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2nd Issue October 2010

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Aims and Scope


he purpose of THE IPRAS JOURNAL is to provide a rapid reporting of things of interest to IPRAS members. This includes all members

of national societies who participate in the IPRAS organization. Because of the broad umbrella of IPRAS this includes matters of interest across a broad spectrum of sub-specialties including burn surgery, microscopic and reconstruction surgery, hand surgery, craniofacial surgery, and aesthetic surgery. In many instances it will include matters of interest to all specialties of plastic surgery combined. Matters of interest include, but are not limited to surgical techniques, patient care, patient safety, recognition and treatment of complications of surgery, humanitarian contributions, and schedules of pending meetings. Authors are encouraged to submit manuscripts for publication which will be evaluated by a peer review process. Letters to the Editor are encouraged and will be published if deemed contributory to the aims and scope of the Journal.


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General Secretary’s Message

Dear colleagues,


hank you all for the overwhelming response to our first issue. We feel that we did a big step forward to establish closer bonds with you.

Our ambitious management team headed by Zacharias Kaplanidis is eager to provide more service to you. Therefore please let us know how we can optimize our service. This issue emphasises on patient safety and quality assurance in new technologies and devices. IQUAM, the International Committee on Quality Assurance, New Technologies and Medical Devices in Plastic Surgery, serves as our IPRAS clearing house. IQUAM`s biennial Consensus Conference took place from September 23 to 26 in Bratislava, Slovakia, together with the first CEN (the European Normalisation Committee) meeting. CEN started to develop standards for Aesthetic Surgery in Europe. The IQUAM consensus declaration will come out soon. It will be sent to you directly. Unfortunately the final evaluation of P.I.P. implants concerning bio-compatibility and toxicity will not be available before January. You will be updated immediately as usual, as soon as new information is available. We expect 300.000 patients to be affected worldwide. The company has filed bankruptcy. Currently we are evaluating potential solutions for lowering the burden for you, our colleagues, and your patients. Fraud never can be ruled out completely but health risks related to products can be identified and measures taken to avoid them. An effective tool to increase patient safety is the WHO Patient Safety Checklist. I work with it since 2 years now and I can reassure you that it does not take extra time, – you have to check all the items on the list anyway, - but with the list you do it in a more structured way. The acceptance of the list by anaesthesiologists and nurses is excellent. Of course you can modify the list according to your needs. The beauty of this checklist is that it can be applied in all 98 member nations of IPRAS, regardless where you work. This was our main objective when we developed this list at WHO. The 8 pilot hospitals worldwide were able to demonstrate that there was a 40% reduction in perioperative complications after introducing the list. Try it and send us your comments! Issue 2

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Dear colleagues, dear industry partners, we all are affected by the economic crisis, – whether we work in hospitals, in private practice or for companies. We as IPRAS try our very best to keep the registration fees low for our congresses, provide you with complimentary services such as publishing your profile on our website for free and offer companies complimentary announcements in our journal. In Germany we are seeing light at the end of the tunnel already, - other countries will follow soon. Let us see this crisis as our chance for developing more solidarity and understanding. Our Panafrican Section Congress in Nairobi is a great chance to get started! With my dearest wishes for all of you! Cordially yours Marita Eisenmann-Klein Prof.h.c. Dr.h.c. General Secretary International Confederation for Plastic Reconstructive and Aesthetic Surgery Direktorin der Klinik für Plastische und Ästhetische, Hand- und Wiederherstellungschirurgie Caritas-Krankenhaus St.Josef, Regensburg, Germany phone +49-941-782-3111, fax +49-941-782-3115


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Editor-in-Chief’s Message

And the beat goes on. The cries of re-birth heard in Berlin, grown louder in Rhodes, were continually progressing in Bratislava….and this Editor is eagerly awaiting the sounds of the drums of Africa, and then the song grown even louder in Qatar….leading to a chorus of “hallelujahs” in Vancouver in the spring. But this kind of growth and enthusiasm doesn’t just happen. It takes a lot of shoulders to pull over 33,000 independent characters who are unaccustomed to the sled of IPRAS. Our lead shoulder was and still is our General Secretary, Marita Eisenmann-klein, aided by the entire Board, and ably directed by Zacharias Kaplanidis. The Journal is now open for submissions for publication. At this time we’re not peer reviewed nor are we indexed….but we do have a large readership and are eager to see and share some of the work being done by our colleagues from around the world. We’re limited , of course, to space and time but if you have an interesting point to make send it to me as a Letter to the Editor. If it’s a larger manuscript send it in as such. I can’t guarantee publication but I can guarantee an interest in what you have to say. So…the Journal thrives, the conferences attract more and more attendees, and the IPRAS voice grows louder. And the beat goes on. Dr Thomas Biggs Editor in Chief’s

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IPRAS Management Office Report 01 July -30 September 2010

Dear members of IPRAS,


hree months have already passed from the historic first edition of IPRAS Journal in July 2010. During this time, the IPRAS Management Office, in collaboration with almost all of the Confederation’s bodies, such as Board of Directors, Executive Committee, National Delegates, National Associations, has fulfilled or has begun a very significant in magnitude and importance project, which I would like to describe in brief: I would like to begin with the feedback we received from several national associations which recently were asked to send us data with the names and the emails of their members (Austria, Belarus, Brazil, Bulgaria, Canada, Chile, Colombia, Cyprus, Egypt, France, Fyrom, Georgia, Greece, India, Indonesia, Iran, Iraq, Ireland, Italy, Libya, Morocco, Nicaragua, Oman, Pakistan, Philippines, Puerto Rico, Slovak Republic, Slovenia, South Africa, Sweden, Switzerland, Taiwan, Turkey, UAE, Ukraine, Uruguay, Uzbekistan), and which we would like to thank for their cooperation. We believe that it is very important for the world of plastic surgery and the five continents of IPRAS, the only official Confederation of Plastic, Reconstructive and Aesthetic Surgery, to have at its disposal the personal contacts of approximately 40.000 members plastic surgeons of the 98 already (Kenya is currently been added as an observer) member-countries. It is very important, in order to receive information concerning plastic surgery in general, or especially for the education of Plastic Surgeons or even for the best interest of its members. What is certain is that this individual data of the members, in no case will be used for reasons other than what the IPRAS Board of Directors strictly commands. The National Associations accessibility to these records, always through the Management Office, aiming to inform and educate the Global Community 6

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of Plastic Surgery about scientific events or achievements, is for instance one of the basic reasons to maintain such a database. Other reasons are easily apprehended, but I would not like to tire you by analysing them. What I would like you to know though is that we already have at our disposal, for the first time after the feedback we received in the last few months, credible data of approximately 28.000 colleagues of yours from all over the world, thanks to the overall cooperation of approximately 60 National Associations, members of IPRAS. I am sure that the value of this database will be appreciated in just time by everybody, and simultaneously, I am certain that this database will soon reach the number of 37.000 plastic surgeons worldwide.

A second issue is that we improved the process used by our individual members to promote themselves through our website. In this way, plastic surgeons worldwide are supported professionally, since IPRAS guarantees its members’ professional integrity and legal as qualified doctors in plastic surgery in their countries. Furthermore, we are making significant efforts to increase the traffic on the IPRAS website to a level of several million unique visitors annually. This promotion of the individual plastic surgeons is done

Management Office met with hundreds of IPRAS members (also members of ISAPS). The perfect relationship shared between IPRAS and ISAPS was verified once again. We had the opportunity to distribute the first IPRAS Journal, and contact all the exhibitors who participated in the particular congress.

with the collaboration and the approval of the National Associations, members of IPRAS. For additional information, please read the relevant information on the website or contact Mrs. Maria Petsa, IPRAS Assistant Executive Director ( Relevant to the above matter, namely the promotion of the individual members of IPRAS, is the decision made by the Board of Directors for the design and promotion of a beautiful official certificate that will grace their offices and will send the message that the particular plastic surgeon belongs to the Global Scientific Community which is represented by IPRAS. This certificate will be at everybody’s disposal very soon, and will be available in a special frame, ready to be hung up. It will be sent by courier to wherever the doctor chooses, after sending a relevant request to the Management Office. The cost has not yet been decided and the payment will be made by credit card through the IPRAS website. The revenue generated will cover the total cost of the certificate (design, shipping & management), a part of it will be attributed to the national associations of the plastic surgeons, and the rest will go towards the IPRAS humanitarian work as well as the promotion of the website. This promotion is scheduled to begin in 2011, through major international media, and the main purpose is to promote to the public the IPRAS aims and scopes and to convince potential patients to use the IPRAS members which we strongly believe that it is for their own benefit and safety.

The General Secretary, Dr. Marita Eisenmann-Klein, the Parliamentarian Dr. Andreas Yiacoumettis and the Executive Director, Mr. Zacharias Kaplanidis, held some very important meetings, such as with the leadership of ASPS (American Society of Plastic Surgeons), and also with the President and other members from the Board of Directors of the Chinese Association of Plastic & Aesthetic Surgery. Our General Secretary has already referred to the basic tops of these meetings. The IPRAS Assistant Executive Director, Mrs. Maria Petsa, and the head of the Congress Department, Mr. Gerasimos Kouloumpis, also joined the Management Office expedition to San Francisco. Furthermore, all future events were promoted, such as the 9th IQUAM Consensus Conference in Bratislava, Slovak Republic (September 23rd – 26th 2010), the Pan African Congress of Plastic & Reconstructive Surgery in Nairobi, Kenya (October 13th – 16th 2010), the joint 12th Pan Arab Association Congress of Plastic, Reconstructive, Aesthetic and Burn Surgery, the 8th Conference of GCC Association of Plastic, Reconstructive, Aesthetic and Burn Surgery, the 2nd Qatar Congress of Plastic, Reconstructive, Aesthetic and Burn Surgery in Doha, Qatar (December 11th – 15th 2010) and the 16th IPRAS Congress in Vancouver (May 22nd – 27th 2011), among others from the booth of IPRAS. At the time that this report is written, the 9th IQUAM Consensus Conference in Bratislava has already been completed with absolute success. Both from an

To continue with our report, we would like to refer to the presence of the IPRAS Management Office, in August 2010, at the 20th ISAPS Congress, in San Francisco (August 14th-18th). There, the IPRAS Issue 2

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organizational and scientific point of view. More details of this congress can be read in the report made by our Parliamentarian, Dr. Andreas Yiacoumettis. I would however like to make a special reference to our sponsors at the IQUAM Conference, and to thank them for their collaboration. Their financial support and their presence, not only in the Exhibition Area, but also at the scientific panels, made a considerable contribution to the success of the 9th IQUAM Consensus Conference.

in Kenya; a congress of great importance. The Humanitarian Team, Women for Women, will arrive 3 days prior to the opening of the congress and with the assistance of the Local Organizing Committee, will operate for free on fellow people who need immediate attention. Furthermore, IPRAS, valuing the presence of members from African Associations at the particular congress, decided to sponsor the 50% of their registration fee. The scientific programme is highly educational and approximately a hundred abstracts from African Plastic Surgeon colleagues have been accepted. The Local Organizing Committee with Dr. Bernard Githae in charge has been working very hard, while the state of Kenya and the Ministry of Health will be attending the events of the congress. The IPRAS Management Office, with the Assistant Executive Director, the head of the Congress Department and the Marketing Department have made every possible effort to make this exceptionally sensitive and multilateral event as successful as possible. Once more, I would like to thank our sponsors, Mentor, Polytech, Silimed and Julphar for their contribution.

Therefore, I would like to thank especially our Platinum Sponsor, Mentor, our Gold Sponsor, Polytech, our Silver Sponsor Lumenis, and our Sponsors Silimed, Hender, Anteis, BSC, Network Lipolysis, Aquamid, Aptos and Dispomed, that as I mentioned previously, with their financial support, their outstanding booths, their exceptional staff and their excellent scientific and corporate presentations, made a fine contribution to the most successful, admittedly, IQUAM Conference ever! The cooperation of IPRAS with the industry of the field of Plastic Surgery is, I consider, imperative for the further development of Plastic Surgery worldwide. The industry’s support at educational events (congresses, scientific meetings, etc.) and IPRAS Humanitarian work (Women for Women, ESPRAS-SHARE) is recognized and highly valued and materialized in every given opportunity. As you may already know, IPRAS offers companies related to the field of plastic surgery, a special space in the IPRAS Journal and gives them the opportunity to present free of charge their scientific work and research. Additionally, in a few days, the Pan African Congress of Plastic and Reconstructive Surgery will begin 8

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More details and a more special review of the Pan African Congress will be presented in the following issue of the IPRAS Journal (Beginning of January 2011). Finally, concluding our report, not because we do not have any more activities of the Management Office to display, but because we have already covered enough space of the IPRAS Journal, I would like to welcome the decision of the Kenya Society of Plastic, Reconstructive and Aesthetic Surgery to become our 98th member / country of IPRAS and to thank all the hierarchy of IPRAS for its cooperation and its support in our difficult, multilateral but challenging task. Zacharias Kaplanidis IPRAS Executive Director IPRAS Management Office Zita Congress Tel: +30 2111001770 – Fax: +30 2106642116 email: URL: Don’t forget to visit the new IPRAS website


Dr. Ashok Gupta

Dear Friends


e are delighted to inform you that Dr. Ashok Gupta, has been nominated to receive the Sheikh Hamdan Bin Rashid Al Maktoum INTERNATIONAL AWARD for Volunteers in Humanitarian Medical Services for the year 2009-2010 by Sheikh Hamdan Bin Rashid Al Maktoum Foundation, UAE. This is in recognition of Dr. Gupta’s humanitarian and medical services through the years to the poor and ailing people. The precious services rendered by Dr. Ashok Gupta have significantly contributed to alleviate human suffering. The award ceremony is scheduled to be held in Dubai, United Arab Emirates, on Monday 13th December, 2010. Dr. Ashok Gupta commented on the news of his award : “I want to thank all my associates and fellows, who actually helped me over the last three decades to reach out to the people in the backward and tribal areas of the Country and help relieving their sufferings through plastic surgery. I am also grateful to my mother, wife, children and other members of family as well all my patients and members of their family, who had reposed faith in me and allowed me to undertake various complex procedures. This is to seek your continuous support, goodwill and blessings for years to come and be able to perform well as well to continue to serve the poor and the underprivileged”.

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Effect of Fat Grafting on Therapeutic Radiation and other ischemic diseases


ransplanted fat has been used for over a century to create fullness and improve facial and corporal proportion, but recently we have observed that autologous fat can improve the quality of tissues into which it is grafted. These qualities make fat grafting an important tool for reconstructive surgery as well as rejuvenation. Reconstruction with fat grafting can achieve the restoration of normal contours, along with an improvement in skin texture, regrowth of hair, and reversal of ischemic damage. New evidence points to an improvement in vascularity and blood flow along with a decrease in fibrosis as the potential mechanism behind these changes. This effect can be seen in reconstruction of deformities resulting from injury, surgery, congenital anomalies, ulceration and therapeutic radiation. The repair of tissues around grafted sites begins soon after implantation. While the volume of fat appears to stabilize about four months after placement the texture of damaged or scarred tissue continues to improve dramatically in ensuing months. The improvement has been noted to continue in many cases for over fifteen years. The mechanism in which fat grafting improves the quality of surrounding tissue is not clear. The role of adipose-derived stem cells, growth hormones and other factors in fat survival and repair remains to be determined. Controlled studies, particularly in animal models, will help us define the mechanism and reproducibility of these fascinating observed phenomena. Even without a clear knowledge of the mechanism through which fat transplantation repairs tissues, consideration should be given for the treatment of therapeutic radiation injuries, scars and ulceration with fat grafts.



annulas used for the removal and the placement of fatty tissue can be multiple-use or single-use. The proper processing of multiple-use cannulas is especially important considering the recent reports of mycobacterial infections related to liposuction and fat injections.(1-10) The reprocessing of multiple-use cannulas is a labor-intensive process, which requires meticulous attention to detail particularly with regard to the non-visible surfaces. Autoclaving should always be performed. Thorough cleaning of all exposed and hidden surfaces followed by removal of all cleaning agents is essential before autoclaving. The autoclave must be used at appropriate settings to eliminate bacteria and minimize mycobacterium, prions and biofilms.


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Exposure to some cleaning agents, especially in combination with high temperatures, may cause degradation of the cannula. Instruments showing corrosion or damage should not be used. If suitable reprocessing of multiple-use cannulas is not available, single-use cannulas should be considered. The manufacturer of such single-use cannulas must process and package the cannulas according to good manufacturing practices and in a fashion approved by the FDA or a country or region’s regulatory agencies. This process should assure sterility and appropriate packaging, which prevents accidental contamination. 1. Torres, J. M., L Bofill, et al. From the Centers for Disease Control and Prevention. Rapidly growing mycobacterial infection following liposuction and liposculpture--Caracas, Venezuela, 1996-1998. JAMA 281: 504-505, 1999. 2. Behroozan, D. S., Christian, M. M., Moy, R. L. Mycobacterium fortuitum infection following neck liposuction: A case report. Dermatol Surg 26: 588-590, 2000. 3. Murillo, J., Torres, J., Bofill, L., et al. Skin and Wound Infection by Rapidly Growing Mycobacteria: An Unexpected Complication of Liposuction and Liposculpture. Arch Dermatol 136: 1347-1352, 2000. 4. Meyers, H., Brown-Elliott, B. A., Moore, D., et al. An outbreak of Mycobacterium chelonae infection following liposuction. Clin Infect Dis 34: 1500-1507, 2002. 5. Newman, M. I., Camberos, A. E., Clynes, N. D., et al. Outbreak of Atypical Mycobacteria Infections in U.S. Patients Traveling Abroad for Cosmetic Surgery. Plastic and Reconstructive Surgery 115: 964-965, 2005. 6. Dessy, L. A., Mazzocchi, M., Fioramonti, P., et al. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling. Aesthetic Plast Surg 30: 717-722, 2006. 7. Al Soub, H., Al-Maslamani, E., Al-Maslamani, M. Mycobacterium fortuitum abdominal wall abscesses following liposuction. Indian Journal of Plastic Surgery 41: 58-61, 2008. 8. Feliz, C. Liposuction Suspended in all of Espirito Santo, Brazil, (after death from infection after liposuction). News article in MedNetBrazil, 2008. 9. Regnier, S., Martinez, V., Veziris, N., et al. [Treatment of cutaneous infections due to Mycobacterium fortuitum: two cases]. Ann Dermatol Venereol 135: 591-595, 2008. 10. Kim, M. J., Mascola, L. Mycobacterium chelonae wound infection after liposuction. Emerg Infect Dis 16: 1173-1175, 2010. Sydney R Coleman, MD New York University Medical Center New York, NY


Novel Stem Cell Based Therapy to improve quality of life for patients with Muscular Dystrophy

Stem cells can be defined as undifferentiated cells that have the capacity to self-renew and can differentiates into various mature cells at single cell level. Stem cells serve to renew tissue throughout an individual’s postnatal life by replacing the cells that are lost owing to everyday wear and tear in our bodies. Multiple cell sources have been investigated for their possible use in tissue regeneration and engineering. Of course, embryonal stem cells are the most potent stem cells, but their application has major ethical considerations. Anyway, mesenchymal stem cells (MSCs) can be obtained from various tissues, e.g. from bone marrow and adipose tissue. Despite bone marrow being the primary and best studied source of stem cell population, subcutaneous adipose tissue is particularly advantageous because of its accessibility, less invasive harvesting technique and the fact that it is self replenishing. In addition, adipose tissue contains a so-called “stromal vascular fraction” (SVF) which consists of a variety of different cell types including circulating blood cells, fibroblasts, pericytes, endothelial cells, pre-adipocytes and multipotent stem cells (Zuk PA et al., Tissue Eng 2001). In comparison, 1 g of adipose tissue yields approximately 5 x 103 stem cells, which is 500-fold greater than the number of MSCs in 1 g of bone marrow (Fraser JK et al., Trends Biotechnol 2006). The Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy proposed minimal criteria to define human MSC. MSC must be plastic-adherent when maintained in standard culture conditions. MSC must express CD105, CD73 and CD90, and lack expression of CD45, CD34, CD14 or CD11b, CD79a or CD19 and

HLA-DR surface molecules. MSCs must differentiate to osteoblasts, adipocytes and chondroblasts in vitro. Another important feature of MSCs is that these cells form colonies when plated as single cell on petri dish. These colony-forming cells can be induced to form bone, cartilage, and fat by simple manipulation of culture conditions. Direct comparisons between human ASCs and MSCs from bone marrow immunophenotypes are >90% identical (Zuk PA et al., Mol Biol Cell 2002). Beside the direct mechanism of tissue regeneration by differentiation in a particular cell type dependent on special microenvironmental niche, ASCs produce also a very favorable mixture of cytokines, which is not only pro-angiogenic, anti-apoptotic but also immunosuppressive and antioxidative (Sadat S et al., Biochem Biophys Res Commun, 2007). With the knowledge of the high potential of mesenchymal stem cells we would like to treat a patient with muscle dystrophy with ASCs from his healthy sister. Muscular dystrophy is characterized by progressive muscle wasting, for which currently no satisfactory treatment exists. Death results usually of respiratory or cardiac dysfunction in early adulthood. Duchenne muscular dystrophy (DMD), the most common form of muscular dystrophy, is an X-linked genetic disorder that occurs in 1 per 3500 males. Women can be carriers of DMD but usally without symptoms. The loss of a functional dystrophin protein, a major component of the dystrophin-glycoprotein complex (DGC), is responsible for the dysfunction and degeneration of the muscle cells. In addition to various different genetic approaches, promising results have been obtained using muscle progenitor cells in dystrophic dogs as described in the literature (Sampaolesi M, Nature 2006). Issue 2

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Recent studies in our own laboratory have shown that stem cells derived from adipose tissue (ASCs) can differentiate into multiple mesodermal and non-mesodermal cell lineages. In addition, ASCs exposed to adequate inductive media were capable of differentiating along the myogenic lineage and forming muscle cells. We show that human ASCs from patients with Duchenne muscular dystrophy participate in myotube formation when cultured together with muscle progenitor cells from healthy donors, resulting in restoration of dystrophin expression. In other studies we have found that the stem cells produce large amounts of soluble factors that support the establishment of new blood vessel supply to an injured tissue, a key step in healing and regeneration. Using a dystrophin-knockout mouse model we confirmed our in vitro data by extracting ASCs from healthy mice and injecting into the mdx mice (C57BL/ 10ScSn-Dmdmdx/J). In order to track applied ASCs cells were labeled with a GFP-Luciferase construct showed successful engraftment after local injection into hindlimb. Tissue of mdx mice treated with ASCs were harvested after 3 weeks and GFP labeled cells were found to express dystrophin. Furthermore, mdx mice treated with stem cells showed improved motoric function in the 4 paw hanging test after local i.m. injection but also after systemic i.v. application. We want to utilize knowledge gained from these preclinical experiments to treat a 23 year old patient with Duchenne muscular dystrophy with severe weakness and plegia in all limb muscles. Muscle biopsies from this patient showed fibre size variation, fibre splitting, internal nuclei, endomysial and perimysial fibrosis and degeneration. Dystrophin staining was completely negative. Molecular genetic testing showed two sequence variants in exon 29 and 48 of the dystrophin gene: c.3970C>T (p.Arg1324Cys)


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and C.7016A>G (p.His2339Arg). Both variants, expecially p.Arg1324Cys are known to cause disease. Furthermore, a nucleoitde exchange in intron 1 IVS1/27C>T (c.32-27C>T) of the dystrophin gene was identified. The healthy sister has neither of the variants seen in the patient. She is also an MHC histocompatible donor (HLA matching A2, A32(19), B52(5), B18, DR17(3), DR52, DR11(5), DQ2, DQ7(3), Bw4,Bw6). Both, sister and patient are also negative for CMV,HIV,Epstein-Barr, hepatitis B and C virus. Adipose tissue from healthy sister will be harvested by a low volume tissue collection procedure (liposuction). The collected tissue will be processed in a specific GMP conform device with a singleuse application to ensure high quality and safety. Tumorigenic potential of the cells is exlcuded by an in vitro test as described by Tremblay JP et al., Neuromusc. Disord. 1991. Freshly isolated cells will be locally injected into the right M. gastrocnemius (medial head). Dystrophin expression will be determined by immunofluoresence from biopsies of the gastrocnemius muscle after 1 and 3 months of treatment using a specific anti-human Dystrophin antibody and RT-PCR with 2 primer pairs binding to deletions in patients dystrophin mRNA. Resulting PCR product will indicate expression of dystrophin transcribed by donor genomic DNA. The improvement of muscle function will be assessed clinically by functional tests, electorphysiologically, by sonography and by MRI. Corresponding author:

Prof. Dr. Lukas Prantl Center of Plastic-, Handand Reconstructive Surgery University of Regenesburg Germany


Introducing the BREAST-Q and the FACE-Q: New Patient-reported Outcome Measures for Plastic Surgery



n aesthetic and reconstructive surgery, new techniques are rapidly evolving. To support this progress, we require increasingly sophisticated ways of measuring outcomes. Throughout healthcare, there is growing impetus to evaluate outcomes from the patients’ perspective. This issue has captured the attention of the public, but also that of surgeons, health care payers, regulatory bodies and device manufacturers. Patient-reported outcome (PRO) measures are specially designed questionnaires that measure procedural outcomes from the patients’ point of view. Current international standards require a strict, three-stage process to optimally develop a PRO measures. When developed to such rigorous standards, PRO measures can provide valid and reliable outcomes data, that may be used to evaluate the comparative effectiveness of new and existing surgical techniques, technologies and devices. The BREAST-Q and FACE-Q: The BREAST-Q© is composed of four separate procedure-specific questionnaires, developed to measure outcomes in different breast surgery groups – breast augmentation, reduction, reconstruction, and mastectomy without reconstruction. The BREAST-Q is the only existing PRO measure for breast surgery that satisfies international criteria for development and validation. The measure was developed and validated in a sample of 3000 patients in Canada and the US. Psychometric analysis of the BREAST-Q© demonstrates that all four modules have psychometric properties which exceed recommended standards. The measure has been translated and

linguistically validated into 8 languages; studies are being performed internationally in each language. The FACE-Q© is a PRO measure designed to evaluate patient satisfaction and QoL following cosmetic facial surgery or non-surgical facial rejuvenation (e.g. Botox�, facial fillers). The FACE-Q is currently undergoing multicenter testing in the United States and Europe. Like the BREAST-Q©, it is being developed with strict adherence to internationally established guidelines. It has been translated and linguistically validated into German and French. Significance: The adoption of broadly accepted, clinically relevant outcome measures such as the BREAST-Q and the FACE-Q will be important for the practice of individual plastic surgeons and as well as for the entire specialty. Widespread use of these new measures will facilitate comparisons between various techniques and guide innovation. As evidence-based medicine is rapidly setting a standard for clinical decision-making, such data regarding patient satisfaction and quality of life will be essential. BREAST-Q and FACE-Q data will provide tangible evidence of the positive impact of reconstructive and aesthetic procedures and support benchmarking of outcomes for quality improvement and plastic surgery advocacy. These data will also inform discussions with regulatory bodies evaluating new technologies and devices. The BREAST-Q© is available to researchers and clinicians at The FACE-Q will be available in early 2011. Adriana Pusica

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Dr. Rafuel de la Plaza Fernandez


’m overwhelmed by the invitation of my dear friend Tom Biggs to write these lines. Overwhelmed because it is indeed an honour that I do not deserve; however, I have accepted the invitation because an old surgeon cannot resist the temptation to relate the ups and downs of his career. I was born in a small mining town of Northern Spain. My father was a doctor and I always admired his dedication, sacrifice and humanitarian vocation, at a time when resources for the exercise of medicine in a rural environment were less than scarce. Since I was a boy, I was particularly interested in architecture and archaeology. Once I finished secondary school, I was faced with the dilemma of choosing between medicine and architecture, but one circumstance helped me to decide and choose medicine: one year before finishing secondary school, my mother, who had a prominent Roman nose, underwent rhinoplasty. I recall how painful it was to see my mother’s swollen face covered with haematomas. The initial result was a complete disaster; she had to undergo surgery for a second time because the surgeon had left a piece of the hump at the dorsum. But the final result was bad both from an aesthetics and from a functional point of view. My mother, who saw me doubting as to which career to choose, told me: why don’t you study medicine and since you have “good hands” specialize in plastic surgery? And that’s how I decided to study medicine with the unusual goal at the time to ultimately specialize in plastic surgery; thus, I would be able to connect the humanitarian side of medicine to my love for design and “construction”. Always pursuing my dreams, I decided to train with the best masters of the time, despite my family’s extreme economic constraints. My intention was to travel abroad once I finished my degree, but my father fell ill and I had to replace him as the town’s rural doctor for six months and then wait for a year and a half until he passed away. My goal was set at the Queen Victoria Hospital, East Grinstead. I managed to get a presentation letter by Dr. Vazquez Añon, who had spent two years there, but first I travelled to Paris and visited for one month at Professor Mark Iselin’s unit, the great hand surgeon, who offered me a six months grant which I gladly accepted after visiting the Q.V.H. In England I reaffirmed my decision that the best place for my training would be the Q.V.H, but I was told that it was 14

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virtually impossible to obtain a vacancy because British doctors had preference followed by those from the Commonwealth; However, I insisted on presenting my application. I spent six months in Paris with Mark Iselin, six more with Morel- Fatio and another six with Paul Tessier, all excellent and creative surgeons. At the time, Tessier was developing his great craniofacial surgery and he offered me the first grant of “asistant etranger” created at his unit; I told him that I was waiting for the Q.V.H.’s reply and a month later I received the confirmation from England. Tessier told me that this one was without doubt the best option for me. When I joined the Q.V.H, it was two years since Sir Archivald McIndoe had passed away, but his disciples, five consultans, were there: Percy Jayes, Jerry Moore, John Watson, McLoughlin and Robin Beare, all of them outstanding surgeons with their own techniques, apart from those inherited from Sir Archivald McIndoe. Moreover, there was the Maxillofacial Surgery service, thus covering the whole range of the speciality and with five operating theatres working five days a week. I spent two years at the Q.V.H. and, in between, one year at the Birmingham Accident Hospital’s Burns Unit, a service with a capacity of 50 beds whose head was Douglas Jackson, and with a research unit with relevant doctors as Sevit, Lowbury and Davies that made it at that time a world reference. I have always said that my greatest privilege was to have had such outstanding masters, that I learnt a lot from their virtues but also from their defects and failings, present in any human being. However, their defects did not tarnish their image nor my appreciation, because what I am, I owe to them to a great extent. For this reason during my period as Secretary General of the Federación Iberolatinoamericana de Cirugía Plástica I set up the “Tribute to the Master” at a time when their image was being trivialized. However, when I say master I’m not speaking about the person who teaches and helps to perform surgical techniques, because that would be a mere coach. The task of the master reaches far beyond, since he has to convey the ethics and rules of conduct inherent to the practice of medicine and foster excellence and creativity. Plastic Surgery’s greatness lies in its nature as a medical speciality; otherwise it would be only handcraft.

Once I finished my specialization period I could have stayed in England or migrated to the United States, but I decided to return to my country and contribute with my expertise to the development of this speciality in Spain, knowing beforehand that I would face many a difficulty in the development of research programmes. In Madrid I founded the Centro de Quemados y Cirugía Plástica de la Cruz Roja and the Servicio de Cirugía Plástica del Instituto Nacional de Oncología. The treatment of burns and oncology patients gave me the chance to keep a closer relation with medicine and become more familiar with patients’ psychological problems. I abandoned hospitals in 1983 and I joined private practice devoting most of my time to aesthetic surgery, setting aside a quarter of my time to reconstructive surgery. Plastic surgery was born and developed under the elan of innovation, creativity and the design of surgical methods and techniques that allow us to treat problems where other disciplines cannot. Innovation has taken up a considerable amount of my professional activity. It is often said that innovative people have an innate disposition, but this is not, I dare say, a decisive factor, nor even essential. There are other factors equally important, such as the association of ideas and, above all, attitude in facing complications, adverse results and the fervent longing for perfection. And what’s more, a critical constructive spirit, not accepting beforehand a technique or a procedure that we consider groundless from an anatomical, physiological or physiopathological ageing basis, regardless of how important the surgeon presenting or publishing it may be. This critical spirit, this rebelliousness have been there all throughout my professional life, together with the idea that in any technique there is room for improvement. Innovation has many sides: excitement, success, failure, difficulties faced when designing, experimenting, circulating and exposing a grounded defence before critics. This last aspect becomes specially complicated when English is not one’s mother tongue, since in discussions the lack of precision, forcefulness and elegance to defend our thesis becomes apparent. On the other hand, it’s very difficult to obtain the acknowledgment of those who for many years have enjoyed professional success thanks to a certain technique, even if their principles have proven groundless and may be the cause of undesired secondary effects in the mid or long term. My modest contributions throughout my professional career were the result of a greater dedication to the various branches of plastic surgery: design of burns unit, craniofacial reconstruction, liposuction, reduction and remodelling of the breast, abdominoplasty, blepharoplasty, supraperiosteal lifting, etc, always with the idea in mind of respecting anatomy and physiology to the utmost and minimizing surgical trauma, following cleavage plans to the greatest extent possible and avoiding affecting tissues not involved in what we want to improve or correct. No trauma, whether it be accidental or surgical, improves the quality of tissues; it may improve its

external appearance, but never its intrinsec quality, and it may even speed up the normal ageing process. The design of instruments such as guided canulae and the tunnel tracer, the blepharoplasty set and others made new techniques easier to perform. The “linear expanders” was perhaps my most ambitious project. I presented it at the IPRAS Congress held in Yokohama in 1995 and I had a preliminary publication in the FILACP Journal. However, it was not commercialized due to its manufacturing difficulties. I think there is a group of surgeons in Great Britain who have made considerable progresses in experimental work with this type of devices. I have been actively involved in teaching, both at hospitals and private practice, as well as taking part in numerous national and international courses. No doubt, this requires an added effort beyond mere professional practice, but it also requires updating and improving the quality of your work, since residents and observers are direct witnesses of what you are publishing and defending. In 1968 I had the honour of setting up the Revista Española de Cirugía Plástica which would later merge with the Revista Latinoamericana and finally became the Revista Iberolatinoamericana de Cirugía Plástica, considered today an international reference journal. Concerning teaching and disseminating the speciality, there is something I dare say I take pride in: setting up the Videoarchivos Españoles de Cirugía Plástica and lately the International Videojournal of Plastic and Aesthetic Surgery ( IVJPAS). From the outset of my professional career, I was aware of the importance of audiovisual means for the teaching and ethical extension of this speciality. I made an early start making films in the first place and then videos, and in 1991 I decided to ask some of my distinguished colleagues for their best jobs in order to edit them and circulate them among the numerary members of the Spanish Society and, given the success, ultimately convey them to most societies comprising the International Confederation. Volumes were edited every four months and they included 3 or 4 techniques, news and publicity for international firms financing the program. It was a non profit program and plastic surgeons received free of charge the copies distributed by their relevant societies or by the commercial firms themselves. The last volume was edited in 2003. However, with the popularisation of Internet people gradually lost interest. During the last years of its distribution, 10,000 copies per volume were edited and they were circulated to 85% of the International Confederation numerary members. Tom asked me to speak briefly about the future of plastic surgery. I honestly believe that there is an extraordinary future ahead of us, particularly in the field of reconstructive surgery. The gradual control of rejection opens endless perspectives to reconstruct and improve the human body. I’m not so optimistic when it comes to plastic surgeons. The misappropriation by surgeons from other specialities of the techniques we created over the last 100 years can seriously affect its future, and for this reason we must strive to keep this innovative spirit that has distinguished us and is today so brilliantly displayed by several

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teams in the field of face and limb transplants. We must not forget that the first kidney transplant was performed by a plastic surgeon, namely Joseph Murray, in 1954, which earned him the Nobel Prize for Medicine. Well, Murray always said that if we stay alert we will always find new fields for research and innovation. Finally, let me make some remarks on voluntary retirement. From the outset, I would like to make it clear that I do not intend to give advice on when to retire because each case is different; however, let me tell you what led me to take a decision that, apparently, greatly surprised those who know me. I believe that retirement is an act of responsibility and it should be planned as such with years of anticipation. And I say it’s an act of responsibility because it affects our finances, our social relations environment and our self-esteem. But it also takes a toll on our family and labour environment, on those people who have worked with us for years: surgeons, anaesthetists, nurses, secretaries, etc, and even in some cases the health institution where we have performed our professional task. But, what’s more important, it also affects those of our patients who require follow-up or decide to undergo other surgeries in the future. I believe that surgeons, unlike doctors, must retire in full health and professional success, for his benefit and that of their patients, and that retirement must be total in order to experience that feeling of freedom that we were deprived of by the strict discipline imposed by programmed consultations and surgery lists, conferences, professional trips, etc. Our professional practice is addictive both from a physical and psychical point of view, and it’s very sad to find oneself in a situation in which we are not aware of our decadence and it will be our patients, colleagues and society who will abandon us. I planned my retirement for 65, and however, for reasons beside the point, I finally retired at 68. Seven years have already gone by, and I can say that I never regretted it. The freedom gained has allowed me to intensify my family life, trips with no professional obligations, and even devoting time to hobbies which for years were left aside by the enormous amount of work. Maybe on another occasion I will write more in detail about this matter, a taboo for many a colleague. When I look back, I feel both surprised and overwhelmed by the work done, which was possible only thanks to a clear vocation and, of course, to the invaluable help of contributors among which I would like to mention anaesthetists and Drs. José Mª Arroyo and Luís de la Cruz, who accepted my iron discipline and made a decisive contribution to the performance of my professional activity. I still occasionally wonder if I should have decided to choose architecture instead of medicine, but I always reach the conclusion that my choice was right. Plastic surgery has enriched me as a person because it has allowed me to get to know human beings better in their moments of pain and happiness, misery and greatness. Nothing can make human beings more equal 16

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than illness and marginalization, and it’s precisely there that our help is truly rewarding if we manage to cure or return their selfesteem to those in suffering. My career has given me the chance to personally meet virtually all the most renowned plastic surgeons of the last 60 years, many of whom are now or have been true friends, and I’m not going to mention any since it would be an endless list, but let me refer to the first one I met in 1961 when I was just a humble resident at Mark Iselin’s Unit: Ivo Pitanguy, whom I was introduced to at the Nanterre Hospital when he went there to meet his old master Iselin. Ivo, 38 at the time, had fully succeeded in Brazil and was becoming a world reference in plastic surgery. He had just published his breast reduction technique and was staying at the Crillon Hotel in Paris. When he learnt that there was a Spaniard at the Unit, he wanted to meet me. With his indescribable friendliness and generosity he invited me to lunch and to accompany him to a film study to work on the soundtrack of the film on this technique, and the next day, to help him, together with Pierre Recht, in a demonstrative breast reduction surgery. I mention it here as an example of the impact it has for a resident to meet someone who was beginning to be considered as one of the great masters. Due to my international activity I have travelled extensively, to the point that I frequently came to consider my seat on the plane, always in economy class, as an extension of my office where I could make the last corrections to my presentations, which was somewhat surprising for my travel companions who were puzzled by my handling of hundreds of slides. Thanks to those trips, I got to know the enormous diversity of the different countries and understand some surgeons’ behaviour, as well as the need for surgeons to respect essential rules of ethics in order to avoid the degradation of our speciality. As an example, during my period as FILACP Secretary General, I set up the Social Medic Committee, which, apart from promoting humanitarian assistance, created a whole set of rules to avoid what Ortiz Monasterio, with his clear-sightedness and proverbial sense of humour, called “surgical safaris”. From these lines, I would like to pay tribute to Jack Mustarde for his humanitarian GHANA project. I had the privilege to be one of the surgeons invited to contribute to this great project, heeding his call with all my team for five weeks. The project culminated with the setting up of a burns and plastic surgery unit with a capacity of 75 beds at the Accra University Hospital, with native specialists trained in different European units. An example of what is considered as a model of assistance for underdeveloped countries: set up the tool and teach how to use it. As a conclusion, I would like to underline once more the importance of a good knowledge of anatomy, physiology and the physiopathology of the ageing of tissues, as well as the significance of the “masters” as promoters of analysis and constructive criticism, innovation and respect of ethics that will distinguish us from the snipers. Plastic surgery is too beautiful and responsible a speciality to be performed with frivolousness.


Dr Li Yin Cao

Dr. Biggs: Dr, Cao, please tell us about your background

DB: When did you return to China?

Dr. Cao: I graduated from medical school in 1977 and was selected to go into plastic surgery. I had very little to say about this as it was the government’s decision. This took me to the Ninth People’s Hospital. I was there for ten years and did all kinds of surgery. My first two years were spent in general surgery, and after that came rotations in head and neck surgery and later micro surgery. We had a tremendous experience there as we had many, many cases. On of my first research projects was one in which we were seeking a way to avoid damage of the donor site when taking a rib graft to reconstruct the ear.

DC: I returned in 1997 to the Ninth people’s Hospital and set up a tissue engineering lab and in 1998 was made Associate Professor at the University of Massachusetts.

DB: You worked in the U.S. How did that come about? DC: In 1991 I applied for a scholarship given by the American Society of Plastic Surgery to come to the U.S. for six months. There were seventy applicants and then four candidates. I was fortunate for being chosen as my English was very poor but my background experience had been excellent. I had repaired a descalped patient in 1989 that was looked upon as noteworthy. I spent six months in Los Angeles with Henry Kawasaki, Bill Shaw, and Malcolm Lesavoy. It was a wonderful time. DB: I thought you spent some time in Massachusetts. DC: I did, but first with Ian Jackson then to Boston Children’s Hospital primarily with Joe Upton. My experience there was fabulous. I worked on creating a polyglycolic acid scaffold for tissue engineering and work using calf chondrocytes as a scaffold for ear reconstruction. This work was published in Plastic and Reconstuctive Surgery. DB: You received the James Barrett Brown Award for this didn’t you? DC: Yes, that was a wonderful honor for me.

DR: So you had feet in both countries? DC: yes, but of course my first responsibility was to China. In 2000 I was made Chairman of Plastic Surgery at the Ninth People’s Hospital with a service of two hundred beds. At that time the government became more active in tissue engineering. In 2005 I was appointed Deacon in Beijing with a service of three hundred twenty beds. DB: So you have a lot of activity to oversee? DC: Yes, a lot, but not too much. I like work. Work is not only my profession but my hobby. We’re working on tissue engineering of bone, tendon,skin, and blood vessels. Of course we’re also doing a multiplicity of other things with stem cells. DB: Thank you, Professor Li Yin Cao. Editor’s Note: The work being done by Professor Cao and his excellent team of research scientists and clinical physicians and surgeons is setting the pace for all the world. With peaceful competition to see who can do the most to aid in the well being of others we are bound to move strongly in the direction of world peace. The IPRAS Journal congratulates Professor Cao and watches expectantly as he continues to move forward out of darkness and shadows of the unknown into a brighter field of scientific knowledge… make people’s lives better.

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Dr Harald Kubiena

Dr. Harald Kubiena, a medical graduate of the Univerity of Vienna in 1997, continued his training in Vienna and had experiences in Traumatology, Pediatric Surgery, Anatomy, Gastric,Thoracic, and Vascular Surgery, and Pharmacology. From 2000 to 2005 he was a resident in Plastic Surgery at the University of Vienna and since then been a Consultant under Professor M. Frey and currently in pursuit of a Professorship at that institution. Dr. Kubiena has been selected as our Young Pioneer because of his dedication to explore the near unknown in Plastic Surgery. His bibliography which follows this report indicates the scope of his efforts which revolve around the embryological causes and treatment of cavernous hemangiomas. As our vision of embryonic and adult stem cells begins to emerge we can see the path he’s following surely will help open the path to finer care to those unfortunate members of our human community who suffer from these problems. We know also that work in this specific direction will shed more light on still unexplored paths that remain.

Below are some quotes from Dr. Kubiena’s philosophy The actual situation in my private and professional life has this taste of “half-time”: you have made your experiences with you and yourself, learned what you like and what you do not want, where your talents are, and where even maximum effort leads only to average


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results, you know what it means to be part of a team – you are also trying to follow your principle to live and not to be lived.

Mindfulness, persistence and couriosity. These are the principles for the next years of professional life probably in an academic environment where plastic surgeons try to manage this acrobatic act of combining basic research on playgrounds like tumor biology or regenerative potentials of stem cells and spending hours in the OR. My active engagement in national and international scientific communities like IPRAS, IQUAM, EURAPS shall lead to an ongoing personal enhancement of knowledge, skills and reflection and exchange of ideas – a contribution for itself and as tribute to those who where engaged before us and have invited as to “come in”.

Vision: To make the “marriage between reconstructive & aesthetic surgery” (T.Biggs) a fruitful – through my hands for the well being of our patients. We are proud to present Dr. Harald Kubiena as a Young Pioneer of IPRAS and look with joyful expectation of more light he will shed on the shadowy pathway toward the sunshiny meadow of medical knowledge.


A Never Ending Challenge


lastic surgery has a very wide range of surgical procedures, from hand surgery, burn surgery, to cosmetic surgery. More and more plastic surgeons, especially the ones that are more involved in reconstructive surgery are willing to share their knowledge with overseas doctors, and to provide their skill to poor patients of the developing countries. The European society of plastic, reconstructive and aesthetic surgery, ( ESPRAS) has founded in 2008 a humanitarian section called SHARE : Surgical Humanitarian Aid Resources Europe. Its goal is to gather a number of NGOs specialised in reconstructive surgery; these NGOs are performing different procedures all over the third world, such as burn acute surgery, post burn reconstruction, cleft lips or palates, hand surgery, post traumatic surgery, nomas, ‌

coordination hopes to prevent overlap, to stimulate sustainability, and to safeguard ethics. The goals of ESPRAS SHARE thus are to facilitate and better coordinate humanitarian activities involving European plastic surgeons, and to improve the quality of humanitarian aid given by European plastic surgeons so that no harm will be done and so that the aid contributes to sustainable development of reconstructive plastic surgery in receiving countries. In reaching targets of sustainability and better coordination, improving communication between the various organizations and individuals engaged in humanitarian aid is necessary. And ESPRAS SHARE is an ideal tool to obtain that. Training and education are the primary instruments to reach the goal of sustainable development of reconstructive plastic surgery in host countries. These instruments are therefore among ESPRAS SHARE’s priority concerns. On January 12th 2010 , one of the most important earthquake of the last centuries happened in Haiti. In less than one minute, a seven million people area was devastated and dislocated, leaving over 400 000 dead people and at least the same amount of

ESPRAS SHARE acts like a clearing house. On the one hand, requests for humanitarian aid are welcomed, on the other hand a database will be run containing plastic surgery teams volunteering to perform humanitarian work. SHARE’s core business thus is a brokerage function mediating between demands and volunteering offers. Centralizing this

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severely wounded women, men ,and children… all very poor, without any medical resources. Half the hospitals of the capital, Port Au Prince were out of order. The international help to Haiti was immediate. Tons of material were immediately sent. Teams from all aver the world, spontaneously arrived on the island, covering many fields… medical, logistics, building, nutrition…. Plastic surgeons from different part of the world , were volunteers to spend a part of their time in order to

operate the great amount of injured people living in the street… not daring to go back to their house…. When they still had one…. The humanitarian branch of ESPRAS, SHARE, immediately reacted to this and organized a SURGICAL BRIDGE TO HAITI. One week after the catastrophy HumaniTerra France, NGO member of SHARE, was on the island with a plastic surgery team, an orthopaedic taem and an gynaecological team. SHARE then sent 12 other surgical teams over a period of 2 months. Each team performed, more or less, an average of 20

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70 surgical procedures, and took care of many out patient, particularly with a great amount of dressings. Surgeons , anaesthetists , nurses and physiotherapists, were coming from HumaniTerra France, Interplast Germany, HumaniTerra Italy, and Interplast Holland. Those groups have mainly been working in two differents private hospitals, CDTI ( Sacre-Coeur) in the center of Port Au Prince, and in Dikini Hospital, in the suburbs.

Cooperation with the other foreign humanitarian teams have been most of the time very good. Operating conditions were very difficult at the early beginning. Then things became more organized and we could even share some members of our teams with American teams ,for instance, working all togheter , for the same goal, to save as many people as we could. During two weeks after the earthquake, as everything was destroyed, our staff was sleeping on the ground, in open air or under small tents. Then we could be hosted in an empty orphanage were a cook was preparing meals, but the living conditions were still very very bad.

After two months we at last could get a proper house, used as a real guest house. Last teams were much more lucky than the first ones… Things are still very slow in Haiti and money is not coming as easely as we might tyink . political problems are still numerous and and reconstruction of the national health services is a very difficult are complicated thing; After the acute period , time for reconstruction has now come. During the initial period SHARE team were operating in private, or semi private hospitals, most of the public ones being out of order or nearly… The university hospital (HUEH, Hopital Universitaire de l’Etat d’ Haiti) was very much damaged, and the operating theatres were not properly functioning. Today SHARE is willing to support the public health system on the island, and therefore has not real possibility to operate, due to the very bad condition of the HUEH. In order to be able to work in good conditions and to teach and train new young surgeon the priority is to rebuilt and/or restore the surgical ward, the O.T. and the emergency department. This will be done with the expertise of SHARE teams , especially for the reconstructive surgery and burns part. Temporary specific operating theatres will be built in the courtyard of the hospital . Technical teams of HumaniTerra, are working very hard on this project, in order to make possible new turn-over of surgical European teams at the beginning of 2011.

SHARE and its partners, is also involved in the reconstruction of the Nurse national institute, that completely fell down during the earthquake, killing two third of the student nurses and their teachers (142 people) the ground breaking of that has been done one September the 23rd. The temporary institute should be built before the end of 2010 allowing then us to teach new nurses… SHARE will provide also help to the training of scrub nurses and anaesthetist nurses who could be then involved as partners for the surgery performed by our teams. The Haitian ministry of health has also asked our teams to help to the restoration of the medical faculty, and to the training of the students. This will give us the opportunity to have a much better coloration with local surgeons, during our surgical camps, and after them ,in order to have a good follow up of the treated patients. Reconstruction in Haiti will be long and fastidious. But we cannot avoid this necessary stage of building or reorganisation of the medical health system, before a real surgical involvement of our teams. When all this will be achieved, SHARE will be able to send in Haiti numerous teams in order to organise a complete surgical turn over at the university Hospital for the benefit of the local surgeons and of course, above all, of the Haitian patients… “Prima la musica, poi le parole”…. Christian Echinard President, HumaniTerra International President, SHARE

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Women for Women IPRAS Charity Programme - News


fter several missions in various regions in India, where mostly women with burn sequelae after homicide attacks were treated

The next missions are planned also in other areas of the world, to again treat women, who had been subjected to homicide attacks, other socio- cultural trauma or just don’t find access to the appropriate care. Certainly many other plastic surgical missions have in the past and still regularly see and treat such cases, although women as patients are under presenting in such mission as they themselves often choose to stay behind the male potential patients, especially if these are their husbands or sons. Other barriers like the problem of children left at home, or identifying some to accompany them to the health care center are well known. WomenforWomen aims to encourage these female patients to find surgical help as also cultural or religious restrictions can be overcome due to the fact that doctors and surgeons are exclusively female, too.

Next missions: Kenya: Preceding the Pan African Congress of Plastic and Reconstructive Surgery Oct.13-16 in Nairobi, Kenya a surgical mission is prepared by the local colleagues

Bangladesh: Medical and surgical services in rural Bangladesh for women are extremely scarce as among other reasons as mentioned above, they, unlike men do not travel to the main land annually for work where medical services are located, as men from these areas do. This November in cooperation with the humanitarian project Friendship (Chairperson Mrs. Runa Khan) a mission is prepared in Bangladesh on the Brahmaputra River. Friendship will supply surgery facilities on their well-established boat clinics.


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The WomenforWomen surgical team will be accompanied by another surgical group from Humaniterra surgical help programme, led by Christian Echinard, President of the ESPRAS SHARE (Surgeons' Humanitarian Aid Resource Europe) programme, who will work on a second boat clinic. Additional cooperation with ASF (Acid Survivor foundation) led by Monira Rahman will be organized on site.

Iraq: The schedules for a mission to the North of Iraq, in Suleiyaman Hospital are defined for late Januaryprepared by Dr. Chanjiv Singh, Plastic Surgeon in Jalandhar, Punjab, who has with his staff worked so hard during our North Indian missions earlier and had coordinated these missions so efficiently.

India: A second mission to Vijayawada Salaja Hospital in the South of India is being prepared as well, again with the owner of the hospital the Plastic Surgeon Dr. Lakshmi Singh. She together with her entire staff was at the same time part of our team and besides organizing operated with us to treat as many patients as possible and offered to repeat these efforts.

Fundraising: Johanna Braun, our public relation and fundraising chairperson has additionally created online funding of the WomenforWomen project, by setting up an account at the platform as well as presenting the organization in facebook for additional awareness. Additionally a fundraising event for friends and partners in Hungary was organized by her just last month.


How to participate

For more information go to or website at and click in the arrow on the front page to open the 10min video on our work in India.

We are thankful for every helping hand that wants to join our mission. If you are interested in participating, you can either:

How can you contribute? Your funds are used for patient care only. We are self administrators. Donate money by financing travel expenses, instruments and medication. Offer other support by fundraising. Donations to: Women for Women K.Nr. 1384181 BLZ: 70030300 IBAN: DE 8170 0303 0001 3841 8100 BIC REUCDEMMXXX Bankhaus Reuschel

• Join the team of Doctors • Help spread the word • Give organizational support If so, please send a short letter of motivation and a CV with photo attached to Dr. med Constance Neuhann-Lorenz, MD Plastic Surgeon, Munich - Germany President Women For Women e-mail:

For detailed information on how to contribute please contact:

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NATIONAL ASSOCIATIONS & PLASTIC SURGERY ORGANIZATIONS NEWS against deliberate disrespect of the security norms by the manufacturer of a medical device.

Société Française de Chirurgie Plastique Reconstructrice et Esthétique (SOFCPRE)

This statement has led the SOFCPRE to approach the French authorities in order to be in the future a more active partner in the safety process of such devices. We are working to implement a program of partnership between our Society and the AFSSAPS (the French safety agency). It will ensure constant tracking and peer analysing of problems or difficulties encountered by surgeons so as to increase fluidity of information and to minimize the detection delay of possible defects. Discussions with the French authorities are also in process in order to increase fillers control and use.


he subject chosen by Claude Le Louarn for the 2010 scientific report of the annual meeting to be held in Paris November 22nd to 24th is: ” Innovation and Creativity in French Plastic Surgery”. All the scientific chapters of the Society have work strongly to show the best of the “French Ecole”. Speakers and exhibitors are showing a strong adhesion with the challenge to meet the theme. At the end of 2010, Claude Le Louarn will be handing over the Presidency of the Society to Jean Louis Foyatier. A very important turn will also take place since our beloved Chief Officer Nicole Labesse will leave for a much deserved retirement. She will be replaced by Marie Christine Chevreux. In the course of 2010 some important issues arose and they are under the process of being solved.

Canadian Society of Plastic Surgeons (CSPS)


he Vancouver 2011 May 23-27 IPRAS meeting plans are well underway. There will be dozens of free courses by the world’s best experts in everything from facelift to cleft lip. Many countries have accepted to present their best national paper of 2010 in the best papers of the world session in Vancouver.

We are proud to announce the implication of SOFCPRE in the elaboration by the CEN of the future European norms for services provided in aesthetic surgery. The project is centered on the intention to provide the best security to patients in regard to the current trend of medical tourism and national rules disparity. The aim is to standardize at the European level, the aesthetic services delivered to patients and the ethic principles applied including during the pre and post operative period. Regarding the PIP situation, current analyses are undertaken and first results are very reassuring. Final in depth testing should be concluded in four months but similar results are expected. Through the PIP crisis, we have discovered the current regulations to be insufficient to ensure good protection 24

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Take a gondola from top of Whistler to top of Blackcomb Mountain, home of the Vancouver 2010 winter Olympics. Enjoy spectacular views, good wine and lunch at the top. Just beside the Vancouver convention center, you can take float airplane rides to

see the mountains and the ocean from the air. There will be an international resident paper session with prizes for the best international resident papers. We have organized great international resident social events as well. The web site will direct you to where you can submit your abstract (deadline October 2010), and you can now book your hotel as well.

Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) Beirut, September 8, 2010 In 1999, encouraged by Ricardo Baroudi, a great plastic surgeon and dear friend, the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) has organized the 1st Lebanese-Brazilian Plastic Surgery Meeting which has attracted many of our Brazilian colleagues as well as many other friends. That meeting was a great success both scientifically and socially. We have since tried to organize a second meeting in 2005; unfortunately this event had to be cancelled. On October 14-17, 2010, the 1st Annual Congress of the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) and the World Congress of Plastic Surgeons of Lebanese Descent will be held in the ever resurrecting vibrant city of Beirut together with the 3rd Conference of Professor Illouz Association. This congress has been officially endorsed by ISAPS and the Euro-Mediterranean Council for Burns and Fire Disasters (MBC). An International Advisory Committee composed of prominent international Plastic Surgeons is a sure guarantee to the scientific value and quality of this event. Already confirmed participation in this congress has surpassed all our most optimistic expectations. With

110 speakers and about 190 presentations, undoubtedly this congress will be one of the greatest scientific events of our specialty in the Middle East in 2010. The Hotel venue along with other hotels within very short walking distance will conveniently accommodate all the needs of the Congress. An attractive social program has been planned and will include dining and dancing as well as organized trips and visits to the most interesting sites of Lebanon including a visit to the newly renovated and rebuilt Beirut Downtown, Jeita Grotto, the new world wonder, and a visit to the old Phoenician port of Byblos, city of the Alphabet, and the most ancient continuously inhabited city of the world. Colleagues from North, Central, and South America as well as from Europe, Australia, North Africa and the Middle East are expected to participate and will enjoy 4 days full of science, pleasure, history and culture.

B. Atiyeh, MD, FACS President, the Lebanese Society of Plastic, Reconstructive, and Aesthetic Surgery (LSPRAS) General Secretary, Euro-Mediterranean Council for Burns and Fire Disasters (MBC) Executive Editor, Annals of Burns and Fire Disasters Professor, Plastic and Reconstructive Surgery e-mail: Tel: +961-3-340032

Croatian society of Plastic, Reconstructive and Aesthetic Surgery (CSPRAS) The Croatian society of Plastic, Reconstructive and Aesthetic Surgery is happy to announce that is holding its 8th Congress between October 6th-8th,2010 in Dubrovnik,Croatia. The congress is endorsed by ESPRAS and is held in English. The main topics of the Congress are: Hand surgery, Aesthetic surgery, Burns and Wound management. For more information about the Congress and our Society's activities can be found on Issue 2

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Serbian Society for Plastic, Reconstructive and Aesthetic Surgery (SRBPRAS)

5. 6. 7. 8. 9. 10. 11. 12. 13. 14.

Nose and surroundings Breast reconstruction Hand and upper limb Trunk Head and neck surgery Blepharoplasty Laser Burns Head and neck reconstructive surgery Lower leg

Over the 50 poster presentation were exhibit during the Congress and 16 sponsors and exhibitors were presenting medical equipment.

ESPRAS Europian Appointed National Congress- 10th Congress of the Serbian Society for Plastic, Reconstructive and Aesthetic Surgery, was held in Belgrade, from 19th to 22nd May, in Hyatt Regency Hotel.

The scientific progra m was participated about 160 plastic surgeons, maxillofacial surgeons, orthopaedic surgeons, trainees and nurses. All of 16 sessions were completely successful.

There were 10 invited speakers from Europe and USA: 1. Andreas Yiacoumettis – Greece 2. Farzad Nahai- USA 3. Henk Giele – England 4. Paul Levick – England 5. Andrea Manconi – Italy 6. Ali Barutcu – Turkey 7. Davor Mijatovic – Croatia 8. Milomir Ninkovic – Germany 9. Milan Stevanovic – USA and 10. invited spekers from Serbia.

Health council of the republic of Serbia performed accreditation program of continuing education. Feedback from evaluation of CME-events are significant for organization of the future scientific events. The Organizing Committee of the 10th SRBPRAS Congress received many congratulations. Sincerely, Nenad Stepic Secretary of the SRBPRAS Society & the Congress

Over the 95 oral presentations were seen, in different sessions: 1. Microsurgery 2. Breast augmentation 3. Breast Surgery 4. Tumors

Egyptian Society of Plastic & Reconstructive Surgeons (ESPRS) 35 th Annual Summer Meeting 6-8 October 2010 Porto Marina – North Coast President: Prof. Hussein Saber Abulhassan Email: Web Site : 41th Annual Congress 1-4 February 2011 J.W.Marriot Hotel –New Cairo General Secretary: Prof. Fouad Ghareeb Email : Web Site : 26

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As plastic surgeons we realize that the problems that women with blefarochalasis, mamary hipertrophia, and abdominal lipodistrophia go beyond simple aesthetic problems. The SNCP got the sponcorship from 3 privates hospitals wich covered all the cost for the surgery, besides the voluntary work of nine anesthesiologist.

Sociedad Nicaraguense de Cirugia Plastica (SNCP) The Nicaraguan society of plastic surgery has been organizing since January of the recent year THE SECOND NICARAGUAN-COSTARICAN CONGRESS OF PLASTIC SURGERY. The following will be taking place on October 7 th and 8th al Granada City, Nicaragua. we are going to have well known guest professor as the directives of FILACP, DR JOSE TARIKI, DR ROMULO GUERRERO, DR CELSO BOHORQUEZ, DR JOSE ABEL DE LA PENA. besider their presence Dr Nelson Shaveltzon (Argentina), Dr Tino Medieta (Nica-USA), Dr Jorge Eduardo

The Turkish Society of Plastic, Reconstructive and Aesthetic Surgery (TPCD) The Plastic Surgery Residents’ School The Turkish Board of Plastic Surgery has published its National Plastic Surgery Curriculum in 2006, to guide and standardize the plastic surgery training that is currently available in more than 78 centers. The curriculum has been built on 5 competencies as knowledge, skills, attitude, academic progress and ethical/professional values ( Core-Curriculum.103.0.html?&L=1) In 2007, in order to support plastic surgery clinics in

Paredes (Colombia), Dr Carlos de los Santos (Rep Dominicana) will be also participating as special guest. we will also have the colaboration of 12 oradors from the hosting societies of Nicaragua and Costa Rica.

VOLUNTARY MISION The Nicaraguan society of plastic surgery (SNCP) completed the first mission voluntary surgeries during May 2010, dedicated to Nicaraguan mothers in their celebration month. Thirteen Nicaraguan mothers with small income experienced the benefits of the doctor’s voluntary work. We performed blefaroplasty, reduction mamoplasty, and abdominoplasty, which are considered aesthetics surgery, and are not found available at public hospitals in Nicaragua. Issue 2

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achieving the training goals cited in the curriculum, The Turkish Society has decided to open annual courses under the name of ‘The Plastic Surgery

Having completed the third Resident’s School, we received a very good feedback from the residents and their clinical chiefs; the growing number of applicants

Resident’s School’. The school has a more skillsbased program that covers the subjects which may be difficult to provide in majority of training centers such as “photography and video recording in plastic surgery”, “patient and in-staff communication skills”, “competency in media and public relations”, “manuscript writing principles”, “medical aesthetic procedures”, etc.

every year also reflects that. Besides achieving the scientific goals, the catalyzing effect of this program between plastic surgery residents is surprisingly striking and strengthens our Society’s hopes for the future.

Lectures/skills training are performed in 20-person classes with an interactive or hands-on approach. Communication skills are given by role-playing, group discussions on scenarios played by simulated patients, and psychodrama sessions. The school is open for 7 days in every spring and the venue is usually a seaside resort. There is a rich social program there are activities like water-sports tournament, paintball, rafting, wine tasting, dance classes, karaoke and disco nights. The faculty is chosen from the experts who also have training for interactive teaching. One or two 4th year or above ranked resident from each training center is expected to attend the school for: 1. Standardizingtheir curricular training, 2. Creating connections with their peers from different cities and clinics. A member of the Society’s Executive Board who is responsible from the scientific affairs chairs this program. An independent observer from a medical education department reviews the program every year by attending the classes, interviewing the residents/ faculty and analyzing the examination results. 28

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Die Schweizerische Gesellschaft für Plastische, Rekonstruktive und Ästhetische Chirurgie (SGPRAC) The 19th European Course in plastic surgery will be held in Bern, Switzerland on November 24-26 2010. The most important topics will be addressed by experts in the field of plastic surgery from many European countries. For further information regarding the program, the faculty and how to register please look under www.


MicroAire Surgical Instruments Acquires the Endotine® Brand


harlottesville, Virginia - MicroAire Surgical Instruments is pleased to announce the acquisition of Endotine® bioabsorbable, multipoint, soft-tissue fixation systems for facial aesthetic surgery. Endotine is a patented system that allows surgeons to attach soft tissue to bone, or to other soft tissue - using special tines instead of sutures - thereby avoiding the tissue-strain associated with sutures. Although Endotine devices have the holding power of multiple sutures, the system actually has more in common with hook-and-loop systems than with traditional needle and thread. This unique system allows surgeons to re-adjust tissue fixation and location during surgery, resulting in optimal aesthetic outcomes. The additional strength from Endotine’s multiple fixationpoints reduces tissue stretching and potential suture failure in a variety of facial procedures, including brow lifts, midface lifts, face lifts and neck lifts. Customers and distributors of Endotine devices will see no change in the availability of the products. MicroAire is planning to continue the product, invest in the product and grow the brand. “Many surgeons already know that this is a fantastic product,” said Alan Connor, MicroAire’s vice president of operations. “We’re ensuring that manufacturing and distribution processes remain the same, so that customers and distributors have full access to Endotine products, as they always have. Same people, same location, same contact information. The only change for now will be the addition of the MicroAire logo, and our commitment to supporting and growing this product line.” MicroAge’s acquisition of Endotine will provide increased distribution capabilities through a larger, combined sales force of Endotine and MicroAire sales representatives. The combined international distribution network could quickly provide distribution of Endotine products and existing MicroAire products into more than 70 countries. Endotine’s products also add a substantial and complementary market segment to MicroAge’s existing body-sculpting products, including the PAL LipoSculptor, which is the only US-patented liposuction instrument to use a powered reciprocating cannula. Endotine, whose first product was introduced in 2003 by Coapt Systems, is the featured fixation system

at many of the advanced surgeon training courses provided by professional organizations including the American Society of Aesthetic Plastic Surgeons (AS APS), the American Society of Oculoplastic and Reconstructive Surgeons (ASOPRS) and the American Society of Facial Plastic and Reconstructive Surgeons (ASFPRS). MicroAire will continue to use the Coapt name on product packaging and business documents (such as invoices) during the period of product registration and transfer to MicroAire. Endotine benefits • Bioabsorbable: post surgery, there are no secondary procedures for hardware removal. Endotine devices hold tissue securely for three to four months and are then absorbed naturally, typically over a twelve-month period • Biologically ‘quiet1: clinical trials showed virtually no issues of inflammation or adverse histologic response • Seven years of clinical history, including excellent success rates in peer-reviewed publications • Endotine mitigates problems associated with traditional suture methods: tissue stretch, tissue cutting (cheese-wire effect), skin irregularities (dimples and depressions caused by suture loops), and nerve entrapment • Endotine can reduce OR time: most Endotine devices can be deployed in a matter of minutes • Adjustable: unlike sutures, Endotine allows surgeons to make rapid corrections during surgery. Endotine allows surgeons to achieve their desired results, without having to remove or replace sutures MicroAire Surgical Instruments, located in Charlottesville, Virginia, is a leading designer, manufacturer and distributor of surgical products in three key areas: orthopaedic power instruments, endoscopic soft-tissue release, and aesthetic plastic surgery. MicroAire is a team, dedicated to enhancing quality of life by providing innovative surgical solutions that improve surgeon and patient outcomes. For more information, visit Contact: D.J. Crotteau (434) 975-8389 Issue 2

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Network Lipolysis 1 - International Workshops The NETWORK-Globalhealth Academy offers international courses

A new column of Anti Aging Therapy: The LipoPower Cure - Dr. Franz Hasengschwandtner, A NETWORK protocol for Aesthetic Mesotherapy - Dr. Michael J. Weidmann, GER

Introduction to Injection-Lipolysis Therapy 1 day hands-on training for physicians Speaker: Dr. Franz Hasengschwandtner, Medical and Scientific Director NETWORK-Lipolysis Location: Frankfurt, Germany Date: December 4, 2010

For further information contact Mr. Uwe Muechler, workshop manager email phone +49-2506-30 61 922

Aesthetic Holidays 3 days of aesthetic trainings in Sharm El Sheik, Egypt with international experts The courses will be held during the morning and evening time, the afternoon is free to relax Program Aesthetic News 2011 - Dr. Michael J. Weidmann, GER Injection-Lipolysis Basic Course - Dr. Franz Hasengschwandtner, A Injection-Lipolysis Advanced Course - Dr. Claudia van der Lugt, NL (members only) Face Composition Advanced Course - Dr. Michael J. Weidmann, GER


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2 - NETWORK-AestheticMeso introduced standardized protocol for Aesthetic Mesotherapy Physicians focused on aesthetic medicine have discovered Mesotherapy for Aesthetics

Mesotherapy, a technique developed in the 50ies of the last century by French doctor Michel Pistor has entered the aesthetic field and therefore raised interest of aesthtetic physicians during the last decade. The problems were numerous: mystic mixtures by every practician, no comparable results, no scientific studies and difficult handling to mix the single substances. An expert group of the NETWORKAestheticMeso has developed standardized protocols for 4 indications during the last 2 years: MesoGlow, MesoLift, MesoHair (hairloss) and MesoCellu (combination therapy with Injection-Lipolysis). Common aim amongst the NETWORK members is to collect statistical data and initiate scientific studies in cooperation with universities. Beside the development of the protocols the members have created so-called Ready Made Mixtures to simplify the treatment procedure and to compare the results on different patients and a standardized education. The mixtures contain substances which could be scientifically identified as active agents to improve the indication scale. A network of compounding pharmacies is producing the mixtures for the NETWORK members all over the world. Further information: Product information: Andreas Kambanas email phone +49-2506-30 61 914



OLYTECH Health & Aesthetics GmbH, founded in 1986, is one of the leading manufacturers of silicone implants in Europe. The company's sales network is spread globally and constantly consolidated. In July 2008, the company relocated its implant production facilities to the site of its headquarters in Dieburg, Germany – thus becoming Germany’s only manufacturer of soft-tissue implants, among them more than 1000 breast implants.

The product range presently consists of more than 1500 different implants and expanders. It is continually extended according to the latest developments and requirements. The company’s focus is directed at breast implants for women; other soft-tissue implants produced are, for example, chest implants for men, implants for the calf and the buttock. In Europe, the company is the only manufacturer producing breast implants with Microthane® coating, an implant surface known for its particular dependability in causing only very low rates of capsular contracture.

cooperation with the surgeons enables the company to develop state-of-the-art products, just as the Sublime Line® breast implants designed for maximum shape control, and the recently marketed Diagon/Gel® 4Two breast implants which have a unique two-gel filling. Breast implants are class III medical devices and thus have to fulfil the highest safety standards. As early as 1995 and as one of the first manufacturers worldwide, POLYTECH Health & Aesthetics introduced the CE-mark for its products. Since then, the company’s products are subject to the high safety standards applicable to class III medical devices. For POLYTECH Health & Aesthetics it is a matter of course to adhere to high quality standards and to continually establish processes in line with the latest requirements. Accordingly, the quality of products and services is permanently optimized and advances in pace with the growing requirements of the market. POLYTECH Health & Aesthetics GmbH Altheimer Str. 32 | 64807 Dieburg | Germany phone +49.6071.9863-0 | fax +49.6071.9863-30 eMail

At POLYTECH Health & Aesthetics, innovation is part of the vision. As a mediumsized enterprise, POLYTECH has unique facilities to adapt smoothly and rapidly to the ever changing requirements of plastic reconstructive and aesthetic surgery and to implement any new standards. Close

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otona’s newest anti-aging aesthetic and surgical laser system SP Dynamis has been very well received by clinicians and experts worldwide since its introduction on the market in early 2010. Its wide range of features and applications are being presented at major recent and upcoming international conferences and exhibition events such as IMCAS Asia, LaserInnsbruck 2010, Aesthetics and Anti-Aging Medicine and, in October 2010, on EADV.

Finally, the SP Dynamis has exceptional system durability and low running costs. Because of its high maximum powers it can operate at half its capacity. This means that it is not constantly working at full power, as is often the case with laser systems of other manufacturers, and this is what makes the SP Dynamis so durable. Additionally, not being pushed to maximum power fundamentally prolongs the lifetime cycle of costly consumables such as the flash lamp.

SP Dynamis – Satisfying Clinical, Economic and Individual Needs

For more information, visit

The SP Dynamis combines the Nd:YAG and Er:YAG laser sources which means that, with one system, you can perform ablative and non-ablative full field or fractional procedures and surgical procedures such as laser lipolysis, endovascular treatments and more. Faster, safer and more effective are the three main attributes of the SP Dynamis. The system's surgical quasi continuous mode (QCW) Nd:YAG with its 80W capacity is one of the most powerful sources on the market, suitable for popular surgical procedures such as laser lipolysis. When compared to other wavelengths, this mode has a relatively low absorption in water, so treatment efficacy and patient comfort are not compromised. When we combine this with Fotona's Variable Square Pulse (VSP) Technology we get the widest range of pulse durations, so the thermal effects can be adjusted to each specific case and the desired clinical outcome. With endovenous laser ablation (EVLA), for example, the heat generated by the laser is controlled and thus does not damage the surrounding tissue. This means faster patient recovery and no undesired side effects. Compared to traditional liposuction, targeting smaller areas, especially on the neck and upper arms area, is much easier with the SP Dynamis’ QCW mode. With this system it is easy to control the laser despite the movement of these topographically awkward areas during treatment. Another advantage of the QCW mode in laser lipolysis is that there is significantly less bleeding during the procedure because of the simultaneous coagulation effects the laser produces.


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Fotona d.d. - With over 45 years of experience, Fotona is a leading developer and manufacturer of medical laser systems. Fotona strives to develop and produce cutting-edge and innovative, highest performance systems that comply with the most stringent international quality and safety standards. Fotona's wide range of laser systems for dentistry, aesthetic medicine, surgery and dermatology purvey durability, reliability and leading-edge innovation. Our mission is to provide only the highest performance, best made laser systems in the world. We fulfill the needs of our customers by offering easy-to-use solutions that improve safety, precision and control, increase treatment speed, offer new challenges and procedures with superior results and ultimate greater patient satisfaction and comfort. We are continuously looking to expand our worldwide network of representatives and reference medical centers, through which we guarantee our customers, exceptional support and technical and clinical training. PRESS CONTACT: Stef HARLEY Fotona d.d. Tel: + 386 1 50 09 178 Fax: + 386 1 50 09 205


The first 3D Physical Web-based Simulator for Plastic Surgery Special price condition for the IPRAS members and readers at the end of the article. Crisalix provides the answer to the unique common question in the plastic surgery field: “How should I look like after surgery?”

From any web-connected place in the world and with any standard digital camera (does not require any additional expensive hardware), every surgeon would now be able to, with e-Stetix, provide his patient a 3D reconstruction and make all kind of drawings/annotations/measures. He can then make unlimited and instantaneous 3D simulation of breast augmentations based on the patient’s own body. This can all be done in less than 5 minutes. Initiated after a research that started in 2006 with the support of the Computer Aided and Image Guided Medical Interventions Network in Switzerland, Crisalix, a spin-off of the Institute for Surgical Technology and Biomechanics from the University of Bern and l’Ecole Polytechnique Fédérale de Lausanne, is the inventor of e-Stetix, the first worldwide technology for 3D simulation based on physical properties applied to plastic, aesthetic and reconstructive surgery. Crisalix is the pioneer in aesthetic surgery in developing a 3D reconstruction system of a patient’s body from 2D photos, and a complete development of its 3D simulation technology through the Web.

In 2008, Crisalix initiated a collaboration between the ISTB, the EPFL and the department of plastic and reconstructive surgery of the Inselspital in Bern (Switzerland). It has been co-financed since 2009 by the Swiss Confederation’s innovation promotion agency (CTI) for its research because of the worldwide impact of its technological innovation. Crisalix is supported by a Medical Board of surgeons with outstanding experience and leading international reputation, including Thomas Biggs (Chief-Editor of Aesthetic Plastic Surgery), YvesGérard Illouz (Inventor of the liposuction), Jan Poell (President of the ISAPS) to name a few. The successful plastic surgeon’s activity and reputation relies – more than in any other medical discipline – upon patient satisfaction. It is also the locomotive for further patient referrals. Failure to achieve patient satisfaction not only leads to a lack of conversion and referrals, but also leads to the cost for re-intervention, which has to be shouldered by the surgeon most of the time. Crisalix’ 3D simulator, e-Stetix, referred to in the press and by the most reputable plastic surgeons as “a revolution for plastic surgery”, is a highly powerful communication tool for plastic surgeons. After having tested and optimized its intuitive and user-friendly stateof-the-art technology by hundreds of surgeons around the world between the end of 2009 and the first semester of 2010 where there has been a significant increase in the number of consultations and several double digit percentage increase in their conversion rate from consultations to operations, Crisalix launches e-Stetix, the most advanced worldwide technology for 3D plastic surgery simulations, internationally in August 2010.

IPRAS member and readers have a special 10% discount on e-Stetix annual subscriptions until December 2010. To benefit from it, you need to add the following code: e056b6db9477 in the Promotional Code on the following page: Issue 2

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Canfield Introduces New VECTRA® 3D Image Capture System


airfield, NJ – 10-31-08 - It looks like it would be more at home on a space ship than in a doctor’s office. But the new VECTRA 3D image capture system from Canfield Imaging Systems is completely down to earth. Combining a clean, elegant design with enhanced functionality, the new system sets the standard for threecamera capture in the Canfield 3D imaging product line. Innovative engineering allows VECTRA to capture either face or body images without any mechanical adjustment or recalibration. This greatly speeds and simplifies workflow in practices that offer a diverse range of services, but there are other equally important benefits. Patients are more at ease, since the technician is not fussing with the equipment to make adjustments during the capture session. And this same smart simplicity dramatically shortens operator training time.

onsite training, and a one year warranty including unlimited technical support from Canfield’s expert team. The new VECTRA is the latest enhancement to Canfield’s leading edge 3D imaging product line. Its groundbreaking design provides the ideal image capture platform for Canfield’s recently introduced Breast Sculptor and Face Sculptor aesthetic simulation applications. Providing the software backbone for the entire system is Mirror medical imaging software, the world’s most widely used clinical image capture, management and database solution. According to Doug Canfield, founder and President of Canfield Imaging Systems, “We’ve been setting the standard for medical imaging for over 20 years, and the industry looks to us for innovation and expertise. Early on we saw the potential of 3D to be the future of medical imaging, and we’ve put enormous resource into developing our product line. And while it’s safe to say that Canfield 3D systems define the state of the art, the new VECTRA is extraordinary by any standard. In this system, you are seeing the future of 3D medical imaging, today” Canfield 3D systems are available in the U.S. directly from Canfield Imaging Systems, and through international distributors worldwide. For more information on this and all Canfield products, contact them at 1-800-815-4330 or on the web at


VECTRA’s sleek new lines complement any workspace, and present a professional, high tech image. And with a typical wall projection of only 10”, it takes up hardly any floor space. All of the mechanical and electronic components are neatly concealed inside VECTRAs smooth, white enclosure for a stylish, patient-friendly appearance. A dedicated computer manages all software applications including image capture, the 3D Mirror database and the programmable, motorized height control. Choose a high resolution, 6 Megapixel capture system for body photography or an ultra high resolution 15 Megapixel system that’s ideal for facial imaging. Included in the purchase are a full day of 34

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Canfield Imaging Systems is a division of Canfield Scientific, Inc., which is the global leader in imaging systems services and products for scientific research and healthcare applications. Canfield Scientific, Inc serves the pharmaceutical, biotechnology, cosmetics, medical and skincare industries. Canfield Imaging Systems utilizes the many years of experience and product breakthroughs of its parent company’s clinical research services, and tailors their products to the unique requirements of direct patient care in healthcare and wellness environments. Peter Lebovitz Canfield Imaging Systems 253 Passaic Avenue Fairfield, NJ 07004-2524 (973) 276-0336


REPORT FROM THE 9th IQUAM CONSENSUS CONFERENCE Bratislava Sept. 23rd – 26th, 2010 Prof Andreas Yiacoumettis


ighteen years ago Jean Philippe Nicolai and Marita Eisenmann-Klein founded EQUAM (the European Committee for Quality Assurance in Medical Technologies and Devices in Plastic Surgery). I remember that during the IPRAS World Congress in Madrid in 1992 (which was postponed by a year, due to the gulf war), all the few interested delegates, myself included, were sitting around a table discussing the scope and role of this new committee. Silicone crisis was at zenith level and the main item on the agenda. As a result of that inaugural meeting, the first “Consensus Declaration” was issued. This declaration was the main tool to convince the medical authorities in many countries, also Greece my own country, not to enforce a ban on the use of silicone breast implants. It seemed that this initiative to create such a committee, was pleasantly

welcomed and it meant that it became an important scientific tool in the hands of Plastic Surgeons in Europe and indeed of the whole world. In Bratislava this year on September 23rd-26th, we witnessed the wonder! Over 150 participants from all

over the globe came to participate in the 9th IQUAM Consensus Conference which was accredited by the UEMS EACCME with 15 CME points. For some years now, instead of EQUAM, this Committee of IPRAS has been renamed IQUAM (International Committee for Quality Assurance in Medical Technologies and Devices in Plastic Surgery). This year’s Conference was the biggest ever and, I dare say, the most successful. It was perfectly organized by the official event organizer and Executive Director of IPRAS Mr Zacharias Kaplanides. His firm “Zita Congress” once again managed the whole event with unparalleled efficiency. Participants came from Panama, Colombia, Mexico, Canada, United States, Brazil, Africa, Asia and from all the European Countries. Over seventy papers were presented from both plastic surgeons and scientists representing medical industry. During this event CEN (Council for European Normalization -Standardization) held its first formal meeting (TC403) on the issue of European Standardization for Aesthetic Surgery Services. The President of IQUAM Dr Constance Neuhann-Lorenz, the Head of organizing committee and General Secretary of IQUAM Dr Josef Fedeleš, the General Secretary of IPRAS Dr Marita Eisenmann-Klein, the President of ISAPS, Dr Jan Poell, the President of ESPRAS and UEMS Section Dr Yiacoumettis and the Chairman of the Scientific Committee Dr Daniel Marchac, welcomed State and other Officials as well as all participants during the opening ceremony. Many Presidents and Secretaries from Societies and Associations were present: Presidents of National Societies from Bulgaria,

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Romania, Greece, Germany, Slovakia, to mention just a few.

Garcia Velasco as the Vice President and Dr Daniel Marchac as the new Secretary.

In the rich Scientific Program, contemporary topics of Plastic Reconstructive and Aesthetic Surgery were discussed. These included: Breast augmentation, reconstruction and the status of breast implants register, current status of other techniques for breast reconstruction and augmentation – tissue transfer, fat grafting and other injectables for breast augmentation. Also: Suspension materials, Stem cell therapy, Tissue engineering, Wound healing, Shock wave therapy, Injectables (lipolysis), Botulium toxin A, Injectable fillers and others.

This was indeed a most successful event and a unique one too. It is probably the only international meeting in which there is an interaction between clinicians, scientists and manufacturers prior to and during the implementation of new technologies. This Committee has come to age and it is increasingly respected and supported by the Plastic Surgery community. Through its activities and mainly with the consensus position

Among the many, we were fortunate to hear the latest on fat grafting in the excellent papers presented by Dr Sidney Coleman, a pioneer in this field. Daniel Marchac, Tom Biggs, Manuel Garcia Velasco, Nelson Piccolo, Bruce Cunningham and many other distinguished speakers gave excellent papers. Claude le Louarn, the President of the French Aesthetic Surgery Society, reported the latest on the PIP breast implants. Dr Roger Wixtrom spoke about biofilms and Ivar Heijningen gave the reasons for implementing Standards in Aesthetic Surgery. Participation in the CEN/TC 403 “Project Committee – Aesthetic Surgery Services” was broad and representative. It was chaired by Dr. Umschaden of the Austrian Society of Plastic Reconstructive and Aesthetic Surgery; the Secretary was Dr Karl Grün. Most of the European Societies’ representatives and officers of European Liaison Organizations took part in a vivid and laborious two day discussion tackling issues like terms and definitions of aesthetic surgery, competencies, knowledge and skills, management and communication with patients, patient consultation and assessment, consent process, documentation etc. Other issues such as medical tourism, advertising, medical indemnityinsurance, quality assurance and improvement, are also important and will be included in the Standardization. Finally, the last day was devoted to the drafting of the “IQUAM POSITION STATEMENT”, which will be distributed to all Health Ministries, the Medical Boards, National Societies and other Associations affiliated to IPRAS. During this General Assembly the delegates reelected Dr Constance Neuhann-Lorenz as the President of IQUAM for another tenure of office, Dr Manuel


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statements, it offers advice and guidance to practicing colleagues on both old and new technologies, devices and surgical procedures, for the assurance of safety and enhancement of patient education. I would finally like to thank our sponsors regarding their contribution to the 9th IQUAM consensus conference. Their financial support and their scientific presence were crucial to the success of the conference. Special thanks to Platinum Sponsor, Mentor, our Gold Sponsor, Polytech, our Silver Sponsor Lumenis, and our Sponsors Silimed, Hender, Anteis, BSC, Network Lipolysis, Aquamid, Aptos and Dispomed for their active participation at the 9th IQUAM consensus conference. They helped IQUAM grow stronger and its congress to attain significant importance. This meeting will continue to thrive in the coming years. The 10th IQUAM CONSENSUS CONFERENCE will take place in Athens Greece in two years time and I am sure it will be even greater. Prof Andreas Yiacoumettis IPRAS Parliamentarian ESPRAS and UEMS Section President

“Support IPRAS, support our African Colleagues, join us in Nairobi!”

Organizing Committee

Scientific Program Topics

President of Organizing Committee: Githae Bernard Kenya Chairman: Badran Hassan Egypt Co-Chairman: Abdulwahab Aref Egypt Agbenorku Pius Ghana Fouad Ghareeb Egypt Kaplanidis Zacharias Greece Khainga Stanley Kenya Mitich Badreddin Algeria Mugwe Winnie Kenya Nangole F.W Kenya Nnabuko Richard Nigeria Rida Franka Mohammed Libya Wanjeri Kimani Kenya Yiacoumettis Andreas Greece

1. 2. 3. 4.

Fat Graft Instructional Workshop Burn Wound Care Guidelines for flap surgery Principles and latest advances in microsurgery 5. Panel on Humanitarian Projects 6. Rhinoplasty 7. Facial Rejuvenation 8. Body Contouring 9. Breast Aesthetic 10. Breast Primary and Secondary Reconstruction 11. Preventive,Regenerative and AntiAging Medicine

A. Gynecology Biology and genetics of aging Breast Cancer risk - A clinical approach using SNPS B. Dermatology Aging Skin C. Genetics D. Ophthalmology Macular degeneration: A progressive age-related disease

Scientific Committee Chairman: Marchac Daniel France Co-Chairman: Githae Bernard Kenya Zaidi Mustafa Libya Abdulaziz Nefzi Tunisia Al-Basti Habib Qatar Biggs Thomas US Evans Gregory US Goran Jovic Zambia Holle Juergen Austria Kadry Mohamed Egypt Kouppas Andreas Greece Madaree Anil South Africa Papadopulos Nikolaos Greece Piccolo Nelson Brazil Reilly Debra US Tazi El Hassan Morocco Zaki Mohammed Sobhi Ahmed Egypt

Contact 1st Klm Peanias - Markopoulou 19002 Peania, Attica, Greece Tel:+30 211 1001782 Fax: +30 210 6642116 Contact Name: Nikos Antonopoulos Å-mail: Web:

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With the support of Euro-Mediterranean Council for Burns and Fire Disasters and the European Society of Preventive, Regenerative and Anti-Aging Medicine “Be there and catch the challenges!”

Scientific Committee

Chairmen: Al-Basti Habib, Qatar (Member of PAN ARAB & GCC) Khalid AL-Hammdani, Qatar (Member of PAN ARAB) Co-Chair: Eisenmann-Klein Marita, Germany (General Secretary of IPRAS) AL-Jaber Hamad, Qatar (Member of PAN ARAB)

Members of Arab-Plast & Gulf Plast:

Peter Bruser, Germany O. Wikston, Sweden Michael Costagliola, France Ashok Gupta, India Ahmed Noreldin, Egypt

International Members:

Organizing Committee

Chairman: Saed Kaladari, Qatar Members: Khalid A. Haji, Qatar Attalla Hamouda, Qatar Ali Shaker, Qatar Mahmoud AL-Sharkawi, Qatar Mahmoud AL-Thalathini, Qatar

Chairman: Al-Basti Habib, Qatar (Member of PAN ARAB & GCC)

Co - Chair: Musleh Al Abdulwahab, Qatar (Chairman Qatar Health)

Members of PAN ARAB & GCC:

Rida Franka, Libya (General Secretary PAN ARAB Association) Mustafa Al-Zaidi, Libya AL-Tamimi Noora, Qatar Hamdy El-Khatib, Qatar Kaldary Saeed, Qatar Seif Makki Ahmed, Qatar Talal AL-Hetmi, Qatar Bishara Atiyah, Lebanon C. Thomas, Oman Hassan Badran, Egypt Mohd Al-Qattan, Saudi Arabia Ali Al-Numari, UAE

Social Committee

(General Secretary PAN ARAB Association)

Ahmad Al Fadhli, Kuwait A. Reda Lari, Kuwait Bishara |Atiyah, Lebanon

Kaplanidis Zacharias, Greece

Rida Franka Mohammed, Libya

Ahuja Rajeev, India Chajchir Abel, Argentina De Mey Albert, Belgium Firmin Francoise, France Foustanos Andreas, Greece Mutaz Habal, US Ninkovic Milomir,Germany Pallua Norbert, Germany Zouboulis Christos, Germany Alain Gilbert, France Piero Raimondi, Italy Aly Al-Aly, USA Marek Dobke, USA Germann Gunter, Germany

IPRAS Journal

(General Secretary of IPRAS)

Al-Basti Habib, Qatar Saeed Tarik, Bahrain Rafat Riad Johar, Egypt Mohd Kadry, Egypt Ali Numairy , UAE (General Secretary of GCC-Plast) A. Baki Al-Khatib, Iraq Mohd A. Batainah, Jordan A.Sallam Abul-Failat, Jordan Mustafa Al Zaidi, Libya

International Members:


Eisenmann Klein Marita, Germany

Kamal Al-Iraqi, Morocco


Husein Tazi, Morocco Mohd Eid, Saudi Arabia

1st Klm Peanias - Markopoulou 19002 Peania, Attica, Greece Tel:+30 211 1001780

Saud Alshlash, Saudi Arabia

Fax: +30 210 6642116

Chonah Thomas, Oman

Omar Mamoun, Syria Antoin Dayoub, Syria Osama Murtadha, Sudan Munsif Guega, Tunisia A. Aziz Nafzi, Tunisia

Issue 1

Contact Name: Gerasimos Kouloumpis Ε-mail: Web:

“The world’s best reconstructive and aesthetic surgery in one meeting”

Organizing Committee

Scientific Program

IPRAS 2011 Vancouver Scientific Program Organizing Committee Chair: Dr. Don Lalonde will offer: Scientific Program Chair: Dr. Peter Neligan Scientific Program tracks including: Local Host Committee Chair: Dr. Richard Warren • Aesthetic surgery Finance & Sponsorship Committee Chair: Dr. Gordon Wilkes • Reconstruction International Relations Committee Chair: Dr. Ronald Zuker • Research Executive Director CSPS, Committee Coordinator: Ms. Karyn Wagner • Education • Administration • Free Daily Master Classes • Invited lectures by established experts • Sessions highlighting young surgeons Scientific Program Committee • Daily plenary sessions & panel discussions Chair, CSPS Scientific Program: Dr. Patricia Bortoluzzi • Specialized subspecialty sessions Pediatric Plastic Surgery: Dr. Louise Caouette-Laberge • Session featuring Best National Society General Reconstruction: Dr. Kenneth Murray Meeting Papers Hand Surgery: Dr. Douglas Ross • Video sessions Aesthetic Surgery: Dr. Walter Peters • E-posters Craniofacial Surgery: Dr. Christopher Forrest • Further information will be posted here Breast Surgery: Dr. Peter Lennox as it becomes available. Burn Surgery: Dr. Edward Tredget • Facilities at the Vancouver Convention Microsurgery: Dr. Steven Morris Center are state-of-the-art. Basic Research: Dr. Michael Neumeister Clinical Research: Dr. Andrea Pusic

Contact IPRAS 2011 Vancouver 4-1469 St. Joseph Blvd. E. Montreal, QC, H2J 1M6 CANADA (T) +1 514 843 5415 - (F) +1 514 843 7005 Web:

Issue 1

IPRAS Journal


NATIONAL & CO-OPTED SOCIETIES FUTURE EVENTS 01 - 06 October 2010 PLASTIC SURGERY 2010 Location: Toronto, Canada URL: 31 October - 04 November 2010 The faces of Jerusalem Location: Jerusalem Venue: The David Citadel Hotel Contact: Mr Sigal Avidan Telephone: 972-3-5639518 Fax: 972-3-5639599 E-mail: URL: 4 - 6 November 2010 Congress of the Korean Society Location: Korea URL: 11-15 November 2010 47th Brazilian Congress of Plastic Surgery Location: Vitoria-ES-Brazil URL: 24-26 November 2010 19th European Course in plastic surgery Location: Bern, Switzerland URL: http:// 27-30 October 2011 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery Beijing, China


IPRAS Journal

Issue 2


IPRAS websites is our new meeting point


ne of the advantages of the web page is that plastic surgeons, patients and people who are interested in plastic surgery field can share their common interests under a website. In our website, we aim to become a meeting place where plastic surgeons can exchange ideas, thoughts, comments and innovations and new procedures with other plastic surgeon around the world. Also, patients and any other who is interested in plastic surgery can view relevant and trustworthy information about plastic surgery field from the worlds leading plastic surgeons. But the most important thing that our website achieves is the interaction between plastic surgeons and the public; plastic surgeons can upload their scientific profile directly on our website and make their profile accessible to other plastic surgeons and to potential patients that look for information about qualified plastic surgeons in their country. • Your colleagues from all over the world will have the opportunity to find your profile and your contact details on the IPRAS website • Potential patients, looking for a specialized plastic surgeon can search through “Find a doctor” section at IPRAS website by choosing country and specialty. In that way, they will be able to find all the plastic surgeons who have uploaded their profile and have chosen their particular specialty. • By uploading your scientific status you will be able to add a link to your personal website as well as a link of the clinic that you are employd. Thus, this is an excellent opportunity to promote yourself and your clinic. • You will be recognized as an IPRAS member and you will have the acknowledgment of IPRAS.

Seize the opportunity and be an active member of IRPAS society. Benefit from participating in an international umbrella organization that is IPRAS and join together with other plastic surgeons our website. It couldn’t be easier to join IPRAS website. Every plastic surgeon can register at IPRAS website and fill in the registration form with its contact details and scientific profile. As soon as its status as a valid national association member is confirmed by the national representative to IPRAS, the plastic surgeon can start to enjoy the benefits of its IPRAS membership. Another great feature of the IPRAS website is the Members’ Forum. Registered members can participate in the forum and exchange ideas, thoughts, concerns and in general participate and interact in discussions regarding every aspect of plastic surgery. • Exchange views, thoughts, ideas with your colleagues as well as to chat with them on several and diverse issues. All registered plastic surgeons will be able to follow the discussion and participate on it. • Every plastic surgeon can inform about events that will be interesting for the rest of his/her colleagues. For example National Meetings. • Upload any information, innovation and development regarding plastic surgery. • Upload safety regulations etc Furthermore you can visit IPRAS website in order to get information about National Associations’ upcoming meetings and IPRAS endorsed meetings and of course don’t forget to visit the latest News of IPRAS. In this particular page you can find information such us updates regarding the PIP alarm, vacancies in hospitals etc. Please do not hesitate to send us your comments and recommendations about the IPRAS website in order to make it a better experience for all the visitors to the website.

Issue 2

IPRAS Journal


2nd Issue October 2010

IPRAS Journal Management Editor: IPRAS Editor-in-Chief: Thomas Biggs, MD Editorial Board: Marita Eisenmann - Klein, MD Andreas Yiacoumettis, MD Constance Neuhann-Lorenz, MD Zacharias Kaplanidis, Economist Page Layout: “In Tempo” Athens Greece e-mail: Photographer: Julian Klein 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: E-mail: Executive Director: Zacharias Kaplanidis E-mail: Assistant Executive Director: Maria Petsa E-mail: Director of Accounting: George Panagiotou E-mail: Congress Organizer: Gerasimos Kouloumpis E-mail: Director of Marketing: Kostas Chamalidis E-mail:

Next issue: January 2011

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

2nd issue  

Welcome to the 2nd issue of the IPRAS Journal

2nd issue  

Welcome to the 2nd issue of the IPRAS Journal