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12th Issue April 2013

12th Issue April 2013

The e-magazine for 40.000 Plastic Surgeons

www.ipras.org/ipras-journals

healing the visible

& invisible

scars

photo from: Christopher Thomas,

IPRAS - WomenforWomen mission September 2012, Jalandhar (India)

105 - Regional Societies 105National National - Regional Societies

ISSN: 2241-1275 ISSN: 2241-1275


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CONTENTS • President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 5 • General Secretary’s Message . . . . . . . . . . . . . . . . . . 7 • New Honorary Editor in Chief . . . . . . . . . . . . . . . . . 8 • IPRAS Management office Report . . . . . . . . . . . . . 9

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• IPRAS-WFW mission photographed by Christopher Thomas . . . . . . . . . . . . . . . . . . . . .

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• Chris Khoo, Santiago, Chile . . . . . . . . . . . . . . . . .

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• Academies and societies reports . . . . . . . . . . . . .

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

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• Pioneer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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• Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

70

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

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• IPRAS Website . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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Dr. Nelson Piccolo, Prof. Marita Eisenmann-Klein and Prof. Ivo Pitanguy

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The founding of International Society of Paediatric Plastic Surgery

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The moment when Dr Nelson Piccolo was honored as “ Amigo de Minas” by Dr. Antonio Vieira

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87

70

BULAPRAS members

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AIMS AND SCOPE

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

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PRESIDENT’S MESSAGE

Board of Directors President Marita Eisenmann-Klein - Germany General Secretary Nelson Piccolo - Brazil Treasurer Bruce Cunningham - USA Deputy General Secretary Yi Lin Cao - China Deputy General Secretary Brian Kinney - USA Deputy General Secretary Ahmed Noureldin - Egypt

Dear Colleagues, Patients around the world trust that all doctors had to swear the Hippocratic Oath before starting to practice medicine. Did YOU? I didn't and I have to admit that I just had a vague idea about it before I attended the unforgettable congress of ESPRAS, the European Section of IPRAS, in 2009 on the island of Rhodes. The Congress President Andreas Yiacoumettis and the congress organizer Zita Congress decided to interrupt the congress for one day to take us to the island of Kos, where Hippocrates practiced. We attended a Prof. Marita Eisemann-Klein Hippocratic Oath ceremony there in the Hippocrates Gardens. President of IPRAS Ever since then it comes to mind, when I feel uncomfortable about advertisements promising Beauty by aesthetic surgery: Some governments banned advertisement for aesthetic surgery, but there are others which even promote this kind of industry. It comes to mind when I have to realize that competition and fights for power start to replace friendship and respect for each other, which was so typical for plastic surgeons throughout the world. It comes to mind when I meet our young colleagues: are we good role models for them? Do we always treat them with patience, respect and generosity? Are we passing on to them our expertise, all the details of our techniques and the improvements which we developed throughout our professional life? Every single day of my life I feel gratitude for my teachers. But do I let them know? Our teachers also are the famous plastic surgeons, who selflessly spend their time to share their experience with us in courses, congresses and workshops. Our pioneer in this issue, Sydney Coleman and our Senior Ambassador Abel Chaijchir are perfect representatives of this group. Some of our national societies like Brazil and Japan keep honoring their founders and pioneers, - others don't. In IPRAS we just started to develop a culture of awareness for the achievements of the last generation by founding the Board of Trustees, - their Chairperson Gueler Guersu and our Honorary Editor-in-Chief are the ideal role models. It is not too late to reach out and say "Thank You" and share the pride of the achievements of our wonderful specialty rather than competing for predominance. Generosity makes us look good, - from inside and outside the specialty. We rely on YOUR support to make us all look good in the eyes of our patients, colleagues and the public. Kos Island, Representation of the Hippocratic Oath

Deputy General Secretary Andreas Yiacoumettis - Greece Parliamentarian Norbert Pallua - Germany Executive Director Zacharias Kaplanidis - Greece

Cordially yours

Marita Eisenmann-Klein IPRAS President

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Hippocratic Oath

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot! Source: “Harvard Classics Volume 38” Copyright 1910 by P.F. Collier and Son.

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GENERAL SECRETARY’S MESSAGE

Dr. Nelson Piccolo IPRAS General Secretary

During the recent 17th Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, papers from all corners of the world covered practically all major aspects of Plastic Surgery. Although there were several presentations demonstrating the strength of some timely assured techniques, with some exponents presenting their 30-(or even more)year experience

17th IPRAS World Congress Conference Dinner. IPRAS Industry Supporters Awarding.

with a determined technique or principle, there were a great number of papers discussing relatively young techniques as well as technologies – this is what a Congress like this is all about! IPRAS has been involved in world congresses for well over half a century and this has been the usual story of all things, although in this more recent one we were able to gather attendees from

over two-thirds of the countries ( 105 ) who are our members. Some top members of Co-Opted Societies also came and we were able to learn about our differences and similarities in goals and objectives which were determined in very important meetings with these leaders. In this way, through our Congress and several meetings with the members of the world leadership in several countries and fields whom were present, IPRAS will permanently work to bring out the best in Plastic Surgery. Through the recently created Academies, in Aesthetic Surgery and Laser, as well as through the Pedriatric Plastic Surgery Society, and the reformulated IPRAS Journal Editorial Board, IPRAS will certainly continue to influence the trend of the evolution of our Specialty. For this, however, it is mandatory that we keep our communication at its best and all are expected to participate and contribute. Our members are our most important asset – you and I, and all of us, create our National Societies and these came together under the umbrella of IPRAS for the benefit of Plastic Surgery as a whole, worldwide! IPRAS will always be open to receiving and distributing all communications which are or will be of interest to our tens of thousands of members. These members in 105 countries are then in constant communication, be it via internet, a World Congress or any of our many sponsored meetings and congresses around the world. Look around, there is one of these happening soon in your corner of the world – we endeavor to be ubiquitous since we consider our presence as important as yours, as we are the same, i.e. Plastic Surgery at its best!!!

Dr. Nelson Piccolo IPRAS General Secretary

IPRAS Board of Directors

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New Honorary Editor in Chief Ricardo Baroudi

Dear Colleagues, We are happy to present our new honorary editor in Chief Ricardo Baroudi. Everybody knows Ricardo as one of the world most famous plastic surgeon with innumerous achievements. He was President of the Brazilian Society of Plastic Surgery twice, President of the IPRAS World Congress 1979, President of ISAPS, President of the ISAPS World congress 2007, IPRAS Journal Senior Ambassador, Editor in Chief of the Brazilian Journal of Plastic Surgery and IPRAS Board of Trustees member. Less people have the privilege to know Ricardo as a warm hearted, kind and wise person with a great sense of humor and fundamental knowledge about philosophy and always as a true gentleman. We all look forward to his valuable contribution for the IPRAS journal. Editorial Board

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

January 2013 – March 2013

Mr. Zacharias Kaplanidis IPRAS Executive Director

The last 3 months, from January to March, went by quickly, and during this time the IPRAS Management Office dedicated most of its energy to the organization and the success of the 17th IPRAS World Congress in Santiago, Chile. Based on the principles that have characterized ZITA Congress’ professionalism over the last 31 years, and our agreements with IPRAS since 2010, we would like to make an honest and objective report of this major event which has occupied ZITA Congress from 2011 until today.

The congress secretariat with Greek and local staff

This congress, undoubtedly, was one of the largest ever to have been organized in the 58-year history of IPRAS. The number of registered participants reached 1,763, coming from approximately 100 countries; the number of faculty and speakers originally exceeded 1300; 26 masterclasses took place, which were attended by 455 participants, and the opening ceremony attracted twice as many people than any other previously organized in an IPRAS World Congress. We mention that the faculty and speakers originally exceeded 1300 because one perhaps disappointing aspect of the congress was that of these 1700 registered participants (most of them preregistered), approximately 250 did not appear at the congress to collect their material, and some of these had registered as speakers. Although we are still working on the final financial aspects of the congress, IPRAS is entitled to approximately 300.000€ as royalties, according to the relevant contract with ZITA Congress. This amount is the largest that IPRAS has ever collected from any previous World Congress and it is even larger than the total IPRAS income from the previous 16 World Congresses. Due to this amount, IPRAS covered its budget for 2012 and will cover the budget of 2013 as well.

IPRAS Executive Committee and National Delegates during the 17th IPRAS World Congress in Santiago

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Opening Ceremony of the 17th IPRAS World Congress

As it is well known, all IPRAS budgets have the approval of the IPRAS Executive Committee, while the final balance sheets are audited by official auditing bodies. Analytical information regarding the financial aspects of the 17th IPRAS World Congress, very soon will be forwarded to the Executive Committee members as well as to all National Delegates.

From left to right: Dr. Nelson Piccolo, Brazil, representative of Prof. Jose Guerrerosantos, Mexico, Prof. Luis Vasconez, US, Prof. Andreas Yiacoumettis, Greece, Prof. Marita Eisenmann-Klein, Germany, Prof. Riccardo Mazzola, Italy, Prof. Hanno Mallesi, Austria, Prof. Guler Gursu, Turkey during the opening ceremony

Besides the impressive statistics and the achievement of financial targets, at least for the IPRAS income (they had been set since 2011), the congress had other important successes, but also encountered some difficulties. Among the best qualities of the congress, we would like to point

out the large number of participants at the opening ceremony; the presence of many important personalities such as Professors Guler Gursu (Chair of the Board of Trustees), Paulino Morales, Mohammed Sobhi Ahmed Zaki, Thomas Biggs, Ivo Pitanguy, Ricardo Baroudi, Riccardo Mazzola, Hanno Millesi, Luis Vasconez, the overwhelming participation (90%) of the IPRAS Executive Committee; the large number of embassies and ambassadors that honored the congress with their presence; the awarding of many important personalities (Prof. Jose Guerrerosantos, Prof. Hanno Millesi, Prof. Riccardo Mazzola and Prof. Luis Vasconez.) and important companies that honour the IPRAS congresses and the field of Plastic Surgery with their support; the agreement for the cooperation between IPRAS and ISAPS in the new Aesthetic Academy; the large attendance at the daily sessions of the congress (approximately 1300 participants per day);

IPRAS Subcommittees meeting

the principle agreement of the Chilean Minister of Health with IPRAS to collaborate on issues concerning Plastic Surgery and WomenforWomen activities; the foundation of the new Paediatric Society of Plastic Surgery; the IPRAS Trainees Association, which officially participated as a new Association, under the IPRAS umbrella;

IPRAS Executive Committee meeting

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Special coffee break during an IPRAS meeting

the donation to the Chilean non-governmental the humanitarian institution COANIQUEM; impressive participation of exhibitors, of whom the majority graded ZITA Congress with an exceptionally high score (9) in the special questionnaire that was sent to them, and we duly thank them for it; the decoration of the congress venue, which was dedicated to all the important moments and the protagonists throughout IPRAS’ history, the use of a smart phone congress application which allowed all participants to view all the program details and congress information online and on the spot; the exceptional food of the venue during the Gala and the afternoon lunches, etc.

The congress indeed faced some difficulties, such as the late delivery of approximately 500 final programs (from 1700), due to the incredible errors of the carriers and airline companies, against whom ZITA Congress and IPRAS have already taken legal action; the delayed service at the opening ceremony cocktail, due to the delay in the schedule of the lectures in the plenary room and the unexpectedly high number of participants; the long queues at the secretariats on the 1st day of the congress which, however, due to the large number of participants at the time (1500), were inevitable to some degree, and the large accommodation dispersion throughout Santiago, which nevertheless was beyond ZITA Congress’s control, since 80% of the participants booked their accommodation by themselves, without using official channels and chose non-official hotels. For all the above and to the extent where ZITA Congress was responsible, we sincerely apologize to participants for the inconvenience.

From the panel in the opening ceremony, from left to right: Prof. Guler Gursu, Prof. Ivo Pitanguy, Prof. Marita Eisenmann-Klein, Prof. Andreas Yiacoumettis, Prof. Teresa De La Cerda, Prof. Patricio Leniz, Prof. Wilfredo Calderon

The Polytech booth at the 17th IPRAS World Congress

The Mentor booth at the 17th IPRAS World Congress

The IPRAS booth in the main exhibition area

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Moreover, the choice of the venue, Espacio Riesco, was the most appropriate for this major event in Santiago. Perhaps the soundproofing in some of the adjacent congress halls could be considered as insufficient at times and therefore seen as a flaw of the venue, but we want to express that it was the most suitable venue for a congress of such caliber. Furthermore, the audiovisual equipment that was used was of a more than satisfactory standard. Some momentary difficulties in producing a few slideshows are considered acceptable,

Congress Dinner

especially regarding the hundreds of presentations in 8 parallel halls and speakers from all over the world. Additionally, the translators’ work was also considered to be highly satisfactory since their task to translate from English to Spanish and English to Portuguese was carried out successfully. One more service that has been frequently commented upon, were the transfers, which could not have been carried out in a more efficient way, since as we explained above, 80% of the participants booked their accommodation individually and therefore they took care of their own transfer from the hotel to the congress venue and vice versa. Those who booked the official congress hotels, which were mainly Sheraton Hotel and Marriott, and had paid for the transfer service, as it had been clearly announced, followed a specific and frequent program and were 100% serviced. We would also like to mention the social events and especially the Official Congress Dinner (we already mentioned the Opening Ceremony above), which was a unique success since the food was exceptional, the show was spectacular and typical of Chile, and the decoration was rather interesting and …expensive. The number of participants reached 600, 430 of whom received a free invitation from ZITA Congress. Moreover, following a decision by the President, Prof. Marita Eisenmann-Klein, approximately one month prior to the congress, a faculty dinner was not organized for purely operational reasons, which concerned a large work load on several committees. We also believe that a special reference must be made to the media which covered this major event throughout the congress and to the whole of Chile. We thank all the 12

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IPRAS Executive Director, Mr. Zacharias Kaplanidis, during his presentation at the General Assembly

reporters for their correspondence, the President of the Chilean Society of Plastic, Reconstructive and Aesthetic Surgery, Dr. Teresa De La Cerda, the President of the Organizing Committee, Dr. Patricio Leniz, the President of the Congress, Dr. Wilfredo Calderon and the IPRAS Media Office in Greece. In conclusion, we would like to thank the entire Chilean Society of Plastic, Reconstructive and Aesthetic Surgery and especially the President of the Scientific Committee, Dr. Wilfredo Calderon, who after the congress thanked us and congratulated us for everything we did for the success of the congress, as well as the Board of Directors and the Executive Committee for their solid participation in Santiago and support to ZITA congress. Finally, we would like to congratulate all the nominee countries for the IPRAS World Congress of 2019 (Colombia, Egypt, Indonesia & Turkey). It is natural for those who were not elected as the host country to feel some bitterness, but with their presence and presentation all these days they definitely earned a great deal. IPRAS and ZITA Congress assisted their efforts with centrally located booths in the exhibition area, which were provided for their public relations and their promotion. Thus, we end this IPRAS Management Office report by wishing a wonderful spring or autumn to all of you from 105 countries around the world.


Some Photographs from the 17th IPRAS World Congress in Santiago, Chile

Participants during the Opening Cocktail

From left to right: Dr. Nelson Piccolo, Prof. Marita EisenmannKlein and Prof. Ivo Pitanguy

The band playing during the opening cocktail

Awarding of Prof. Ivo Pitanguy as Hinderer Lecturer

Prof. Patricio Leniz, Prof. Teresa De La Cerda, Prof. Luis Vasconez, Prof. Manuela Berrocal, Prof. Liacyr Ribeiro, Prof. Jaime Arriagada, Prof. Wilfredo Calderon

Prof. Manuela Berrocal during the opening cocktail

IPRAS Assistant Executive Director, Mrs. Maria Petsa, presenting IPRAS social media & application during the General Assembly

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Bidders for the 2019 IPRAS World Congress

The booth of the Egyptian Society of Plastic Surgeons

The booth of the Colombian Society of Plastic, Reconstructive and Aesthetic Surgery

The booth of the Indonesian Association of Plastic, Reconstructive and Aesthetic Surgery

The booth of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons

Photos from the Exhibition Area

The RICHTER booth at the 17th IPRAS World Congress

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The MARINA MEDICAL booth at the 17th IPRAS World Congress


Photos from the Exhibition Area

The ARION booth at the 17th IPRAS World Congress

The ANTEIS booth at the 17th IPRAS World Congress

The ALLERGAN booth at the 17th IPRAS World Congress

The SEBBIN booth at the 17th IPRAS World Congress

The MICROAIRE booth at the 17th IPRAS World Congress

The SILIMED booth at the 17th IPRAS World Congress

The DEKA booth at the 17th IPRAS World Congress

The TULIP booth at the 17th IPRAS World Congress

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Press Conference of the 17th IPRAS World Congress The press conference that took place during the 17th World Congress was a success with a lively journalist audience who kept on asking interesting questions! The panel was itself a very prominent one bringing together world famous plastic surgeons like Ivo Pitanguy and Maria Siemionow! The later also gave interviews and were much praised by the press! The Chilean Minister of Health, Jaime Mañalich, also honored the Congress with his presence for a whole day, during one of the days of the Congress!

Dr. De la Cerda worked hard to promote the event and other major news related to the industry and IPRAS to the media an dTV especially! This wide broadcast promoted the Congress news and findings even more. There was world-wide radiance and publicity! We would like to thank Dr. De la Cerda and the Chilean Society Secretarial team led by Mrs. Veronica Novoa for all the organizational support and communication on the local level. The Chilean society really worked hard on this one!

The Chilean Minister of Health, Jaime Mañalich, also honored the 17th Ipras World Congress with his presence for a whole day visit, during the Congress where he announced the donation of a great number of free plastic reconstructive surgeries to Chilean women who underwent mastectomy due to breast cancer! 16

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Media Coverage Canal 13 TVN MEGA (Programa “En Pauta”) CNN Chile El Mercurio La Tercera La Hora Radio BioBio (Program “Peor es nada”) ADN Radio Radio USACH (Program “Las cartas sobre la mesa”) Estético.cl Clínico.cl Santiago Times Terra SoyChile.cl El Dínamo Direcmed Flickr page of Chilean Ministry of Health


We should also mention Mrs Maria Sevastaki, the IPRAS Media OfďŹ ce, Marketing Coordinator, who managed, even from the opposite Hemisphere and other side of the Atlantic, to mobilize many important media and prepare a very professional and complete Press kit. Overall, the exposure of the event to the media was of a wide range. From big Newspapers to major TV channels like CNN and high level Public Relations. Speakers, topics, calls from journalists that wanted to receive material from congress and PC. Dr. Patricio Leniz, Prof. Marita Eisenmann-Klein, Prof. Andreas Yiacoumettis, Prof. Maria Siemionow

Prof. Ivo Pitanguy, IPRAS Board of Trustee Member

Prof. Marita Eisenmann-Klein, Dr. Nelson Piccolo, Prof. Maria Siemionow

Journalists from Chilean Newspapers

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Prominent doctors from all over the world coming to meet in one place created a commotion. The Ambassadors or highly ranked staff from the Embassies of Brazil, Egypt, Germany, Greece, India, Indonesia, Mexico, Portugal, Russia and Turkey honored IPRAS with their participation in the Congress and added extra diplomatic and ceremonial status. IPRAS social events, including the Opening Ceremony and Gala Dinner, were really major happenings. The 17th IPRAS World Congress was indeed an event of scientific, social and international aura that moved IPRAS one step forward!

President’s Table during the Congress Dinner

Show during the Congress Dinner

Indonesian Mission Greek Ambassador, Mrs. Balta, Prof. Eisenmann-Klein, Prof. Yiacoumettis, Dr. Piccolo, Dr. Palmos, Mrs. Piccolo during the Congress Dinner

A great thanks and appreciation to the Greek Embassy in Chile which has greatly helped to communicate with the Ambassadors in Chile and generate the official invitations.

Turkish mission

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Comments from some important people for the organization of the 17th IPRAS World Congress

Maria Siemionow, MD, PhD, DSc Professor of Surgery Director, Plastic Surgery Research Head, Microsurgery Training Dept. of Plastic Surgery Cleveland Clinic

Dear Colleagues, The 2013 IPRAS meeting in Santiago de Chile brought an exceptional number of participants. The Congress program covered all aspects of plastic, reconstructive and aesthetic surgery supported by keynote lectures given by experts in their respective fields. There were Panel discussions devoted to standard techniques, innovations, and the future of plastic, reconstructive and aesthetic surgery. The great scientific program which was attended by so many well known colleagues and friends, combined with the vibrant city of Santiago, with so many wonderful restaurants and cafe's, made this trip to Chile a very worthwhile experience.

Sincerely yours, your friend, Dr. Wilfredo Calderon Chair of the Scientific Committee of the 17th IPRAS World Congress

Kindest regards, Prof. Norbert Pallua IPRAS Parliamentarian, Member of the IPRAS Board of Directors

I am very grateful for your wonderful work in this tremendous Congress. I have never seen such coordination and dedication! Please give my Thanks to all others in your group. Have a nice return to your beautiful country and feel happy because you have done the Best. You will be always in my heart. I will see at the next IPRAS World Congress in 2015.

After having returned from the exiting city of Santiago de Chile I would like to congratulate you on the perfect organization of the 2013 World Congress of the IPRAS. It was a great pleasure for me to participate in this highly scientific event! I very much enjoyed the wonderful atmosphere and the interesting discussions with my colleagues from all over the world. It was a wonderful event in one of the most beautiful places of the world. Many thanks for all your kind efforts and your continuous support. I am very much looking forward to seeing you again soon.

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Prof. Mohamed Sobhi Ahmed Zaki, M.D. Professor of Plastic Surgery, Kasr El- Aini Faculty of Medicine, Cairo University Member of the IPRAS Executive Council Live Member of the IPRAS Board of Trustees Council Honorary Vice-President of the Egyptian Society of Plastic & Reconstructive Surgeons

The 17th IPRAS Congress which was held in Santiago –Chile on 24 February to 1 March 2013 was the largest in the whole history of IPRAS, concerning the number of attendants; the number of scientific sessions and the number of presenting papers. The scientific topics included all aspects of Plastic & Reconstructive Surgery and Burn Management. Many of the papers were presented by junior plastic surgeons which is a great achievement for IPRAS, which looks always forward and encourages the future of our speciality. The foundation of the IPRAS Paediatric Plastic Surgery Society during the congress was a real success for our speciality as many topics are rapidly advancing in this subspecialty and necessitates a recognised separate society. The social program was elegant and a special one for all junior staff that were invited to the Gala Dinner of the congress free of charge. The IPRAS President Prof. Marita EisenmannKlein conducted the congress in a smooth, noble and distinguished way. The great efforts of Prof. Andreas Yiacoumettis; the staff of Zita Congress company and members of different committees were remarkable. I am looking forward to the coming 18th IPRAS Congress. I hope and pray to GOD to be of the same standards.

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Prof.K.Güler Gürsu,MD Chairperson of the IPRAS Board of Trustees

Dear colleagues, We have left another World Congress behind us and began to look forward to a new one already. The Congress in Santiago/Chile certainly was a different experience for most of us, coming from long distances, seeing old friends and making new ones. This congress had a special meaning for me. As the Chair of the Board of Trustees I was honoured to be the host (or hostess) of the Opening Ceremony. During this ceremony, we had the great opportunity to hear Prof. Pitanguy’s excellent presentation and to witness Prof. Luis Vasconez to be honoured as a new Trustee of IPRAS. For me it was an unforgettable event to be at the same place and same time with these two giants who happened to be also, my very old friends. My most sincere congratulations to them once more. Welcome on board! I believe it was one of the best and most dignified opening ceremonies, with exception of going over time as usual. I would like to take this opportunity to point out one great problem, according to me. What happened with the execution of the Scientific program is unacceptable. I know how hard several colleagues worked for months and months in order to give us a good program. Several people who had their papers accepted did not show up and did not even bother to send a polite note stating that they cannot attend. This caused a great discontent amongst the participants and despair for the chair persons of the sessions. This was not an end result of other actions as aired by some, but just the contrary: it is an old disease of our plastic surgery circles. Just to have your name appear in the program and not to show up. I condemn this very strongly and urge ExCo to take a noticeable action in order to avoid this to happen in the coming meetings. I would like to express my thanks to all who had a hand in making this difficult congress in to a successful one. The only disappointment for me personally was, not having enough time to see enough of a beautiful country.


"Burnt women" - IPRAS Gratefully thanks Christopher Thomas and Ira Stehmann For the copyright of the title photo from "Burnt women" - an exhibition of works by photographer Christopher Thomas and curator Ira Stehmann for the benefit of the organization "IPRAS-Women for Women" Bernheimer Fine Art Photography in Munich presented in February 2013 in cooperation with "IPRAS-Women for Women", the exhibition Christopher Thomas. Burnt women. A project for "IPRAS-Women for Women" (WfW). The photographer Christopher Thomas, world famous especially for his portraits of cities Venice The Invisible (2012), New York Sleeps (2009) and Munich Elegies (2001-2005) and curator Ira Stehmann, joined the team of WFW founder IPRAS President Marita Eisenmann-Klein and WFW President Constance Neuhann-Lorenz at a hospital in Jalandhar to create portraits and interview women and girls who became victims of criminal attacks. Whether in India, Pakistan, Bangladesh, Africa or Iraq, women have been victims of various forms of violence. Every hour in India alone, a woman is burnt "to punish the bride for an inadequate dowry or to get them out of the way, so that the man can re-marry" (Nicholas Kristof, Sheryl WuDunn). Thousands of women are burnt alive in Pakistan or etched with acid. Girls are also often victims of murder attacks, because they are a financial burden for the family. In this exhibition Christopher Thomas presented selection of 26 images. Christopher Thomas' empathic perspective, his sensitivity, his compositional skill and great lighting can create images powerful and touching and at the same time put the viewer under their spell. His pictures show the incredible suffering and their astounding suffering endurance, but also the

admirable strength these women and girls. He focuses on the representation of individual fates. While the patients in the hospital were waiting patiently and full of hope for the consultations, Christopher Thomas discovered a ten year old burn victim named Neha. The girl stood patiently to be photographed. Her grandmother showed him Neha scars with the red-brown, butterfly-shaped net patern. According to her grandmother, angry neighbors set the house on fire while the family slept. The shape and surface of her scars create suspicion that someone tried to kill Neha with a burning blanket. Christopher Thomas and Ira Stehmann plan, to accompany and cover as photographer and journalist more missions of "IPRAS-Women for Women". Also planned is a new photographic publication regarding the invaluable work of "IPRAS-Women for Women”. The goal is to inform more people about the violence against women in third world countries. The work of "IPRAS-Women for Women" as a project of IPRAS is funded through donations. All income from the sale of the photographs goes to “IPRAS-Women for Women”. "IPRASWomen for Women" does not use any paid advertisement, and due to the support of the founder, the International Confederation for Plastic Reconstructive and Aesthetic Surgery, the administrative costs are minimal. Donations can be used directly for the treatment of the victims.

Women for Women

Account: 138418100 - Bank Short Code: 20030300 IBAN 8170 0303 0001 3841 8100 - BIC CHDBDEHH Bankhaus Donner and Reuschel

B I O G R A P H Y Christopher Thomas, born in Munich in 1961, graduated from the Bavarian State SchoolofPhotography, works worldwide as a prestigious advertising photographer. His photo reportages for Geo, Stern, Süddeutsche Zeitung Magazin, Merian and other magazines were internationally awarded many times. As an artist, he became known with his extensive cycle Munich Elegies, which was shown in 2005 at the Fotomuseum in Munich and published in the same year

by Schirmer / Mosel. New York Sleeps was published short time later, another Polaroid series. These works have been exhibited at Bernheimer Fine Art Photography in Munich, at Steven Kasher Gallery in New York, Fifty One Fine Art Photography in Antwerp and The Wapping Project, in London. The associated publication New York Sleeps. Photographs by Christopher Thomas, was published in 2009 by Prestel Publishing (3rd edition 2011), and was shortly thereafter awarded the German Photo Book Award. Christopher Thomas Oberammergau Passion originated during rehearsals for the local PassionPlay. For his Passion cycle in 2011 he received the highest award: (Silver) Art Directors Club of Germany in the Photography category. An extensive selection of this cycle was exhibited at the Bavarian National Museum from October 2011 to January 2012. The Publication of Christopher Thomas’. Passion, photographs of the Oberammergau Passion Play 2010 is also available at Prestel edition. There is also the book of his latest work: Christopher Thomas. Venice, The Invisible Appeared. Christopher Thomas lives in Munich. Issue 12

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Moros y Cristianos…. y un Congreso Some thoughts after 17th World Congress, Santiago It was a glorious day at the end of the Congress. There were no more committee meetings, or sessions to chair, and so we were free to take the Turistik bus to Valparaiso and Viρa del Mar. Come lunchtime, we headed for a restaurant which we had read about, and followed the map to a little side street just off the Avenida Peru. We were the only diners, and were shown upstairs to the little outside gallery which had a view of the blue Pacific in the middle distance. The restaurant was called Moros y Cristianos, Moors and Christians, and a travel website ranked it #1 amongst 94 restaurants. Of course, coming from Europe, we were intrigued. Why name a restaurant after the Moorish Conquest of Spain in the 8th Century, or the subsequent Reconquista when several Christian kingdoms reconquered the Iberian Peninsula? These were the times of the Crusades, when armies were pitted against each other in continuous bloody conflict. Alas, although the waiters tried to understand my question, they spoke no English, and we spoke no Spanish at all. Then, a breakthrough! Gesturing us to wait, they fetched a charming young lady who had just started to work in the restaurant. She spoke perfect English, or should I say perfect American, because she had been brought up in New York City, and had just returned to her family home in Chile. “No”, she said, the name of the restaurant had nothing to do with battles of the past, “Moros y Cristianos is a dish of rice and beans from Cuba.” She explained that the blend of the black beans and the white rice on the same plate symbolised the harmonious mixing of peoples, just as in Cuba.

Then she took us through the seafood menu and helped us to order a delicious lunch. We enjoyed the meal, and afterwards wanted to find out more. “Chilean Sea Bass” it turns out is not a bass at all, but the Patagonian toothfish, Dissostichus eleginoides, despite being marketed as such in the United States and Canada, and “Conger Eel” or “Congrio Colorado” is actually a different species, the Pink Cusk Eel (genypterus blacodes)! We left the restaurant in a haze of contentment brought about by the excellent fish cuisine and a glass or two of local Sauvignon Blanc. As we walked back to the bus we reflected on a recent session at the Congress where tensions, many of them understandable, had been brought out into the open. But the Congress itself had many enjoyable moments, and we have all come home with happy memories of our time in Chile. In some ways, our lunch was a parallel experience. It could have been problematic, but once we understood each other, could communicate, and were sympathetically treated, everything was fine. And it didn’t matter a bit that we didn’t understand the taxonomy of the fish we had enjoyed on our plates - but we did learn the science later and banked it in the memory to bring home. I wanted to remember the name of the lovely lady from New York to share with you, and went back to the restaurant website. Only the front page came up on screen, with the message: SITIO EN CONSTRUCCIΣN. So, work in progress. Was there a lesson in that lunch for us: the “Moros y Cristianos” of IPRAS?

Chris Khoo

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IPRAS Laser Academy

Katharina Russe-Wilflingseder MD Coordinator of the IPRAS LASER ACADEMY

The IPRAS Laser Academy was founded by the IPRAS Board of Directors at the IQUAM Meeting in Athens in November 2013 with the intention to install a platform for plastic surgeons interested in laser medicine and to create a forum of experts under the umbrella of IPRAS aiming to exchange knowledge of laser and energy based technologies and procedures in plastic and aesthetic surgery. Further on, the Laser Academy takes care of training and education in using laser and light technologies in our specialty, which are already well established in treatments of vascular malformations. Other promising fields are scar revisions with fractionated ablative lasers in combination with drug delivery into scar tissue. Deeper delivery through ablative conduits might be accessible in the near future. At present tissue tightening and rejuvenation from inside to outside with minimally invasive cannula guided laser side fire fibers has growing interest, as well as from outside to inside, for instance, with fractionated lasers, radiofrequency and ultrasound technologies. Picosecond lasers are on the way to open new possibilities in treating tattoos. A Laser Round Table on Facial Rejuvenation was held on February 28, 2013 during the IPRAS meeting in Santiago di Chile. Romulo Mene, Brazil, presented data of his 25 years of experience on laser treatments versuschemical peelings in facial rejuvenation. Lina Triana, Colombia, pointed out her experience on full and fractional ablative laser resurfacing especially in Latin skin types. Katharina Russe-Wilflingseder, Austria, gave an overview on non-

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surgical facial rejuvenation with minimally invasive laser skin tightening and lipolysis, non-invasive laser resurfacing and fat grafting in combination with lasers. The first meeting of the IPRAS Laser Academy was held on February 27, 2013, within the biannual world congress. More than 50 colleagues attended and demonstrated their interest in the new founded IPRAS Laser Academy. An active discussion on needs, future projects and possible collaborations with other societies took place. Katharina Russe-Wilflingseder also informed the attendees about the invited advisors to the Academy who all agreed to join the IPRAS Laser Academy. As of February 2013 the confirmed advisors are Rox Anderson (Havard and Wellman Institute, Boston), Merete Haedersdahl (Biberg University, Copenhagen), Suzanne Kilmer (Laser and Skin Surgery Center of Northern California, Sacramento), Emil Tanghetti (Center for Dermatology and Laser Surgery, Sacramento) and Christopher Zachary, University of California, Irvine). The next IPRAS Laser Academy Round Table will be held at the 8th BAPRAS Congress, September 5-7, 2013, in Budva, Montenegro. The membership to the IPRAS Laser Academy is free of charge for IPRAS members. For more information, please contact Katharina Russe-Wilflingseder, coordinator of the IPRAS Laser Academy (katharina@russe.at) or Maria Petsa, assistant executive director of the IPRAS management office (maria.petsa@iprasmanagement.com).


The Academy for Aesthetic Surgery Training

Miodrag M. Colić Coordinator of Aesthetic Surgery Training Academy

The mission statement of IPRAS states that two of its main goals and objectives are to “promote the art and science of plastic surgery” and “to further plastic surgery education and research” worldwide. As an expression of concern for young plastic surgeons in training, IPRAS TA (the International Association for Plastic Surgery Residents and Trainees) came into being at the 10th IQUAM Congress in Athens in November 2012. At the same time the IPRAS Academy of Aesthetic Surgery Training was born, dedicated to residents in their last year of training. It aims to provide graduating trainees with the best possible knowledge and experience in aesthetic surgery. To achieve this goal the most natural response was a collaboration between IPRAS and the International Society of Aesthetic Plastic Surgeons (ISAPS), a sister society and long-time partner in the field of aesthetic surgery. The first joint meeting was chaired by IPRAS President, Marita Eisenmann-Klein, and ISAPS President, Carlos Uebel, during the 17th World Congress of IPRAS in Santiago, Chile, in February 2013. It was acknowledged that there is a need for experienced senior members to dedicate their teaching abilities to aesthetic education for trainees. Dr Miodrag Colic was proposed as the coordinator of these activities for both societies. Immediately after the main meeting, two smaller working groups followed, co-ordinated by Dr Colic. Members of the IPRAS group were Drs Nelson Piccolo, Paolo

Persichetti and Manuel Garcia-Velasco, while members of the ISAPS group were Drs Susumu Takayanagi, Fabio Nahas and Theo Voukidis. During the meeting which lasted more than one hour the following issues were approved: • The official sessions of Trainees Academy will only be open to accredited trainees in Plastic Surgery. Approving individual participation and checking credentials will be the responsibility of the organizers. • Academy meetings should be planned for, and scheduled, during the official national or regional meetings. • They will be free of charge (usually included in registration fee of the meeting). • The program is to be announced for the whole year and published in the abstract book. • Demonstrations of surgery should be included (live whenever possible). • Sponsors will be listed in the program of each meeting and given appropriate credit. • Academy meetings should not coincide with courses planned for experienced specialists. • They will be organized as separate sessions – in a different place, auditorium, faculty, topics etc. • Proposed name for the lecturer will be: Aesthetic Training Professor • Proposed meetings: Balkan Society Meeting (BAPRAS, September 8), Lebanese Meeting etc.

Marita Eisenmann-Klein and Carlos Uebel during the initial meeting of the proposed Aesthetic Academy for Trainees

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The International Society for Paediatric Plastic Surgery a New IPRAS Society Andreas Yiacoumettis IPRAS Deputy General Secretary

Yet another idea of our President Prof Marita Eisenmann Klein is well under way. After discussions with several colleagues, a decision was taken to proceed with the founding of a Society which will promote Paediatric Plastic Surgery worldwide. At the inaugural meeting held in Santiago, Chile, during the 17th World Congress, the turnout of colleagues interested in this particular topic of our Specialty was beyond expectation. In all, over seventy declared their interest in becoming members of this new IPRAS Society. A vivid discussion developed, creating a climate of enthusiasm and demonstrating the willingness to work towards strengthening the role of this topic in the management of children with deformities and functional or aesthetic problems. Our specialty is credited with improvising, developing and establishing methods and techniques widely employed by Plastic Surgeons and colleagues from other specialties. During this meeting the provisional Bylaws were presented by the Deputy General Secretary Prof Andreas Yiacoumettis and they were accepted with minor changes.

Further deliberations will take place after receiving comments from the members via email communication. It was also unanimously decided that the first scientific meeting will take place next year in Turkey with Prof Guler Gursu as the Congress President, but the dates and the location will be announced later. During this congress the General Assembly will convene officially for the first time to approve the Bylaws and elect the Executive Committee. All members interested in becoming members of IPRAS/ ISPPS please contact the IPRAS executive management office at : maria.petsa@zita-congress.gr; During the inaugural meeting in Santiago, it was also decided that the temporary administration of the IPRAS/ ISPPS will be in the hands of the following members: Guler Gursu (Turkey) Dan Enescu (Romania) Ashok Gupta (India) Nelson Piccolo (Brazil) Andreas Yiacoumettis (Greece)

The founding of International Society of Paediatric Plastic Surgery, Santiago, Chile, March 2013

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IPRAS Trainees Association - IPRAS-TA: Santiago, Chile.

Benjamin Khoda MBChB, MRCS (Eng) Plastic Surgery Specialist Registrar Oxford and Wessex Training Programme, UK

The 17th World Congress for IPRAS took place in Santiago, Chile from 24th February to 1st March 2013. The congress saw high attendance with trainees and Faculty from diverse backgrounds sharing and enhancing knowledge. During the Congress, IPRAS-TA held two successful meetings which enabled us to raise awareness of the newly formed IPRAS-TA and to recurit National Delegates. It was an opportunity for the Executive Committee to meet and expand on the ideas created during the launch of IPRAS-TA in November 2012.

IPRAS-TA EXCO members and our President Prof. Eisenmann-Klein Marita during the conference dinner at 17th IPRAS world congress.

The association has made tremendous progress in only a short period and we will continue to work hard and champion the voice of trainees worldwide. The first three months of the year 2013 were very fruitful for IPRAS-TA. We continued developing our projects within the Executive Comittee, searching for new National Delegates, establishing the IPRAS - TA webpage, and organizing scholarships and exchange programs. The biggest achievement was undoubtedly the launch of a brand new webpage within the main domain of IPRAS (www.ipras.org/residents-trainees). This webpage is devoted to the IPRAS - TA. You can find basic information

Ondrej Mestak Department of Plastic Surgery 1st Medical Faculty Charles University in Prague, Czech Republic

about our society here, lists of upcoming meetings, our by-laws, and information about members of Executive Comitee including their contact details. This webpage contains a questionnaire evaluating plastic surgery training in different IPRAS countries. We highly encourage all plastic surgery trainees to participate in this survey. In an effort to achieve greater participation from various IPRAS member countries, we openly approached representatives of National Societies from countries not yet represented in IPRAS-TA to nominate a National Delegate. The IPRAS-TA National Delegate will thus be the link between IPRAS-TA and the respective National Society. During the IPRAS world congress in Chile, our Chairperson, Sarah Lorenz presented provisional results of the trainees survey and the aims, vision, outcomes and progress made by IPRAS-TA. At the first meeting, which took place on Monday 25th of February, we were honoured by the presence of IPRAS President Professor Marita Eisenmann-Klein, IPRAS General Secretary Nelson Piccolo, and Deputy General Secretary Andreas Yiacoumettis. We are grateful that the IPRAS Executive Committee has shown tremendous enthusiasm in supporting IPRAS-TA and have reassured their continued support. Many trainees especially from South America attended the meeting and supported the mission of IPRAS - TA . We had trainee participants from 14 countries (Argentina, Czech Republic, Colombia, Chile, Cyprus, Germany, Greece, Guatemala, Italy, Norway, Paraguay, Spain, U.K. and Venezuela). The meeting also provided a platform to engage and profit from networking with leaders in the field of Plastic and Reconstructive Surgery. The Masterclasses and the scientific programme were excellent and encouraged discussion. We will continue to pursue communication between trainees all around the world. Our main goal in the immediate future is to gather more members as well as to start new scholarship programs, which would help trainees visit departments in different countries. We are working towards the 2nd IPRAS-TA meeting to be held in conjunction with the 11th IQUAM meeting in Paris, 2014. Issue 12

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SENIOR AMBASSADOR

Abel Chajchir, MD

Please tell us about your professional background, where did you go to school, your training, etc? I got my Medical degree from Buenos Aires University, following the teachers’ indications training in general surgery until 1969, beginning the plastic surgery in Argentina as well as visiting several Centers in different places in Europe, but only making visits to England, France, Italy and Spain. Overall I trained in Rio in the Pitanguy professor school and made a lot of friends. I trained In San Pablo with professor Ricardo Baroudi, who also with his friendship he helped me to carry out my scientific work, as well as in Mexico with professor

Jose Guerrero Santos who distinguished me by inviting me to participate in his scientific researches. During my professional activity I occupied all the charges in the Argentine Society of Plastic Surgery , and in the Buenos Aires Plastic Surgery Society and in some international Societies. I was visiting professor at the Richmond Medical College and in the Catholic University of Buenos Aires. What about your family background? Did you have other Plastic Surgeons in your immediate family? My wife Dr. Iliana Benzaquen is a Dermatologist, my daughter Gabriela Irina Dermatologist and Laser specialist and my son Gustavo Andres a Plastic Surgeon. When you initiated your practice in Plastic Surgery, what were the most frequently performed procedures? At the beginning in Plastic Surgery the most frequent procedure was the rhinoplasty. This procedure was performed twice or three times a week at that time. What led you to start using fat as part of your everyday practice? What did you think then one could possibly do with fat? Were you able to predict this widespread and multifaceted use of fat and ADSC´s as we are doing more and more today? My use of fat began in 1981 when I made my first demonstrations of liposuction, as we at that time used big Issue 12

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cannulas, because of which some depressions appear. In order to correct the defects I started with the fat graft. When I saw that this was useful I began to use it in the face, with following re injections obtaining very good results. As logical as this procedure was, it was used by professionals without the appropriate knowledge of the technique, and that was an obstacle, but as I had very good results I continue using it. In your opinion, what was the major advancement that was obtained with the use of fat grafting? Without any doubt this is the right way to the tissular regeneration, with the use of fat graft, stem cell and rich plasma. These three important points, for tissue regeneration, are based on fat grafts, stem cells and platelet-rich plasma. With the most recent research on this topic we will

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achieve great advances in reconstructive surgery, not only in plastic surgery in all the medical specialties like orthopedic surgery, hand surgery, trauma, and so on. What is your opinionof how Plastic Surgery is taught nowadays? Do you agree that residents today have a much wider exposure to the universe of Plastic Surgery? Without doubt I agree that residents today have much more exposure to plastic surgery but it is necessary also to introduce the basic science to begin this career. Training in basic science is very important for all doctors. As Senior Ambassador, please tell us what would be your message that you would convey to Plastic Surgeons around the world? My message is that, return to the basic science, return to research.


PIONEER

Sydney Coleman, MD

Did you ever consider a different career than Plastic surgery? I’m from a ranching family in West Texas, and never thought I would be a physician, let alone a plastic surgeon. When I was 18 years old, after two semesters at the University of Texas in Austin, I took the Medical College Admissions Test because I knew I wanted to go into scientific research, and this was the least expensive test ($25 at the time). An advisor at the school called me in and told me that I had scored a very high score on my exam, and I might be able to get into medical school even though I was only 18 years old. I applied and was accepted. In Medical School, my first advisors were Ted Huang, a plastic surgeon, and Mary Knudson, an anthropologist. They talked me into working with them on my first research project, interviewing 13 to 16 year olds who had disfiguring facial and hand burns. When I started, I really and truly thought the kids should be allowed to die—I was 20 years old and that was my gut reaction. As I got to know the disfigured adolescents, their siblings and their parents, I realized that there were amazing and important people behind those masks of scars on their faces. I became obsessed with the importance of the appearance of the face and body in relating to the outside world. If yes, what other options were you considering and what made you finalize your selection? My only career path in medicine that deviated from

plastic surgery was pediatric surgery. However, as much as I loved pediatric surgery I saw too many children die when I was training. I realized that I didn’t want to see so many children die. And I especially did not want to have to tell another parent that their child had died. On the other hand, when you’re dealing with plastic surgery patients, you’re making them more productive people who can interface with the world in a way that makes it easier for them to express their emotions and conditions as well as feel better about themselves. You are a visionary: did you ever have doubts that the break-through for your pioneer work will come? Fat grafting has been a natural progression for me. I was in my residency when liposuction arrived in the US from France in 1982. By the time I moved to NYC in 1985 for a 6-month fellowship at MEETH and NYU, I began seeing subtle as well as remarkable iatrogenic liposuction deformities. So when I began practicing in New York in 1986, some of the first problems I encountered were liposuction deformities in women’s thighs and arms. Iatrogenic liposuction deformity was a new problem that the world of plastic and reconstructive surgery had not faced before. I asked all of the new “experts” on fat suctioning about grafting liposuctioned fat, and most of them told me that it would not work or it would not last any longer than injectable collagen. With that information, I approached the correction of the first liposuction deformities with the idea that the grafted fat might only last a few months. However, taking specific Issue 12

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photographic images before and months after surgery, I found that the fat seemed to last a long time. In fact, even my very first fat graft procedures had every indication of permanence. I listened to my patients as they asked me next to place fat grafts into the face. In the mid 1980’s, injectable silicone was commonly used in the face as a filler, and many patients were skeptical. However, they witnessed in their friends that fullness in the lips, cheeks, temples, nose, et cetera had a remarkable rejuvenating effect. First, the women in whom I had corrected liposuction deformities asked me why I did not use fat instead of silicone in their faces. Then, their friends found out about the possibility of fat grafting to attain fullness in the face. Patients pointed out the areas, and I listened. I started first with nasolabial folds and marionettes, then lips, temples and brows. Next, they asked me to place fat into the lower eyelids and even the nose. A big leap from filling lines and folds was to understand how fat could be used in the lower face to restore a strong jawline and chin and improve the cervical-mental angle. Even in the late 1980’s, I began to notice the remarkable improvement in the quality of the skin overlying areas of fat grafting. It was with that in mind that I began grafting fat into the dorsum of the hands: to restore not just fullness, but also to improve the quality of the sundamaged, aging skin. Then my patients started asking me about enhancing the body with fat grafting: the calves, buttocks and chest. Eventually, many patients asked why I wasn’t doing breasts, and in 1995, after the silicone implant crisis was spreading throughout the US, I advanced to using fat grafting in the breast. The progression of discoveries for me has always been patient-driven: patients asked me to do something, and I cautiously did it, with the patient understanding that it was the first time. And it often worked. In recent years, the challenges have come more and more often from other physicians seeking solutions for their patients with difficult problems. Did you feel disappointed or discouraged about the skepticism which the majority of plastic surgeons showed towards fat grafting for a long time? I was alone in the woods for so long that I became used to it. It is amazing to me that the same plastic surgeons who were vehement disbelievers in the past are now “experts” in fat grafting, claiming 10 or 20 years of “positive results,” seeming to use fat on almost every case they do. Some disappointing moments during your professional life? When plastic surgery “friends” who were bad-mouthing fat grafting just a few years ago, were quoted in news articles as having claimed to “invent” LipoStructure or fat grafting. 32

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Is there something you regret not having pursued? I wish I had devoted more time to studying languages and maintaining those that I have studied. I studied German, French and Spanish, but only really keep up a little with the Spanish. In research: did you focus on fat tissue from the beginning? Which results of your research projects do you consider to be most important? The research in which I have been involved has focused on either anatomy or fat grafting. The most important projects have shown that the method by which fat influences the area into which it is placed is by improving the vascularity and reducing scarring. Briefly describe your current position and the variety of patients you treat on a daily basis. I am in a private practice in TriBeCa in downtown New York City. I hold two academic appointments: one at New York University Medical Center and one at the University of Pittsburgh Medical Center. For several years, I have been travelling to Pittsburgh every month or every other month to work on three research projects with Peter Rubin, one of our greatest plastic surgery scientists. One project focuses on understanding how fat grafting can be used in cranial and facial combat injuries. A second project involves the use of fat in cranial and facial combat injuries as well, but is a controlled study in which stromal vascular fraction is added. The newest project examines the use of fat grafting in treating painful amputations. These three projects are funded by the Department of Defense. My practice is about 60% aesthetic in nature, although much of the aesthetic procedures might be considered reconstructive since they often involve correction of complications caused by other surgeons. Most of my practice is fat grafting based. The best part of my practice is when I sit down with someone and figure out how to make them look like they think they should look. The second best thing is sitting down with them a year or more later, looking at the pictures, and making sure they are happy and we've done all the things we were supposed to do. What are your goals for the next few years? My biggest goal is to unravel the mysteries of adipose tissue and stromal vascular fraction. There is much that we don’t know, and I believe there is enormous potential in fatty tissue. Explain what ISPRES means, why it was founded, how it developed and what you expect from the next ISPRES congress in Berlin. ISPRES is the International Society of Plastic Regenerative Surgery. ISPRES is an organization whose primary goal is the education of Plastic Surgeons and clinicians regarding fat grafting and emerging technologies based


on the regenerative properties inherent in grafted fat. ISPRES is a forum for sharing observations and research about the applications of fat grafting, stromal vascular fraction (SVF), adipose derived stem cells (ADSC), and growth factors (GF) in plastic surgery. We emphasize the functional qualities of grafted fat, particularly the recently recognized role of fat tissue as a repair organ, and how it can aid us in reconstruction and rejuvenation. We also explore the clinical uses of fat grafts for creating or restoring fullness in order to improve our aesthetic and reconstructive procedures. Along those lines, we review both research and clinical experiences that help us determine how to maximize fat graft survival. The March 2012, ISPRES Congress in Rome had 90 speakers and attendees from 55 countries. We turned away over 200 people who tried to register. There were over 150 abstracts submitted from all over the world. We used these abstract submissions to create a fresh, vibrant meeting in which much new information was presented. We mingled invited speakers (often in panels) with speakers who had submitted abstracts. Much of the information was heard for the very first time in an international forum. This worldwide participation of new presentations, made possible by the abstracts, rendered our first ISPRES Congress different from most other conferences, and more exciting for the attendees and participants alike. The vision of ISPRES Berlin 2013 Congress For the next Congress in Berlin, we will maintain the fresh approach of our first Congress in Rome. The invited faculty will present their latest observations, discoveries

and research. The scientific and organizing committees have worked together to develop a program in which innovative abstract submissions will complement the panels and invited lectures. ISPRES Rome 2012 had many pleasant surprises for those who attended. It is difficult to comprehend the changes that have occurred in the last year alone. I promise you that ISPRES Berlin 2013 will have many more surprises than you can imagine. The exchange of ideas about fat grafting, SVF and tissue engineering will occur not just during the sessions, but on the Congress floor and during the evenings. The attendees will have opportunities to befriend scientists and surgeons from every corner of the world. There will be many pleasant surprises every day and night of the congress. That exchange of ideas will change the world we live in immeasurably over the next decades. What is the future of Plastic surgery in the US? Plastic surgery is moving toward minimizing procedures, performing prophylactic treatments and, most importantly, regenerative surgery. Regenerative surgery involves the use of the patient’s own body and tissues to treat maladies instead of performing larger surgeries and/or using implants and medications. This is obvious at every meeting in plastic surgery in the world. Fat grafting and related regeneration are now the topic of the present and the future. What do you like to do in your free time; hobbies/ sports? I love to ski, do aerobics and weight lifting.

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RISING STAR

Alexandre Marchac, MD

Did you ever consider a different career than Plastic surgery? Not since I was 15, when my father, Daniel, showed me a film he had just done, on a bipartition for a Tessier #0-14 cleft. I was amazed by the combination of mechanics and biology, the ability of his hands to create something totally new, and the good he had done to this little girl. I was set on becoming a plastic surgeon. Such a precise goal made my medical studies both dynamic and stressful, because our system is solely based on test ranking, without any interviews. Today, I feel grateful for succeeding, because although many other medical specialties are interesting, none has the same combination of technical skills, creativity, and humanism that I enjoy so much in Plastic Surgery. Describe some of the highlights of your training. Great mentors/teachers, great cases, great opportunities. Beside my father, on whom much has been written recently and for who I had the greatest love and admiration, I have met many excellent surgeons during my 7 years program.I was lucky to spend 6 months of residency with Vladimir Mitz, my uncle, who I admire for his technical skills and artistry. Laurent Lantieri certainly was the most pivotal one in my academic training, because taking part in the face transplant program was an incredible experience. The most memorable story that I can recall is when Laurent Lantieri was away at AAPS and we got a call for a transplant, on a Monday at 7pm. Surprisingly, he told us to go ahead and start, and that he would jump on a plane! I did the tracheostomy at 3am, and a colleague and I started to prepare the recipient, while two colleagues went to harvest the donor. At noon, we had just done the anastomosis when Lantieri arrived from the airport. It was wonderful to see the cavalry arrive! The most incredible part of the story is that he went back to the US on Wednesday, and we got another donor on Friday. And, just like the first

time, we did our second transplant of the week. After this, my greatest opportunity was surely to meet with Françoise Firmin. At a dinner, Eric Arnaud told me that she was looking for a fellow because a guy had bailed out at the last minute. I called her the next day, and I found myself unexpectedly spending the next six months learning ear reconstruction, right after my residency. She really is a superb surgeon and I am glad that today we keep working closely together. Some disappointing moments during your training? My biggest disappointments came from senior surgeons who chose the easy way instead of the right way for the patient. Shortly after my Firmin fellowship, I was called one day by a senior surgeon in my department to help him to do a transnasalcanthopexy on a pan-facial fracture in a young adult. He had already done a bi-coronal incision and I saw that the patient had a total ear amputation. I respectfully asked him if he had considered preserving the superficial temporal artery, but his answer was that “he was simply going to put in implantsâ€?. He preferred to bill expensive implants rather than offer his patient a chance of a lifelong autologous reconstruction. Mistakes you could have avoided? Of course. But I know that I am not the only one, because I recall my father calling me to tell me about a mistake he had made, how it had turned out, and most importantly the lesson he had learned from it. He would then make sure that I understood it well. Mistakes are inevitable and we must betotally prepared to correct them. This is the essence of professionalism. Is there something you regret not doing during your training? Yes, I regret not getting more exposure to vascular surgery. It's a great training for a flap surgeon. Perhaps I will in another lifetime. Issue 12

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How about research? Did you do any and what were your topics? Research is not mandatory during medical school in France and I was so focused on getting good scores that I discarded it.I took part in several clinical research projects, but at the end of my surgical training, I felt lost reading the experimental papers of PRS. It gave me an incentive to do research. At a craniofacial meeting, I met Stephen Warren who was the lab director at NYU. He really impressed me by his bright intellect and I asked if I could work with him. This was after my two clinical fellowships, with Françoise Firmin and my father. I spent a fascinating year at NYU, doing basic research on angiogenesis and stem cells. How much emphasis should we give in research during plastic surgery training? Research should definitely be encouraged during residency. In Paris, we had a cadaver and animal laboratory available every day for residents. Once in a while, I would escape the service and practice in the lab before a difficult operation or explore some point of anatomy that looked confusing. At NYU, I loved Monday morning research meetings, when Joseph McCarthy, in his role of experienced and talented conductor, was untangling problems, assigning someone to help a resident who was stuck on a project, and motivating everyone to give their best. Today, I dream of a program where residents would have half a day every week to work on a research project, with appropriate mentoring of course. Since you spent training time on both sides of the Atlantic could you please share you personal opinion on strengths and weaknesses of either system. I was very impressed by the quality of the training at NYU and other top American programs. Broad exposure to surgical problems, good mentoring, research. I don’t see much to change there, whereas I would like to add more research into our French programs, which are mostly hands-on. Based on your training experiences what advice would you give to young trainees? I tell my trainees to forget about the difficult tests and remember their natural curiosity, and enjoy this short period of training in life. I tell them to learn as much as possible and later identify what they like most, and then thrive at being the best at it. I tell them not to hurry, to travel and look for a mentor. Briefly describe your current position and the variety of patients you treat on daily basis. I’m a consultant surgeon in Laurent Lantieri‘s department, where I spend two days a week doing ear reconstructions and microsurgery, mainly for autologous breast reconstruction. The rest of the week, I’m in private practice, not far from the hospital, where I do both reconstructive and aesthetic surgery. I switched from full time faculty to part time 6 months ago, and I must confess that I truly enjoy building up my practice, despite the administrative burden and economical crisis. 36

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So far, what were the highlights of your career? 1/ the face transplants, 2/ Victor and David, two African patients with total lip and nose amputation, from Bonobo Monkey bites, which I reconstructed simultaneously in the span of 6 months and 3/ my first humanitarian mission in Bolivia, which moved me beyond expectations. What are your goals for the next few years? 1/ to organize a great meeting in Paris on September 25-27th 2014 for the International Society of Auricular Reconstruction (www.isar.org), 2/ to establish my private practice further and 3/ to have a great creative idea that makes us leap forward. What is your definition of a complete and successful Plastic surgeon? It is a balance between technical skills, scientific knowledge, expertise in a subspecialty, willingness to teach and share, and devotion to his patients. Are you involved or plan to participate in volunteer surgery? Yes, I go once a year to South America to do autologous ear reconstruction, with Françoise Firmin at first, and now with a small group of friends, with the support of La Chaîne de l’Espoir. We do about 30 microtia cases in a week, first and second stages. Microtia is an excellent model for volunteer surgery, as long as you can train local surgeons to take care of healing problems and come back to do the second stage. Françoise and I are going to Uganda this September for the first time. What does IPRAS mean to you? Why should plastic surgeons around the world become active with this organization? IPRAS is the United Nations of Plastic Surgery, an organization that has the unique ability to speak to everyone and coordinate international efforts. It is a place for everyone to share and learn. What is the future of Plastic surgery in France and what are the major pressures that our specialty faces? Since October 2012, the government is raising a 19,6% VAT on aesthetic surgery, under the pretext that it is not therapeutic. We have been fighting this decision, and a European regulation just gave us a positive answer. Otherwise, I believe that Plastic Surgery is still an expanding field, unlike cardiac surgery, and that we will see great innovations in the coming years. What do you like to do in your free time; hobbies/sports? I like to run and go to the gym, and I sail and ski during the holidays. I draw a lot for pleasure and play the guitar, and in general I like arts and design. And I am expecting a son in May, and this will take me a lot of time, because I definitely want to be a good father and a good husband for my lovely wife Nathalie. What is your favorite book? Favorite music? The book that I would take with me on a deserted island: the complete works of Antoine de Saint-Exupery. I listen to a lot of jazz, but the record I would take is a best of Frank Sinatra songs, to lift my spirit when I’ll be down.


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ISPRES SECTION

2nd ISPRES Congress, Berlin, Germany June 7-9, 2013 Message from the President of ISPRES Dear Colleagues, As the Chairman of the Board of Directors of the International Society of Regenerative Surgery, it is our pleasure and honor to invite you to the 2nd ISPRES meeting to be held in Berlin at the Steigenberger Hotel, June 7-9, 2013. By inviting you to Rome for the first meeting, I pointed out that the 70’s and 80’s were characterized by the discovery and study of the axial flaps, a necessary step for the development of reconstructive microsurgery in the 90's. At the end of this period, the “fat graft” was inserted forcefully in our clinical practice. The first meeting of ISPRES in Rome began to define and point out the biological capacity of adipose tissue graft, emphasizing both its use as a filler and as a regenerative agent and mentioned that "fat" is characterizing the current period in the history of plastic surgery. I think it is right to say this. After Rome in each meeting around the world, the term "fat" has always had an honorary place and increasingly many of us engage in its research, testing and its clinical application. It is not yet time for further and deeper consideration on the use of this new feature of plastic surgery, which I would define revolutionary, since there are still many things to be learned about it, while a lot of assumptions based on results of basic research, form part of this discipline. Surely we understand that many positive surprises are yet to come. A year later following Rome, its notion is clearer and we expect that the participants of the meeting in Berlin will furthermore, lead to a better understanding of the biological complexity of fat graft. For all these reasons I invite you to join us to follow, monitor and contribute to the growth of possibilities of this new adventure in plastic surgery.

Gino Rigotti ISPRES President

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Message from the General Secretary of ISPRES The 2nd Congress of the International Society of Plastic Regenerative Surgery (ISPRES) convenes in Berlin June 6-9, 2013. In Berlin this June, you will learn about a paradigm shift in medicine and plastic surgery towards regeneration and how you can apply these philosophies to your own clinical practice. Regenerative surgery manipulates our own body’s tissues to treat and cure conditions rather than using drugs and more invasive, non-natural procedures. This regenerative approach is no longer a dream of the future, but is rapidly becoming part of our current practices. The invited faculty, Scientific Committee and the Organizing Committee have devised the content of ISPRES Berlin 2013. We have combined scientists with surgeons from around the world to provide a fresh understanding of adipose derived stem cells (ADSC), stromal vascular fraction (SVF) and fat transplantation. The program is not just at the cutting edge of science, but also full of clinical knowledge which surgeons can implement into their practices. The first sessions of ISPRES Berlin 2013 will update the attendee with a new understanding of how adipose derived stem cells work. The early sessions will lay the groundwork so the audience can appreciate the fascinating clinical studies presented in the rest of the meeting. During the first session, Gino Rigotti will explain the newly recognized entity, the “postadipocyte”, and its integral role in fat grafting. The earlier sessions will also present studies that help clarify where and how we find ADSC and how they work to regenerate tissue. Many talks will focus on the speakers’ understanding of how fat grafts work and methods of enriching fat. Hans Hauner, the first scientist who isolated and cultured human preadipocytes, is our keynote speaker this year. New information about how adipose stem cells work will help clinicians understand the many scientific presentations on tissue engineering. These presentations will lay the groundwork, so the audience will be able to appreciate the fascinating clinical studies and experiences presented from around the world. Much time will be devoted to maximizing donor and recipient sites for fat grafting, including external volume expansion, hyperoxygenation and the effect of PRP and other additives. Stromal Vascular Fraction (SVF) is thought by many to be the future of medicine. For that reason, ISPRES Berlin 2013 will devote several sessions to SVF, and will include the role of SVF in almost every session. An international faculty will provide an in depth analysis of the different methods of processing and using SVF. For instance, in one of the sessions on processing SVF we have the following presentations: • Carlo Tremolada and Camillo Ricordi from Italy will explain a potentially revolutionary advance in SVF: “LipoGems” • David Daehwan Park from Korea will show us automated extraction of adipose derived stem cells. • Sundar Raj Swathi from India will introduce a new automated device for SVF isolation • Jae-Ho Jeong from Korea will demonstrate the use of SVF for bedside treatment of surgical complications • John Fraser from California will give an update on the SVF clinical studies currently underway using the Celution® System 42

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After the above session, Guy Magalon from France and John Fraser from California will clarify how to determine what is present in SVF. Every section of the Congress will present an international perspective, like the ones above. There will be sessions on SVF-enriched fat for rejuvenation, combat injuries, scars, burn wounds, scleroderma, diabetic ulcers, open fractures, and a range of maxillofacial and craniofacial applications. We will also spend much time discussing potential problems with the use of SVF, including safety issues, potential complications, and governmental regulation of SVF. In a session running concurrent with the facial and wound presentations, we will have over six hours on the use of SVF and fat in aesthetic and reconstructive breast surgery, including much discussion of the preparation of the breast for fat implantation and of the potential cancer risks associated with this procedure. A course entitled “Fundamentals of fat grafting: complementary and conflicting techniques” will take place on June 6, 2013 from 1:30pm to 6pm, the afternoon before the Congress begins. This will be a basic course comparing the varying techniques that have evolved in fat grafting: contrasting the many techniques that have developed for different indications, and looking at how they contrast with and complement each other. We will also include some of the fundamentals of the preparation of SVF using different methods and devices. Also during that pre-meeting, we will have a specific course with the purpose of educating practicing physicians about the nomenclature of Cell Biology, which has rapidly become a part of the plastic surgery literature. Another course will help us all to understand and interpret specific scientific studies more intelligently. The scientific program of ISPRES Berlin 2013 will present the world’s most clinically relevant research and experiences with the regenerative phenomenon that is revolutionizing plastic surgery. Presentations will be at the highest scientific level, but the Conference is aimed at making the science of fat grafting, SVF, ADSC and growth factors accessible to the practicing clinician. I will begin to tease you with the planned presentations over the next weeks from the Facebook site, LipoStructure https://www. facebook.com/LipoStructure

Sydney R. Coleman, MD President of ISPRES 2013 Secretary General of ISPRES


INTERNATIONAL SOCIETY OF PLASTIC REGENERATIVE SURGERY

CONGRESS

June

B E R L IN , G E R M A N Y

Steigenberger Hotel

new frontiers and horizons in the field of tissue regeneration

Be at the edge of the latest developments

Learn more about new

extraordinary techniques

Pre-Congress Instructional Course 6 June 2013, 1:30pm-6:00pm

“Fundamental Principles of fat grafting: complementary and conflicting techniques”

www.ispresberlin2013.com also available from your mobile devices

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Supported by

ZITA

American Society of Plastic Surgeons

Austrian Society of Plastic, Reconstructive & Aesthetic Surgery

British Association of Plastic, Reconstructive & Aesthetic Surgeons

German Society of Plastic, Reconstructive and Aesthetic Surgery

Turkish Society Korean Society of Plastic & Reconstructive of Plastic Reconstructive and Aesthetic Surgeons Surgeons Issue 12 www.ipras.org IPRAS Journal

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INTERNATIONAL SOCIETY OF PLASTIC REGENERATIVE SURGERY

CONGRESS

June

B E R L IN , G E R M A N Y

Steigenberger Hotel

new frontiers and horizons in the field of tissue regeneration PRESIDENT of the Congress:

Sydney Coleman, ISPRES General Secretary, USA

LOCAL Organizing Committee

Norbert Pallua, ISPRES Treasurer, Germany Dennis von Heimburg, Germany

INTERNATIONAL ORGANIZING COMMITTEE

Fahd Benslimane, Morocco Valerio Cervelli, Italy Abel Chajchir, Argentina Suk Wha Kim, Korea Paulo Roberto Leal, Brazil Riccardo Mazzola, Italy Fernando Molina Montalva, Mexico Ahmed Adel Noreldeen, Egypt Sergey Nudelman, Russia Norbert Pallua, Germany Zsolt Revesz, Hungary Ewa Siolo, South Africa Peter Vogt, Germany Andreas Yiacoumettis, Greece

SCIENTIFIC COMMITTEE

Luigi C. Clauser, Italy Marita Eisenmann-Klein, Germany Brian Kinney, USA Qing-Feng Li, China Sin-Daw Lin, Taiwan Guy Magalon, France Norbert Pallua, Germany David Daehwan Park, Êorea Nelson Piccolo, Brazil Lee L. Q. Pu, USA Peter Rubin, USA Ricardo Tieghi, Italy Kotaro Yoshimura, Japan

INVITED FACULTY

Eckhard Alt, Germany Jean Christophe Bichet, France Steve Cohen, USA Dan Del Vecchio, USA Marita Eisenmann-Klein, Germany John Fraser, USA Seung-Kyu Han, Korea Hans Hauner, Germany Alexes Hazen, USA Roger Khouri, USA Luca Lancerotti, Italy Paulo Roberto Leal, Brazil Qing-Feng Li, China Sin-Daw Lin,Taiwan Ramon Llull, Spain Guy Magalon, France Alessandra Marchi, Italy Ali Mojallal, France

Dennis Orgill, USA Norbert Pallua, Germany David Daehwan Park, Nelson Piccolo, Brazil Valerie Planat-Ben ì ard, France Lee Pu, USA Gino Rigotti, Italy Peter Rubin, USA Andrea Sbarbati, Italy Sandeep Sharma, India Ewa Siolo, South Africa Aris Sterodimas, Greece Ricardo Tieghi, Italy CarloTremolada, Italy Carlos Ventura, Italy Peter Vogt, Germany Dennis von Heimburg, Germany Jorg Wiltfang, Germany Kotaro Yoshimura, Japan

TOPICS

Introduction and Historic Perspectives The Biology of Fat, Stromal Vascular Fractions, Adipose Derived Stem Cells and Growth Factors Maximizing and Understanding Results of Clinical Fat Grafting Stromal Vascular Fractions: Processing and Use Storage of Harvested Fat and SVF Acute, subacute & chronic conditions treated with fat grafting Safety issues with SVF, Fat Grafting and Growth Factors Fat Grafting to the Breast Corporal Fat Grafting Facial Fat Grafting Regional Considerations of fat grafting in the Face & Neck Craniofacial/Maxillofacial Applications of Fat Grafting Regulations & Ethics concerning Fat Transplants, SVF, ADSC & Growth Factors Special Course: “Cliff notes” on Cell Biology for Clinicians Special Course: Understanding and interpreting specific scientific studies on fat grafting, SVF, ADSC & GFs Terminology consensus

44 IPRAS Journal www.ipras.org Issue 12 SA, Mrs. Irene Katti, tel. (+30) 211 100 1783, i.ka@zita-congress.gr Contact: Zita Congress & Travel


Regenerative Applications of Plastic Surgery

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Pre-Congress Instructional Course 6 June 2013, 1:30pm - 6:00pm

“Fundamental Principles of fat grafting: complementary and conflicting techniques”

Invited Speakers Sydney Coleman Roger Khouri Nelson Piccolo Gino Rigotti Ewa Siolo

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Laser Stimulation on Adipose Stem Cells (ASC) and Adipocytes Authors: Centurión* Patricio, Noriega** Adrián. *MD. Plastic & Regenerative Surgeon. Research Professor, Faculty of Health Sciences. Universidad Peruana de CienciasAplicadas (UPC) - Laureate International Universities. Lima – Perú. **MD. Plastic Surgery Assistant. Author Email: Patricio Centurión: pccenturion@gmail.com

Background: Research on the 1210-nm Laser –which is subsequent to our experience using the 980-nm Laser– introduces a technique, ideal for treating lipodystrophy, that causes less trauma to tissues, presents a low rate of minor complications and produces no damage to adipocytes. The 1210-nm Laser has high absorption-affinity for Lipid-Rich Tissue and has demonstrated to stimulate the adipose-derived stemcells (ASC) and adipocytes of subcutaneous tissue, with a new concept: A Selective Photothermostimulation (SPS) confirming that Light (LASER) is life; making its use possible for regenerative medicine and tissue engineering,as for fat grafting in Liposculpture, Breast Reconstruction or as filler in Face Rejuvenation, demonstrating that this technique is suitable to harvest both cells. Our study originated in the search of a gold standard in Laser technique, that offered high preservation of the subcutaneous tissue, its adipose and stem cells and less trauma for the patient. We changed the concept of Lipolaser so far related to “lipolysis” and created the new concept of “fat preservation by laser “. The present study is based on the analysis of the Subcutaneous tissue after the application of Laser 1210nm with a Selective Photothermostimulation effect. Adipose-derived stem cells (ASCs) have been identified as an ideal source for tissue engineering, because of its simple harvesting possibilities and its potential to differentiate into several cell lineages. With this lasertechnique we demonstrated that it was possible to preserve the integrity of adipocytes and ASCs.

cells presented in the sample Laser 1210-nm demonstrated a higher number: 357 cells /µL (8.9 x 106 cells)with a viability of 90% compared with the sample of conventional liposuction: 14 cells /µL (0.35 x 106 cells)with a viability of 90%. Also the samples were measured after cryopreservation and the ones obtained through Laser liposuction doubled the number of the ones of the conventional Liposuction. The mitochondrial activity of adipocytes indicates an index of 1.4 of well-defined and unaltered cells with the Lipolaser 1210-nm compared with an index 0.6 for the conventional liposuction.

Conclusions: Several studies demonstrated that the 1210-nm has high absortion-affinity for Lipid-Rich Tissue and has proven to stimulate the adipocytes and mesenchymal cells of the subcutaneous tissue, with a new concept: Selective Photothermostimulation (SPS). This effect maintains adipocytes and ASC unaltered, providing with an optimal harvesting material compared to conventional Liposuction and therefore making them viable for regenerative medicine, autografts in Liposculpture, Breast Reconstruction or as fillers in Face Rejuvenation.

Key words: Lipolaser 1210-nm, Laser Selective Photothermostimulation, Adipocyte derived Stem Cells, Regenerative Medicine.

Materials and Method:

References:

Data were collected from 225 patients who underwent Laser Liposuction between June 2010 to December 2012. Histological samples of the subcutaneous tissue were analysed and compared to samples of conventional liposuction. Mitochondrial activity was measured to determine the viability of the samples. A group of these samples were submitted to thermal stress by cryopreservation and their viability was measured after. Results from both groups were compared before and after cryopreservation.

1. Anderson R R, Farinelli W, Laubach H, Manstein D, Yaroslavsky A, Gubeli J, et al. Selective photothermolysis of lipid-rich tissues: a free electron laser study . Laser SurgMed. 2006 ; 38 : 913 – 919 .

Results: Histological studies determined that the mesenchymal 46

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2. Centurion P, Noriega A. Fat Preserving by Laser 1210-nm. Journal of Cosmetic and Laser Therapy, 2013; 15: 2–12. 3. Peplow P, Chung T, Ryan B, Baxter D. Laser Photobiomodulation of Gene Expression and Release of Growth Factors and Cytokines from Cells in Culture: A Review of Human and Animal Studies. Photomedicine and Laser Surgery 2011. 29(5): 285-304.


Imagenologic Findings in Breast after Autologous Fat Grafting Dra Federica Zlotniski -Uruguay

The objective of this work is to review the medical literature in order to answer the following questions: What has changed since 1987, when the American Society of Plastic and Reconstructive Surgeons, banned the use of this technique due to the possibility of interfering with breast cancer screening tests? What are the expected imagenologic findings after breast fat grafting? Does fat grafting increase the difficulty breast cancer detection? Autologous fat grafting to the breast is not a simple procedure and should be performed only by well-trained and skilled surgeons. This procedure is being performed incorrectly by untrained and untutored physicians and could result in major complications. The primary complication of breast lipografting is the formation of liponecrotic cysts which have characteristically benign appearances in sonography, mammography or magnetic resonance imaging. 1 2 Fat necrosis, cyst formation, and indurations can be seen as in any other surgical manipulation of the breast. The incidence of calcifications after all types of breast operations varies but has been reported to be as high as fifty percent of patients after two years. Fortunately, radiologists are adept at distinguishing the calcifications of malignant causes from the benign calcifications resulting from fat necrosis. 3 A range of mammographic findings such as parenchymal asymmetrical densities, radiolucent cysts, heterogeneity of the subcutaneous tissues, and benign-looking calcifications can be expected after autologous fat transplantation to the breast.4 5 Ultrasonographic features like anechoic lesions with posterior acoustic enhancement or shadowing, cystic lesions with internal echo, and increased echogenicity of the subcutaneous tissues can also be expected after breast lipofilling.6 7 In the magnetic resonance the fat necrosis appears as masses less intense in T1 compared with native fat of the breast. In T2 fat necrosis appears more intense. This could be due to the fibrosis of the grafted areas or because they contain less fat. 8 In patients that presented breast cancer, the first thing to consider is the difference between fat necrosis and malignant recurrence. Usually, the patients follow up is

based in the physical examination and mammography. If lumps appear, the combination of sonography and mammography is generally enough for their evaluation.9 10 In few cases a magnetic resonance would be necessary. If there are doubts, a biopsy of the lesion can be performed.11 12 13 14 Some authors, like Fulton15, say that such lesions can hide microcalcifications associated with carcinomas and confuse the breast cancer screening. Most of the calcifications, even the grouped ones, are benign. Therefore the decision of performing a biopsy should be based in multiple factors, analyzing the patient’s history. In multicenter study16 from three institutions confirms that lipofilling following breast cancer treatment leads to a very low rate of complications and does not affect the radiologic follow-up after breast-conserving surgery. What has changed since 1987, when the American Society of Plastic and Reconstructive Surgeons, banned the use of this technique due to the possibility of interfering with breast cancer screening tests? Several grafting techniques have been reported, being Coleman´s principles, the most respected by most plastic surgeons. Atraumatic technique, processing and infiltration, ensues better graft survival and overall clinical results. Other technical improvements have also been reported, like the pre-expansion of the receptor site, allowing for higher volumes of injection with better survival rates. What are the expected imageneologic findings after breast fat grafting? The most frequent complications are fat necrosis, cysts formation, calcifications and palpable masses. The appearance of these lesions, according to some authors, might interfere with the diagnosis of breast cancer, being this the main reason for the ongoing debate surrounding breast fat grafting. Does fat grafting increase difficulty of breast cancer detection? This is a safe technique and does not interfere with breast cancer screening. Both technique and screening, should be performed by skilled surgeons and radiologists specialized in breast pathologies. Issue 12

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1. Hyakusoku H, Ogawa R, Ono S, Ishii N, Hirakawa K (2009) Complications after Autologous Fat Injection to the Breast .Plast. Reconstr. Surg. 123: 360-370

10. Veber, Tourase C, Toussoun G, Moutran M, Mojallal A, Delay E (2011) Radiographic findings after breast aumengtationby autoloous fat transfer. Plast Reconstr Surg 127:1289

2. Illouz YG (1989) Body sculpturing by lipoplasty. London, Churchill Livingstone, pp 390–394

11. Botteri E, Bagnardi V, Rotmensz N, et al. (2010)Analysis of local and regional recurrences in breast cancer after conservative surgery.Ann Oncol. 21:723–728.

3. Sydney RC, Alesia PS.(2007) Fat grafting to the breast revisited: safety and efficacy. Plast Reconstr Surg.119:775–783. 4. Illouz Y.G, Sterodimas A (2009) Autologous fat transplantation to the breast: A personal technique with 25 years of experience. Aesth Plastic Surg

12. Petit JY, Gentilini O, Rotmensz N, et al. (2008) Oncological results of immediate breast reconstruction: Long term follow-up of a large series at a single institution. Breast Cancer Res Treat. 112:545–549.

5. Veber, Tourase C, Toussoun G, Moutran M, Mojallal A, Delay E (2011) Radiographic findings after breast aumengtationby autoloous fat transfer. Plast Reconstr Surg 127:1289

13. Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames FC (1997) Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol 4:193–197

6. Bilgen IG, Ustun EE, Memis A (2001) Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol 39(2):92–99

14. Helvie MA, Bailey JE, Roubidoux MA, et al. (2002) Wilkins mammographic screening of TRAM flap breast reconstructions for detection of non palpable recurrent cancer. Radiology 224:211–216

7. Taboada JL, Stephens TW, Krishnamurthy S, Brandt KR, Whitman GJ (2009) The many faces of fat necrosis in the breast. AJR Am J Roentgenol 192(3):815–825

15. Fulton JE. (2003)Breast contouring with “galled” autologous fat: A 10-year update. Int J Cosmet Surg Aesthet Dermatol. 5:155–163.

8. Goehde SC, Kuehl H, Ladd ME (2005) Magnetic resonance imaging of autologous fat grafting. Eur Radiol 15(12):2423–2426 9. Pierrefeu-Lagrange AC, Delay E, Guerin N, Chekaroua K, Delaporte T. (2006) Radiological evaluation of breasts reconstructed with lipomodeling. Ann Chir Plast Esthet. 51:18–28.

16. Petit J.Y, Lohsiriwat V, Clough K.B, Sarfati I, Tarik Ihrai, Rietjens,M, .Veronesi, P, Rossetto F, Scevola A, Delay E. (2011) The Oncologic Outcome and Immediate Surgical Complications of Lipofilling in Breast Cancer Patients: A Multicenter Study–Milan-Paris-Lyon Experience of 646 Lipofilling Procedures Plast. Reconstr. Surg. 128: 341

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International Society of Plastic Regenerative Surgery (ISPRES)

Application For Membership Family Name: …………………………………………………

www.ispres-ipras.org

Name: ………………………………………………… IPRAS national society/association or regional association Country member: ………………………………………………… Board Certification in: …………………………………………………

Membership(s): ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………………………………

Hospital/Private Practice

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City

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Address

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Telephone

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Fax

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E-mail

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My involvement / experience with fat research /application or other regenerative factors: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………………………………

Please send the application at maria.petsa@iprasmanagement.com or fax it at 0030 210 664 5176

I attach a recent Curriculum Vita (one page) I Hereby Declare that the above mentioned details are true and correct Full Name and Signature:

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SERVEYS

What is the future of laser in the modern plastic surgery? Author: Romulo Mene, MD, Plastic Surgeon* Co author: Yuri Mene, Dermatologist** Member of: SBCP, ISAPS, IPRAS, *IPRES, ASPS, ALSMC, ESLMC,SBLMC *Regent of the Laser and Resurfacings Chapter of the Brazilian Society of Plastic Surgery, 2009/2010, 2011/2012, 2013/2014. *President of the Brazilian Society of Laser in Medicine and Surgery 2011-2012 and 2013-2014 CEO for Center for Advanced Skin Therapy Ipanema, Rio de Janeiro, Brazil. **Dermatologist in the Advanced Center

Skin aging is clearly a progressive atrophy process, where the tissue receives less and less blood and tends to decrease its volume. The appearance of wrinkles, blemishes, and loss of shine are the most significant signs reported by our patients.

1996

2012

Fig 1A - RA , 45 YO. Before treatment

Fig 1B -16 years after ablative CO2 laser resurfacing (full face)

Over the past century, different combined techniques have been developed to improve the dermal and epidermal signs of photo- and or chronological skin aging.

Nowadays, modern plastic surgery is complemented with different non-surgical procedures such as lasers and chemical peelings. The goal in the use of non-invasive skin procedures is to achieve patient satisfaction to give them a more youthful look by diminishing the signs of aging and the damage caused by years of sun exposure in both facial and nonfacial areas such as the hands, neck or chest. The history of laser skin resurfacing brought a lot of hope for the recovery of skin quality for those patients with a high degree of photo-aged skin. Unfortunately, these techniques are still limited to the photo types 1, 2 and 3 (Fitzpatrick classification). It is fundamental that the laser equipment used for resurfacing be of the highest technology and the operator be well trained to avoid sequels. The best laser equipment to remove the epidermis and to stimulate the dermis, is that which uses the highest power of Erbium-YAG (3,000 mJ); it has the same advantages of CO2 lasers, without the side effects typically caused by CO2 lasers. (Hypochromia, long recovery time of the skin tissues and long lasting erythema). New laser technologies offer another alternative to rejuvenate the skin with fewer side effects than earlier lasers. The latest generation of laser resurfacing is

2010 FIG 2A - 2009 – EK, 60 YO. Before treatment

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FIG 2B - 5 days after the traditional Blepharoplasty done with the CO2 laser in continuous mode and periorbital ablative Laser Resurfacing with Erbium-YAG

FIG 2C - 45 days after


fractional resurfacing. It penetrates deep into the skin, leaving the surrounding skin unaffected and intact, thereby allowing for the surrounding, healthy skin cells to assist in the healing of the damaged cells. This advanced technology enhances the ability to fine-tune treatments, and allows us to better refine and customize treatments based on each patient's specific needs. It gives the option to work in a selective and fractionated manner in great depth, to work safely on patients with extensive skin damage, to increase collagen production that creates dramatic results to improve the appearance of skin texture and reduce the appearance of wrinkles and acne scars with considerably less downtime than other invasive laser technologies. These procedures facilitate the interaction with chemical peels. With a better understanding of the interaction between the laser, the tissues, and the limitations of laser resurfacing techniques, we seek to offer our patients the best all round results, whilst decreasing our risks. Modern Plastic Surgery needs to be prepared for new concepts in REGENERATIVE PLASTIC SURGERY. The correct diagnosis of the skin to be treated and the choice of the methods that can restore or reverse the atrophic skin are very important. In the Brazilian Society of Plastic Surgery, where for the past five years I've been the head of the Chapter for Laser and procedures to regenerate and reverse atrophic human skin, our main goal is to prepare young Plastic Surgeons during their academic formation (Plastic Surgery Residency) and also to pass these advanced skills to experienced colleagues who are not familiar with these lasers technologies and adapt them to the use of these procedures with regenerative potential that are able to reverse the atrophic lesions that occur during the natural aging process, or accelerated aging process produced by the sun. We suggested some theoretical topics for the national program for academic formation of new Plastic Surgeons. 1. Interaction of Laser-Tissue, understanding the skin histology applied to laser and chemical peeling procedures.

2009 FIG 3A - IBP, 78 YO. Before treatment

FIG 3B - 22 days after upper eyelid Blepharoplasty done with the CO2 laser in continuous mode and sun damaged skin treatment with Fractional CO2 Laser Resurfacing

2. Differential diagnosis of the major skin lesions, benign or malignant. 3. General knowledge of physics applied to the lasers used in dermatology and plastic surgery. 4. Chemical Peels Agents: how they work, their limits and the control of possible complications. 5. Selection of skin lesions and the parameters for the lasers and chemical peels. 6. Management of post-inflammatory process that normally occur with the use of lasers and chemical peels. Among these proposals is the use of different types of lasers combined with different types of chemical peels that can work in harmony and maintain laser resurfacing results for a long time. Figs: 1A/1B, 2A/2B/2C and 3A/3B).

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Replantation in Children Ruiz Alonso # * María Elena (marilenbur@yahoo.es), López Fernández** Susana, García Cano* Pilar, Zamora Parra* Belén, Rivera Vegas* MariaJesus, Fernández Sierra*** Abel # Current director of FILACP Hand Section * PlasticSurgery. Hospital Universitario de Burgos. Burgos (Spain) ** PlasticSurgery. Hospital de la Santa Creu i Sant Pau. Barcelona (Spain) *** Encoding Service. Hospital Universitario de Burgos. Burgos (Spain)

Introduction: Amputations are injuries that are experienced with great anxiety and much more when they occur in children. Replantation performed by specialists in hand surgery usually gets very good results both vascular and functional, also improving the psychological consequences associated with trauma of this type. In children, the indications for replantation include any upper extremity part. In fact, the decision to replant resides solely in the operating surgeon who will assess the feasibility of the

reconstruction. We evaluate the results obtained from different points of view, not only assessing the vascular outcome but also the functional status and growth obtained in the replanted segment. We also evaluate differences from adult patients in terms of mechanism of injury, amputation level and indications of replantation. The emphasis is on technical differences in terms of material and human resources, which require the management of these patients; taking into account that the management of both patient and amputee segments should be even more exquisite and meticulous, which is required in adult patients.

Materials and methods: During a 10-year period, 432 people required replantation or revascularization of the upper extremity at our center, the Reference Replantation Center of Spain, 29 of which were children, representing 6.7% of the total; below most of the world average that are at around 10%. This is probably because we work in a very industrial area which may increase the cases in tool workers.

Results: The most common types of injuries found in the children were avulsion and crush (PHOTO 1). Only 1 case was

PHOTO 1

PHOTO 2

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macroreplantation, being amputations of the thumb (15 cases) and the little finger more frequent (8 cases). Obviously, we develop these procedures in children under general anesthesia and we also add a regional catheter for postoperative care which decreases the pain and vasospasm in the repaired vessels. We use a tourniquet in the majority of the procedures. As in adults, bone fixation is the first step after an adequate debridement. When needed, shortening of the bone should be conducted, facilitating bone healing and decreasing tension on the repairs of the other structures (vessels and nerves). During the bone shortening, it´s very important to avoid compromising the epiphyseal growth plate. The extensor and flexor tendons are repaired next, before vascular structures, to prevent movement that could injure them. In vascular reconstruction, we prefer to do the arteries first for two main reasons; ischemia time (to prevent the return of the toxic metabolites into the systemic circulation), and the veins of the children are too small and sometimes it’s easy do it after the reperfusion because they’re filled with blood and it’s easy to identify them. It is essential to avoid tension; this is why we use vein grafts whenever necessary. If possible, primary nerve repair should be carried out at the time of replantation. Nerves, tendons and bone grafts should be delayed until the stable coverage. An adequate coverage of vessels is mandatory, as well as avoiding tension on the closure that might compromise the revascularization. For proximal amputations, decompressive fasciotomies are indicated to protect against a compartment syndrome that can be develop after revascularization. A

bulky and soft dressing is applied to prevent the disrupting of anastomotic suture lines with an uncontrolled movement. Functional results used to be excellent but despite this success, from the vascular point of view, replantation in children is not as successful as in adults because of the greater frequency of crush / avulsion injuries and the smaller size of the vessels. Success rates among larger pediatric replantation series range from 63% to 97%, we’re in 83% (PHOTO 2 AND 3). The replanted part usually continues growing if the epiphyseal plate does not close prematurely, averaging 86-92% of contralateral size.

Conclusions: The upper extremity amputations in children are fortunately very rare. The need for both human and technical methods, means that treatment should be carried out in centers with appropriate specialists in comprehensive management of such injuries, obtaining very good results in the vast majority of patients from the vascular and functional point of view and an adequate growth.

Bibliography: 1. Raja Mohan, Zubin Panthaki, Milton BA. Replantation in the pediatric hand. J Craniofac Surg 2009; 20: 996-8. 2. Michalko KB, Bentz ML. Digital replantation in children. Crit Care Med 2002; 30: S444-7. 3. Kim JYS, Brown RJ, Jones NF. Pediatric upper extremity replantation. Clin Plastic Surg 2005; 32: 1-10.

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Induced Angiogenesis in PCL Bioactive Scaffolds with a new Prefabrication Method Experimental study on rats Dębski Tomasz1,2(tdebski@o2.pl), Gilewicz Joanna1, Kurzyk Agata1,Ostrowska Barbara 3, Jaroszewicz Jakub3, Wysocki Juliusz1, Machaj Eugeniusz1, Jaworowski Janusz1, Święszkowski Wojciech3, Pojda Zygmunt1 1 Maria Skłodowska-Curie Cancer Memorial Centre, Warsaw 2 Department of Plastic Surgery, The Medical Centre of Postgraduate Education, Warsaw. 3 Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology

Background: The initiation and development of a fully functional vascular network in bioengineered artificial bone are crucial for reconstruction of large osseous defects. One of the methods of inducing neovascularization in bioactive scaffolds is prefabrication. The majority of prefabrication methods described in literature relies on neovascularisation from arteriovenous loop or ligated arteriovenous bundle. These

methods are technically difficult and may lead to vessel thrombosis and dysfunction. In our study we are proposing a prefabrication method where vascular pedicle is of a flowthrough type and is located inside the scaffold. Such design diminishes the risk of thrombosis, and enables vascularisation not only from vascular pedicle inside the scaffold, but also from surrounding tissues like skin, fascia or muscle.

Fig. 1. Scaffold implantation. On the left side the scaffold is implanted in proximity of vascular pedicle (arrow). On the right side the scaffold is closed on vascular pedicle (new prefabrication method).

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Aim of the study: The purpose of the study was to determine whether a new prefabrication method could successfully induce angiogenesis in PCL scaffolds cultured with adipose-derived stem cells (ADSC).

Material and methods: Tube-shaped scaffolds (fi 6x10 mm) with inner diameter of about 2 mm were produced from polycaprolactone (PCL) using a 3-D printing method. All procedures were performed on 36 WAG male rats divided into 3 groups of 12 rats each. In the first group, empty PCL scaffolds were tested as a control group. In the second group the scaffolds were seeded with ADSC, and in the third one the scaffolds were seeded with ADSC after osteogenic induction. The animals underwent the surgical procedure under general anesthesia. In each animal, two scaffolds were implanted. On the right side, the scaffold was positioned adjacently to the superficial inferior epigastric artery (classic method). On the left side, the scaffolds were prefabricated by closing them on the superficial inferior epigastric artery (new method). (Fig. 1)

a

In each group half of the animals were euthanized after 2 months, and the other half after 6 months of implantation. The scaffolds were harvested for analysis. Angiogenesis and osteogenesis were assessed by uCT scanning and histopathological examination such as H-E staining, immunohistochemical staining for osteocalcin and CD31 positive cells.

Results: Angiogenesis and osteogenesis significantly increased in the groups of scaffold cultured with ADSC prefabricated with the new method. (Fig.2,3)

Conclusions: The promising results obtained with the new prefabrication method encourage clinical application of this technology.

Acknowledgments: This work was supported by the European Regional Development Fund within the Innovative Operational Program in the frame of project BIO-IMPLANT (Grant No. POIG.01.01.02-00-022/09)

b Fig. 2. Hematoxylin-Eosin staining of the empty scaffolds 6 months after implantation (cross-section):

a) scaffold with vascular pedicle located outside (classic prefabrication method);

b) more vessels and more mineralised tissue in scaffold with vascular pedicle located inside (new prefabrication method).

Fig. 3 Mineralisation in the scaffolds after 2 months of implantation. (% of mineralised tissue)

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NATIONAL ASSOCIATIONS’ & PLASTIC SURGERY ORGANIZATIONS’ NEWS

Free your publications – with GMS GPRAS

Forwarding your scientific article to patients, linking to it from your website or spreading it as a PDF – by publishing in “classic” journals are often not possible. “GMS German Plastic, Reconstructive and Aesthetic Surgery – Burn and Hand Surgery” (GMS GPRAS), the open access e-journal by German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRΔC) and German Society for Burn Medicine (DGV), offers a new form of publication. Surgeons can publish their works in GMS GPRAS after an internal peer review. Submissions in English are possible – only a German abstract has to be attached. All articles in GMS can be accessed worldwide and free of charge – for experts and patients: http://www.egms.de/dynamic/en/journals/gpras/index.htm All rights on your work will remain with you. The author only grants GMS GPRAS the right to store the work in databases for an unlimited period of time, and to distribute and reproduce the article in electronic form. You can publish the scientific results on your department website, copy it as often as you want, and forward it to colleagues. GMS only asks that you make reference to the original publication. More information on GMS: http://www.egms.de/static/en/help.htm For further questions please contact: German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRΔC) Luisenstrasse 58-59 10117 Berlin Germany info@dgpraec.de

Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons (PAPRAS) The Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons (PAPRAS) will be hosting, for the first time, an ISAPS Course in Manila and the First National Meeting of the PAPRAS, on March 2-4, 2014. The Course Director will be Dr. Susumu Takayanagi, President-elect of ISAPS. Details of the course will be sent later. T: (555) 123 - 4567 - F: (555) 523 - 4567 W: http://www.papras.org - E: info@papras.org

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43rd Annual Meeting of the Egyptian Society of Plastic and Reconstructive Surgeons (ESPRS)

In a relaxing atmosphere in the sunny warm resort of Ain Sokhna, under the theme Exchanging Experience, the 43rd Annual Meeting of the Egyptian Society of Plastic and Reconstructive Surgeons (ESPRS) was held this year in collaboration with the Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons (TSPRAS) on February 13th – 15th 2013, preceded by an instructional course and workshop on February 12th. The Egyptian Society of Plastic and Reconstructive Surgeons (ESPRS) is the first Plastic Surgeons’ Society in the Middle East. It was established in 1962, and the Annual Meeting is the grand socio-scientific event among many others held by the different Plastic Surgery Departments of Egyptian universities. The official opening ceremony began by the National Anthem and a short video demonstrating the scientific and social activity of the ESPRS through 2012 as well as the symposia held by the different Plastic Surgery Departments of the Egyptian Universities. This was followed by welcome messages from Prof. Sobhi Hweidi (ESPRS President and the Presidents of the Conference) and the Conference Organizing Committee: Prof. Fwazy Hamza (ESPRS Secretary General), Prof. Atef Emam (ESPRS Treasurer) and Prof. Amr Magdy (ESPRS Assistant Secretary). The international guests were welcomed and five Senior Egyptian Plastic Surgery Pillars were honored: ESPRS

Honorary President Prof. Farid Mostafa (Alexandria University), Brig. Gen. Prof. Farook Khoider (Military Academy), Prof. Hasan Badran (Ain Shams University), Prof. Mohamed Sobhi Zaky (Cairo university) and Prof. Alaa Gheita (Cairo university) for their major contribution to the establishment and progress of Plastic Surgery in Egypt.

Prof. Ismail Kuran.

To their honor, three Honorary Lectures were delivered: Regenerative Trends of Fat Grafting in Plastic Surgery by Prof. Ahmed Adel Noreldin, How to Adopt Your

Opening ceremony.

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Own Plastic Surgery Technique by Prof. Ikram Seif and Cultivation of a Thinking Plastic Surgeon by Prof. Fathi Khodeir Throughout this three-day conference, more than three hundred and fifty participants and international guests enjoyed up-to-date knowledge, fruitful discussions, exchanged their experience and gained international friends. The international guests were Ismail Kuran, President of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons (TSPRAS), Reha Kisnisci (Turkey), Baris Ηakir (Turkey), Serdar Eren (Turkey), Derya Φzηelik (Turkey), Naem Moamen (UK), M. El Labban (UK), Osama Mortada, President of the Sudanese Society of Plastic and Reconstructive Surgeons, Abd Samiee (Sudan), Attala Hamoud (Qatar) and Ahmed H. Rahoma (Malysia) Among the national lecturers there were Hasan Badran (Ain Shams University), Mohamed Sobhi Zaky (Cairo University), Mostafa Hemeda (Ain Shams University), Alaa Gheita (Cairo University), Aly Moftah (Cairo University), Ahmed EL Sharkawy (Cairo University), IKram Seif (Ain Shams University), Sobhi Hweidi (Zagazig University), Amr Salah (Ain Shams University) and Ahmed Adel Noreldin (Cairo University). Over 29 hours, 105 oral presentations by international and national speakers were delivered during eleven scientific sessions, including: aesthetic and reconstructive breast surgery, rhinoplasty, facial aesthetics, maxillofacial

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surgery, reconstructive head and neck surgery, body contouring, trunk and genitalia, lower limb reconstruction, hand surgery and burns, as well as an instructional course on upper limb reconstruction and a work shop on Botulinum toxin and fillers. The best five papers presented by junior authors were nominated for Best Research Paper of the Year and they were awarded five valuable textbooks. These distinguished papers were Evaluation of Cranial Bone Production Using Bone Marrow Stem Cells (Experimental study) by Khaled El Gazzar, Skin Banking by Serag Monier, Early Tendon Transfers For Median or Radial Nerve Injuries by Youssif Khachaba, Validation of the Stepwise Flexor Tendon Simulation Model by Ahmed Hweidi and The Role of Adipose Derived Stem Cells in Enhancement of Peripheral Nerve Injuries Repair by Ayman Mandour. The schedule of the conference permitted plenty of leisure time for the participants to enjoy the charming atmosphere and many seaside activities The meeting was a very successful one and at the end of the conference, the general assembly meeting of ESPRS was held. The new board was elected and the Presidency of ESPRS was handed to Prof. Ahmed Adel Noreldin, IPRAS Deputy General Secretary, becoming the ESPRS President for 2013. Amr Magdy, MD Professor of Plastic Surgery Ain Shams University Ass. Secretary of the Egyptian Society of Plastic & Reconstructive Surgeons, ESPRS- Cairo, EGYPT


Challenges Delivering Cleft Surgery in the Underdeveloped Word:

Lessons Learned and how to Avoid Making New Errors Seth Thaller MD, DMD Mimis Cohen MD, FACS, FAAP

Comprehensive cleft care in the U.S. is delivered by a limited number of well trained plastic surgeons affiliated with cleft/craniofacial teams. Although the vast majority of plastic surgeons received adequate background education and hands on experience in cleft care, during their training, they did not necessarily have contemporary experience with surgical management. In addition, they had lost their “confidence” that they could once again perform such procedures particularly during mission surgery. The board of the American Society of Maxillofacial Surgeons (ASMS)recognized a specific need related to updated education for comprehensive cleft care and proposed to organize a “refresher” course in order to provide not only well trained and experienced Plastic Surgeons with additional education and experience, but young plastic surgeons as well. The goal was to provide these surgeons

with updated knowledge, renew their education in surgical cleft care and give them the opportunity to efficiently and safely participate in volunteer cleft surgeries around the world.

Members of the Faculty: Drs. Warren Schubert, Peter Taub, Andrew Wexler, Henry Kawamoto, Seth Thaller, Mimis Cohen, Henry Vasconez and Pravin Patel.

Brochure of the Course

ASMS partnered with the American Society of Plastic Surgeons (ASPS) and organized the first refresher course in 2007 during the annual ASPS meeting in Baltimore. This course was successful beyond any expectation and the feedback received from participants was very positive. It became very clear that the need was much more diverse than what we had initially proposed. For instance, a significant number of the attendees were exceedingly experienced surgeons who had already completed a number of surgical missions. They wanted more of a forum to discuss pertinent issues. On the other side were the so-called neophytes who wanted to be “refreshed” so the course evolved. With financial support from Stryker and Operation Smile, a biannual multidisciplinary course was established and planned to follow the ASMS Basic Maxillofacial Course. This one day course possesses a “refresher” aspect but also provides a forum to permit free and open interactive dialogue between faculty and attendees regarding the most commonly encountered surgical, logistic, financial, ethical and other issues related to mission cleft surgery. This year’s meeting took place on January 27, 2013 and was hosted at the University of Miami. The meeting was very well attended and overall very successful. In addition to the co-chairs of the event, speakers included Drs. Henry Kawamoto, Henry Vasconez, Andrew Wexler, Warren Schubert, Pravin Patel, Peter Taub and Carlos Navarro. Additional lectures on nursing, pediatrics, anesthesia and organization of missions were also included in the program. Issue 12

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Center West Regional Meeting of Plastic Surgery in Brazil gathers 228 attendees With Facial surgery as the main theme, the Regional Center West Meeting in Plastic Surgery of the Brazilian Plastic Surgery Society gathered together 228 plastic surgeons in Goiania, from March 21 to 23, 2013. During the Opening Ceremony, Former National Presidents, Farid Hakme and Ewaldo Bolivar , as well as IPRAS General Secretary, Nelson Piccolo, and Carlos Alberto Calixto were honored by the Board of Directors. Regional President, Nelson Fernandes welcomed and thanked present and past members of the Brazilian Plastic Surgery Society Board of Directors for their support in the acquisition of the new Regional Society offices, as well as for the success of this meeting. Past National President and current Director of the Humanitarian Surgery Department, Pedro Martins welcomed and thanked all the local surgeons as well as surgeons from other states who helped on the humanitarian day of breast reconstruction surgeries.

Program Director, Niveo Steffen, shared with the audience that the current trend of the National BOD is to emphasize all aspects of Plastic Surgery at their meetings, and that there will be contributions to the programs of all of the next seven regional and National meetings from all chapters of the Brazilian Society. He also mentioned that this year, the Brazilian Congress of Plastic Surgery, on its 50th Anniversary, is to be one of the largest, if not the largest, in the entire world; over 3500 plastic surgeons are expected in Rio this November. Similar thoughts were shared by President Jose Horacio Aboudib, who mentioned the importance of the current ( growing ) interaction of all Chapters and Committees of the Brazilian Plastic Surgery Society, aiming at the improvement of all activities of the Society, in all levels of training as well as in relation to the practicing Plastic Surgeon.

Just before the 26ยบ Jornada Centro Oeste de Cirurgia Plรกstica, a Humanitarian Plastic Surgical Day occurred on March 20, 2013 when one stage breast reconstruction was performed in 15 patients. This Picture shows the surgical team and directors of the Humanitarian Surgery Department of The Brazilian Society of Plastic Surgery.

The President of the Brazilian Plastic Surgery Society, Dr. Jose Horacio Aboudib and the President of the Goias Regional Section, Dr. Nelson Fernandes at the inauguration of the Regional Society Office Building.

Opening Ceremony of the Center West Regional Meeting with members of the BOD of the Brazilian Society of Plastic Surgery and the Regional Section, with Presidents Jose Horacio Aboudib and Nelson Fernandes, and IPRAS General Secretary, Nelson Piccolo, who was honored that night.

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VII Plastic Surgical Complications Symposium in Minas Gerais, Brazil, Prioritize Patient Safety The VII Symposium in Complications in Plastic Surgery was held by the Sociedade Brasileira de Cirurgia Plastica, Minas Gerais Regional Section, in Ouro Preto, Minas Gerais on April 5-6, 21013, and it maintained a recurrent theme throughout: guidelines to direct the practice of combined procedures and the limits of patient safety. Plastic Surgeons, ICU specialists, anesthetists and counselors at Law were unanimous : combined procedures need to follow pre-established standards regarding duration , i.e., there should be a time limit for the time it takes to perform these procedures. The safety check list has become even longer, with aspects to be checked from the first Office visit until the post operative discharge.

pregnant woman. Minimum age was not a unanimous consensus, but most agreed that the patient must be at least 16-18 years of age, while procedures in younger patients, should be possible for special cases like post-bariatric procedures for example. Another common point of discussion was the overall opinion that the surgeon should stick to the planned ( and consented ) procedure, with no intraoperative changes and that patients undergoing combined procedures must be admitted for at least 24 hours. Another issue widely discussed was that the patient must know that in combined procedures, there will be two teams operating and that intracavitary surgery should not be performed together with plastic surgical procedures.

Liposuction and Breast Implants There was an overall consensus that the Brazilian Society of Plastic Surgery that only plastic surgeons are capable of performing liposuction, placement of breast implants and other related plastic surgical procedures. Also, several complications of breast implants and facial fillings which came to plastic surgeons’ offices with irregular or non-licensed materials were presented and there was a general alert placed on this products.

Conferences The moment when Dr Nelson Piccolo, IPRAS General Secretary, was honored as “ Amigo de Minas” by Dr. Antonio Vieira

Combined procedures check list Although combined procedures may have benefits, such as single anesthesia, cost cutting and increased efficiency in hospital admission time, there is a greater risk of complications with the longer procedural time length. Safety standards must be followed pre, per and postoperatively, with a safety checklist being rigorously followed. Procedures which may last up to 4 hours have a Green light, up to 5 hours a Yellow light, and over six hours, a Red light. Lawyers went a little further and have recommended that the Office visits should be videotaped and all procedures are to be performed only after a consent form is signed. Another warning must be clearly understood by the surgeon when seeing a very demanding patient or a patient with multiple complaints, which should raise one´s awareness for a possible emotional unstability which could hinder part or all of the patient´s post-operative recovering.

Immediate past President of the Brazilian Plastic Surgery Society, Sebastião Nelson Edy Guerra presented a retrospective of his 38 years practicing our specialty, also stressing the importance of administering the wishes of the patient within the reality of Plastic Surgery . Nelson Piccolo demonstrated his 25 year-long experience regarding the use of tissue expanders on burn sequellae as well as the relatively recent, two-year experience with ADSC´s, since over three hundred patients with burn wounds and sequellae were adjuvantly treated with this “new” technique. “Disecting the Unsuccessful Result” was presented by the team of the local university Professor Rodrigo Otávio Gontijo Tostes. His conference excelled in counselling and guidance - his main warning was : “ one should always be against the simplification of Plastic Surgery – one should never forget the details.... “

Forum There were several discussions about minimum age and when, and IF, to perform procedures in pregnant women or in the immediate post-partum period. Most participants ageed that one must wait 6 months to one year for procedures in a recently

One of the main sessions when immediate past President of the Brazilian Plastic Surgery Society, Sebastião Nelson Edy Guerra, discussed some of the aspects of his 38 years as a Plastic Surgeon

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Using Skin derived ABCB5 cells in aesthetic medicine - A novelty of pluripotent stem cells. News from Klentze Medical Faculty in Phuket Cellular therapy has evolved quickly over the last decade both at the level of in vitro and in vivo preclinical research and in clinical trials. Embryonic stem cells and non-embryonic stem cells have all been explored as potential therapeutic strategies for a number of diseases. One type of adult stem cells, mesenchymal stem cells, has generated a great amount of interest �������������������������������������������������������������������������������� The more developed a cell is (from embryonic to adult stem cells), the less is the ability to replace more than one tissue type. The reason for this can be found in the progressive development of the stem cell to be part of one germ layer (endodermal, mesodermal and ectodermal layers) of the body tissue. Among the adults stem cells, one group is called mesenchymal cells, which can be harvested from bone marrow, fat or skin. A new cell population has been found , which show in their engraft capacities a behavior like MSC cells, but with pluripotent power, thereby replacing apoptotic cells of all three germ layers.

ABCB5 cells : Among adult cells from adipose tissue, bone marrow and skin, Ganss, together with Frank detected a new generation of pluripotent stem cells, the so called ABCB5 cells, which are Mesenchymal cells, but have pluripotency like embryonic or IPS cells and which have the ability to repair and replace aged and damaged cells in all body tissues. ABC B5 means ATP-binding cassette sub-family B member 5 also known as P-glycoprotein ABCB5. This is a plasma membrane-spanning protein that in humans is encoded by the ABCB5 gene. ABCB5 has been suggested to regulate skin ����������� ����� �������� ����������� ������ ���� ����� ����� ��� �������������� ��� chemotherapy drug resistance.

What are the advantages of ABC B5 cells, compared with adipose derived cells. ? One has to understand, that the term stem cell treatment involves only ���������������������������������������������������������������������������� as well. But most of the users do not typically cultivate or extend them. Us���� �� ������������ ���� ���������� ����� ����� �������� ������� ���������� ���� ����������������������������������������������������������������������������� ��������������������������������������������������������������������������� clinics use devices which separate adult stem cells from fat tissue using a combination of spinning motions and chemical reactions with more or less good results. The disadvantage lays in the potency of these cells products.


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One problem with the autologous use of adult stem cells is that the quantity of cells is only as good as the patient’s supply. Older patients with fewer stem cells will not likely have enough to overcome, say, osteoporosis when a bone fractures, or a tear in cartilage or a dead spot on the heart muscle. In those cases, one strategy is to put the patient’s small number of stem cells into a culture media and allow them to expand. While fat or bone marrow derived mesenchymal stem cells display multipotency, ABCB5 cells have given their evidence to be pluripotent, meaning they target damaged cells of all three layers, like embryonic cells or IPS cells, to replace them.

Conclusion: We need to focus on stem cells which are: a) Harvested by a mini biopsy b) Cultivated in a GMP laboratory c) Banked in a GMP facility d) Expanded in a GMP facility ��� ������������������������������������������������������������ f) Pluripotent and therefore can be used for all organs to treat various diseases, used for Anti-Aging reasons and used to build up skin tissue and vessels in skin treatment and breast tissue and vessels to maintain longer than usual treatments. ABCB5 cells have this ability, without the ethical burden and cancer risk of embryonic cells, without the risk of retro virus infection by IPS cells, without liposuction, but done only by a tiny skin biopsy behind the ear. ABCB5 cells are the future of stem cell therapy, and Klentze Medical Faculty is proud to present these cells in their education programs and partnerships.

References 1. Shihua Wang, Xuebin Qu , Robert C Zha; Journal of Hematology & Oncology 2012, 5:19 2. Zouboulis CC, Adjaye J, Akamatsu H, Moe-Behrens G, Niemann C.Human skin stem cells and the ageing process. Exp Gerontol. 2008 Sep 9. 3. Frank MH, Sayegh MH. Immunomodulatory functions of mesenchymal stem cells. Lancet 2004 May 1;363(9419):1411-2 4. Frank NY, Pendse SS, Lapchak PH, Margaryan A, Shlain D, Doeing C, Sayegh MH, Frank MH. Regulation of progenitor cell fusion by ABCB5 P-glycoprotein, a novel human ATP-binding cassette transporter. J Biol Chem 2003 Nov 21;278(47):47156-65. Klentze Medical Faculty Education for physicians Professor Dr. Michael Klentze, MD Thanyapura Integrative Health Clinic Phuket, Thailand 120/1 Moo7 Thepkasattri Road, Thepkasattri, Thalang, Phuket 83110 Thailand www.klentze.com Tel : + 66 76 333 000 Email : info@klentze.com


HISTORICAL ACCOUNTS

Bulgarian Association of Plastic, Reconstructive and Aesthetic Surgery (BULAPRAS) - a concise history, recent activities and perspectives Considerable progress in medical science during the last few decades worldwide along with dynamic growth in the demand of plastic surgery services in Bulgaria has set new requirements for our professional society. As a response to this new public necessity, a group of Bulgarian plastic surgeons led by Assoc. Prof. Dimitar Evstatiev, MD, PhD, Head of the Clinic of Plastic Surgery at Medical University of Sofia, initiated the establishment of BULAPRAS in the year 2000. He was elected to be the first president of this organization. Because of the widespread malpractice in our country at that time consisting in performance of aesthetic surgery procedures mainly by unqualified medical practitioners, a number of various measures were undertaken in order to preserve the public from these injurious services. With regard to the severe complications after breast augmentation by using of the so called “Ukrainian hydrogel”, a series of discussions were organized as well as well-grounded scientific papers and mass-media articles were published. A further step to the patient’s safety campaign was the consent for thorough ban of synthetic and semisynthetic fillers’ application, voted and approved at the First National Conference of Plastic, Reconstructive and Aesthetic Surgery held in April 2010 in Sofia. During the period 2002-2008, due to some disadvantages and imperfections in the Bulgarian public health system

and, probably, to mercantile interests, a paradoxical separation of the medical specialty of plastic, reconstructive and aesthetic surgery, was performed. Two novel specialties were introduced, namely ‘plastic and reconstructive surgery’ and ‘aesthetic and cosmetic medicine’. In the training program for aesthetic surgery, neither any basic knowledge of plastic surgery, nor practical training in reconstructive surgery was included at all. The chief person of the educational program wasn’t qualified and even lacked any acquired specialty of plastic surgery. Huge efforts were necessary and hard work was done by BULAPRAS president and Board members to attain changes in the regulations for plastic surgery training and education in Bulgaria. Аs a result, nowadays there exists only one united medical specialty named ‘Plastic, Reconstructive and Aesthetic Surgery’ and the training of aesthetic surgery is an integral part of the whole course of education. The Second National Conference of Plastic, Reconstructive and Aesthetic Surgery held in cooperation with IPRAS in April 2011 in Pravets, represents an undoubted success in the activity of BULAPRAS Board. The rich scientific program devoted to the single fields of plastic, reconstructive and aesthetic surgery and the interesting scientific presentations, debates and comments proved the good level of mastering the matter by Bulgarian plastic

BULAPRAS members attended the Ist annual meeting in Hisar on March 23th 2013

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surgeons. The significance of this event was emphasized by Prof. Marita Eisenmann Klein, President of IPRAS, and Prof. Andreas Yiacoumettis, General Secretary of IPRAS, who delivered invited lectures and were actively involved in the discussions during the Conference. In November 2012, BULAPRAS General Assembly Meeting was held and new Board elections were conducted. In the report of the former Board, not only the positive achievements, but also the failures and unsolved problems were comprehensively analyzed. Special attention was paid to the need for continuity inmanagement, overcoming disadvantages and setting new goals and practical tasks for the new Board. Following the vote, Prof. Juriy Anastasov, MD, PhD, DSc, Head of the Clinic of Plastic and Cranio-Facial Surgery at the Medical University of Plovdiv, was elected as President of BULAPRAS. Assoc. Prof. Dimitar Evstatiev, MD, PhD, was elected as Vice-president, Daniel Yankov, MD, PhD - as Research Secretary, Michael Skerlev, MD - as Organization Secretary and Ilio Stoyanov, MD - as treasurer. In the course of the Conference, the changes and additions of the by-law, the new rules for internal organization and for a good medical practice as well as the program for the scientific events in 2013 year were intensively discussed and finally approved. One thing that deserves attention is the accepted decision to organize a minimum of 4 scientific meetings annually at exchange hosting of the three leading academic centers in the cities of Sofia, Plovdiv and Varna. All the meetings are open events for participants from other specialties, plastic surgery trainees and foreign guests and lecturers. Main priorities in the new Board program consist in the further increase of integration and influence of BULAPRAS in the medical community and public as well as support of the plastic surgery training education and successful marginalisation of the incompetent medical service. Besides this, we emphasize medical ethics issues and their diverse aspects and shapes as well. The implementation of

the tasks of the variety of activities initiated by the previous government body, taken and continued by the present one, related to the creation of new standards adequate to the principles for good medical practice represents a crucial step towards the improvement of the quality of plastic, reconstructive and aesthetic surgery in Bulgaria. The vast majority of the members of the commission founded by the Bulgarian Ministry of Health with the obligation to implement the new standards for plastic surgery are BULAPRAS members. Obviously, we should more intensively promote young physicians’ professional qualifications by facilitating participation in regularly performed educational and training courses and individual specializations. Singleauthored and collective research and publication activity represents an integral part in this process. In this respect, together with IPRAS member societies in other countries, we should promote not only joint research activities but also active participation in international scientific meetings abroad. The practice of foreign ‘visiting professors’ should become more popular in Bulgaria, too. Young Bulgarian scientists should be encouraged to prepare and defend dissertations on hot topics of contemporary plastic, reconstructive and aesthetic surgery. Apart from the set objectives of the new Board of BULAPRAS, I would like to add my personal ambitions and expectations. They embrace a narrower collaboration and integration between BULAPRAS and IPRAS, as well as broader participation of Bulgarian plastic surgeons in organized scientific events, aswell as in other thematic directions of the work of our large international family. The internationalization of our specialty is a fact, and I believe that this is not only the present, but the future of plastic, reconstructive and aesthetic surgery. Daniel Yankov, MD, PhD Secretary, BULAPRAS Research Naval Hospital of Varna, Military Medical Academy of Sofia, Bulgaria

BULAPRAS Board, from left to right: Dr. Michael Scerlev Organization Secretary, Prof. Jury Anastasov President, Prof. Dimitre Evstatiev Vice-president, Dr. Daniel Yankov Research Secretary, Dr. Ilio Stoyanov Treasurer

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InaPRAS (the Indonesian Association of Plastic, Reconstructive, and Aesthetic Surgeons) or PerhimpunanDokterSpesialisBedahPlastik, Reconstruksi, danEstetik (PERAPI) Teddy O.H. Prasetyono, M.D. CiptoMangunkusumo Hospital/ the University of Indonesia

Plastic surgery in Indonesia was first introduced by Prof. Moenadjat Wiratmadja after completing his studies at Washington University, in the US in the late 50’s. He then started work at the academic hospital, the top referral Cipto Mangunkusumo Hospital, which is affiliated with the University of Indonesia in Jakarta. Subsequently, although after a somewhat long time, he managed to have his surgeon fellows work with him, who later became his early time colleagues after their apprenticeship under his expertise. They are R. Bisono, SidikSetiamihardja, A.J. Riewpassa, and others. The late Prof. Wiratmadja was the one in our history who created an avenue for plastic surgeons to grow and develop in their professions. In 1980, the early group of this unique specialty came to have the desire to initiate the foundation of their society, an organization called “PerhimpunanAhliBedahPlastikda nRekonstruksi Indonesia”, or “Indonesian Association of Plastic and Reconstructive Surgeons”. In the year 1982, the organization changed its name into “Perhimpunan AhliBedahPlastik Indonesia” (PERAPI) or Indonesian Association of Plastic Surgeons (IAPS). Members of the association at that time were BayuNugroho (†), SidikSetiamihardja, Bisono, DjohansjahMarzoeki, August J Rieuwpassa, HerwandarSastrasupena (†), SoeminthaBismaDjaya,F.X. Soetoko (†), R Soedibyo

(†), and BuchariKasim (†). They are the founding members of IAPS, which then late last year transformed its name to become InaPRAS (Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons) in order to maintain the field of aesthetic surgery as its domain nation wide. Throughout its existence, InaPRAS has held a number of national and international events. Although it has been somewhat late in starting its annual scientific meetings in 1997, InaPRAS has decided to catch up with its counterparts internationally by taking English as its official language since 2005. The upcoming 17th Annual Scientific Meeting will be held in Bandung city on April 27th-30th 2013 featuring many prominent national faculties as well as international ones such as the rising stars Rei Ogawa of Japan and JoonPio Hong of Korea. For those who are interested in participating in the event, they may send an email to pitperapixvii@pharma-pro.com. InaPRAS, through one of its young members, David Perdanakusuma, has further enhanced its annual scientific meeting by initiating a free paper competition named the Golden Knife (PisauEmas) Award which has become an icon of prestigious achievement for free paper presenters. Dr. Perdanakusuma is currently the Chairman of Indonesian College of Plastic Surgery; a body authorizes the plastic surgery training program in the country. The first winner of the Golden Knife Award was Teddy O.H. Prasetyono who was then a resident of the University of Indonesia. Dr. Prasetyono has further initiated an annual research proposal competition and named the award as Purple Lotus (TerataiUngu) Award in 2008 during the 14th ASEAN Congress of Plastic Surgery which was held in Jakarta and chaired by himself. This was the first competition held by InaPRAS to include international participants. Just as the Golden Knife Award, the Purple Lotus Award has also become an icon where young researchers really compete. Besides having its own programs, InaPRAS has also hosted several international events, such as the 3rd ASEAN Congress of Plastic Surgery that was chaired bylate Dr.DwiyoSugondo in 1986, followed by the 8th

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ASEAN Congress of Plastic Surgery in 1996. In 2001, one IAPS member, Gwendy Aniko, was elected as the president of OSAPS in 2001, and the 8th OSAPS Congress was successfully held in Bali. The next 15th OSAPS Congress will be held in Indonesia in year 2016 after the bid conducted by Dr. Prasetyono during OSAPS business meeting in Seoul last year. In addition, several international congress bids have been successfully won by an InaPRAS member, Dr. Prasetyono, whosuccessfully brought about the 9th APFSSH (Asia Pacific Federation for Surgery of the Hand) Congress that was held in Bali in 11-13 October 2012. That was the first APFSSH Congress held in Indonesia in the history of hand surgery. The success of the bids in Hong Kong, 2008, was preceded by his success in organizing 3 consecutive years of the International Symposium in Hand Surgery and the Advances of Hand Therapy from 2004 to 2006, which became famous throughout Asia. Recently, he and the InaPRAS team (organized by Dr. Audy Budiarty) also succeeded in winning the bid of the 21st IPRAS World Congress to be held in Bali in 2019. The success in Santiago, March 2013 was then followed with the success of the plastic surgeon-burn enthusiasts to bring about the 10th APBC (Asia Pacific Burn Congress) to be held in 2015 in Bali during the APBC Executive Committee Meeting in Hanoi, April 4th 2013. All those events are beyond the contribution of InaPRAS members in some upcoming ISAPS Post Graduate Courses, such as China ISAPS Course in Shanghai September this year, Indonesia ISAPS Course next year, and the Philippine ISAPS Course also next year. Armed with its 116 members, InaPRAS has continuously produced new techniques and innovations in plastic surgery. Dr. David Lalonde who introduced wide awake hand surgery by using tumescent solution has inspired one of InaPRAS’s members, Dr. Teddy O.H. Prasetyono, to expand its usage for various purposes. Earlier work of Dr. Prasetyono was the use of epinephrine injection for hypospadia surgery. Recently, he developed the tumescent with much lower concentration (the “One-perMil” tumescent) to broaden its indications for various hand and upper extremity pathological conditions. He presented his work at IPRAS Santiago this year on NonTourniquet Hand Surgery for babies and patients of all ages, wherein the session was chaired by Dr. Lalonde. Some of the prominent plastic surgeons, who specialize in hand surgery in Indonesia, have taken part in founding HIPITA (Himpunan Indonesia untukPengembanganIlmu BedahTangan) or the Indonesian Society for Surgery of the Hand. This society is not exclusive to plastic surgeons, but orthopedic and leprosy surgeons are also eligible for membership among other specialists. Regardless, it is a plastic surgeon who contributed 2 chapters to the 2011 IFSSH TextBook titled: “Hand Surgery Worldwide:

International Reconstruction of a ‘Beautiful and Ready Instrument of the Mind,’” edited by James Urbaniak, Scott Levin, Goo-Hyun Baek, and Soucacos. Being compassionate for the needy, InaPRAS repeatedly conducts a number of humanitarian activities every year. Free cleft lip and palate surgery has been held extensively since 1997 in numerous places throughout the archipelago

of Indonesia through the “Thursday to Sunday” scheme. At most of the events, InaPRAS comes with an effective team consisting of 6 plastic surgeons, 2 anesthesiologists, and 4-5 scrub nurses and anesthesia nurses with all the surgery equipment anddisposables. Always doing the mission at the local district or provincial hospitals, the team usually operates on 3 beds for 2 babies or small children per bed in one rounding sit, and 2 beds for surgeries under local anesthesia whenever necessary. The local staffs are always of help during all the charity events, especially the scrub and anesthesia nurses. On average, the team is able to manage 60-80 patients during the “Thursday to Sunday” scheme. Cooperating with the national Dharmais Foundation and OBI (OborBerkat Indonesia) Foundation, the outbound by the InaPRAS exclusive programs has come to more than 10,000 cleft lip and palate surgeries. The number is not included the inclusive charity surgeries on daily bases in the centers of cleft lip and palate across the country which are supported by many national as well as international foundations, such as the Smile Train. InaPRAS has also collaborated with InterplastANZ (Australia-New Zealand) since the 1990’s to provide charity programs for those in need of plastic surgery reconstruction, including burn contractures and noma. Through all its activities, InaPRAS will continue to be an avenue for plastic surgeons in Indonesia to develop the science of plastic surgery and its application for the benefit of others.

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NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS 07 - 09 Jun 2013

2nd ISPRES Congress 2013

Location: Berlin, Germany - Venue: Steigenberger Hotel Contact: Mrs. Irene Katti - Telephone: +30 2111001783 - Fax: +30 2106642116 E-mail: i.ka@zita-congress.gr - URL: http://www.ispresberlin2013.com/ 11 - 15 Jul 2013

2015 WSRM World Congress (World Society of Reconstructive Microsurgery) Location: Chicago, USA - URL: http://www.wsrm2013.org/ - E-mail: contact@wsrm2013.org 05 - 07 Sep 2013

8th Congress of the Balkan Association of Plastic, Reconstructive and Aesthetic Surgery (BAPRAS)

Location: Budva, Montenegro - Venue: Avala Resort and Villas Contact: Mrs. Mina Ploumpi - Telephone: +30 2111001781 - Fax: +30 2106642116 E-mail: a.pl@zita-congress.gr - URL: http://www.baprascongress2013.com/ 10 - 14 Sep 2013 44th Congress of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) & 18th Congress of the Association of German Aesthetic-Plastic Surgeons (VDÄPC) Location: Münster/Westfalen, Germany 12 - 14 Sep 2013 Congreso de Cirugía Plástica del Cono Sur Paraguay 2013 Location: Paraguay - E-mail: info@cirugiaplastica.org.py 12 - 14 Sep 2013 XV Dominican Congress of Plastic Surgery Location: Santo Domingo, Dominican Republic Venue: Hotel V Centenario E-mail: otoniel888@yahoo.com 03 - 05 Oct 2013 2nd International Pan African Congress of Plastic and Reconstructive Surgery Location: El Alamein, Egypt - Venue: Porto Marina Hotel Contact: Mr. Nikos Antonopoulos - Telephone: +30 2111001782 - Fax: +30 2106642116 E-mail: n.an@zita-congress.gr - URL: http://www.panafricanps2013.com/ 11 - 15 Oct 2013 Plastic Surgery The Meeting 2013 Location: San Diego, CA, USA - Venue: San Diego Convention Center http://www.plasticsurgery.org/For-Medical-Professionals/ Resources-and-Education/Meetings/Plastic-Surgery-The-Meeting-.html 24 - 26 Oct 2013 Technology Innovations In Plastic Surgery / 4th International Congress of the Armenian Association of Plastic, Reconstructive and Aesthetic Surgeons (AAPRAS) Location: Yerevan, Armenia - Venue: Matenadaran Contact: Mrs. Irene Katti - Telephone: +30 2111001783 - Fax: +30 2106642116 E-mail: i.ka@zita-congress.gr - URL: http://www.aapras-tips2013.com/


Technology Innovations in Plastic Surgery Expected

October 2013 24 26

Organizers

Above expectations....

New evolutions that add value in our field

Supporters

Endorsed by

Organizational Support

ZITA

C O N G R E S S & T R A V E L

ISO 9001 ISO 14001

Metenadaran Museum - Yerevan, Armenia

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Committees

Congress President: Gagik Stamboltsyan, AAPRAS Founding Member, Armenia

Scientific Committee Chairman: Armen Hovhaanissyan, AAPRAS President, Armenia Co-Chairpersons: Marita Eisenmann Klein, IPRAS President, Germany Andreas Yiacoumettis, Technology IPRAS Deputy GeneralInnovations Secretary, Greece

Expected Expected

Organizers Organizers

International Invited Faculty

Gregory Antoine, USA Stephan Ariyan, USA Charlotte Ariyan, USA in Plastic Surgery Mimis Cohen, USA Sydney Coleman, USA Horacio Costa, Portugal Armenia Members: Bruce Cunningham, USA Garegin Babloyan Karen Danielyan Marita Eisenmann-Klein, Germany Artavazd Sahakyan Raffi Gurunluoglu, USA Leon Torosyan Outi Kaarela, Finland Gevorg Yaghjyan Chris Khoo, UK Brian Kinney, USA Russia Members: Gaylle Lloyd, USA Ruben Adamyan Ramon Llull, Spain Nikolay Milanov Guy Magalon, France Igor Reshetov New evolutions that add value in our field Nicolay Milanov, Russia Constance Neuhann-Lorenz, Germany Georgia Members: Marlen Sulamanidze Norbert Pallua, Germany Andre Panossian, USA Organizing Committee Othon Papadopoulos, Greece Chairman: John Persing, USA Set Kazaryan Nelson Piccolo, Brazil Co-chairman: George Psaras, Cyprus Zacharias Kaplanidis, Kirill Pshenisnov, Russia IPRAS Executive Director, Greece Igor Reshetov, Russia Ricardo Rodriguez, USA Members: Katharina Russe-Wilflingseder, Austria Hrachya Arshakyan Arthur Arutunian Dirk J.Schaefer, Switzerland Tatevik Babayan Io Sofianou, Greece Aram Boroyan Aris Sterodimas, Metenadaran MuseumGreece - Yerevan, Armenia Iva Kuzanov James Zins, USA Lilit Nerssisyan Aram Sahakyan Hovhanness Stamboltsyan Anna Vanesyan

October 2013 24 26

Above expectations.... Supporters Supporters

Endorsed by by Endorsed

Organizational Organizational Support Support

ZITA ZITA

C O N G CR OE NS GS R E S S & T R A& V T E RL A V E L

ISO ISO 9001 9001 ISO 14001 ISO 14001

www.aapras-tips2013.com

Contact: ZITA CONGRESS & TRAVEL SA, Mrs. Irene Katti, tel. 0030 211 1001783, i.ka@zita-congress.gr


Topics

Abstracts

Should be submitted online or via e-mail at

Surgery of the Skin and Cutaneous Malignancies Fat Grafting

abstracts@aapras-tips2013.com

Facial Rejuvination Breast

Abstracts Submission Deadline

Body Contouring Tissue Engineering

1/06/2013

Flap Reconstruction Present State of Research in Peripheral Nerve Regeneration New Trends in Fillers and Toxins Energy Based Devices Set – up Successful Plastic Surgery Practice New Frontiers in Plastic Surgery Practice

Accommodation

Registration FEES

EARLY UNTIL 1/7/2013

LATE UNTIL 1/9/2013

PARTICIPANTS

200€

250€

RESIDENTS

100€

150€

hotel

SINGLE ROOM

DOUBLE ROOM

GOLDEN TULIP

115€

70€

Prices quoted on “per person/ per night” basis and include tax and breakfast

Venue Golden tulip is a central 5* hotel with historical and rich cultural heritage

Metenadaran Museum

a major research center with the largest collection of Armenian Manuscripts

To book your flights at special rates please contact Mrs. Orsa Dritsa at: o.dr@zitatravelcongress.gr

ON LINE REGISTRATION/ACCOMMODATION BOOKINGS AVAILABLE AT: www.aapras-tips2013.com


Social Media Networking

IPRAS International Confederation

for Plastic Reconstructive & Aesthetic Surgery

www.ipras.org

Join our group!

IPRAS Facebook page

Follow our news!

IPRAS Twitter account

Connect with our professional network! IPRAS - professional page IPRAS - group Women for Women - group

Share our experience!

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ISPRES Professional page

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Ass. Prof. Efterpi Demiri

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Edinburgh International Conference Centre, Edinburgh, UK 6 – 11 July 2014 Hosted by the British Association of Plastic Reconstructive and Aesthetic Surgeons

A European Voice for Plastic Surgery Come to Scotland and enjoy...

• • •

A full scientific programme

international guest lecturers interactive education up-to-the-minute surgical advances in our specialty

A full social programme

The perfect opportunity to network with colleagues and industry peers – a chance to meet new people and conduct future business while sampling the best Edinburgh has to offer.

Sponsorship

There is limited availability for relevant companies to support ESPRAS 2014 as a sponsoring partner, or to exhibit products and solutions at this important congress. To register your interest please contact the team now on sales@espras2014.

espras2014.org supported by


IPRAS WEBSITE

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

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

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must be approved by the National Association you are a member. The application will be sent at the Association of the country that you have declared, ensuring that only IPRAS members of good standing and high ethical principles are able to upload their personal details. As soon as your Association verifies you as a member, your profile will automatically be uploaded at the website’s, “Find a doctor” option in the “Members”section. It is also up to you to decide whether your profile will be classified as “private” or visible to all visitors of the IPRAS webpage. Our aim, besides facilitating communication among colleagues, expands to allowing patients to verify the good standing and high ethical principles of the doctors’ profiles hosted, allowing them to choose qualified IPRAS members for needed procedures. There are two new Sections at the IPRAS website. • IPRAS-TA section where you may find more information concerning the Trainees Association • Congress Registry section where you may find the all the plastic surgery related congresses. If you face any difficulties please do not hesitate to contact us at: maria.petsa@iprasmanagement.com Always at your disposal! IPRAS Management Office


INDUSTRY NEWS SECTION Patient 3D-Web Access: patients and doctors want it! “Special offer for the IPRAS members and readers. See end of the article for more details.”

Over 1’000 patients sent their intimate photos In less than 3 months since the first web-banner for patients was launched, already more than 1’000 patients have used it to send their photos to doctors and this figure is growing every day. Without any extra effort, doctors receive the patient’s contact information and 3D before the consultation even starts. It’s that easy! An online survey was conducted among the patients who sent their 3D to doctors. The results clearly showed that the Crisalix web-banner is one of the most important qualified lead providers in the plastic surgery industry ever developed.

…now for both Breasts and Face! Crisalix just released a new highly intuitive and easy-touse new generation of its 3D face simulator. It comes with a fully automated application for rhinoplasty and combines Crisalix’ lead generator capabilities with the web-banner. From now on you can simulate a nose job in just a few clicks using this new interactive tool. With up to 12 different anatomical controllers, you can independently modify any main part of the nose, and use the other advanced tools to fine tune the final result.

“I am looking forward to my surgery and am happy I got to see the 3D image that helped set my mind at ease”. A.S. (USA).

And over 140 doctors already have it Already during these first three months, doctors around the world have started reaping the benefits of attracting more patients, facilitating their consultations and increasing conversion rate and referrals without any extra work by simply installing the web-banner on their website. Some of the most recognized doctors and clinics such as Clinica Planas (Spain), Hilton Becker (USA), Ruth Graf (Brazil), Cornette de Saint Cyr (France) and many more are already enjoying the benefits of the new web-banner. Crisalix sets the banner up for the doctor in no time so patients can immediately click on it and prepare the 3D by taking their photos from home. “The patient sent us the photos through the banner for a 3D consultation, and in two days she already had a consultation with us, where she immediately decided to proceed with the surgery after seeing the simulation results.” Piotr Sikorski, MD (Finland)

Increase patient satisfaction and demand, and effortlessly grow your business through higher conversion rates and referrals. IPRAS members and readers have a special 10% discount on Crisalix annual subscriptions. To benefit from this offer, please visit www.crisalix.com/prices� and proceed to “sign up”. Use the following code in the “Coupon Code” field:

41f282e1d8

“Only a few days after I placed a 3D banner on my website for my new potential patients to prepare their 3D from home, I had already 1 patient who came up for a consultation, was pleased with the 3D simulation, and finally booked the surgery.” Matt James, MD (St-Thomas Hospital, UK)

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Crisalix PSE-A 1015 Lausanne Switzerland info@crisalix.com

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IPRAS PAST GENERAL SECRETARIES

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Tord Skoog (Sweden) 1955 - 1959

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

Thomas Ray Broadbent (USA) 1963 - 1967

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

John Watson (U.K.) 1971 - 1975

Roger Mouly (France) 1975 - 1983

Jean-Paul BossĂŠ (Canada) 1983 - 1992

Ulrich T. Hinderer (Spain) 1992 - 1999

James G. Hoehn (USA) 1999 - 2006

Marita Eisemann-Klein (Germany) 2006 - present

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

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12th Issue April 2013

IPRAS Journal Management Editor: Honorary Editor-in-Chief: Editorial board:

GS Print: E-mail: Post Editing: Photographer: IPRAS Management Office ZITA CONGRESS SA 1st km Peanias Markopoulou Ave P.O BOX 155, 190 02 Peania Attica, Greece Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216 URL: www.ipras.org • E-mail: zita@iprasmanagement.com Executive Director: Zacharias Kaplanidis E-mail: zacharias.kaplanidis@iprasmanagement.com Assistant Executive Director: Maria Petsa E-mail: maria.petsa@iprasmanagement.com Accounting Director: George Panagiotou E-mail: george.panagiotou@zita-congress.gr Association Management Director: Labrini Nikolopoulou E-mail : l.ni@zita-congress.gr IPRAS Media Office: Maria Sevastaki E-mail: m.se@zita-congress.gr Commercial Director: Gerasimos Kouloumpis E-mail: gerasimos.kouloumpis@zita-congress.gr

Next issue: July 2013

IPRAS Ricardo Baroudi, MD Marita Eisenmann-Klein, MD Nelson Piccolo, MD Andreas Yiacoumettis, MD Mimis Cohen, MD Chris Khoo, MD Zacharias Kaplanidis, Economist Diastasi info@diastasi-print.gr William Greenall Julian Klein

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


IPRAS JOURNAL, 12th ISSUE, APRIL 2013