room reservation during the period of π Australasian Society of Aesthetic Plastic Surgery night, I woke up to the view Kong Golf Club, a beautiful Kurama Fire Festival because of the limited number of accom- (ASAPS) Staff at St. Mary’s of Hong Kong Island across facility with lush gardens. modations. It is recommended that you make a one-day trip to π European Association of Societies of Aesthetic Plastic Victoria Harbor from the hotel Members of the Hong Kong Kurama, to take a train or a taxi (advance reservation required) at Surgery (EASAPS) room — a magnificent view, Society of Plastic Surgeons, the best possible time when the crowd is supposed to be smaller, π Societé Française des Chirurgiens Esthétiques which I could not enjoy for too staff and trainees from both and to walk in areas where taxis cannot enter. To be honest, I Plasticiens (SOFCEP) long as I had to prepare for the hospitals were in attendance. have never seen this fire festival because there are so many peo- π Svensk Förening för Estetisk Plastikkirurgi (SFEP) busy day ahead. The morning I presented a lecture entitled ple and it is not easy to go and come back from Kurama — even π United Kingdom Association of Aesthetic Plastic to be spent with Dr. Joseph “The Role of Evidence-Based though I was born and grew up in Kyoto. Surgeons (UKAAPS) Hon Ping Chung, Dr. George Medicine in Aesthetic Surgery” Li, their trainees and staff at the followed by lively discussion University of Hong Kong St. and a multi-course dinner. Mary’s hospital and the after- After a day of touring Hong ISAPS Board of Directors Meeting – noon with Dr. David S.Y. Wong, Kong, arranged by my hosts November, 2014 – Rome, Italy his staff and trainees at the Chi- with Dr. Josephine Mak as our Board members and Committee Chairs nese University of Hong Kong guide, it was time for the 4th Front row: Gianluca Campiglio, Tom Davis, Prince of Wales Hospital across Congress of the World Asso- Nazim Cerkes, Susumu Takayanagi, Renato Staff at Prince of Wales town. ciation for Plastic Surgeons of Salts, Carlos Uebel. At St. Mary’s, perched high Chinese Descent. I was again Back row: Peter Scott, Ivar van Heijningen, on the mountain side, I made rounds with the group who pre- humbled and honored to be asked to present a plenary lecture at Lokesh Kumar, Tunc Tiryaki, Lina Triana, Kai sented a number of challenging cases. I was not only impressed this prestigious meeting. Schlaudraff, Catherine Foss. with the complexity of the cases and their treatment, but also continued on page 47

20 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 21 PSYCHOLOGY PSYCHOLOGY

PSYCHOSOCIAL ASPECTS OF ple, an individual who forces herself to smile in response to visual References stimuli will rate the stimuli more favorably. Other research has 1. American Psychological Association. Diagnostic and Statistical MINIMALLY-INVASIVE PROCEDURES suggested that restricting the movement of facial muscles asso- Manual of Mental Disorders. 5th ed. Washington, D.C.: American ciated with the expression of negative emotions, such as anger Psychological Association, 2013. David B. Sarwer, PhD – United States or sadness, also can have a positive impact on mood. 2. Sarwer DB, Spitzer JC. “Body Image Dysmorphic Disorder in Per- Professor of Psychology, Departments of Psychiatry and Surgery This is particularly the case for neuromodulators such as sons Who Undergo Aesthetic Medical Treatments.” Aesthet Surg J, Consultant, The Edwin and Fannie Gray Hall Center for Human Appearance botulinum toxins. Botulinum toxin injections can reduce nega- 2012;32:999-1009. Perelman School of Medicine, University of Pennsylvania tive facial expressions and may have a secondary effect of reduc- 3. Sarwer DB, Spitzer JC, Sobanko JF, Beer KR. “Identification and ing the internal experience of negative emotions. At the same Management of Mental Health Issues Among Dermatologic Sur- time, some preliminary evidence suggests that botulinum toxin geons: A Survey of American Society of Dermatologic Surgery injections may improve depressive symptoms in those with a ver the last several decades, a now relatively large body enact legal action or violent behavior directed toward their treat- Members.” Dermatologic Surgery, in press. history of depression.7 This is a particularly intriguing finding. of research has investigated the psychosocial charac- ing physician. In a 2002 survey, almost one-third of aesthetic 4. Crerand CE, Phillips KA, Menard W, Fay C. “Nonpsychiatric Clearly, additional research of this issue, as well as research on teristics of individuals who present for aesthetic sur- surgeons reported that they were threatened legally by a patient medical treatment of body dysmorphic disorder.” Psychosomatics O other minimally invasive facial procedures, is needed to help 2005;46:549-55. gery. Many of these studies have been undertaken with the with BDD; 17% reported that they had been threatened physi- us understand the psychosocial benefits that accompany them. larger goal of identifying patients who may be experiencing cally.5 Almost two-thirds of dermatological surgeons considered 5. Sarwer DB. “Awareness and identification of body dysmorphic psychological symptoms or conditions that would contraindi- BDD to be a contraindication to a facial aesthetic procedure.3 The author has no financial relationship with the manufacturer of disorder by aesthetic surgeons: results of a survey of American Society for Aesthetic Plastic Surgery Members.” Aesthet Surg J cate surgery. While some degree of psychological distress likely Putting the issue of BDD aside, is there evidence to suggest any product mentioned in this article. 2002;22:531-5. motivates the pursuit of an aesthetic surgical procedure, exces- that patients experience psychosocial benefit from aesthetic sive distress or profound psychopathology might contraindicate procedures of the face? While some procedures, such as rhino- 6. Imadojemu S, Sarwer DB, Percec I, Sonnad SS, et al. “Influence a procedure at a given point in time. Other studies have focused plasty, can profoundly impact facial aesthetics, minimally-inva- of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review.” JAMA Dermatol on the psychosocial changes that occur following aesthetic sur- sive procedures often produce subtle and temporary changes 2013;149:1325-33. gery. Many of these studies have documented improvements in to discrete aspects of the face and which may not be readily body image and self-esteem in individuals who have undergone observable to others. Along with colleagues in the Department 7. Wollmer MA, de Boer C, Kalak N, Beck J, et al. “Facing depression with botulinum toxin: a randomized controlled trial.” J Psychiatr the most common surgical procedures, such as cosmetic breast of Dermatology, Division of Plastic Surgery and Center for Res. 2012 May;46:574-81. augmentation. Human Appearance at the Perelman School of Medicine at the In contrast, surprisingly little is known about the psycho- University of Pennsylvania, we recently reviewed this literature social characteristics of the millions of individuals who pres- in an article published in JAMA Dermatology.6 We found a num- ent for minimally-invasive aesthetic treatments. Concerns ber of studies have documented improvements in psychosocial with changes in facial appearance associated with aging likely functioning following facial aesthetic procedures in general, motivate the pursuit of minimally-invasive treatments. At the but we also found a lack of evidence for these changes after spe- same time, excessive concern and body image dissatisfaction cific procedures. The most common procedures — including may suggest the presence of body dysmorphic disorder (BDD), botulinum toxin and soft tissue augmentation — have the least generally defined as a preoccupation with a slight or imagined data suggesting changes in psychosocial functioning. defect in appearance and that is associated with marked distress An unanswered question at this point is how do minimally- CEN, continued from page 6 or impairment in social, occupational, or other areas of func- invasive procedures impact psychosocial well being. One poten- the importance of this comprehensive European Standard, which 16372) could help offer assurances to consumers in countries tioning.1 While BDD is believed to occur in 1-2% of the general tial explanation is that patients who undergo these procedures population, the rate among aesthetic surgery patients has been experience improvements in their physical appearance that sub- was developed through an open, inclusive, multi-disciplinary and where there are no legal requirements in this area. found to range from 7-21%.2 A recent study of dermatological sequently enhance their mood, self-esteem, and body image. The evidence-based process." The CEN Project Committee on 'Aesthetic surgery and aesthet- surgeons found that 94% were aware of BDD in their patients improvements in appearance, no matter how subtle, may allow Speaking on behalf of ANEC, Stephen Russell, ANEC Secre- ic non-surgical medical services' (CEN/TC 403) is currently devel- and 62% indicated that they refused to treat a patient believed the patient to feel more comfortable and less self-conscious in tary-General, says: "ANEC welcomes the publication of EN 16372. oping a separate European Standard in relation to non-surgical to have the disorder.3 social interactions, thereby enhancing ANEC sought the inclusion of consumer relevant requirements in medical procedures (prEN 16844). CEN Members will open public Is there a compelling reason not to mood and body image. Another potential the standard during its development and we consider the standard enquiries in order to invite comments on this draft standard (these treat patients with BDD? More than explanation comes from the facial feed- satisfactory from the consumer perspective. Promoting consis- enquiries are due to be launched at the end of February 2015). 90% of individuals with BDD who back hypothesis. The hypothesis, which tently high standards for aesthetic surgery service providers across report undergoing appearance-enhanc- has a long history in the area of the psy- Europe is increasingly important, as more and more consumers For more information on European standardization in relation to ing medical treatments experience no chology of emotions, suggests that mus- travel abroad for aesthetic treatment." services, please see the CEN website: improvements in their BDD symp- cular manipulations that result in more According to Mr Russell, the new European Standard (EN http://www.cen.eu/work/areas/services/Pages/default.aspx toms.4 These patients also may be the positive facial expressions may lead to ones most likely to threaten or actually more positive emotional states. For exam-

22 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 23 JOURNAL JOURNAL

REPORT FROM THE JOURNAL EDITOR REPORT OF THE 2015 JOURNAL RETREAT Henry M. Spinelli, MD – United States Renato Saltz, MD – United States Editor-in-Chief, Aesthetic Plastic Surgery President-Elect and Chair, Journal Operations Committee

n behalf of the staff at Aesthetic Plastic Surgery (the blue The page count of each issue was increased by 40%. In keep- ur journal has a powerful and dedicated team working top articles of previous issues. It will be his “connection” with journal) I would like to thank its readers, authors and ing with our modern times, APS is fully accessible digitally using behind the scenes to produce our six annual issues. It the membership through our newsletter.) O reviewers for their continued support. We are very the ajax app instituted over the last year. Likewise, all issues are O is the responsibility of the Journal Operations Commit- π Rewrite the Aim & Scope of the Journal (we currently have a excited about the current state of the journal, which has grown accessible to members in the Member Area of our website. tee (JOC) to work as liaison among the publisher, the editor and very antiquated statement that does not really represent what significantly over the past five years under my leadership as Edi- What are the results of just a few of these changes? the board. Once a year, a meeting is arranged by the publisher the journal does today) tor-in-Chief thanks to the efforts of many people. In partnership to review strategy and to inform the JOC about progress and to π The number of submissions has doubled and yet the turn- π Editorial Board revamp (recruit new names to help “market with our publisher, Springer, we have greatly altered the journal plan for the future. This year, the Journal Retreat was held in the around time is at a record low. Selectivity has profoundly the Journal.” Also include multi-specialty names since they since my taking over the helm. increased with fully 75-80% submitted papers rejected. New York offices of the publisher on January 30 and attended by Recently, we had an important meeting in New York City will now be speaking at our meetings and soon will become π The number of active recognized reviewers who have defini- Editor-in-Chief, Hank Spinelli; President, Susumu Takayanagi; attended by the chairman of the Journal Operations Committee, affiliate members.) tive expertise and interest has easily tripled. These dedicated Springer Vice President, Bill Curtis; Springer Publishing Editor, Renato Saltz, and our President, Susumu Takayanagi. Key rep- π Involve ISAPS Course Directors as “Journal ambassadors” men and women are from all corners of the world. Victoria Ferrara; Springer Executive Editor, Antoinette Cimino; resentatives of Springer explained the intricacies and complexi- Executive Director, Catherine Foss, and me. (recruit authors to publish in APS. Hank will work with Lina ties of operating and publishing an international journal and an π Submission downloads of our published articles is fully inter- The day-long meeting provided many insights regarding oper- regarding future courses and approach course directors to interactive, fruitful discussion was engaged in by all of us. national and in geographically in keeping with our society's ations governing our journal and also showed in several ways the help with the Journal. Since they are organizing the meeting, I would like to underscore changes in our journal which have membership. strength of our major publication and primary member benefit. they know of any new technology/techniques being presented occurred and what we are planning in the future. Many, if not π Manuscripts are routinely downloaded equally in North and We came away with a new understanding of the complexities of and will approach the authors in a much more directed way. most, of the changes we have undertaken seem to have been South America, Europe and Asia. We are seeing more African producing the journal and developed strategies to take it to the Therefore, we don’t need to have the editor-in-chief traveling unnoticed or, as Springer executives pointed out, have occurred continent participation as well. next level. What follows is an outline of the discussion and result- to every single course but will have someone representing behind the scenes. In that respect, the meeting in New York City π APS has generated record revenues for this publication to him there.) was very valuable. Furthermore, it gave both Springer and me an ing action items. ISAPS and Springer. π Course Directors to collect presentation summaries (bullets appreciation of the direction of our society. This will enable us to Main Retreat Objectives: These and many other changes have been laboriously insti- of course presentations) and submit to the editor for possible measure if the journal is improving accordingly, within the con- π Define the role of APS in relation to ISAPS’ overall strategic tuted resulting in a quality publication and the results delineated expansion in an article, editorial or topic supplements. text of quality peer review and integrity of the content. plan (multi-specialty meetings and membership) Aesthetic Plastic Surgery (APS) is larger and more diverse than above. In the future, Springer will be providing us with data con- The editor-in-chief was very open to the recommendations π Define the role of APS as a benefit of ISAPS membership ever. One only has to peruse old issues to notice the profound cerning articles which were highly cited and/or downloaded in made by all participants and appeared to be enthusiastic about the recent past that we will share with you. Upcoming articles π Definethe role of APS in the aesthetic plastic surgery commu- changes. the direction we are taking. He was reminded by President that are of special interest to us in the editorial office will also be nity at large We have introduced independent double-blinded peer review Takayanagi that the Board expects to see changes taking place highlighted for the readership. for the first time. Evidence-based medicine (EBM] has been fully π Synchronize with above APS Aims & Scope, Editorial Board within six months of the meeting in Rome. I believe this Journal We at the editorial office are never satisfied with the status quo integrated into our journal. In fact, ours is only one of five jour- composition Retreat was critical and very instrumental in setting the right and we are actively listening to our readership and membership nals in the Springer family of over 700 journals that utilizes path for the Journal, the publisher, and Dr. Spinelli as editor-in for suggestions. Members have already been sent a reader survey Action Items developed: this metric. Our proprietary watch glass icon and numeric scale chief. I am hopeful many of these changes will be already in allows the reader to immediately see the level of cogency of an to determine their opinions of the journal to help us make any π Distribute a Membership Survey (what do our members think place by the next Board Meeting in Montreal in May. article. The description of levels of evidence (I-V) has been pro- needed adjustments. Authors will also be polled in due course. about the journal) As the Chair of the Journal Operations Committee, it is vided to authors, reviewers and readers. At the New York meeting, we noticed that the Aims and Scope π Author Survey (identify why they submitted to APS and their my responsibility to insure that our journal is the best it can The EBM levels were incorporated into the submission pro- of the journal are out of date and will be updated reflecting the interest in digital format) be and, along with my committee members, to work to con- cess and countless hours of altering and instituting many other goals and aspirations of the society, but in keeping with the pur- π Author recruitment letter (invite renowned authors to publish tinually review and recommend changes that will improve this changes to the online submission process instituted during my pose of a peer-reviewed journal. in APS) publication. I call on all members to help us grow and develop tenure, in concert with the Springer group to ensure a fair, objec- Finally the success of APS can only be assured by the active π Demographics (there is interesting the diversity of authorship this important asset. Our education programs serve to advance tive and timely review process. participation of the ISAPS board and the membership. Certainly and readership of our Journal — create strategy to engage We completely changed our editors to represent most special- challenges will arise, given the dual allegiances and obligations of our skills. Our journal serves to represent ISAPS as the leading more authors based on that diversity) ties including dermatology, ophthalmology, urology, gynecology, many of our board and society members. international aesthetic plastic surgery society in the world. Let statistics, law, ethics and basic science, to name a few. In fact, Our society and the journal have enormous strength and we π Use the newsletter to “market” APS. (Hank will have a regular us ALL contribute to make Aesthetic Plastic Surgery the highest APS was significantly ahead of the ISAPS initiative to introduce can capitalize on these together. I look forward to working with column in the newsletter to promote the journal where he will ranking publication in our field. other specialists beyond our core plastic surgeons into our soci- the Journal Operations Committee and our esteemed president. announce top articles coming up in future issues and discuss ety’s family. 24 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 25 GLOBAL PERSPECTIVES: Non-invasive Procedures GLOBAL PERSPECTIVES: Non-invasive Procedures

NORTH AMERICA: UNITED STATES EUROPE: ITALY Nina Naidu, MD Dentists and aesthetic procedures: toward a new regulation in Italy ISAPS Assistant National Secretary for the US Gianluca Campiglio, MD, PhD ISAPS Secretary he demand for non-invasive cosmetic procedures con- The two more “aggressive” (and expensive) technologies which tinues to increase in the United States. According to the I offer include Pellevé® and Ultherapy®. Pellevé® is a radio-fre- T American Society of Aesthetic Plastic Surgeons (ASAPS), quency-based treatment that delivers energy to the dermal tissue. n Italy, the recent recession greatly and work as a dentist. are therefore excluded), and ONLY using there was a 13% increase in non-surgical procedures from 2012 The heat emitted induces collagen denaturation and subsequent reduced the number of patients who Dentists who graduated in medicine products in an on-label way (botox injec- to 2013. The appeal is obvious: no incisions, no scars, minimal contraction, which creates skin tightening. There is a reasonable Iregularly counsult dentists and undergo treat tooth problems, but, as doctors, they tions are excluded as they are currently down-time (if any), and decreased cost. In my own practice, I amount of literature supporting its safety and effectiveness for oral treatments. In the meantime, many can also perform any other medical pro- considered off-label in the perioral area). have gradually shifted away from facelifts and towards minimally the treatment of fine wrinkles. Patients do see an immediate students continued to take up this career cedure, including aesthetic medicine. The debate is still open as odontologists invasive and non-invasive procedures of the face and neck. This result, which is typically sustained following three treatments which once was very profitable. This has Because of the current laws, nothing can rejected this advice and their lawyers are decision was influenced by two factors: 1) the growing number of spaced one month apart. It takes 30 minutes to perform, is resulted in a marked decrease of the mean be contested if these professionals decide considering an appeal against the Health patients who request facial rejuvenation without the use of sur- painless, and can be done in conjunction with other non-inva- yearly income of such professionals so to inject botox or fillers or perform a laser Minister. gery, and 2) the addition of an experienced and aggressive aesthe- sive procedures. I have been generally pleased with the results that many of them have decided to offer resurfacing. Unfortunately, in the last Apart from the legal points, the safety tician to my practice. Unless a patient has significant skin laxity of Pellevé® treatments, although both the machine and dispos- various aesthetic procedures that were tra- years odontologists (who are not medi- of the patients should be the touchstone of or platysmal banding, I advise them that a number of non-surgi- able supplies are expensive. Ultherapy® uses intense, focused ditionally included in the armamentarium cal doctors) also started to offer aesthetic any final decision by the health authorities. cal regimens are available. I advise patients that while these treat- ultrasound energy to create thermal injury zones deep to the epi- of plastic surgeons. procedures in the oral region stating that Injection of fillers or botox requires proper ments can never replace surgery, they are a good starting point, dermis for non-invasive lifting of the neck, brow, and submental Currently in Italy two different types this was permitted as they are performing training and in-depth clinical experience and do not preclude me from performing surgery in the future if regions. Unfortunately, I have been relatively unimpressed by of dentists can treat dental problems. The them in the anatomical area of their com- especially where it concerns the preven- the patient wishes to move forward. Ultherapy®. The treatment is painful, and somewhat costly for first and larger group includes odontolo- petence. This conduct raised a legal issue tion and treatment of potential complica- In my practice, I currently offer professional facials, chem- the patient ($2,000-3,500 USD). Although results are seen, they gists who concluded their five-year degree between core specialists (plastic surgeons tions. Companies and private schools are ical peels, microdermabrasion, dermabrasion, microcurrent, are not, in my opinion, dramatic enough to justify the very high at specific schools for dentists according and dermatologists) and odontologists currently offering odontologists short and Pellevé®, and Ultherapy®. Facials, chemical peels, and micro- cost of the machine and its disposables. I have avoided lasers and to European law. The second group con- which has been recently cleared by offi- intensive courses which cannot be consid- dermabrasion have the benefit of gently introducing patients to fat dissolution machines in my office, as they are both - expen sists of physicians who have been admit- cial advice of the Italian Health Minister. ered appropriate for these purposes. Sec- what can be achieved non-invasively. In addition, they allow the sive and readily available in almost every spa in New York City. ted to medical universities (six-year degree According to this document, odontologists ondly, the present insurance for odontolo- patient to begin a maintenance regimen for healthy skin which Having an experienced aesthetician in the office is very helpful courses) before the institution of these can offer aesthetic procedures ONLY as a gists does not cover any “aesthetic” risk so will enhance any surgical outcome. Dermabrasion is a tool in both promoting and performing these treatments. Although specific schools for odontologists in 1985. completion of a program of oral care and the patients (as well as the professionals) which is under-utilized by plastic surgeons in the United States, I perform dermabrasion myself, my aesthetician is trained in all This limited group will gradually disap- not with a pure cosmetic purpose, ONLY would not be properly protected in case of although it is widely used by dermatologists. This is my pro- of the other modalities. Without her, I frankly wouldn’t have the pear in the next years as, since then, it is if addressed to correct lip defects (cheek, litigation. cedure of choice for addressing the fine wrinkles above the lip time or patience to perform these procedures. no longer allowed to graduate in medicine nasolabial folds and labiomental folds which plague many women over the age of 50. Microcurrent was Despite our desire as surgeons to be in the operating room introduced to me by my aesthetician. Electrodes are placed on delivering immediate, dramatic results, we need to acknowledge the surface of the skin, and low electrical impulses are delivered the growing demand for and role of non-invasive procedures. If Global Perspectives — Future Themes which supposedly tone muscle and provide a temporary “micro- we don’t add these techniques to our arsenal, we will quickly lose July – Optimizing Wound Healing and Scar Quality lift” of the face. While there is good data that demonstrates the patients to our non-surgical colleagues and the growing number utility of microcurrent in inducing wound healing, its use for of medi-spas. November – Current trends in Liposuction and Lipoplasty cosmetic applications at this time remains anecdotal. Nonethe- If you would like to contribute an article of 500-750 words, please forward to [email protected] less, patients are pleased with the immediate results, and the The author has no financial relationship with the manufacturers of machine costs less than $1,000 USD. any products mentioned. This is a non-referenced opinion piece of several paragraphs giving your observations and perspectives on the topic. What do you do in your practice? What unique approaches do you use? What do you see your colleagues doing in your region?

26 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 27 GLOBAL PERSPECTIVES: Non-invasive Procedures GLOBAL PERSPECTIVES: Non-invasive Procedures

EUROPE: UNITED KINGDOM EUROPE: FINLAND Nigel Mercer, MD – United Kingdom Timo Pakkanen, MD, PhD Past President, BAAPS and BAPRAS ISAPS National Secretary

t Bristol Plastic Surgery, our plastic surgeons work patient who has a bad experience will put five others off coming ccording to the ISAPS statistics, non-invasive therapies therapies being gradually shifted away from plastic surgeons to closely with two cosmetic doctors, Dr. Rita Rakus (aka to you. As a result, the deeper fillers are done by our cosmetic have been gaining popularity in recent years. The same non-core practitioners and non-physicians. The industry-driven A The London Lip Queen), her young associate Dr. Sher- medical colleagues and the surgeons do the surgery. Having the A trend applies in Finland. Considering the phenomenon marketing together with still lacking legislation is causing seri- ina Balaratnam and a nurse injector in delivering state-of-the art broad breadth of experts means that the patients can choose who known as 7-47 effect, we as plastic surgeons cannot afford to lose ous safety concerns all over Europe. The ultimate goal for the injectables and skin rejuvenation. Before any facial rejuvenation looks after them in the knowledge that the treatment (‘simple’ this rapidly growing market. In Hospital Siluetti, we are among manufacturers for maximal distribution would undoubtedly be surgery, the patient will have an assessment of their individual BONTA and fillers) will be delivered in exactly the same way. the top three private clinics using lasers in Finland. an “inject yourself” home kit. needs to get their skin in as good condition as possible. This We are not great fans of putting a lot of fat into faces. We always We have used CO2 laser for years for cutting purposes in the From a physician’s or clinic’s point of view, these non-inva- usually takes the part of Hydrafacial to start with for cleaning ask to see pictures of the patient in their 20s or 30s to allow us operating room. For peeling and resurfacing, we shifted from sive procedures have become a valuable source of income as the skin and preparing it for topical skin products. Depending to assess what has happened to their facial volume. NONE of CO2 and Erbium to 2790-nm erbium:yttrium-scandium-galli- the devices can be operated (under a physician’s supervision) on the skin damage and laxity we may also recommend the use our patients want the risk of ‘pillow face’ or of fat from another um-garnet (Er:YSGG), but occasionally still also use CO2 laser. by nurses and staff members, thus increasing their productivity of RF (Thermage) and occasionally peels, which are usually TCA anatomical site gaining weight as they age. We use 1064-nm Nd:YAG (neodymium-doped yttrium alumin- while away from the operating theater. The remaining challenge based. We found the side effects after phenol and croton oil were We believe strongly that it is always better to under treat a ium garnet; Nd:Y3Al5O12) for vascular lesions, hair removal and is to find the right tools from the marketing jungle as only a few such that patients, whilst liking the effect on lines and skin tone, patient and top up if necessary. to treat facial redness (Cutera Cool Glide, Lasergenesis). of the devices survive through serious peer-reviewed studies. A really did not like the need to stay away from the sun afterwards. We use RF with 810nm diode laser or RF with 915nm infra- new device also needs to pay for itself before the competitors We use only FDA approved injectables for their safety pro- The author has no financial relationship with the manufacturers of red therapy for hair removal and skin tightening (Syneron E-max arrive with even newer models. file and we believe in running a very safe practice. Any single any products mentioned. DSL, -Matrix IR). Also 1100-1800nm infrared device (Cutera Titan) is used for skin tightening. IPL is used mainly for vascu- The author has no financial relationship with the manufacturer of lar or pigmented lesions (Cutera LimeLight 520-1100nm, Acutip any products mentioned in this article. 500-635nm) and hair removal (Cutera Prowave (770-1100nm). The devices for hair removal are operated by our beauticians. EUROPE: BELGIUM As an alternative for laser resurfacing, we also use chemical Ivar van Heijningen, MD peels, such as TCA. These therapies usually consist of three to five consecutive treatments performed by our nurses. Guess who! ISAPS National Secretary for Belgium and Membership Committee Chair Laser skin resurfacing — being performed in the operating theater — is often combined with face lifting procedures or fat ortunately, in Belgium the majority of procedures are the plastic surgery community, but there is an increased inter- grafting under general anesthesia. When performed as a solo done by registered specialists mainly dermatologists and est with the large number of patients electing non-surgical procedure, local anesthetic and/or anesthetic cream can be used. plastic surgeons. But the group of non-core doctors have treatments. The periodical skin tightening therapy and repetitive fat grafting F sessions are also great options to be able to offer your patients to worked hard to obtain a better position. This resulted in a law It is of utmost importance that we as a specialty embrace stating that “specialist in non-surgical aesthetic medicine” will non-surgical treatments which are an important part of aes- maintain the facelift result. be added to the list of specialties. However, where and how this thetic medical procedures. We need to offer these because we For fat dissolution we currently use Ultrashape 3, which is a specialty will be trained remains unclear. are better trained, know anatomy better, and thus get better combination of external mechanical suction, RF and ultrasound. The term “non-invasive medical treatments” is suggestive that results if we focus on this area. We also need to ensure that we This device is a perfect alternative for some patients, but most of these procedures are light, but a deep TCA peel or ablative laser are “in touch” with these patients when they decide on surgical all it also brings customers requiring liposuction to our clinic. treatment is more invasive to the patient than a simple upper options. Depending on the accumulating scientific data, we may consider blepharoplasty. The more important that proper training for a fat-freezing device in future. these procedures is ensured, since they are definitely invasive. The author has no financial relationship with the manufacturer of We use IR (infrared), bi-polar RF (radiofrequency) and vac- Toxins, HA-fillers and laser procedures are the most fre- any product or device mentioned in this article. He is on the faculty uum device (Vela Shape 3) for cellulite treatment and post lipo- quently offered treatments in Belgium. Other devices such as of the Allergan Medical Institute. suction therapy. RF treatments, LED and Coolsculpting® are scarce for sure in The most popular non-invasive therapies are injections (botu- linum toxin and fillers) whose popularity has sky rocketed in the See page 51 for details. past ten years in Finland. The general trend also indicates these

28 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 29 GLOBAL PERSPECTIVES: Non-invasive Procedures GLOBAL PERSPECTIVES: Non-invasive Procedures

ASIA: SOUTH KOREA MIDDLE EAST AND MEDITERRANEAN: DUBAI David Daehwan Park, MD Luiz S. Toledo, MD – United Arab Emirates ISAPS Assistant Chair of National Secretaries National Secretary for United Arab Emirates

ven if lipoplasty remains the most performed procedure Currently, I use two primary ways to resurface the skin of the or the last two years, I have been very happy with the Coolp- beginning one feels pressure and intense cold. It soon disap- in western countries, periocular rejuvenation is the most periorbital area: fractionated carbon dioxide and IPL (Intensive las treatment in my office. It is an alternative to liposuction pears - in a few minutes. Sessions last from forty-five minutes E common procedure in Asia and specifically in Korea. Pulse Light). I don’t use RF treatments or chemical peels. F by fat freezing. The machine is based on the cryolipolysis to one hour. Patients read, watch TV, play with their phones, or Asian periocular rejuvenation includes the use of all non-surgi- A combination of invasive and non-invasive technologies is technology. The cold energy under accurate control will be deliv- even take a nap during the treatment. They can return to normal cal and surgical technologies. also increasing abruptly. Anatomical classification and staging ered to selected fatty areas via a non-invasive cold energy device. activities right after the treatment, since it is non-surgical. Some Non-invasive periocular rejuvenation is increasing rapidly in is a powerful tool for the selection or combination of proper The fat treated by cold energy will consequently lead to apoptosis patients experience redness, minor bruising, tingling, numb- the Asian region. Botulinum Toxin Type A and fillers are most non-operative and operative procedures. Proper analysis and (a form of cell death necessary to make way for new cells,) and ness or discomfort in the treated area, but this is temporary and common non-surgical procedures for periocular rejuvenation. slow technique is needed in non-invasive procedures. will be slowly removed from the body through normal metabo- will resolve completely. Korean doctors use three Korean-made Botulinum Toxin Type lism, without any damage to other tissues. The only disposable is the gel pad, which costs around four A: Botulax, Neuronox and Nabota. Hyaluroidase is frequently The author has no financial relationship with the manufacturers of The new machines with CE certification come with three dollars each. I already bought my second machine. It keeps the used for filler dissolution. any products mentioned. different arms, with two different sized curved applicators for office busy and patients who come for the procedure usually end different areas, such as abdomen, flanks and back, and with one up undergoing other aesthetic treatments while they are there, flat applicator which can be used for thighs and other areas. We such as Botox and fillers. Some patients decide to have other can use two applicators simultaneously. I am now treating up to surgical procedures. I photograph, measure and weigh patients six areas per session. during every visit to help document a noticeable reduction of fat The cryolipolysis machine is a skin cooling device, which in the treated area. After the initial treatment is complete, it is THE mainly works for resolving the stubborn fat and reshaping upper possible to have further reductions with additional treatments, arms, back, abdomen and flanks. According to the thickness of resulting in even more fat loss, after one or two months. Some the fat, the system has three different size arms and five modes patients find that just one treatment fully addresses their goals. utting dge 2015 with five different temperatures and treatment times. As long as the patient maintains a normal diet and exercise, the C E result should be permanent. In the beginning, I was skeptical of the treatment, but seeing TH 35 AESTHETIC SURGERY SYMPOSIUM my results made me change my attitude. Patients start seeing results after one month, but final results are seen two months THE WALDORF ASTORIA HOTEL - NEW YORK, NEW YORK DECEMBER 3, 4, 5, 2015 after the application. Patients are happy. They keep coming for COURSE CHAIRMEN: SHERRELL ASTON, MD DANIEL BAKER, MD more and referring friends.

WILLIAM ADAMS JR., MD JORGE HERRERA, MD STEPHEN PERKINS, MD Contraindications: Treatment with Coolplas is not indicated for MARCELO ARAUJO, MD ALFREDO HOYOS, MD SANDY PRITCHARD, MD patients who present any of the following conditions: hernia, abnormal bleeding time, during pregnancy or lactation period, FRITZ BARTON JR., MD DENNIS HURWITZ, MD DIRK RICHTER, MD JEFFREY KENKEL, MD Raynaud’s disease, patients with pacemaker or who have recently JOSEPH CAPELLA, MD ROD ROHRICH, MD VAL LAMBROS, MD OSVALDO SALDANHA, MD undergone abdominal surgery. Other contraindications are the NURI CELIK, MD presence of infected wounds, eczema, dermatitis, or other skin STEVEN LEVINE, MD GRANT STEVENS, MD Liposuction procedures that use laser or ultrasound to remove CHRISTOPHER CHIA, MD problems. RICHARD LISMAN, MD SPERO THEODOROU, MD fat require downtime for the body to heal. One of the advantages MICHAEL EDWARDS, MD MICHAEL LONGAKER, MD CHARLES THORNE, MD of Coolplas is that it targets fat cells alone, eliminating them in JACK FRIEDLAND, MD The author has no financial relationship with Sincoheren, the man- G. PATRICK MAXWELL, MD STEVEN TEITELBAUM, MD an easy, non-invasive manner that exercise and diet can’t achieve ufacturer of the Coolplas system. MARCO GASPAROTTI, MD CONSTANTINO MENDIETA, MD DEAN TORIUMI, MD as quickly or as effectively. The treatment is not painful. At the ASHKAN GHAVAMI, MD FOAD NAHAI, MD LINA TRIANA, MD PER HEDEN, MD WARWICK NETTLE, MD SIMEON WALL, MD Faculty in Formation http://thecuttingedgesymposium.com/

30 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 31 GLOBAL PERSPECTIVES: Non-invasive Procedures FEATURE SKIN CARE SPECIALISTS: AN INTEGRAL PART SOUTH AFRICA OF YOUR PLASTIC SURGERY PRACTICE My experience with minimally invasive and non-ablative surgical procedures: Thermage Renato Saltz, MD – United States ISAPS President-Elect Ewa A. Siolo, MD (Warsaw), MBChB (Natal), FCS Plast (SA) ISAPS Assistant National Secretary wenty-two years ago, a group of aes- The skin care business within plastic sur- As the SPSSCS moves forward, the focus thetic plastic surgeons recognized gery has become a necessary, revenue-gen- will remain on education and the advance- ment of the science and art of skin care and use Thermage, a nonsurgical, non-ab- I am observing are on a younger group of in contour and cellulite appearance. The T the need to provide an educational erating adjunct to the aesthetic surgeons’ skin health. The members of the SPSSCS lative procedure for facial rejuvenation patients (35-45) with thicker and less wrin- effects can vary from patient to patient and forum for the emerging specialty of plas- patient portfolio, complementing and will continue to work alongside their sur- as an office procedure that can be done kled skin. Males are also responding to generally is assessed as 5-20% improve- tic surgical skin care. It was their belief supporting their cosmetic surgical prac- I that a team approach can enhance and tices. Surgeons who have implemented geons to aid in safe and effective care for without anesthesia. Although oral analge- treatment with better final results. This is ment in skin elasticity. Unfortunately that their patients. Just think - if every plastic sia can increase patient pain control and due to thicker and better vascularized der- cannot be guaranteed so patient expecta- deliver better patient care, collaborating these services know that many surgical surgeon were aware of the SPSSCS, and offers very mild sedation to decrease anx- mis in male patients. tion must match the occasional unpredict- and forming a unified organization for the and non-invasive procedures began in the made a commitment to having their skin iety, I personally do not use sedation or The level of discomfort that patients ability of the result. ancillary staff that supports the aesthetic aesthetician’s suite. care specialists become a part of this elite local topical anaesthetic as patient comfort may experience during the treatment The benefit of this procedure is that surgeon’s practice. The aesthetician’s position on the prac- organization — how successful the out- level is an indicator of the effectiveness of depends on the level of energy applied. patients are usually complimented as Today, the Society of Plastic Surgical tice team isn’t limited to the introduction come would be. the procedure. In some areas, this may be more easily less tired looking or questioned if they Skin Care Specialists (SPSSCS) plays a and uses of a skin care product. Today, My nurse and three master aestheti- Adjusting the level of energy is crucial. tolerated that in other areas such as bony returned from holiday because results are seminal role in the education, training and skincare professionals integrate and coor- cians have attended the Skin Care Soci- It needs to be kept at the border of patient prominences or nerve exits from the facial obvious but subtle. That gives patients a service improvement of plastic surgery dinate the use of adjunct technologies ety Annual Meetings. They benefit from discomfort and pain threshold to assure a skeleton that may cause greater discom- lot of confidence as looking youthful with- practices throughout the United States. such as lasers, permanent makeup, tattoo- it in so many ways, but especially they visible immediate result. Moisturizing the fort and pain. The physician doing the out being accused of vanity or fighting the ing, injectables and peels to produce the learn from doctors, nurses, and other aes- skin with special gel is very important as procedure should pay attention to the ageing process. best results for their clientele. Success in theticians what works and what does not this assures a proper contact area of the tip patient’s reactions to maintain strict and Thermage addresses only elasticity of disseminating the technical knowledge for skin care, treating pigmentation and to the skin conduction of radiofrequency proper application of the tip’s surface the skin. Recent trends in facial rejuve- and expertise, as well as the business other skin conditions. They enjoy the wide waves. It is helpful to do one side of the area to the skin. Because there is a risk of nation emphasize replacement of volume savvy in packaging and marketing skin variety of panel speakers, the multidisci- treated area first and compare it with the causing superficial burns, I strongly rec- which cannot be addressed with tighten- care services has led to recognition of their plinary approach to education and find the untreated side so the patient gains confi- ommend this procedure be done by the ing sagging skin. So the next step in get- innovative thinking, and greater respect meetings very informative. dence in the procedure. physician him or herself. ting optimal results is a combination of for their skills and expertise. The SPSSCS 21st Annual Meeting is on It is very important to explain to the Although Thermage is a non-surgi- volume replacement and skin tightening. Today, The Society of Plastic Surgical May 12-15 in Montréal, Québec, Canada. patient that the final result requires 4-6 cal and non-invasive procedure, compli- Modes of treatment of volume depletion Skin Care Specialists is an elite group, For more information please visit http:// months to properly show obtained rejuve- cations can be expected. These include are fillers and autologous fat transfer. A known internationally for its drive for www.spsscs.org/microsites/meeting2015/ nation. In my observations, the original, immediate superficial burns, prolonged few studies have already investigated tis- knowledge, science and professionalism. index.php immediate result of smoothness of the erythema, or transient neuropraxia. Later, sue interactions of monopolar RF heating skin may relapse 2-3 weeks after the pro- soft tissue depressions and nodules can with commonly used fillers. It is appar- cedure as initial swelling and inflamma- appear, or there can be a lack of expected ent that there is no increased risk of local tion settles. This is the time when patients results. burns or observable effect on filler being South Africa, continued from page 32 can become disappointed because they Thermage as a non-surgical treatment persistent in the tissue. RF also does not don’t see the expected result. The only way for sagging skin and cellulite is a popular cause any structural changes in fillers. Thermage has proven to be useful for a specific group of patients who want subtle to deal with this is to reassure the patient procedure in North America and Europe. In my practice, I like a combination of results with no downtime. I find it very satisfying in combination with minimally inva- and keep good standardized photographic It is a “lunch time” procedure providing Thermage and autologous fat transfers, sive surgical techniques which provide volume restoration like fat transfers. examples. the patient with improved skin elasticity usually about three weeks post-Thermage Patient satisfaction with treatment is high as long as they are properly counseled This is not a surgical procedure where with minimal downtime. Remodeling of when any possible inflammatory reaction about expected results. Thermage is a very good adjunct to cosmetic practice. I enjoy control of the final result is easily obtained collagen leads to clinically visible improve- to Thermage wears off. Due to the con- doing the procedure as I can see immediate response of treated areas and long term during surgery and predictability of results ment in aging skin in its quality and tents of adipose derived stem cells, vas- follow up will give me even more satisfaction. is much higher. Different age groups, dif- elasticity. Remodeling of deep collagen cularity of soft tissue improves and the ferent genders and different types of skin in fibrous septae connecting dermis and quality of skin improves dramatically due The author has no financial relationship with the manufacturer of any product or device men- give different results. For example, results fascia of the muscle allows improvement to formulation of new collagen. tioned in this article. continued on page 33 32 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 33 HUMANITARIAN HUMANITARIAN

© sional and compassionate medical establishments has been an needed most. At such time when opportunities arise, we eagerly ISAPS-LEAP SURGICAL RELIEF TEAMS UPDATE honor. We can only hope that each of these organizations have await coordinating with new and returning volunteers. Should Ryan Snyder Thompson – United States been blessed with an equally positive experience of our surgical you have questions regarding the upcoming mission calendar team members. and/or how you can support those ISAPS-LEAP Surgical Relief Director of International Disaster Relief, LEAP Foundation As prospective avenues for future surgical missions develop, Teams©, we look forward to hearing from you. For information, we anticipate expanding our work around the world where it is contact me at: [email protected]

s ISAPS-LEAP Surgical Relief Teams© continues to pur- As for chronic injuries and wound management, ISAPS-LEAP sue and develop new mission opportunities for 2015 and surgeons focused primarily on returning as much mobility and A beyond, we wish to highlight the achievements of 2014. functionality to the patient as possible. To keep expectations low, Participating in surgical missions to Jordan and Lebanon, an our teams sought to give their best working with patients who international collective of 27 plastic, reconstructive and aesthetic had often received less than adequate care for injuries sustained, surgeons and six surgical assistants representing 14 countries in some cases more than two years prior. Particular attention was evaluated more than 381 patients and treated 233 for all manner given to instruct and assist with proper wound debridement and of war-related injuries, both acute and chronic. dressing including, when available and appropriate, the proper use of negative pressure dressing therapies, and delayed primary or secondary closures. While ISAPS-LEAP Surgical Relief Teams© was not initially established to provide surgi- cal services in the midst of man-made civil conflicts, we felt that the need to assist a pop- ulation of war-wounded persons represented LEAP Foundation volunteer surgeon Dr. Burt Faibisoff (back ISAPS USA member surgeon Dr. Diane Duncan (center left) a unique opportunity to offer disaster relief left), LEAP Foundation Director of International Disaster Relief and ISAPS France member surgeon Dr. Emad Dannan (center services particular to our international com- Ryan Snyder Thompson (back right), Rosemary Jacobs, CST right) with Jordanian OR personnel during Jordan Mission 5. munity of surgical specialists. In so doing, (front left), ISAPS USA member surgeon Dr. Gary Jacobs (center) and Jordanian plastic surgeon Dr. Firas Neshwati at this innovation to the ISAPS-LEAP program the conclusion of Jordan Mission 3. has enabled us to help a population of people far more numerous than those our volunteers directly treated. We must also consider the lives of patients’ family members who have Dr. Jamil Ahmad (ISAPS Canada) finalizing a donation of surgical supplies to the likewise benefited from our charitable sur- ISAPS-LEAP DONATIONS administrative staff of Treating the Wounded Syrian Program in Amman during Jordan gical services. As our teams have witnessed We gratefully acknowledge the generous donation provided by Dr. Giovanni Botti (Italy) of $40,000 Mission 16. first-hand, the return of health, function- in support of the ISAPS-LEAP Surgical Relief Teams© efforts that are highlighted in this issue of ality and a semblance of the normalcy that ISAPS News. The funds are held in an income generating account with our investment advisors at was present prior to the Syrian war is a gift Morgan Stanley. Invited as consultant surgeons to work alongside organiza- enjoyed by whole families. We have created a link on our website home page to make donations easily through ISAPS. Each tions including the Treating the Wounded Syrian Program, the This measure of success would not have been possible without donor will be sent a receipt for tax purposes. Donations are tax deductible, but we recommend that Syrian Medical Relief Office, and the Syrian-American Medical the dedication and generosity shown by our volunteer surgeons you check with your own financial advisor on this point. Society, our volunteers have significantly increased the surgical and assisting medical professionals who graciously gave of their Each donation is matched at twice its value by our partners at Marina Medical who provide sur- capacity of these host programs. In the case of acute and trau- time and talents to participate in these surgical missions. Our gical instruments to our mission teams. We appreciate your donation of money, time, supplies, and matic wounds, ISAPS-LEAP surgeons provided expert level care success to date demonstrates the strength of this valuable part- even frequent flyer miles to help our volunteers reach our mission destinations. alongside hosting general, orthopedic and burn surgeons. While nership between the LEAP Foundation and ISAPS. We celebrate Donations can also be made through the LEAP Foundation. the absence of key equipment and instrumentation have thus far the international diversity of surgeons who have thus far brought prevented the use of free flaps, teams routinely preformed a vari- tremendous skill and resources to the program. We also wish to ety of local flaps, which incidentally provided unique educational thank again each of the aforementioned humanitarian partners opportunities for our hosts. and their hosting hospitals. To have worked with such profes-

34 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 35 FINALISAPSLEAPFullPageAd022515.qxd:Layout 1 2/25/15 4:25 PM Page 1 HUMANITARIAN

AICPEonlus RECOGNIZED BY THE PRESIDENT OF THE ITALIAN REPUBLIC Claudio Bernardi, MD – Italy President of AICPEonlus, ISAPS member Marina Medical is proud to partner in the joint collaboration between ISAPS and the ICPEonlus, the non-profit association of the Italian onlus had to interrupt a few missions already planned in Togo, LEAP Foundation to train, Association of Aesthetic Plastic Surgery, received a but created the new “Ebola Emergency Project,” which provides equip, connect and deploy donation from the president of the Italian Republic. financial assistance to the hospital of Afagnan, Togo, to set up an Surgical Relief Teams© A (SRT) of highly-skilled plastic Not only is this an effective economic aid, but also an important insulation area, which is now lacking, in order to isolate possible and reconstructive surgeons for short-term sign of recognition of our association and its aims. This is the early cases of infection. disaster relief medical missions. purpose of the 3,0001 contribution that the non-profit associa- Meanwhile, we have planned two humanitarian missions, tion AICPEonlus, a branch of AICPE (the Italian Association of one in Paraguay (Marco Stabile, treasurer of AICPEonlus and Your generosity to ISAPS/LEAP means more than Aesthetic Plastic Surgery), dedicated to humanitarian activities ISAPS member) and a second in Guatemala (Claudio Bernardi), ever.Your donation for instrument purchases will be DOUBLED by Marina Medical during the in plastic surgery, has received by the Presidency of the Italian pending continuation of those already started in Togo which will months of April, May and June of 2015. Visit our Republic. probably resume in May 2015. website for details. Such contribution is also a major incentive for our associa- Lastly, there has been a large number of patients from many tion to continue to implement our projects. (ISAPS News Vol. Asian countries and western countries visiting Korea for rhino- Join Marina Medical, the surgeons we champion and the many volunteers of the ISAPS-LEAP 8, No. 1, p. 25 – www.isaps.org/Media/Default/newsletters/8_1_ plasty. Thus the Korean plastic surgery market has been focusing Surgical Relief Teams© in providing medical NL_int-1.pdf ) on medical tourism because the domestic situation has slowed support worldwide. Following international alarm about the outbreak of the Ebola down and become highly competitive! virus that has affected some countries in West Africa, AICPE- To volunteer or for additional information please contact: Catherine Foss, Executive Director of ISAPS Phone: 603-643-2325 Email: [email protected] Bringing Relief. Saving Lives. http://www.leap-foundation.org/about/disaster-relief Make your donation today!

Partnering with highly-skilled surgeons dedicated to the noble art of healing is an inspiration. Marina Medical offers Dr. Constantino G. Dr. P. Craig Hobar In January 2010 the construction of a dispensary building in Aného, April 2014: The Centre de Secours Medical Fernando Giardinetti Mendieta Plastic Surgery, Togo begins. is ready to start clinical activity. innovative surgical instrumentation Founder and Medical designed and inspired by these ISAPS Plastic and Reconstructive Surgery Director for LEAP members. Visit our online community Miami, FL USA Dallas, TX USA and see what’s new! Improve the visibility of your Dr. Nazim Cerkes Dr. Alfredo Hoyos Dr. Tunç Tiryaki practice website! Rhinoplasty and Facial Plastic and Aesthetic and Aesthetic Plastic Surgery Aesthetic Surgery, Regenerative Surgery Link your practice's website to your profile on the ISAPS website. Istanbul, Turkey Pioneer of High-Definition London, UK Create more patient traffic to your practice. Cost is $100 per year. Liposculpture Istanbul, Turkey Bogotá, Columbia Contact the ISAPS Executive Office for information or select weblink when you pay your dues on-line. www.marinamedical.com • 954.924.4418 x104 • se habla español

©Copyright 2015 Marina Medical Instruments, Inc. January – April 2015 www.isaps.org 37 HISTORY HISTORY

morning. I detached with a lancet on my that followed, this pale border extended JAQUES REVERDIN, THE FIRST SKIN GRAFT? own leg two to three fragments of skin more and more to form a little pale and Fig. 3 – Reverdin showing his collection of as thin as possible and placed them on a thin islet quite analogous to the epider- butterflies to a colleague in 1920 HISTORY OF A SURGICAL INNOVATION granulating wound of one of my patients. mic border which has formed along the edges of the wound. Denys Montandon, MD – Geneva, Switzerland I secured it with tape and a dressing and Today, December 8, it is observed, that Why is Reverdin considered the waited for the result with anxiety. After a the islet is notably enlarged and the few days, my previsions had been totally inventor of wound practically healed. Gentlemen! Anyone who has — at any time — studied the process of wound healing will always skin grafting? confirmed; not only the small pieces had taken and were solidly adherent, The 28-year-old Reverdin then con- remain interested in this topic. Therefore, the beautiful invention of Reverdin’s seemed to me an invi- Although there have been numerous but around them new skin was forming, cludes: tation to take up again my earlier researches in the healing process of wounds. —Carl Thiersch, 1874 reports and anecdotes of replantation of growing day after day at a distance from Such are the facts that I have the honor portions of skin since the 16th century, the borders of the wound.” to submit to the Society of Surgery. I report them now as a matter of record, Reverdin showing his collection of This case report would have remained his acknowledgment of Reverdin’s invention was pub- but I pledge myself to pursue these butterflies to a colleague in 1920 lished five years after the first skin graft presentation by unnoticed if Félix Guyon, Reverdin’s researches. I will have to study as closely Tthe Swiss surgeon, Jaques-Louis Reverdin, at the Imperial chief, had not decided that it should be as possible the histological process: Is Surgical Society of Paris. During these five years, skin grafting reported as soon as possible to the Impe- it a simple result of contact, of environ- had become a routine procedure all over Europe for treating it was never presented and published rial Academy of Surgery in order to pren- ment? Is there proliferation of the trans- and accelerating the healing process of granulating wounds. in a well-known medical academy. On dre date (a means of fixing a date). This planted elements? Here are many ques- another hand, the interesting experi- was done the 8th of December 1869 and tions, which deserve some researches Who was Jaques-Louis Reverdin? that I intend to undertake. mental studies published by Giuseppe published three months later in the Bulle- Born in Geneva in 1842, Jaques Reverdin, like most of his Baronio in 1804 and by Paul Bert in 1863 tin of the Society with the commentaries of No wonder, several questions and French-Swiss colleagues, studied medicine in Paris because were performed only on animals. Johann the eminent surgeons who had attended commentaries were very critical and there was no medical Friedrich Dieffenbach had stimulated the presentation. would have discouraged many young sur- faculty in his city at that geons from pursuing further research. the latter to study skin grafting following Greffe epidermique— time. Already “Interne a visit to Claude Bernard in Paris. The expérience faite dans le service π M. Trélat: M. Reverdin believes that epi- des Hôpitaux” in 1865, he renowned Berlin surgeon had written de M. le Docteur Guyon, dermic proliferation must be attributed was working at the Hôpi- to the graft. In order for this experiment Professor Gosselin and his interns at the Charité in 1870 his doctoral thesis on skin transplanta- à l’hôpital Necker. tal Necker in 1869, under tion in 1822, but admitted that he failed to have a real value, it would be necessary Gentlemen: The communication, which I the direction of Félix to succeed in performing a free graft in for it to be repeated a great many times, have the honor to make to the Society of Sur- and that it nearly always succeeded. It Guyon, a young chief-sur- credited to be the first to have noticed, before Theodor Kocher, humans. In 1869, the young Reverdin gery, pertains to a very common question of is necessary, in fact, to exercise on this geon who became in apparently had not read these publica- another Swiss surgeon from Bern, the symptoms of hypothy- pathology, apparently well understood, but 1876 the first professor point a very great amount of reserve. roidism after extensive thyroidectomy and gave it the name of tions. As he explained later on, the idea which still presents some obscure and inter- of urology at the Fac- π M. Blot: From the practical point of view myxedema, suspecting an endocrine function of the gland. In came to him from another German sur- esting points for elucidation. I refer to the cic- ulty of Paris. During the the question of the epidermic graft, or 1908, he was invited to present his experience and observations geon: “I had read in the surgical lessons atrization of wounds by second intention . . . that of the Malpighian or mucous layer, Franco-Prussian war in on this subject in a major surgical meeting in Chicago. But in of Billroth that sometimes islets of cica- A detailed description of the case appears to me to be of no importance. To 1870, Reverdin, although 1909, it was Kocher who received the Nobel price for his work trization can develop at a distance from report and the result obtained was then remove a piece of dermis from the arm Jaques Reverdin in 1870 Swiss by nationality, col- on thyroid! the wound borders in burns or varicose produced: or elsewhere to unite it to the surface of laborated with the French For cleft palate surgery, Reverdin created a needle for sutures ulcers. The apparition of these islets November 24, I tried the following exper- a suppurating wound which is slowly cic- army, at the head of the arose in spots where the deep dermis which bears his name and is still commonly used in Europe. In iment: I removed with the point of a atrizing, just to save a little healing time, “Swiss Ambulance” in Paris, treating many wounded soldiers. layers had been spared. The idea to imi- 1881, with two other colleagues, he founded the Revue Médicale lancet from the right arm of the patient is to expose the patient, above all in our Back in Geneva two years later, he became chief-surgeon at de la Suisse Romande,* which he then edited for 38 years. He tate such a process surged in my mind three small slivers of epidermis. I placed hospitals, to the danger of erysipelas. the Hôpital Cantonal de Genève and the second professor of briskly one night; I told myself: could we retired from the University and the practice of surgery in 1910 my epidermic slivers in the middle of the π M. Léon le Fort: I share completely the surgery in the newly created Faculty of Medicine at the Univer- and started a new career as a lepidopterologist (the study of not, by placing small fragments of living wound, their deep surface in contact with opinion of M. Blot. The recent wounds sity. He was the first Swiss surgeon to recognize the importance butterflies), founding the Swiss Society of Lepidopterology and epidermis on the surface of a granulating the granulations and I supported them borne by the patient from which the epi- of Lister’s antiseptic method and introduced it in the Geneva publishing 49 papers on this subject until his death in 1928. wound, stimulate the creation of islets of with some dichalon bandelettes. dermis had been taken were re-covered hospital. In 1884, he wrote a book on surgical antisepsis and cicatrization? Would these small pieces December 1, the skin slivers have united by a reddened crust showing that at least asepsis and in 1910 a book on war surgery. During his 34 years of epidermis adhere? There was only and form a little pale white plaque; there a bloody discharge had followed. There- fore, the epidermis alone had not been of professorship, he published many papers, mainly on surgery * In 2014, the Revue Médicale de la Suisse Romande remains the most widely one means to know; it was to attempt the has evidently grown a small epidermic of goiters, in which he had acquired a large experience. He is read journal by general practitioners in French-speaking Switzerland. experiment. I made this attempt the next zone around each of them. In the days continued on page 40

38 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 39 HISTORY MEMBERS WRITE

History, continued from page 39 and Longaker, ”innovation is a broad term defined I WANT TO BE THIS WAY: removed; a fragment had been taken comprising capillaries and ious skin grafts. as the act of introducing something new or the a new book dedicated to our patients use of a new idea or method. In some instances, a door opened for erysipelas. As to the utility of the method, it The second mistake is more striking. How can we explain is without importance, even granting that one can cast here and it is used synonymously with invention, although Gianluca Campiglio, MD, PhD that he never realized that long-term all his allografts would there a sort of seed, which by germination on the spot will result in innovation is more precisely defined as something fail? “I often took the skin fragments on myself, to graft them cicatricial islets. This cicatrix will have, like all others, a tendency thought up or mentally fabricated. Importantly, no on patients who would refuse the operation, thinking that it was to contraction, and this autoplasty cannot replace that to which, technology or its application is entirely new, as no plastic surgeon in Milan (Italy) and painful. In our first grafts, I had taken the tegument on the sub- for example, one has recourse to prevent the scar retraction of an inventor works within a vacuum. The discoverer has ISAPS Secretary, recently edited a book ject himself, but I became soon assured that the result was the eyelid which could result in ectropion, or one of the face causing a often proceeded by analogy.” Reverdin followed the dedicated to aesthetic surgery patients. deformity. same when transplanting grafts from one subject to another; A observations of Billroth on the healing of wounds Written with an Italian journalist in a simple, clear, this fact has been abundantly demonstrated . . .” The same Léon Lefort published two years later a case of eye- of unequal depths, where islands of epidermis are but at the same time very scientific way, it is 150 lid ectropion’s correction using a skin graft harvested from the In fact, for decades, almost every surgeon believed that a skin growing from the remaining skin adnexae. He did pages long and contains many pictures of clinical arm! transplant could be harvested on another person or even on ani- not care about theory; he just wanted to improve the cases. As he promised, Reverdin undertook a series of researches mals. The use of cadavers or amputated limbs as donor sites was healing of his patient. Once it had been published, A preface by a professor of sociology describing performing more than fifty skin grafts in humans and study- common and was almost never questioned until the nineteen he realized that his idea could lead much further. the evolution of the concepts of beauty and attractiveness during the centu- ries enriches the book. The first part analyzes eight common myths about ing experimental grafting in animals in the same laboratory as twenties. Winston Churchill recorded a famous homograft in Surgical innovations may be incremental, mean- aesthetic surgery such as the risk of explosion of breast implants during Paul Bert, the medical experimental lab of the Collège de France, his memoires. To replace a nurse who was fainting when asked ing that it marginally improves upon currently avail- flights or of poisoning after Botox injections. In each case, the origin and directed by Claude Bernard, the founder of experimental and to give a piece of her skin for a wounded officer during the bat- able technology, or enabling, leading to further devel- reasons why the information is incorrect is scientifically explained. scientific medicine. For his memoire of 69 pages, published tle of Omburmann in 1898, heroic Churchill offered himself: opment of new procedures within a field. Reverdin’s The second part refers to important practical suggestions on how to in the Archives générales de Médecine, Reverdin received the Prix “The doctor then proceeded to cut a piece of skin and some needle is an example of incremental innovation, approach aesthetic surgery including the choice of a properly trained Amussat of the Academy and, in November 1872, Claude Ber- flesh about the size of a shilling from the inside of my forearm. whereas the idea of skin grafting wounds belongs surgeon, limits of medical procedures, and typical categories of patients nard himself presented Reverdin’s memoir at the Academy of I managed to hold out until he had cut a beautiful piece of skin definitely within the field of enabling innovations, who consult a plastic surgeon’s office. Another myth is that our patients Science. with a thin layer of flesh attached to it. This precious fragment opening not only on the field of the various meth- are only actresses or aristocrats while most of them are normal, mentally During the same two years, Reverdin, who was not yet thirty, was then grafted on to my friend’s wound. It remains to this day ods of skin grafting, but also on other tissues and healthy persons of every age and social background. started visiting other surgeons who had tried to perform skin and did him lasting good in many ways. I for my part keep the organ transplantations. During his experiments, The third part lists the main surgical and non-surgical treatments cur- grafts: Billroth in Vienna, Pacchiotti in Milano, and Pollock in scar as a souvenir.” Reverdin was also particularly concerned with the rently available for aesthetic improvements of facial and corporal defects. London where even in a journal his visit had been announced: Even more surprising is the fact that many surgeons, par- observations that the transplanted islets of skin were The book concludes with data from several research studies about the “to flatter my pride, they had imagined to announce in a medical ticularly ophthalmologists, claimed to practice successful xeno- growing and the epidermal cells spreading to cover positive effect of aesthetic surgery on the self-esteem and sexual life of journal the presence of my noble person in London. Noblesse grafts, using frog skin for eyelid repairs. Reverdin himself the wound: “The grafts, once adherent, the islands patients and with a report of the personal experience of a psychologist oblige!” recorded the use of rabbit’s periosteum in a case of partial nasal continue to grow, depending on the general state of who has also been a breast augmentation patient. The book is written in plasty. In the 16th century, Tagliacozzi was already doubtful in the patient and the local status.” What were the mistakes of Reverdin? Italian and is currently available in libraries and on line. this matter: An ex alieno corpore, an vero ex proprio tradux eligen- The concept of cell culture was born. Considering nowadays the publications of Reverdin on skin dus fix?* grafting, one must conclude that he made two mistakes: 1) Even References Ollier, the father of bone and periosteal grafts, was in favor of though he called it epidermic graft, he was transplanting pieces 1. Lexer Erich: “Free transplantation.” Ann Surg 60 Aesthetic Plastic Surgery in Asians: allografts, but against the use of xenografts. One had to wait for of epidermis with some dermis. 2) He pretended that he took :166-194, 1914 Principles & Techniques Lexer’s publication in 1914 to put serious doubts on the perma- skin from his own leg to cover the wound of his patient, and 2. Mazzola Ricardo: “Giuseppe Baronio and the origins nent viability of allografts or between different species. But even Lee L.Q. Pu later on claimed successful grafts from Negros to Whites, from of free Skin grafting.” ISAPS News 10/30/2013 at that time, Alexis Carrel, Nobel Prize winner in 1912 for his rabbits to men, to cats, from man to sheep and to other species, 3. Montandon Denys: “Jaques Reverdin, la première π Focusses on the differences in surgi- research on organ transplantation, claimed that he had grafted while we know that these allografts could never have survived. greffe de peau.” Edilivre, Paris 2014 cal techniques when treating Asian successfully skin from a black dog to a white one! The first mistake is mainly a matter of language that the sur- 4. Reverdin JL: “Greffe épidermique. Expérience faite patients, as well as procedures specific geons attending his first presentation had immediately noticed. Why has this so-called “invention” become dans le service de M. le docteur Guyon à l'hôpital to this group He admitted that he could not harvest only epidermis, “it is Necker.” Bulletin de la Société Impériale de Chirurgie de a landmark in the practice of surgery? π Contributors from Asian regions share almost impossible to do otherwise,” but insisted on the impor- Paris pendant l’année 1869, 10: 511-515, 1870 The state of art of our profession is a compendium of surgi- their signature procedures tance of the epidermal cells for the healing of wounds. This cal methods, which have been selected among thousands of 5. Riskin DJ, Longaker MT, Gertner M, Krummel TM: wrong appellation gave the opportunity for others to claim new “Innovation in surgery. A historical perspective.” Ann π Over 2500 drawings and photos innovations brought throughout the ages. According to Riskin inventions or innovations (Pollock 1870, Lawson 1870, Ollier Surg. 244 :686-693, 1996 π Includes four DVDs showing surgical

1872, Lefort 1872, Thiersch 1874, Wolfe 1875, Krause 1893 and * Is it possible to take skin from another person, and if this is possible, will techniques many others). Already in 1884, Emil Bock, an ophthalmologist, it be more successful and advantageous ? No: the single character of each π Includes searchable e-version had collected more than 200 published articles describing var- individual speaks against the harvesting on another one.

40 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 41 IN MEMORIAM IN MEMORIAM

Yves-Gerard Illouz, MD instability with a huge need for recognition. As early as 1986, liposuction was the second most common more than ever. We worked together in my office surgery from (1929-2015) – France In his last book, A la recherche d'Aphrodite, Illouz cites this procedure performed in the US and by 1987 it would become 1994 to 1999 and when he decided to stop we agreed to tell sentence of François Jacob, winner of the Nobel Prize in medi- the most practiced intervention by the combined specialties. patients who telephoned that Dr. Illouz was not retired, but that Contributed by cine: “Inspiration, the spirit of synthesis, patience but also inge- It is common to see some countries or some authors claim he had simply decided to cease to operate for now and dedicate Dr. Jean-Claude Dardour nuity are components of scientific discovery. . . . Researchers to be the first to describe certain techniques or certain diseases. himself to research. Translated from the French are adventurers, science is bound to unusual minds, discovery This was never the case for liposuction. I thought it was a simple flirtation, but actually that was remains the triumph of singularity, the achievement of an indi- Regarding the evolution of the technique itself, we can say exactly what he did. There were more congresses, more confer- Y-G Illouz was born in 1929 in Oran, vidual.” This sentence seems created to describe this man. that the only notable changes that have appeared since the orig- ences, and more books written since 1999. Algeria into a modest family. At that We know his career better after liposuction because this inal description have been the use of increasingly fine cannulas But there was also the man: his qualities, intelligence, sim- time, Jews who had acquired French citizenship in 1870 by the invention was a veritable Big Bang as much for us in the field of that allowed the exploration of virtually all parts of the body. So plicity and even the flaws. Y-G was not a saint — far from it. Crémieux Decree wanted one thing: to integrate and become plastic surgery as for his personal and professional life. far, all processes invented to improve it did not really prove their He was a faithful friend who never failed — I never heard him “true French.” For this, it was necessary to study and in this Assuming that it was this tool that created the technique, superiority. speak ill of anyone — but he was also impulsive, versatile and milieu that meant to become a doctor or lawyer. He told me and not the reverse, we can say that liposuction is not a tech- Since 1980, another adventure began creating his interna- especially impatient, the opposite of a contemplative. He always that one of the major traumas of youth was the abolition of the nique but a tool which allowed fabulous progress not only in tional celebrity, his travels around the world, and global recog- needed to go fast, he needed to move, he needed to change. Crémieux Decree from October 7, 1940 until 20 October 1943 cosmetic surgery, but also in all areas of reconstructive surgery nition both by his peers and by the general public. In conclusion, we wish to thank Y-G Illouz for the funda- by the Vichy Government. At the age of 11, for three years, he by a better understanding of the fatty tissue of the cutaneous For Y-G, surgery was his life, his passion. Ceasing to operate mental progress he brought to plastic surgery, but also for his lost his French nationality of which he was always proud. vasculature and the consequences of subcutaneous dissection. was not for him synonymous with abandonment of the medical contribution making France shine all over the world. In 1945, he was sixteen years old when he decided to go to Y-G was recognized very late by his peers, as he had no time community. On the contrary, he began to publish and to teach France to continue his studies, first in Montpellier, and then to be part of the Seraglio. Yet I was always amazed to see what the following year in Paris. These years were not easy for him, patience, one can even say how selflessly, he agreed to receive national and international conferences and was a Visiting Pro- with no money and without his family. He took courses in phi- the first colleagues who believed in him, and then secondarily Prof. Dr. med Johannes Franz Hönig fessor in the USA and Japan. He possessed longstanding expe- losophy to achieve a diploma at the Sorbonne University — not those who had criticized him. (1956-2014) – Germany rience and qualifications and his work was honored by interna- surprising to those who knew his knowledge in this area. As always, the mysteries of life have shown the character that Professor Dr. med Johannes Franz tional organizations. When I met Y-G in 1980, some said then that he was not most know today. In the years 1977-78, an idea was in the air in Hönig studied in Münster, Ulm, Lon- He was admitted to, among others, the “Who’s Who in Med- a surgeon and therefore his publications could not be trusted. surgery — to remove fat through a small hole, without making don, Paris, Brussels, Geneva, Würzburg icine and Healthcare,” “Who’s Who in Science and Engineer- It is true that the first photos, presenting the liposuction tech- large scars: a challenge having seen at this time many more or and Göttingen and was professor at the ing” as well as “Wer ist Wer.” Moreover, he was an advising nique that he had developed, were not truly of a quality consid- less fanciful publications involving real disasters. This is where Georg-August-University in Göttin- member of the European Academic Commission in Brussels ered as “professional.” Y-G had the brilliant idea to develop this simple, effective tech- gen from 1996 until his death, where and was added to the “Leaders of Plastic and Aesthetic Surgery” On completing his thesis on acute breast cancers, he gradu- nique, without risk, that the world knows today: emulsify fat by he instructed in the field of plastic and in 2004. He was a member of the German Society of Plastic, ated and settled quickly into private practice, but, and this was injecting hypotonic serum and aspirate via cannula by making reconstructive surgery. Reconstructive and Aesthetic Surgery, International Society of one of his character traits, he was constantly looking for new tunnels and applying continuous suction. This idea occurred to Professor Hönig was an internationally-renowned special- Aesthetic Plastic Surgery, American Society of Plastic Surgeons, things. In 1965, he realized his dream of creating his own clinic him in order to meet the request of a pretty young woman who ist in plastic surgery who developed and refined many new American Society of Maxillofacial Surgeons, European Associ- that he built in Montrouge, a suburb of Paris. He maintained wanted to remove a large lipoma without scar. surgical techniques that are today part of accredited surgical ation for Cranio-Maxillo-Facial Surgery, Association of German this practice for only five years before he left to practice in The principle of the technique of liposuction is so basic that methods, such as the endoscopic-video assisted facelift. He Aesthetic Plastic Surgons, and the German Society of Aesthetic Réunion. Fate led me to operate in this clinic at the beginning it could be developed and practiced simply using a cannula, a had countless patients and developed the “biological” frac- Surgery. of my own practice in 1978. Little did I know that our paths tube, and a vacuum machine. As for the postoperative period, ture treatment through stabilizing the bone fracture frag- Professor Jannes Franz Hönig died on December 24th, 2014. would cross again two years later and that we would remain complications are the exception, always related to the techni- ments with punctiform osteosynthesis plates (Multi-Point- friends thereafter. cian, never the technique. The technique is so simple that a Contact-Plate), also establishing this in trauma surgery. Y-G would stay less than two years in Réunion to operate, number of general practitioners have unfortunately pierced Training in the USA led to specialist knowledge, including as one might imagine, in rudimentary conditions, but would the body which sometimes resulted in fatal complications. In the use of diverse and customized operational methods. undertake a variety of procedures combining general surgery, France, it was necessary to legislate liposuction to prohibit prac- Mario Vahos, MD Prof. Hönig made a name for himself in treating facial defor- orthopedic surgery, reconstructive surgery, labio-nasal cleft sur- titioners who are not surgeons from practicing this procedure. (1929-2014) – United States mities, lip and facial clefts, facial profile and nose correction gery and surgery to treat after-effects of polio. The first publication of Illouz’s technique of liposuction through transposition osteotomies of the craniofacial bones, as Long-time ISAPS member, Mario Vahos After the death of his father, he returned to settle in Paris is dated 1979. The following one is from 1980 in the Revue well as in the field of reconstructive surgery after tumor dis- passed away on December 28, 2014. He again. It is there in 1971 that we can see his name appear among Française of Chirurgie Esthétique and then in PRS in 1983. In eases and trauma surgery. was a highly respected pioneering plastic the founders of Doctors Without Borders alongside those of our 1988, we contributed to the drafting of several chapters of his Professor Hönig researched in the field of aesthetic and plas- surgeon at St. Agnes Hospital and other colleagues Bernard Kouchner and Jacques Béres. This would be book, La sculpture chirurgicale par lipoplastie (Churchill Living- tic surgery with a focus on the treatment of age-related changes. area hospitals in the Greater Baltimore the beginning of numerous trips around the world both private stone), followed the same year by the English edition. In 1988, He was the author of over 200 scientific publications, released area. He is survived by his children, Victo- and professional. he published in Aesthetic Plastic Surgery the results of injections multiple instructional videos, gave more than 100 lectures at ria and David and his wife, Alexa. Two character traits seem essential to understand Y-G Illouz: of fat in about 167 cases carried out from 1983 to 1987.

42 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 43 IN MEMORIAM IN MEMORIAM

Sergey Nudelman, MD (1956-2014) – Russian Federation Benito Vilar-Sancho Altet, MD stage. In 1983, the 7th ISAPS Congress was held in Montreal Former National Secretary for Russia (1924-2014) – Spain and he was elected as president of ISAPS, ultimately organising the 8th Congress of ISAPS in Madrid in 1985. Dr. Sergey Nudelman passed away on of the major Beauty Medicine Forum. Don Benito (as he liked to be called) was He joined an array of plastic surgery associations, delivered December 7, 2014 in Ekaterinburg, Dr. Nudelman earned great respect of his colleagues and born in Valencia 90 years ago into a fam- speeches at congresses and symposia, and became chairman of Russia after a long fight with a chronic trust of his patients for his professional honesty and decency. ily with a long tradition of medical prac- the UEMS, where he approved the name change of our special- illness. In July 2014 Sergey Nudelman was awarded the title of the tice. His grandfather was a doctor, his ity to include the term AESTHETIC. In 1992, he chaired the Dr. Nudelman founded the Cos- Honored Doctor of the Russian Federation by a Presidential father an ENT specialist and one of his IPRS World Congress, where he also successfully adopted the metology and Plastic Surgery Center Decree. In November 2014 he received the “Golden Lancet” uncles a dental surgeon. He graduated word aesthetic into the name of the International Confedera- which is now the largest clinic of aes- National Prize in aesthetic medicine for his contribution to the with distinction from the Valencia School of Medicine and then tion, it being renamed IPRAS. thetic medicine in Russia. It was thanks development of plastic surgery. moved to Madrid to undertake doctoral studies. In 1950, he saw In 1960, the National Centre for Surgical Specialities was to his pursuit of excellence that many Sergey Nudelman loved Ekaterinburg, which was the most Sir Archibald McIndoe perform surgery in Madrid, which influ- created and he won the official selection process to be named Western surgical innovations and pio- beautiful and interesting town for him and he did everything for enced him so much that he left his budding ear, nose & throat director. From then on, he worked at the former Pavilion neering technologies, such as facial endoscopy, were first intro- its prosperity. He participated in various social charity projects. career to engage in plastic surgery at the Queen Victoria Hospi- Number 8 of the Madrid School of Medicine on all kinds of duced in his clinic in Russia in the mid-1990s and early-2000s. He was known among artists and musicians as a connoisseur tal in England, alongside McIndoe and Mr. Percy Jayes. treatments: post-burn scars, congenital malformations, skin In October 2014, the clinic celebrated its 25th anniversary. and patron of arts. He liked literature, music and fine arts of He returned to England on several occasions to further his tumours and post-mastectomy reconstruction. He trained Sergey Nudelman was the first Russian plastic surgeon who different genres and supported cultural institutions, artists and studies, visiting Professor Kilner, Mr. Pet and Harold Gillies. numerous resident doctors and worked with a team of highly- joined the International Society of Aesthetic Plastic Surgery in labor veterans. Many outstanding musicians, singers and poets, From day one, he was fully dedicated to plastic surgery and his experienced plastic surgeons. 2000. Serving as the ISAPS National Secretary (2000-2008), including Nikolay Petrov, Boris Berezovsky, Daniel Kramer, doctoral thesis “Surgical treatment of partial-thickness scalp It was commonplace for surgeons from both Spain and he opened the doors of this prestigious society for his Rus- Andrey Voznesensky and Georgy Garanian gave friendly con- defects” was perhaps one of the first in this speciality. abroad to come and observe his work. Visits were constant both sian colleagues. Dr. Nudelman was also an international active certs in his clinic. He had a taste for authentic things and a After the creation of the National Institute of Medicine at Pavilion 8 and at his private consultations, especially to wit- member of ASAPS and a board member of the Russian SPRAS. brilliant sense of humor. and Workplace Health and Safety in September 1952, he was ness rhinoplasty surgery, a technique that he mastered and that In 1996, Dr. Nudelman initiated an educational course However, his top priority was his family and children. His appointed Head of Plastic Surgery. From then onwards, he paid his own father, Dr. Rafael Vilar-Sancho imported in 1922 from in plastic surgery. The knowledge and experience of world- wife Irina was always by his side. His two daughters, Alexan- particular interest to congenital facial malformations, publish- Germany, after seeing Dr. Joseph operate. renowned plastic surgeons became available for Russian sur- dra and Nataliya gave him adorable grandchildren. Sergey was ing a classification of the cleft lip and palate and a procedure for He performed his last nose operation in 2007, the crowning geons including those practicing in remote places in the coun- a caring son, a loving husband and a wise father. unilateral cleft lip surgery. point of forty years of practice. He retired to his beloved Ibiza, try. Sergey Nudelman considered this course to be his mission This is a great loss for all his family, friends and colleagues. In 1956 he founded, along with Doctors Álvarez Lobel, José where he would sit in the spacious library of his house in San and a matter of professional honor. Over time, this course has We will miss this extraordinary man, who changed the lives of Sánchez Galindo and José Antonio Soraluce, the Spanish Soci- Antonio Bay, looking out to sea and recalling his other great become a biannual international meeting and an integral part so many of us for the better. ety of Plastic Surgery (SECPRE). His knowledge of French, Ger- passions: sailing, spearfishing and diving. He passed away on man, English and Italian enabled him to travel the world and 21 December 2014 and was buried beside his mother, wife and rub shoulders with leading figures of the time. This also allowed two of his children. Peter Randall, MD (1923-2014) – United States geons, the American Cleft Palate Association and the Robert him to organise and chair firstly the European Plastic Surgery A man of immense culture, sharp intellect, extreme gentle- H. Ivy Society. He was a member of the International Society Congress, then the World Aesthetic Surgery Congress and finally Peter Randall, 91, was an innovator in the ness and subtle English humour, he has left a profound mark of Aesthetic Plastic Surgery, the American College of Surgeons the World Plastic Surgery Congress, all of which were held in field of cleft palate surgery who brought on Spanish medicine and plastic surgery in particular. and the unique Pithotomy Club. www.pithotomy.com. Madrid and thrust Spanish plastic surgery onto the international his skills to patients in Philadelphia and abroad. He died on November 16 at his Dr. Randall traveled the world to train doctors and nurses to home in Pennsylvania. perform reconstructive surgery. In India, he operated on lepers Dr. Randall, a former chairman of to restore the use of their hands, and during the war in Vietnam the departments of plastic surgery at the he volunteered to teach local surgeons how to perform skin Hospital of the University of Pennsylva- grafts on burn patients. nia and Children’s Hospital of Philadel- Through several tours with Operation Smile, Peter, with his phia, focused his research on the repair wife, Posey, and multidisciplinary medical teams, traveled to and reconstruction of facial deformities, especially cleft lips and China, Israel, Vietnam and India to work with cleft lip and pal- palates. ate patients. His service and compassion changed the lives of He helped to develop one of the most robust training pro- thousands of patients. grams for plastic surgeons in the United States and founded “Peter loved his work, and he loved to teach. He was driven the Cleft Palate Clinic at Children’s Hospital. In the late 1980s, by a deep faith and compassion to help his fellow man,” his Dr. Randall battled the Federal Trade Commission against gov- family said in a tribute. Outside the operating room, Dr. Randall ernment criticism of board certification. was cheerful and gentle. He was an enthusiastic singer, gar- He was past president of the American Society of Plastic Sur- dener, birder, and sailor.

44 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 45 IN MEMORIAM

Lieutenant Colonel Awni Abu Lail (1970-2014) – Jordan Visiting Professor Program, continued from page 20

Contributed by Dr. Samer Haddad The impressive opening ceremonies included a Dragon Dance and a warm welcome from Dr. Wing-man Ko, the secre- On the 8th of December 2014, the Jorda- Dr. Awni was known for his happy demeanor, one could tary of food and health, Government of Hong Kong. This large nian Royal Medical Services lost one of its never be sad around him. He was always helpful in more ways gathering of plastic surgeons of Chinese descent from all over finest plastic and reconstructive surgeons than could be counted. He was considered a genius in com- the globe included many of my world-renowned friends and — Lieutenant Colonel Awni Abu Lail. puter technology and therefore took charge of organizing Royal colleagues such as Prof. Yi-Lin Cao, Fu-chan Wei, Yu-Ray Chen, Dr Awni died in the operating theater Medical Services conferences whether national or international. Andy Lee, Lee Pu and David Chiu. I reflected on the significant while preparing to operate on a patient. He was approached by his friends and acquaintances and their contributions that these thought leaders and many more of the He was 43 years old. families to help with computer issues and he would fix it for faculty in attendance have made to our specialty. It was a privi- Dr. Awni was born on the 15th of them no matter how difficult or time consuming it would turn lege for me to be amongst them, to listen to their talks, and to December 1970. He completed his sec- out to be. He simply did not know how to say no to anyone. share ideas. ondary education in Zarqa, Jordan. He Dr. Awni was a member of many distinguished societies I was asked to present a talk on “The Future of Plastic Sur- Fellowship opportunities attended medical school at the university of science and tech- including the International Society of Aesthetic and Plastic gery” which is a challenging topic that I enjoyed preparing and nology in Irbid, Jordan. After graduating from medical school Surgery and the Jordanian Society of Plastic and Reconstruc- presenting. Following two days of presentations in dual sessions, Anglia Ruskin University in the UK offers an MCh in 1994, he joined the Jordan Armed Forces Royal Medical Ser- tive Surgeons among many others. He was well acknowledged the meeting concluded with a Gala Dinner on the well known program in Aesthetic Surgery. Some members vices where he did his residency in general surgery after which and appreciated by many members in those societies who knew boat restaurant “Jumbo.” provide informal fellowships in their practices, he sub-specialized in plastic and reconstructive surgery. During him on a personal as well as professional level and who were My thanks go to friends and colleagues whom I have already clinics and academic settings. Our website lists those 20 years he was often deployed as part of a Jordanian very saddened by this great loss. mentioned and to Dr. Daniel Lee for their generous and warm programs offered by ISAPS members that accept medical mission with the United Nations’ peacekeeping force Dr. Awni did not believe in normal working hours. When- hospitality. Whilst I will soon forget the heavy traffic and the plastic surgeons for short periods of training. to many war-stricken countries such as Eritrea, Lebanon, Iraq ever he was awake he was working. His loyalty to his job and mist that seemed to hang around during my visit, the friendship Please contact the program directly for more and the Palestinian territories. He did so without ever complain- friends sometimes came at the expense of his health and his and kindness will remain with me ’til I next have the fortune of information. ing; on the contrary, wherever he went, he was always content, family. He left behind a young wife and two lovely children. For returning to Hong Kong. To see the current list or to add a fellowship that glad and proud to be of service to his country and humanity as anybody who had the pleasure of knowing him, although gone, Finally, I offer my gratitude to ISAPS for selecting me as a your facility offers, go to Medical Professionals at a whole. he will never be forgotten. Visiting Professor. the top of our homepage www.isaps.org and click on Fellowship Programs.

Survey, continued from page 11

π 27 said their national society requires that their members π 24 felt that medical tourism is a positive factor in their coun- practice in accredited facilities. 32 reported that this is not a try; 21 said it is a problem; 10 said they are indifferent, and 3 requirement. said this was not applicable for them. π 57 (98%) supported the suggestion that ISAPS members π 39 reported seeing patients with complications from surgery should be required to operate in accredited facilities. 43 (86%) performed in another country once or twice a year. 14 said they thought that the members in their country would support an saw such patients once or twice a month. 2 reported seeing ISAPS membership requirement that they operate in accred- patients with problems once or twice a week. ited facilities. ISAPS considers Patient Safety and Education the two primary π The majority reported that there is no patient safety committee purposes of our overall mission. Based on the responses to this in their country or society. However 42 (80%) said that they survey, the Committee will to continue their work to advance use patient safety guidelines in their practice. patient safety among our members. π 47 (82%) answered yes when asked if we should have more content at ISAPS courses and congresses on the topic of patient safety.

46 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 47 CALENDAR CALENDAR

May 2015 DATE: 18 SEPTEMBER 2015 – 19 SEPTEMBER 2015 January 2016 October 2016 Meeting: 8th Mediterranean DATE: 14 MAY 2015 – 19 MAY 2015 Congress of Aesthetic Surgery – DATE: 22 JANUARY 2016 – 24 JANUARY 2016 DATE: 23 OCTOBER 2016 – 27 OCTOBER 2016 Meeting: ASAPS/ASERF Annual Meeting & ISAPS Board Focus on the Face Lift and the Face Anti-Aging Meeting: ISAPS Course – India Meeting: 23rd Congress of ISAPS Location: Montreal, QC, CANADA Location: Montpellier, FRANCE Location: to be determined, INDIA Location: Kyoto, JAPAN Contact: American Society for Aesthetic Plastic Surgery Email: [email protected] Contact: Dr. Lokesh Kumar Contact: Catherine Foss Email: [email protected] Tel: 33 4 42 54 42 60 Email: [email protected] Email: [email protected] Tel: 1-800-364-2147 Website: http://www.atoutcom.com Tel: 91-112-922-8349/91-114-16-37-288 Tel: 1-603-643-2325 Fax: 1-562-799-1098 Fax: 91-114-610-4541 Fax: 1-603-643-1444 Website: http://www.surgery.org/professionals DATE: 26 SEPTEMBER 2015 – 29 SEPTEMBER 2015 March 2016 Meeting: ISAPS Course & Cadaver June 2015 2016 date to be announced Workshop – Czech Republic DATE: 10 MARCH 2016 – 12 MARCH 2016 Meeting: ISAPS Course – DATE: 04 JUNE 2015 – 06 JUNE 2015 Location: Prague and Brno, CZECH REPUBLIC Meeting: ISAPS Course – Qatar United Arab Emirates Meeting: ISAPS Symposium – Nice, France – Contact: Gabriela Malá Location: Doha, QATAR Location: Dubai, UNITED ARAB EMIRATES Immediately preceding the 28th SOFCEP Congress Email: [email protected] Contact: Dr. Habib Al-Basti Contact: Dr. Venkat Ratnam Bandikatla Location: Nice, FRANCE Tel: +420 725 809 870 Email: [email protected] Email: [email protected] Contact: SOFCEP Website: http://www.isapsprague.com Tel: 974-493-5699 Tel: 971-2-617-9741 Email: [email protected] Fax: 974-442-5550 October 2015 Fax: 971-2-631-7303 Tel: +33-05-3431-0134 April 2016 Website: http://www.congres-sofcep.org/ DATE: 08 OCTOBER 2015 – 10 OCTOBER 2015 Meeting: ISAPS Course – Serbia DATE: 12 APRIL 2016 DATE: 10 JUNE 2015 – 14 JUNE 2015 Location: Belgrade, SERBIA Meeting: ISAPS Symposium – Argentina Meeting: Vegas Cosmetic Surgery and Aesthetic Dermatology Contact: Drs. Violeta Skorobac Asanin & Dana Jianu Location: Buenos Aires, ARGENTINA Symposium & International Breast & Body Symposium Email: [email protected] Contact: Cristina Picon Location: Las Vegas, Nevada, UNITED STATES Tel: 381-11-244-3152 Email: [email protected] Contact: Delphine Hepp Fax: 381-11-244-3002 Tel: 54-11-48032823 Email: [email protected] Website: http://www.belgradecourse.org Fax: 54-11-48074883 Tel: 1-877-673-3273 Fax: 1-859-422-5073 DATE: 16 OCTOBER 2015 – 18 OCTOBER 2015 DATE: 22 APRIL 2016 – 24 APRIL 2016 Website: http://www.vegascosmeticsurgery.com Meeting: ISAPS Symposium – Australia Meeting: 1st German Brasilian Aesthetic Location: Sydney, AUSTRALIA September 2015 Meeting (GBAM) Contact: Dr. Morris Ritz Location: Munich, GERMANY DATE: 04 SEPTEMBER 2015 – 06 SEPTEMBER 2015 Email: [email protected] Contact: Dr. med. Joachim Graf von Finckenstein Meeting: CATFAS V Tel: 61-3-9508-9508 Email: [email protected] Location: Ghent, BELGIUM Fax: 61-3-9508-9588 Tel: 00 49 (0) 8151 29968 Contact: Elien Van Loocke Fax: 00 49 (0) 8151 29968 DATE: 28 OCTOBER 2015 – 1 NOVEMBER 2015 Email: [email protected] Meeting: Global Aesthetics Conference Tel: 32-9-269-9494 May 2016 Location: Miami Beach, Florida, UNITED STATES Fax: 32-9-269-9495 Contact: Delphine Hepp Website: http://www.coupureseminars.com/ DATE: 26 MAY 2016 – 27 MAY 2016 Email: [email protected] Meeting: ISAPS Course – Tunisia DATE: 05 SEPTEMBER 2015 - 06 SEPTEMBER 2015 Tel: 1-877-673-3273 immediately preceding the International Meeting of the Location: Taipei, CHINESE TAIPEI Fax: 1-859-422-5073 Société Tunisienne de Chirurgie Esthétique on May 28 Contact: Nancy Dsen Website: http://www.globalaestheticsconference.com Location: Tunis, TUNISIA Email: [email protected] Contact: Dr. Atef Maherzi Tel: (886)-3-3273726 Email: [email protected] Fax: (886)-3-3273369 Tel: 216-71-801-080 Fax: 216-71-801-080

48 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 49 NEW MEMBERS

Admitted November 2014 – March 2015 Where in ISAPS Executive Office BAHRAIN FRANCE POLAND EXECUTIVE DIRECTOR Ramesh PADUBIDRI, MBBS, MS, MCh Daniel BIALEOKO, MD Zbigniew LUCKI, MD the World? Catherine Foss [email protected] BELGIUM GERMANY Marek WISNIEWSKI, MD Janusz ZDZITOWIECKI, MD, PhD Serge DE FONTAINE, MD Timo BARTELS, MD DIRECTOR OF MARKETING Kristoff VERDONCK, MD GREECE PORTUGAL Jodie Ambrose BRAZIL Georgios DRIMOURAS, MD, MSc, FEBOPRAS Joao FERREIRA MD** [email protected] Nuno GOMES, MD * Romes Joao AYUB, MD ** INDIA DIRECTOR OF ACCOUNTING Rodrigo Otávio CARBONE, MD ** Monisha KAPOOR, MD RUSSIA Carol Gouin Augusto PUPIO, MD ** Rahul TANDON, MBBS, MCh Igor Vladimirovich RESHETOV, MD, PhD [email protected] Luiz Guilherme FARIA LOPES, MD ** SAUDI ARABIA Answer: National Secretaries Palmyra GEISSLER, MD ** IRAN MEMBERSHIP SERVICES MANAGER Sari RABAH, MD, FRCSC Chair Peter Scott in Mali. The Rachid GORRON MALOOF, MD ** Saeed MARZBAN, MD Jordan Carney Dogon culture of the 14th and Yuji IKUTA, MD IRAQ SOUTH AFRICA [email protected] Alex LANDAU, MD 15th centuries is animistic Samir Daniel JANNE HASBUN, MD * Ahmed ATTIYAH, MD ** EDUCATIONAL PROJECTS MANAGER Wagner LOPES SILVA JR, MD ISRAEL SOUTH KOREA and relates to Sirius, the Dog Michele Nilsson Andre REDA, MD ** Keren AGAM, MD, PhD Hae Cheon CHOI, MD, PhD Star, which they say has three [email protected] Ronald RIPPEL, MD ** David MENDES, MD Yeop CHOI, MD Charles SA, MD Myoung Chul LEE, MD parts. This was only confirmed ITALY CANADA by scientists in 1920. The cliff Alessandro INNOCENTI, MD SPAIN ISAPS EXECUTIVE OFFICE Khalid ARAB, MD * Eduardo FORCADA, MD dwellings are listed as World LITHUANIA 45 Lyme Road, Suite 304 CHILE Heritage Sites and symbolic Ernest ZACHAREVSKIJ, MD ** TURKEY Hanover, NH, USA 03755 Stefan DANILLA, MD, MSc Naci CELIK, MD paintings depict their beliefs. Phone: 1-603-643-2325 Cristobal LONGTON, MD ** LUXEMBOURG UNITED ARAB EMIRATES Dr. Scott, an avid amateur Fax: 1-603-643-1444 Erick Jose ALIAGA SANTOS, MD ** Atoosa AMIR-MANAVI, MD ** Buthainah AL SHUNNAR, MD, FACS archeologist with a major Email: [email protected] Claudio THOMAS, MD MAURITIUS Zouahir ALDAKKACH, MD interest in the paleoneuropsy- Website: www.isaps.org CHINA Didier VAN DEN BROECK, MD Crescenzo D'ONOFRIO, MD Chunjun LIU, MD, PhD MEXICO Medhat Emil HABIB, MBBCh, MS, EBOPRAS, AFRCS chology of rock paintings and Sang Keun PARK, MD, PhD Angel ALVAREZ REGIL, MD Naseebah NAYEF, MD engravings, is pointing to a CHINESE TAIPEI Jose CORRO MORA, MD Allen REZAI, MD circle of life symbol. Tsai-Ming LIN, MD, PhD Guillermo HERNANDEZ, MD UNITED KINGDOM ISAPS NEWS Management Maximiliano MARTINEZ, MD Ali JUMA, MD, FRCS (Plast) CZECH REPUBLIC Editor-in-Chief Pedro Arturo VALDEZ GOMEZ, MD Thangasamy SANKAR, MBBS, FRCS(Plast) Pavel GIEBEL, MD J. Peter Rubin, MD, FACS (United States) NETHERLANDS Ali SOUEID, FRCS(Plast), MBA, MSc** DENMARK Guess Who! Chair, Communications Committee Gustavo KOEIJERS, MD UNITED STATES Andreas PRINTZLAU, MD Arturo Ramirez-Montanana, MD (Mexico) Diederik VOOIJS, MD Alexandra CONDE-GREEN, MD, FICS * DOMINICAN REPUBLIC PERU David KUNG, MD Managing Editor Manuel VENTURA GONZALEZ, MD Rudy CHAMULI, MD** Catherine B. Foss (United States) Ricardo VENTURA HERRERA, MD VENEZUELA Jose CORDOVA ORRILLO, MD ** Linda RINCON, MD Designer EGYPT Soraya LOPEZ, MD ** Hossam ABOL ATTA, MD Barbara Jones (United States) PHILIPPINES * indicates Associate-Resident/Fellow Member EL SALVADOR Ma. Arlene CALA-OR, MD ** indicates Associate Member Eduardo REVELO JIRON, MD Joel Reginald UNSON, MD DISCLAIMER: ISAPS News is not responsible for facts as presented by the authors or advertisers. This newsletter presents current scientific informa- tion and opinion pertinent to medical professionals. It does not provide advice concerning specific diagnosis and treatment of individual cases and is not intended for use by the layperson. The International Society of Aesthetic Plastic Surgery, Inc. (ISAPS), the editors and contributors, have as much as possible, taken care to ensure that the information published in this newsletter is accurate and up to date. However, readers are strongly advised to confirm that the information complies with the latest legislation and stan- dards of practice. ISAPS, the editors, the authors, and the publisher Answer: Renato and will not be responsible for any errors or liable for actions taken as Flavia Saltz riding in the a result of information or opinions expressed in this newsletter. ©Copyright 2015 by the International Society of Aesthetic Plastic Grand Teton National Surgery, Inc. All rights reserved. Contents may not be reproduced in Park, Wyoming, USA. whole or in part without written permission of ISAPS.

50 ISAPS News Volume 9 • Number 1 January – April 2015 www.isaps.org 51 KF2_2015_Ad_ISAPS.indd 1 2/3/15 3:54 PM