IPRAS Journal 3rd Issue

3rd Issue January 2011

ISSN: 1792-457X Issue 3

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IPRAS JOURNAL

Aims and Scope

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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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I IPPRRAASS J JOOUURRNNAALL

General Secretary’s Message

Dear colleagues, o other year since I serve you as the General Secretary has been as challenging but at the same time as joyful and important for the development of our confederation as the year 2010.

I am happy and grateful for the support of all readers of our Journal in 99 countries in the world and all the participants of last year’s events, the IQUAM Consensus Conference in Bratislava, the Pan African Section Congress in Nairobi and consequently the Pan Arab Association Meeting in Doha. Thank you all for your outstanding contributions, for your dedication and for joining us in creating a corporate identity for IPRAS members. Many of you have asked us for certificates of membership: we are ready now to offer this service to you.

This year we look forward to three major events: the IPRAS World Congress in Vancouver in May, the International Congress of the Armenian Society in June co-organized by IPRAS and the Chinese-European Congress end of October in Beijing, co-organized by the Chinese Society of Plastic Surgery, the European Society of Plastic, Reconstructive and Aesthetic Surgery and IPRAS with the support of the American Society of Plastic Surgery, Brazilian Society of Plastic Surgery, the European Society of Preventive, Regenerative and Anti Aging Medicine and ISAPS. In 2010 we also increased our humanitarian activities with 3 WomenforWomen missions in India, Kenya and Bangladesh and we founded HUGS, the Humanitarian Union for Global Surgery upon the initiative of Christian Echinard. Read the story of Christian’s incredible success with a Burn Hospital in Afghanistan and this is only one out of many successful projects Christian has been involved with Nelson Piccolo Chairman of the Committee for Coordination of Humanitarian Projects experienced an overwhelming response, when he sent out a letter to all members asking for information about involvement in humanitarian work. We are extremely impressed how many of you -besides your hard work in the hospitals- reach out and take responsibility for individuals who are less privileged than we all are.

This year we also shall increase our efforts to establish Plastic Surgery units in Africa. We shall send out information to you soon to invite you to become a supporter of a new training center for African surgeons.

While we are grateful for your support we are eager to serve you as well: Share with us what ever your concerns are, e.g. government regulations, difficulties to practise or to protect our specialty in your area. But also share with us your joy about being a Plastic Surgeon. We would love to receive your story, moving or funny or a cry for help, whatever affects you.

We want to be there for you!

We wish you a year full of happy moments, joy and visions to become true.

Happy to serve you as your General Secretary Yours

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Marita Eisenmann-Klein General Secretary Issue 3

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II P PR RA AS S JJ O OU UR RN NA AL L

Editor-in-Chief’s Message Should auld acquaintance be forgot And never brought to mind?

Should auld acquaintance be forgot And auld lang syne?

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EDITORIAL

he above words, the first in a longer poem, were published in 1788 by Robert Burns, the most famous of all Scottish poets. He alleged he got them from an “old man” but it seems other poets had used bits and pieces of the entire poem from many years before.

Nevertheless it was after Burns’s publication that the people of Scotland began using them while celebrating their “Hogamanay” or New Year’s Eve. Soon it was adopted by all of Britain and then to the rest of the English speaking world. I’m told in many places where English is not the area’s first language one can often hear the words sung by celebrants near the stroke of midnight. In addition to New Year’s Eve we now begin hearing it at graduations, farewell occasions, and even funerals.

As popular as it is, when questioned many well educated people don’t know its meaning, but still often shed a tear or two with its singing.

The poem raises the question as to whether we should forget old acquaintances…and… auld lang syne…or “old long since”,or “days gone by”, or “olden times”. This question has provoked me to ponder this very issue.

In plastic surgery today we’re involved in the most rapid evolution of change ever known to man. When I was in my residency we had three journals in English dedicated to plastic surgery and three text books. We had two major annual meetings (Society and Association) and an assortment of annual state and local meetings. There was no Aesthetic Society, no Burn Society -nor were there any other national specialty societies. There was the International Society of Plastic, Reconstructive, and Aesthetic Surgery which met every four years. There were no videos and device manufacturers didn’t go world wide with state of the art faculty members giving up to date lectures on their sponsor’s products.

In the years of 50’s and 60’s air travel was a mere diminutive of its present state and world travel costs were out of the budget of many clinical plastic surgeons. In short, word spread very slowly.

During these years we were concentrating on the basics that had been established by our forefathers in World War I and later in World war II. The Great Depression of the interim years had been a roadblock to progress. My colleagues and I during those years were treating burns with silver nitrate and waiting for maturation of the wound to accept a graft (usually three weeks) and then laboriously covering the third degree areas with skin taken by a Padgett dermatome or later by the new Brown dermatome. Early tangential approach was unheard of as was tube feeding. In cleft lip repair we were taught the Tennison method although a few of us moved to the Millard method , a technique he had perfected during the Korean Conflict in the late 40’s and early 50’s. Cleft lip noses were corrected with an open technique and it took us three to four decades to understand its excellence in general rhinoplasty. Transfer of large bodies of tissue was by random flaps ,with the tube pedicle an excellent way to move large blocks of tissue longer distances. In hands we never

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repaired primarily lacerated tendons in “no man’s land” Maxillofacial surgery utilized wire fixation and some of the more extensive work employed large .external fixation devices Face lifts were skin only procedures, breast reductions’ major goal was to remove tissue and not lose the nipple, and augmentation mammaplasty was with as series of totally unacceptable implants so was rarely done. In general, “cosmetic surgery”, as it was called then, was done somewhat secretively as it was felt by some that no respectable plastic surgeon would involve himself with “vanity surgery”. Anesthesia was either local or general, but general was often with ether or the new Cyclopropane, both of which were highly flammable thus no electrocautery. More examples are abundant but it is a fact that we were , relative to today, in a somewhat primitive state. “The days gone by” were poorly advanced.

During those olden days certain important lessons from earlier times were strongly emphasized: the importance of asepsis, the recognition of the limits of blood supply, the importance of gentle tissue handling. Some of my residents, who are now superb world class surgeons, may remember my saying:” Dr. X, you’re a plastic surgeon but you’re not operating like one. You’re operating like a general surgeon….NO, like a pathologist”. Others may remember: ”Handle the tissues with the softness you’d employ when brushing your two year old daughter’s hair”.

During these years we began to appreciate the humanness of our patients. We were no longer in a wartime setting but in a post war realization of the necessity of the patient’s participation in the decision making process. We came to understand the importance of clearly employing the “Risk/Reward ratio’ and learning how to tell a patient that we’re unable to do what he/she was wanting and expecting.

As we passed through the decades many changes occurred. Silicone implants arrived on the scene and, despite their initial inadequacies, breast surgery would never be the same. Vascularized flaps replaced the random and replaced the tube pedicle. Microsurgery opened a huge door of our knowledge base making the movement of tissues, even composite tissues, a routine matter. The endoscope took us further…into surgery of a higher skill, though an immensely smaller incision. Better lighting and anesthesia opened more doors These great steps forward in technique were accompanied by more technology: the software revolution continues to open doors. Soon surgeons will be able to photograph a patient and send the picture to a server continents away and receive an appraisal of a proposed

implant or techniqe not in the days or weeks that it may take today, but in seconds. The concept of allografting has become a reality so much so that major centers (with hand and face transplants coming more and more coming into reality) are enlarging to incorporate CTA (composite tissue allografting) into their range of services .Fat and the accompanying adipocyte derived stem cells are being recognized as the greatest source of stem cells, and total breast reconstruction with fat alone (no incisions, no scars) is being done. As we learn more and more about this phenomenon we realize that we’re not only creating a neoangiogenesis but with the reconstructed breasts being sensate we’re creating a neoneurogenesis. As we progress along these lines our work will spread into all the other surgical fields…..neurosurgery, orthopedic surgery, general surgery, urology…all facing problems that may be resolved with the twins neoangiogenesis and neoneurogenesis.

So….as we celebrate our great progress and welcome the new year, in which we expect to catapult into further development of the fields we’ve recently encountered, we may ask ourselves if we should forget the pioneers and the old ways ( Should auld acquaintance be forgot and never brought to mind? Should auld acquaintance be forgot and days of auld lang syne?). Then we stop and think….antisepsis, gentle tissue handling, necessity of blood supply, humanity of our patients….and remember that our understanding of cellular metabolism, our recognition of the great potential of stem cells, the wonders of modern technology, and our excellent vision as to our potential, and the marvels of a future that awaits us….are all because we stand on the shoulders of these old acquaintances, these pioneers with less opportunity to share their knowledge with others, who were limited by lack of progress in cooperative fields (anesthesia, general metabolism, cellular physiology, complexities of biocell physiology, and the immune mechanism)….but whose dedication and contributions formed the foundation upon which all we’re doing now stands.

Saying all this takes me to the chorus of the Burns poem: “For auld lang syne my dear For auld lang syne We’ll take a cup of kindness yet For auld lang syne” And with this note to you I ask you to raise your cup in thanks…to those old acquaintances… upon whose shoulders we stand….and see farther and more clearly…to help make our patients’ lives longer, better, of both.

Dr Thomas Biggs Editor in Chief’s Issue 3

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

IPRAS Management Office Report 01 October -31 December 2010

Dear IPRAS Member, 2011 has already emerged and throughout the world our hearts are filled with hope and anticipation that 2010 was the last year in more than a decade of global financial uncertainty. It is my belief that we have every good reason to be optimistic for a better year in all levels worldwide, but without any doubt, besides our hopes and wishes, our own effort is required to materialize our expectations. To take a good example, once upon a time in Ancient Greece (it must have been around the 5th century BC), a Greek ship sunk during a storm. Within minutes, the entire crew was thrown overboard into the Aegean Sea, attempting to swim towards the closest shore. One of the sailors didn’t seem to be trying hard enough, but on the contrary he was calling for the help of the Goddess Athena to come to his rescue. Things didn’t seem to be going very well for him, until a fellow sailor who was struggling to survive for himself, found the courage to offer him an advice: “Besides your prayer to Athena, move your hands as well”. From then on, the following ancient saying is commonly used: “Óõí ÁèçíÜ êáé ÷åßñá êßíåé” (Besides your prayer to Athena, move your hands as well). I believe that all of us, and perhaps most importantly the Greek people, should remember today the words of this castaway.

and its role with actions such as the attendance of Women for Women Charity, the sponsoring of the registration of many African Participants, the financial aid to the Kenyan Society, and the participation of important scientists from various countries around the world. I would also like to point out the large scientific and organizing success of the Pan African

Photo 1: Photo from the Pan African Congress at Mentors’ booth. From the Left: Gerasimos Kouloumpis (IPRAS management office, Assistant Congress Organiser), Hassan Badran (President Organizing Committee), Mohammed Sobhi Ahmed Zaki (IPRAS EXCO member), Ahmed Noreldin (President IPRAS Pan African Section), Marita EisenmannKlein (IPRAS General Secretary), Guillaume Dubor (International Product Manager of Mentor)

For IPRAS and the Management Office these last few months of 2010 have been full of activities and positive feedback. Two regional congresses, the Pan African in Nairobi, Kenya, and the Pan Arab in Doha, Qatar, gave the opportunity to mobilize institutions (Associations / Federations) and individual scientists, not only from African and Arab countries but also from the five continents of the planet. Although I cannot claim that the participation, in both congresses, was large, the achieved goals are very important for both regions and for IPRAS as well.

In the Pan African congress, for example, Kenya and its local Society joined IPRAS as the 99th official member.

On the other hand, IPRAS underlined its importance 6

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Photo 2: From the Left:Ahmed Noreldin (President IPRAS Pan African Section), Bernard Githae (President of Organizing Committee and Co-Chairman of Scientific Committee of the Pan African Congress), Participant of Pan African Congress during the award ceremony

Adel Noureldin (Egypt), Mohammed Sobhi Ahmed Zaki (Egypt), Norbert Pallua (Germany), Don Lalonde (Canada), Nelson Piccolo (Brazil), Sukwha Kim (Korea), Chona Thomas (Oman), who are in fact dedicated to the goals and ideals of IPRAS.

Photo 3: From the Left: Gevorg Yaghjyan (President of 3rd International AAPRAS Congress), Norbert Pallua (IPRAS EXCO member), Ahmed Noreldin (President Pan African Section), Gino Rigotti (Head Plastic Surgery Department), Sydney Coleman (New York University Medical Center, New York, NY), Marita Eisenmann-Klein (IPRAS General Secretary), Gregory Evans(IPRAS EXCO member), Nelson Piccolo(IPRAS EXCO member)

congress, which was confirmed by all participants.

Moreover, IPRAS chose Doha, as their Executive Committee’s and Board of Directors’ meetings venue.

More than 22 members of the Executive Committee were present from countries of Asia, Africa, Europe, North and South America. This gave the opportunity to discuss and make decisions on important issues such as the amendment of the IPRAS bylaws. This congress was also characterised by the participation of important scientists. I would like to thank personally Sydney Coleman (USA), Monika Piccolo (Brazil), Leonardo Cunha (Brazil), Malcolm Paul (USA), Mansour Bin Dago (Canada), Mutaz Habal (USA), Dmitry Melnikov (Russia), Marlen Sulamanidze (Russia), Marek Dobke (USA), Lydia Masako Ferreira (Brazil), Andrey Polyakov (Russia), who made this long journey to spread their knowledge and experience. Naturally, I make no reference to the IPRAS Executive Committee members and the IPRAS Board of Directors, such as Marita Eisenmann-Klein (Germany), Bruce Cunningham (USA), Brian Kinney (USA), Andreas Yiacoumettis (Greece), Mustafa Zaidi (Libya), Zacharias Kaplanidis (Greece), Thomas Biggs (USA), Gregory Evans (USA), Mohammed Rida Franka (Libya), Habib Al-Basti (Qatar), Debra Reilly (USA), Daniel Marchac (France), Ahmed

Photo 4: Opening ceremony of the 12th Pan Arab Association Conference, Doha, Qatar, 11th - 15th December, 2010

Furthermore, at the Doha Congress, we tried out an innovation: The Public Day. Although the public did not participate in large numbers, I consider the feedback to be highly satisfying and without a doubt I recommend that time should be allowed to familiarize the public with the field of plastic surgery, not only at Regional Congresses but also at National Congresses. I have always believed, as a non-plastic surgeon, that in a plastic surgery congress, educational sessions must be held, not only with doctors addressing doctors but also with doctors addressing ordinary civilians, who are potential patients. This briefing, undoubtedly, brings specialists and potential clients closer.

Concluding the summary of these two (2) major regional events of the last 3 months of 2010 (October-December), which had the support and the auspices of IPRAS, I would like to thank the Presidents of the Local Organizing Committees, Bernard Githae and Habib AlBasti, all the members of the organizing and scientific

Photo 5: Among others: Andreas Yiacoumettis (IPRAS Parliamentarian), Mohammed Rida Franka (President Pan Arab Association), Gevorg Yaghjyan (President of 3rd International AAPRAS Congress), Mohammed Sobhi Ahmed Zaki (IPRAS EXCO member), Bruce Cunningham (IPRAS Treasurer), Gregory Evans (EXCO member), Michael Sherif (Sales Manager Mentor), Tim Crocker (Mentor Manager Distributor Operations)

Photo 6: Among others: Marita Eisenmann-Klein (IPRAS General Secretary), Andreas Yiacoumettis (IPRAS Parliamentarian), Thomas Biggs (Editor in Chief of IPRAS Journal), Nelson Piccolo (EXCO member), Mohammed Rida Franka (President Pan Arab Association), Ahmed Noreldin (President Pan African Section), Mustafa Zaidi (IPRAS Board of Directors Member), Gevorg Yaghjyan (President of 3rd International AAPRAS Congress), Fabian Wyss (Crisalix,Chief Marketing & Sales Officer), Patrick O’Leary (Chief Executive Officer of POLYTECH Health & Aesthetics),Vivian Breinhild(Polytech International Sales director)

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committees, as well as our important sponsors such as Mentor, Polytech, and Silimed, who made an important contribution with their presence and their elegant and functional booths, in both Doha and Nairobi (but also in the 9th IQUAM Consensus Conference in Bratislava in September). With their cooperation in “difficult” organizations with relatively small participation (which was anticipated in a way), they proved to everybody that they support the field of Plastic Surgery worldwide and they do not aim solely, in conjunction with the supply, towards material benefits. IPRAS acknowledges this and warmly thanks them.

Additionally, over the last 3 months, IPRAS and the Management office made a number of significant actions, one of which was the presence of the IPRAS General Secretary, Prof. Marita Eisenmann-Klein, and the Executive Director, myself, in Japan (November 1st-3rd) and South Korea (November 4th-7th). These two journeys of major importance brought the Confederation closer to two of the largest Plastic Surgery Socie-

take place in Beijing in October of 2011.

Furthermore, during the IPRAS Executive Committee Meeting in Doha, our Executive Director suggested, and was accepted in principle by all participants, to create an IPRAS media office and the IPRAS e-TV. The Management Office has already begun working on this project in order to complete something that undoubtedly will add new potential and perspectives to our Confederation.

In the next edition of our IPRAS Journal, we will present more detailed information on the complete scheme, ranking the Media Office and Networking throughout the world as the first priority.

Finally, the IPRAS management office presented the financial balance sheet of 2010 and the budget of 2011, which were approved by the Executive Committee and the Board of Directors. For the very first time, both the balance sheet and the budget were sent to all 99 National Associations/Members of the Confederation. Therefore, with sincerity and transparency, the income and outcome of IPRAS are at the disposal of all individual members of these Associations.

Additionally, at the beginning of 2011, IPRAS General Secretary, Dr. Marita Eisenmann-Klein, and Executive Director, Mr. Zacharias Kaplanidis, visited the Thailand Society of Plastic & Reconstructive Surgeons, where they met with the President of the Society, Dr. Apirag Chuangsuwanich, and discussed matters concerning the closer relations between IPRAS and the Thai Society. I would like to thank him for his warm hospitality during our stay.

Photo 7: OSAPS 2010, 12th International congress of Oriental Society of Aesthetic Plastic Surgery, 1-3 November 2010, Tokyo, Japan

ties in the world, the Japanese and the South Korean.

Positive feedback of these journeys came shortly after.

Our database has already been enriched with 990 emails / members of the Korean Society and we are expecting to receive a large number from the Japanese Society soon.

Also the General Secretary participated at the 47th Brazilian Congress of Plastic Surgery that took place in Vitoria 11th to 15th of November 2010. The congress had a great success. Apart from the great scientific value of the conference, the Brazilian Society offered their cooperation to IPRAS for the 1st Chinese European Congress of Plastic Reconstructive and Aesthetic surgery that will

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In conclusion of the Management Office report, I would like to wish you all, your families and the entire scientific community of Plastic Surgery, for 2011 to be a year of peace, joy and productiveness. However, just to be on the safe side, don’t forget the words of the Ancient Greek castaway (Besides your prayer to Athena, move your hands as well)!

Zacharias Kaplanidis IPRAS Executive Director IPRAS Management Office Zita Congress Tel: +30 2111001770 – Fax: +30 2106642116 email: zacharias.kaplanidis@iprasmanagement.com URL: www.ipras.org Don’t forget to visit the new IPRAS website

SURVEY REPORT

Cross Cultural Adaptation of Armenian Version of BREAST-Q questionnaire

Introduction

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lastic surgeons perform a wide range of surgical procedures that have different clinical goals and complex effects on patients’ lives. Reconstructive and aesthetic surgery can include all areas of the body and deal with all age groups. During recent years, quality-of-life outcomes have become ever more important to clinical practice as well as plastic surgery research (1, 2).

Today, the single use of such clinical variables as mortality and morbidity is considered to be of limited significance to patients, plastic surgeons and researchers (3, 4). Clearly, in the current setting of surgical quality surveillance and healthcare industry limitations, data on complications alone are no longer considered sufficient for plastic surgery outcomes evaluation.

Currently, the assessment of patient experience is more important than ever in breast surgery, as its overriding aim is to satisfy with respect to the patient’s psychosocial state, physical functioning, as well as perception of the aesthetic result (5, 6). For many procedures, the more discriminating result is the patient’s own perception of the surgical result and impact on the quality of life. Furthermore, surgeons and researchers are increasingly cognizant of how patient perceptions may differ from those of providers. It is widely accepted, that in aesthetic surgery, the surgeon’s opinion of successful outcome of the surgery is not always matching with the patient’s assessment.

Cosmetic and reconstructive breast surgeons aim at satisfying their patients with respect to aesthetic results, quality of life as well as body image. Thus, patient’s perceptions of the impact of disease and treatment are increasingly being considered as essential to understanding health outcomes (4, 7, 8, 9, 10).

As evidence-based practice is rapidly setting a standard for surgical decision-making, complete measurement of surgical outcomes requires the combination of objective and subjective measures (2) and the collection of reliable

and valid outcome data is essential to plastic surgeons and their patients. Therefore, there is a need for a new clinically significant, scientifically accepted patient-reported outcome measure that measures the opinions of reconstructive and cosmetic breast surgery patients and at the same time satisfies the accepted international health measurement criteria (9, 11). Thus, to appropriately measure the effect of surgically pertinent outcomes, well-developed and validated patient questionnaires are needed.

Likewise, cross-cultural adaptation of the ‘Disabilities of the Arm, Shoulder and Hand’ (DASH) Outcome Measure which is an established and well-studied measure of upper extremity disability/symptoms was performed for patients living in Armenia. The validated and reliable Armenian and the Russian DASH versions will enable quality of life measurement in Eastern Armenian and Russian speaking patients with various upper-limb disorders. These questionnaires were recommended by AAOS to be as formal translated versions and are available on the IWH website (12).

For these purposes three modules of BREAST-Q questionnaire (Mastectomy, Augmentation and Reconstruction), which is known as a valid and reliable tool for patient-reported outcome measure for breast surgery, were used to obtain a standardized, valid Armenian version of the questionnaire, which would enable the professionals to obtain representative, valid and reliable data. Each of the modules of the questionnaire has pre- and postoperative items and includes both, quality of life domains (physical well-being, psychosocial well-being, sexual well-being) and satisfaction domains (satisfaction with breasts, satisfaction with outcome, satisfaction with care).

Besides, it is worth mentioning that the validated Armenian version of BREAST-Q can be used in patients emigrated from Armenia, who are not “culturally adapted” for the new life and have not completely obtained the language knowledge of the host country yet.

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Objective

References:

The aim of the current study was cross-cultural adaptation of the Armenian version of BREAST-Q questionnaire: particularly Mastectomy, Augmentation and Reconstruction Modules with pre- and postoperative items. The validated and reliable Armenian Version of Breast-Q questionnaire will give the opportunity to get applicable results that can be used for obtaining representative data, high quality outcome report as well as will enable cross-country and clinical comparisons and ongoing quality improvement in the field.

1. Fitzpatrick R, Jenkinson C, Klassen A, Goodacre T. Methods of measuring health-related quality of life and outcome for plastic surgery. Br J Plast Surg. 1999;52:251.

2. Cano SJ, Browne JP, Lamping DL. Patient-based measures of outcome in plastic surgery: Current approaches and future directions. Br J Plast Surg. 2004;57:1.

3. Bunker J. Operation rates, mortality statistics and the quality of life. N Engl J Med. 1973;289:1249.

4. Spilker G, Stark GB. Quality of life considerations in plastic and reconstructive surgery. Theor Surg. 1991;143:6.

5. Faria F, Guthrie E, Bradbury E, et al. Psychosocial outcome and patient satisfaction following breast reduction surgery.

Br J Plast Surg. 1999;52:448–452.

6. Reaby L, Hort L, Vandervord J, et al. Body image, selfconcept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy: Collaboration of plastic surgeon and medical psychotherapist. Health Care Women Int. 1994;15:361–375.

7. Troidl H, Kusche J, Vestweber K, Eypasch E, Koeppen L, Bouillon B: Quality of life: An important endpoint both in surgical practice and research. J Chronic Diseases 1987, 40:523-528.

8. Pope C, Mays N: Qualitative Research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995, 311:42-45.

9. Scientific Advisory Committee of the Medical Outcomes Trust: Assessing health status and quality of life instruments: attributes and review criteria. Qual Life Res 2002, 11:193-205.

10. Revicki D: FDA draft guidance and health-outcomes research. Lancet 2007, 369:540-542.

11. U.S. Food and Drug Administration. Patient reported outcome measures: Use in medical product development to support labeling claims. 2006. Available at: www.fda.gov/ downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071975.pdf.

12. The DASH Outcome Measure. “Disabilities of the Arm, Shoulder and Hand” Outcome Measure. Available at: www. dash.iwh.on.ca 13. Adaptation of Health-Related Quality of Life Measures: Literature Review and Proposed Guidelines. J Clin Epidemiol. 1993;12:1417-32.

14. Beaton D.E., Bombardier C., Guillemin F., et al. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. SPINE. 2000;25(24):3186-191

Methods The original BREAST-Q questionnaire was obtained after online registration and permission from the MAPI RESEARCH TRUST. The entire process of cross-cultural adaptation consisted of 5 stages (2 forward translations, synthesis of the translations and 2 backward translations) and was conducted according to the widely accepted guidelines of Guillemin et al.(13, 14) After completing forward translation, synthesis and backward translation of the Mastectomy, Augmentation and Reconstruction modules, some inconsistencies were revealed, which were later resolved during the consecutive meetings of expert committees, consisting of interpreters (2 for English into Armenian, 2 for Armenian into English), a synthesis- versions recorder, a methodologist, a clinician, and a language expert. Because of cultural peculiarities and habits of respondents living in Armenia, minor changes were made by the expert committee to reveal the main topics that the questions are intended to measure.

The separate modules of the questionnaire were administered to the patients after an informed consent was obtained from all the participants.

The statistical analyses performed were the following: internal consistency assessment by Cronbach’s á coefficient, test-retest reliability assessment (subgroup of Armenianspeaking patients, who again completed the questionnaires 2-8 days later without any medical intervention), construct validity assessment (Spearmen correlations (rs) with Armenian validated version of SF-36 subscales). The results of the data will be reported in another scientific journal.

Significance The formal translated Armenian version of BREAST-Q will enable obtaining standard measures and comparable data which will highly facilitate conducting international multi-centre studies and clinical trials. Thus, we highly recommend using the translated version of the mentioned questionnaire in the daily practice of plastic surgeons and researchers for comprehensive evaluation of plastic surgery outcomes.

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G.V. Yaghjyan, MD, PhD G.A. Avagyan, MD, MPH S.A. Aghabekyan, MD, MPH Yerevan State Medical University

SURVEY REPORT

The possibilities and risks of the aesthetic fronto-cranial remodelling in adults

Craniofacial surgery has been developed by Paul Tessier (1) in the sixties and seventies to deal mostly with the severe disfigurement of children and adolescents affected by facial clefts and facio craniosynostosis, bringing the orbits together, pushing forward retruded faces.

In the seventies and eighties, attention was turned to the infants and craniofacial procedures were descrbed to correct especially craniosynostosis with satisfactory long term results (2).

In 1989, Kenneth Salyer (3) published a book called “Techniques in Aesthetic Craniofacial Surgery� and asked me and Fernando Ortiz Monasterio to write a foreword. I was surprised by the title associating aesthetic and craniofacial surgery, but in fact this helps to realize that the principle goal of craniofacial surgery is to improve the appearance of the people affected with anomalies, and that is really what aesthetic surgery is about.

With the improvement of techniques and the diminution of complications, one can utilize craniofacial techniques - skeletal mobilization - to correct minor anomalies in adults if there is no other way to do it.

There are adults suffering from a cranial anomaly due to an untreated craniosynostosis. They were not treated because the diagnosis was not made in moderate forms, or because it was a progressive deformation like in oxycephaly, or because the parents refused the surgery since it was involving an intracranial approach.

I have seen two adults with the triangular shape of the trigonocephaly, six with the elongated skull of scaphocephaly, three with the flat and vertical forehead of brachycephaly, seven with the obliquely retruded forehead of oxycephaly, and seven with the asymmetrical unilateral deformation of the plagiocephaly (4).

In all there patients (age between 18 to 54 except one), the demand was purely aesthetic as they were concerned by the abnormal shape of their forehead and cranium. Only one, a 21 year old suffering from oxycephaly, complained of headaches. In his case an X-ray discovered finger printing on the skull with a recessed forehead, and her headaches disappeared after the bony remodelling. For all the other, 24 adults examined since 1980, the demand was aesthetic and there were no functional problems. In monosutural craniosynostosis, the percentage of functional impairment is limited, especially in moderate forms like those we are discussing about.

In a few cases, the improvement of the shape of the frontal cranial region can be obtained without an intracranial approach by combining burring of crests or bossing and application of an implant on the recessed areas. For this purpose we like to use methylmethacrylate which is very well tolerated when well immobilized, easy to remove in case of problems and cheap. The best indication is a plagiocephaly with unilateral frontal retrusion(5). Sometimes, injection of fat can attenuate a moderate contour defect .

For the majority of patients presenting a craniosynostosis sequelae, involving usually the forehead and the vertex of the cranium, only a radical fronto-cranial remodeling can provide a satisfactory aesthetic outcome, allowing to reposition the supraorbital barr, correct the shape of the forehead and of the top of the head (fig.1 ).

An orbital asymmetry, like in plagiocephalies, needs also to be corrected effectively by an orbital vertical displacement with intracranial approach.

We have operated 17 adults affected with unoperated craniosynostosis, and 13 had an intracranial approach and radical remodeling. We had no significant Issue 3

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A

B

C

D

Fig 1. A 33 years old man with an unoperated oxycephaly.

A: The forehead is tilted with a retruded supraorbital ridge.

B: 4 months after correction.

C: The supraorbital barr will be rocked forward and the pieces of the upper forehead exchanged.

D: The bony pieces have been fixed with wires and microplates in the desired position.

complications and only 2 necessitated minor contour revision. Classical aesthetic surgery techniques can be useful to further improve the result of skeletal repositioning (fig. 2).

Fig 2. A 18 years old girl with an unoperated plagiocephaly.

A: Note the asymmetrical forehead and orbital dystopia.

B: After right orbital downward mobilization and frontal right side advancement.

C: Rhinoplasty, elevation of left eyebrow, fat injection in eyelids improved the final result.

The results were very gratifying for the operated patients and one realizes then how disturbing it is for a person to have an abnormal appearance of the fronto cranial region if the lower part looks normal.

Of course, operations utilizing craniofacial techniques with an intracranial approach to correct a purely aesthetic moderate anomaly are raising many questions.

The first one is technical: how it compares with the way fronto cranial remodeling in infants and young children 12

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usually done? In adults the bone is hard and thick, difficult to mold and frontal sinuses have developed – increasing the risk of infections.

The corrective plan involves the deposition of the forehead and anterior cranial vault and often of the supraorbital barr. In unoperated patients, this bone flap elevation is usually simple with adapted tools, but it is the thickness of the bone and some internal irregularities that create difficulties and dural tears are not uncommon. The frontal sinus has to be suppressed.

Therefore , it is not an easy operation compared to the early age surgery, but when well planed and executed, the results are very rewarding.

The second important question, if it is difficult but feasible: Is it legitimate to take the risk of an intracranial procedure for a moderate anomaly?

Information to the patients about the possible risks is crucial. The patient must know that a severe neurosurgical complication can occur, leaving neurological sequelae or even threatening his life. He must know that in case of a severe infection one may have to remove all the mobilized pieces of bone , creating a big bone loss difficult to repair. None of this occurred in my group of patients, but it could happen tomorrow!

Besides the major risks, an imperfection, a minor asymmetry, irregularities or a palpable – or visible - ridge is possible . I had to perform only two minor revisions. A few patients refused the surgery because of the post-operative risks. All the others accepted, duly warned several times.

For each case, it is finally up to the surgeon to evaluate the technical possibilities, the chances of obtaining a result that will meet the expectations of the patient, his psychological equilibrium, his understanding of the magnitude of the surgery and the risks involved.

Plastic surgery has enlarged its field as craniofacial surgery, microsurgery and transplants are allowing spectacular repairs. These sophisticated techniques can be utilized for anomalies which are not shocking at first sight but represent a major problem for the affected patients. Each case represents a technical challenge and an ethical problem.

References 1.

2.

3.

4.

5.

Tessier P. Osteotomies totales de la face : syndrome de Crouzon, syndrome d’Apert, oxycéphalies, scaphocéphalies, Turricéphalies.

Ann. Chir. Plast. 12:273, 1967.

Marchac D. Radical forehead remodeling for craniosynostosis. Plast Reconst. Surg. 61,823, 1978.

Salyer K. Technique in aesthetic craniofacial surgery. 1 vol. 292 pages, Lippincot, Philadelphia, 1989.

Marchac D. Renier D. and Arnaud E. Unoperated craniosynostosis patients: correction in adulthood. Plast Reconst. Surg. 122,1827, 2008.

Marchac D. Greensmith A. Long-term experience with methylmethacrylate cranioplasty in craniofacial surgery.J.Plast Reconstr.Surg.61,744,2008.

Daniel Marchac Paris France

SURVEY REPORT

A Brief History of Evolution of Burn Care in the Last Three Decades

Since I was a resident, back in the early eighties, burn care has greatly evolved. The comprehensive care of the burn patient as a whole, aiming at complete recovery (physical, aesthetical, functional and emotional) is the state of the art in the treatment of patients.

Although some European burn centers were quick to aprehend and use then Yugoslavian, today Slovenian, Zora Jazenkovic’s “tangential excision”, its inception in the Americas, particularly North America was relatively delayed, really occurring during the eighties.

Zora initiated with her technique during the fifties and brought it “officially” to the medical world at a presentation in Zagreb in 1962. Prof. Derganc (her original boss) presented the method in Edinburhg in 1965 and Zora presented it again during the 3rd Yugoslavian Plastic Surgery Congress in 1968.

In our opinion, tangential excision, was the single most important advance in the treatment of burn patients, ever!

This technique may have been the originator of several significant research efforts in the most recent decades. As the world of burn care takers took on Zora’ s technique, suddenly there was an urgent need of autograft substitutes. Tangential excision entices the shaving of the burn eschar, in as many as needed “tangential” passages to attain healthy, bleeding viable tissue - deep dermis or fat. Additional need could bring the excision down to fascia. This technique produced a live wound which could be immediately grafted, with healing of the burn in a matter of a week and some days.

Total burn areas above 30 to 40% of the body surface soon proved to be a problem for appropriate coverage and general patient homeostasis.

As immediately as the several services would take upon using this more aggressive approach, these service’s surgeons were suggesting alternatives to suply the shortage of skin in major burn patients, and defining new goals for hematocrit and hemoglobin levels (these latter ones, soon to be “lowered” after the HIV era became a fact).

Zora Jazencovic in 1954

The Tanner-Vandeput Expanding Meshing Dermatome, was created by Dr. Tanner, of Atlanta, Ga and Dr. Vandeput, from Belgium, then a resident at Dr. Tanner’ s service. This machine was able to expand skin grafts several times, from 1 to 1.5 times up to 12 times, making several penetrations on the skin, when the graft was passed trough a pair of cilinders with cutting edges on the superior one, which would “match” to prearranged ridges on the graft carrier and make multiple cuts on the entire thickness of the skin graft, allowing it to expand the amount of times, according to the number/size of cuts. This then meshed skin was placed in the wound, and after “taking”, the epithelium would grow into the previously “empty’”

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spaces. Soon, it was used to associate the meshed autograft, sometimes 1 to 9 or 1 to 6, under allograft meshed into 1 to 3 or even less, so the allograft would protect the autograft, until take and growth into the interstices. (1) Also aiming at solving the shortage of skin in major burns, was the technique created by Meek. A fragment of skin graft can be pressed through the Meek Dermatome, beeing cut into several smaller fragments and with the use of a folded gauze, carried into the wound where it would be placed in an expanded manner ( separating the fragments, allowing for a much larger coverage area, up to 1:9 being frequently employed ).

Both techniques relay on a high percentage taking of the skin and peripheral “ growing” into the non-grafted areas of the epithelium of the incorporated graft. (2-4) The need for a skin substitute prompt Dr. Burke and Mr. Yannas, of Boston, Ma, to create a regeneration template, with the use of collagen and glycosaminoglicans (INTEGRA (R)), which was one of the first dermal regeneration templates, allowing for coverage of the wound, yielding a dermal layer, and later coverage with a very fine autograft, with obvious advantages. Acellular matrices, Alloderm (R) and the like also have a significant role in these coverages.

Cultured epithelial autografts, pionereed by Gallico and Green, were soon expanded to Cultured Epithelial Substitutes, Spray Cultured Epithelial Cells (FIona Wood) and more recently, cultured cells populated biopolimers, originally as the work of Steven Boyce, in Cincinatti, which shows an even newer horizon to large area coverages.

Of interest also is the complete turn around of the clinical intensive care tendency in relation to ventilatory support and treatment of the burn patients.

In the early eighties, the idea was to normal-to-over insuflate the lung, which was guaranteed by volume ventilation, with additional PEEP and volume as needed, which slowly evolved to amuch more rational pressure regulated ventilatory support. In this modality, ventilatory support is usually started . In the nutritional aspect, total parenteral nutrition was progressively abandoned (since it was a “must” for burn patients in the eighties) to the more natural, enteral high calorie, immune-revovering, enteral so-called “trauma” diets.

As a mainstay of treatment, silver sulphadiazine has been the main topical agent for decades, since Dr. Charlie Fox introduced it in the early sixties. Sheets black stainning silver nitrate, Dr. MOnafo’s preferred topical agent, slowly lost its place, and mafenide acetate still finds its use in resistant infection or as a liquid solution to protect grafts. Most recently, nanocrystaline 14

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silver delivering dressings have greatly improved the efficiency of topical agents, tipping the balance once again for survival.(7) Of great interest today are the several aspects of research in relation to the transplantation of composite tissue. Also in burns, there have been some significative gain of knowledge in this field, since although the major burn patient is immunocompromised for some while, the patient is capable of rejecting foreign tissue.

Although dome researchers have tried to diminish

Zora Janzencovic and Nelson Piccolo in Graz, Austria, 2 days before she turned 90, in September 2007

reaction to the foreign tissue with immunosuppressive drugs in burn patients (8), the main course of research is to generate a way of the receiving patient accepting the foreign tissue.

It would be ideal if there could be a perfect match with the donor and recipient, which unfortunately ( for this purpose) can only be achieved, in the identical twin. Close relative live skin donation is occasionally performed in some burn centers of the world (9), as well as in our service, when usually a parent is the donor of the live skin. Maria Siemionow, of Cleveland and several other pioneers in composite tissue transplantation are spearheading this most important field of research, with the common objective of attaining a common factor or method which will be able to permit the free transfer of foreign tissue to the burn patient yielding permanent wound coverage.

The icing on the cake is the current concept of comprehensive care which includes several types of post cure assessments of the burn patient, aiming at evaluating how completely he or she has recovered.

Important tools for this assessment are the Burn Specific Health Scale, created por Blades, Jones e Munster in 1978, still in use in its several forms (BSHSA, BSHS-R, and BSHS-B), translated into multiple languages. Even more specific are the questionaires created by Daltroy et allii, and Kazis et allii, which evaluates quality of life in children who are burn survivors. Dr Cooper-Fraps in 1985 has also published a questionaire to evaluate recovery in relation to sexual health, which is currently been used by several burn centers around the world. (11-14) The main concern in the past was burn patient mortality. In these last 30 years, survival of these patients has greatly improved, so evolution of care brought a series of progressive and different concerns, all aiming at attaining full recovery. Today, quality of life after a burn accident is the main concern – it is obvious that whatever the team has done to the patient will influence his outcome, but the result should be one that will allow the patient to return to “normnal”l life, and there are even some psycho-ethical concerns in how much or up to what amount of treatment should one offer to the major burn patient. These answers are still to be established, but for certain the quest for normality of a burn injury will always be sought after, since human resilience is a gift of God, and it is certainly infinite!

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

References: 1.

2.

Vandeput J, Nelissen M, Tanner JC, et al. A review of skin meshers. Burns. Aug 1995; 21:364-70 Kreis R., Mackie D.P., Hermans R.P.: Expansion technique for skin grafts: Comparison between mesh and Meek island/ sandwich grafts. Burns, 1994; 20:39-42

14.

Kreis, R., W. et allii. The use of Non-viable Glycerol PReserved Cadaver Skin COmbined with Widely Expanded Autografts in the Treatment of Extensive Third Degree Burns. J Trauma, 1989; 29:51-4 Khoo, T.,L. et allii. The Application of Glycerol-Preseved Skin ALlograft in the Treatment of Burn Injuries: an Analysis based on INdications. Burns, 2010; 36:897-904 Smailes, S., T. Noninvasive Positive Pressure Ventilation in Burns Burns, 2002; 28:795-801 Wasiak, J.; Cleland, H.; Jeffery, R. Early Versus Delayed Enteral Nutrition for Burn INjuries. Cochrane Database of Systematic Rteviews, 2006. Issue 3 Wood, F.; Fong, J. Nanocrystalline Silver Dressings in Wound Management: A Review. Int J Nanomedicine, 2006; 1:441-449 Frame, J., D. et allii The Fate of Meshed Allograft Skin in Burned Patients Using Cyclosporin Immunosupression. Br. J Plast Surg, 1989; 42:27-34 Coruh, A et allii. Close Relative Intermingled Skin Allograft and Autograft Use in the Treatment of Major Burns in Adults and Children. J Burn Care Rehab, 2005; 26:471-76 Siemionow M, Nasir S. Immunologic responses in vascularized and nonvascularized skin allografts. J Recon Microsurg. 2008;24:497-505.

Blades, B.; Mellis, N.; Muster, A.,M. A Burn Specific Health Scale,. J Trauma, 1982; 22:872-5 Daltroy L., H. et allii. American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire: Construction and Psychometric Properties. J Burn Care Rehabil, 2000; 21:29-39.

Kazis, L., E. et allii The Development, Validation, and Testing of a Health Outcomes Burn Questionnaire for Infants and Children 5 years of Age and Younger: American Burn Association / Shriners Hospital for Children. J Burn Care Rehabil, 2002; 23:196-207.

Cooper-Fraps C. Burn Sexuality Questionnaire. J Burn Care Rehabil, 1985; 6:426-7.

Piccolo, Nelson, S.; Piccolo, Monica, S.; Piccolo, Maria, T. S. Pronto Socorro para Queimaduras, Goiania, Goias, Brasil

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SURVEY REPORT

Breast Reduction using the Supralateral Dermoglandular Flap

Introduction

Objective

The most currently applied breast reduction technique still used in our Country is the technique described by Pitanguy in 67. Consists of removing breast tissue like a keel, forming two lateral pillars and giving the structure necessary to raise up the nipple areola complex (NAC) in a very natural shape and in a good physiological function. It is indicated specially for small and medium hypertrophy breasts. However, for patients with large breast hypertrophy, with or without asymmetry, there is a bigger challenge in raising the NAC with some stretching difficulties and in such cases, we use the technique described by Skoog (3) in 1971, Silveira Neto (4) in 1976 and modified by Uebel (5) in 1978.

Demonstrate the versatility of the Breast Reduction using the Supralateral Dermoglandular Flap to correct large breast hypertrophy and gigantomasty.

Material and Method The technique is demonstrated in a 52 year old patient with a bilateral hypertrophy. The points ABC are marked in a sitting position like Pitanguy technique and the supralateral flap is outlined. We use epidural anesthesia with a continuous infusion catheter. To reduce bleeding transoperative we use local infiltration with saline and epinephrine 1:200,000.

The dermoglandular flap is deepitelized and prepared

Fig. 1 – 52 year old patient with a large breast hypertrophy showing the principal steps of the Supralateral Dermoglandular Flap, its rotation and its vitality.

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Fig. 2 - Same patient showing a postoperative of 2 months still using micropore in the inframamary scar.

together with the NAC and ready to be twisted up to its new site without stretching and with a good blood supply.

Results We show the different stages after surgery with a good filling of the upper pole of the breast and the new NAC projection showing its vitality and elasticity. The new contour and axillary reduction is demonstrated.

Discussion Tord Skoog in 1971 published his nipple areola dermis flap rotation for large hypertrophy breasts .

This technique however brought sometimes vascular support and lactation problems.. Silveira Neto in 1976, using the same principle of Skoog , modified the technique adding glandular tissue in the pedicle and so improving irrigation and lactation activity .

Uebel in 1978 outlined the dermoglandular flap in the supralateral region and beside to achieve good vascular support and function, he got a better contouring of the lateral and axillary region.

Conclusion In patients with large breast hypertrophy with or without asymmetry, there is a bigger challenge to rise up the NAC. In such cases the technique of

Supralateral Dermoglandular Flap is indicated to bring it upward without any tension , preserving neuro vascular supply and physiological lactation function.

Good sensibility and a new shape of the breast and axillar region are achieved .

References: 1.

2.

3.

4.

5.

Pitanguy I (1960) Breast hypertrophy. In: Transactions of the International Society of Plastic Surgeons, 2nd Congress, London, Livingstone, Edinburgh.

Pitanguy I (1967) Surgical treatment of breast hypertrophy.

Br J Plast Surg 20:78.

Skoog T (1971) A technique of breast reduction transposition of the nipple on a cutaneous vascular pedicle. Acta Chir Scand 126: 126.

Netto ES (1976) Mastoplastia redutora setorial com pedículo areolar interno. Anais 13º Congresso Brasileiro de Cirurgia Plástica , p13-15. Porto Alegre, RS. Abril 1976 Uebel CO (1978) Mamaplastia Redutora com Rotação Retalho Dermo glandular Súpero Lateral . Anais 15º Congresso Brasileiro Cirurgia Plástica .São Paulo,SP. Abril 1978

Carlos O. Uebel, MD, PhD PUCRS University – Division of Plastic Surgery Vitor Hugo, St. 78 Porto Alegre – Brazil ZIP: 90630-070 Phone: 55 51 3330-1177 Fax: 55 51 3330-2660 e-mail: carlos@uebel.com.br Issue 3

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INTERVIEW: PIONEERS

Dr Daniel MARCHAC

My plastic surgery training was done in Paris, with Claude Dufourmentel and Paul Tessier.

I went then for one year in the US where I visited Dr Cronin in Houston, Dr Converse in New York and became one of the first fellows of Ralph Millard.

In the seventies, after my return in Paris I started to perform cranio-facial surgery, trying to duplicate what I had seen Dr Tessier perform, mobilisation of the orbits, facial advancements, cranial remodelling, all this in adults or children.

The real adventure began when I was called in 1976 to operate in the main paediatric neuro-chirurgical unit in Paris, in Hopital Necker Enfants Malades.

I discovered there many infants presenting with craniosynostosis. This was a new field since Paul Tessier could not operate infants in Hopital Foch. We then devised with my neuro-chirurgical colleague Dr Dominique Renier, various techniques for the different types of craniosynostosis ..

The cranio-facial principles of elevating the distorted parts, correcting and repositioning them to restore a normal anatomy, with a fixation with bone plates and fine wires allowed us to obtain aesthetically and functionally much better results than the previous sutures release performed by the neuro-surgeons.

Our work was presented at the American Society in 1977 and a book published in 1982 “Cranio-facial Surgery for Craniosynostosis”.

We studied our series (2 500 patients from 1976 to 2007) in many papers.

The changes that have occurred concerned technical details (fixation done with resorbable material, zigzag incision in the hairs) but the fundamental concepts 18

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did not need to be modified. The main changes have concerned the facio-craniosynostosis, Crouzon and Apert. At first we were doing an early frontal remodelling and advancement and a le Fort III.Later. when F. Ortiz-Monasterio introduced the monobloc concept in 1978, we started to perform this spectacular operation. We had some excellent results but infections were too frequent and we stopped - like most teams – to perform it to come back to the 2 stage – forehead and face later – concept.

Distraction has really opened new doors. The inner distractor we devised in 1995 for maxillary retrusions allowed a more effective advancement, but the real break through has been the monobloc advancement with the inner distractors we started in 2000. Now Dr Eric Arnaud has completed 100 cases with very good results, normalizing the appearance, improving the breathing, correcting the exophthalmos. Unfortunately, contrary to the mandible, reossification is slow at the level of the maxilla and forehead, and we must keep the inner distractors in place for 6 months. The new development will be using resorbable part system, extractable activators, and may be one day, micromotors.

I am also now interested on the treatment of adults presenting with cranial anomalies related to unoperated craniosynostosis. It is hard bone , difficult to mold, the frontal sinuses have developed with the risks of infection, but results are very gratifying.

I have done many things in plastic surgery, from skin graft to the vulva to finger pulp grafts, abdominal hernias to transsexual surgery. But it is the facial repair after skin cancer -mostly basal cell carcinomas- that I like most, and I published a book “Surgery for Basal Cell Carcinoma of the Face” in 1986.

This surgery underlines the links between aesthetic and reconstructive surgery: the patient expects to be cured from his cancer, but he wants also to have an “aesthetic result” and have no visible sequelae.

Aesthetic surgery has always interested me as well as cranio-facial surgery. I have devised a mammoplasty technique to limit the visibility of scars, “Mammoplasty With a Short Infra-mammary Scar”, published in 1982 in the PRS. I’ve worked on the undedectality of the face lift operations, to hide scars and avoid hair displacement, and published my vertical approach in the PRS in 2002.

Besides surgical problems, I was interested in the organisation of plastic surgery. In 1985 I was the chairman of the first International Congress of CranioFacial Surgery, held in France, with Paul Tessier as President. In 1984 I initiated the European Society of

Cranio-Facial Surgery, meeting since then every second year.

But I feel that my most important contribution was to stimulate the creation of the European Association of Plastic Surgeon, EURAPS, organised on the model of the American Association.

The first meeting was on Strasbourg in 1990, and this high level scientific meeting has been a great success, bringing the Europeans together in a friendly competition with the large American societies Plastic surgery is a wonderful speciality, so diverse, with so many aspects. I feel that we must work hard to maintain its existence, since our only territory is innovation and excellence. We must also work hard to keep it united and especially to keep the aesthetic and reconstructive branches together.

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INTERVIEW: STARS ON THE HORIZON

Dr Pericles Vitorio Serafin Filho

Dr. Biggs: Dr. Filho I was looking at your CV and it is very impressive. I note that you attended the University of Federal Paraiba and you did your general surgery there as well your plastic surgery in Sao Pablo at the Hospital _Brigadeiro. Furthermore I noticed that you are the Director of the Plastic and Reconstructive Surgery Service at the Fundacao Laureano Hospital and that you are the former president of the Paraiba Section of Brazilian Society of Plastic Surgery. That is an impressive bit of accomplishments for a person of your particular generation. Tell me some more about what you have been doing.

Dr. Filho: For the last thirteen years, i have worked at our local cancer hospital (laureano foundation cancer hopsital) as a volunteer plastic surgeon along with other colleagues, and within the last five years as the plastic surgery service director (chefe). this awsome experience has taught me that ones simplicity, although sometimes hard to practice, usually is a god’s gift for those who can afford to sense it, and that our biggest asset is not what we earn, but what we give.

It’s been now twenty years since my medical school graduation party and a few other parties in between, three kids… therefore surprises became scarcer, now,

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most of the time it’s easy to predict how the story ends, and some patients scare us more than surgical procedures.

For the next ten years, my plan is not to make plans. i feel like i should do my best, as if it was the last. i’ll try to be more proactive, do it right and walk away for the next task, each one at a time Dr. Biggs: Dr. Filho where do you see things going for plastic surgery in Brazil?

Dr. Filho: Absolutely better and better. With our organization like I described above we will increase the quality of our educational processes and with the cooperation of the government and of the people in general our patients will see nothing but increase in quality of care and better lives for our patients.

Dr. Biggs: Thank you very much Dr. Filho. Rising Star.

It’s inspirational to this Editor to hear stories such as yours. This was the attitude many years ago but there’s a sense that it’s been lost. Your story, which I’m pleased to think, is being replicated by young “Rising Stars” around the globe and therefore throughout our plastic surgery family….and happy that The IPRAS Journal can designate YOU…as a Rising Star

INTERVIEW: SENIOR AMBASSADOR

Dr. Thomas Baker

Dr. Biggs: Upon examination of your C-V I can say it’s about the size of a small city’s phone book. It would be impossible for us to go into it in great detail but this interview has to do with why we’re pleased to have chose you as our Senior Ambassador for IPRAS. Dr. Baker: I didn’t include all the meetings I attended.

Dr. Biggs: Thank you for that. Had you, I’d have needed to pay extra for my overweight luggage as I took it on flights.

But let’s get on with it. You were born in a small town in Kentucky in 1925.

Dr. Baker: Yes, my father owned and operated a small café and I grew up working in it.

Dr. Biggs: Your education consisted of undergraduate work at Indiana University with a B.S. in 1946 and an M.D. in 1949, then residency in General Surgery in Jackson Memorial Hospital in Miami with Plastic surgery in Galveston at The University of Texas , finishing in 1957.

Dr Baker: Yes, but that doesn’t include The U.S. Navy from 1944-1945 which supported me in school but included a stint from 1951-1953 as a general surgeon in the Korean Conflict.

Dr. Biggs: I see you received your certification by The American Board of Surgery in 1958 then from the American Board of Plastic Surgery in 1959. Where did you go after Galveston?

Dr. Baker: I went to Missouri where I was the founder of the Plastic Surgery Department at the University of Missouri Medical School and Chief of the Division.

Soon after that I moved to Miami and was appointed Assistant Professor of Anatomy and taught upper extremity and head and neck anatomy. I was also appointed Assistant Professor of Plastic Surgery. Over the years I rose in the ranks, becoming full Professor in 1994 but as a voluntary basis as I had begun my private practice with Howard Gordon in 1960.

Dr.Biggs: You’ve held numerous offices in Plastic Surgery. Which do you feel were most significant?

Dr. Baker: Of course they all were significant, but on a local basis the President of the Medical Staff at South Miami Hospital made me privy to the myriad of complications in the operating of a hospital.

After the American Society for Aesthetic Plastic Surgery was formed in 1969 I began working my way up that ladder and was elected president in 1982. I was also on the American Board of Plastic Surgery and elected Vice-Chairman in1991.

Dr. Biggs: You’ve held many more positions than that and have served as Visiting Professor at most of the major Universities in the U.S. and have travelled and lectured and operated in many countries around the world, but tell us of the special awards you’ve received.

Dr.Baker: In 1989 I received the Distinguished Service ward from the Plastic Surgery Educational Foundation.

In 1990 I received the Distinguished Service Award from the American Society of Aesthetic Plastic Surgeons. In 1999 came the Special Acheivement Award in Plastic Surgery by the ASPRS. I was awarded the Best Scientific Paper from ASAPS in 1999 and the Distinguished Fellow Award from the American Association of Plastic Surgeons in May, 2000. Also 2000 I received the Best Scientific Paper Award for my work with Roger Khouri on the BRAVA for breast expansion ,which we’re using now as an adjunct to breast reconstruction with fat grafting.

Dr. Biggs: Dr. Baker, your positions of significance in Plastic Surgery and your many well deserved awards (more than have been mentioned here) are without parallel. In looking back on your career what do you see as your most significant accomplishments?

Dr.Baker: That’s a difficult question, for what may have seemed important at the time may, in retrospect, have less significance. But since you asked the questions I’ll mention a few.

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Dr. Howard Gordon and I became aware of a lay woman who was using a compound she would apply to the skin and, after redness and swelling, the patient would have significant improvement in the small rhytides of the skin.

have our 45th consecutive meeting. Jim Stuzin is doing the bulk of the work but it’s still the most important date on my calendar.

We managed to get her formula, which consisted of phenol and croton oil, improved on it, and began doing controlled skin peels. Of course we had problems but with persistence we got better and better, and following these efforts more and better ways emerged to deal with small skin wrinkles but this seems to have been the opening to the concept of aggressive skin care in the treatment of facial rejuvenation.

Dr. Baker: One thing for certain things are changing, and what we do and see today will be looked back upon in a very short period of time as being quite antiquated. Certainly fundamentals such as the gentle handling of tissues and the need for vascular supply to sustain viability will persist,but for sure changes will be immense. There is no question that fat will play a significant role in our surgical armamentarium and there is no question the more we learn about the procurement and delivery of stem cells that they also will play a significant role. The fact that fat is the largest source of mature stem cells will make the increase in the sophistication of dealing with fat paramount. The use of other mechanisms employed for improving a patient’s appearance will be incorporated and the relationship with aesthetic medicine will have to grow because the surgical techniques of incision and dissection and suturing will always be with us but yet will be accompanied by a multiplicity of other aspects of cure that will enhance all we do. The future is bright for plastic surgery because the one thing plastic surgeons have is the capacity to be innovative and this is what is going to sustain us in the future, and I look forward to it with great enthusiasm. Dr. Biggs, thank you very much.

With Dr. James Stuzin I helped popularize the bi-directional lifting of the face by extensively undermining the SMAS and folding it over at the malar eminence and arch, giving the patient more emphasis in that area. This also provided us with an option in the correction in dealing with the asymmetric face.

My current primary interest is the use of the BRAVA to prepare the recipient site (the breast) for grafting.

We’ve seen near miraculous results in total breast reconstruction , even in patients with severe radiation deformities, using fat grafting and employing no incisions and no new scars….and…have a resultant breast that is soft, natural, and, very interestingly, sensate. All this is work with Roger Khouri.

Dr. Biggs: All this is remarkable and is certainly the basic material for a book rather than an interview for our IPRAS Journal….but…we’ve not mentioned what may be your greatest accomplishment.

Dr.Baker: What’s that?

Dr. Biggs: The creation of the Baker-Gordon Symposium.

Dr. Baker: Well, that’s a long and very interesting…and quite a happy story. In 1960 Dr. Gordon and I had formed a partnership and realized we knew very little about aesthetic surgery (we called it cosmetic surgery in those days) so we decided to create a meeting which had as its sole purpose the refinement of techniques in aesthetic surgery. We had our first meeting in 1967…. thirty-five people attended and we had stands built around the operating table for the attendees. Since then we’ve had over 15,000 attendees (some were returnees) and over 200 speakers. This January we’ll

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Dr. Biggs: Dr. Baker what can you tell us about the future and where all this seems to be going?

Dr. Biggs: Thank you Dr. Baker Editorial Note: In the years before 1969 aesthetic surgery was considered somewhat of a step child of academic plastic surgery. A person performing aesthetic surgery was looked upon as an outsider by the powers of our specialty. The formation of ASAPS in 1969 was a step in the redirection of thinking regarding this matter, but the Baker Gordon Symposium in 1967 was the first open statement as to the need for education in this area, and the first to provide it. After all of Dr. baker’s contributions to operative techniques this bold move, in the opinion of this Editor, was his greatest contribution…and it lives on.

HUMANITARIAN WORK

Humanitarian burn surgery in Afghanistan: care, teaching, developpement and prevention

December 2001, US troops invade Afghanistan, while the Talibant must leave the country or at least hide in the mountains... It is the end a dramatic period of oppression and tragedy. Nearly four millions emigrates come back from Iran and Pakistan after years of exile.

Among them, thousands very young women, who hardly knew their own country, are forced by their parents to get married, versus money and the tragedy goes on…

Every year in Herat, the second larger town in Afghanistan, 350 young girls, aged 12 to 18, unhappy and mistreated by their husband , are committing (or forced to commit) suicide by self immolation.

June 2002, a team of plastic surgeons , from the French NGO HumaniTerra, is organizing two surgical missions to Afghanistan, in Chagcharan, Ghor Province, (in the Indu Kush mountains, two days four-wheel drive trip at 3200 meters altitude) and in Herat, former intellectual capital of Persia, 80 km from the Iranian border.

In Herat they are absolutely shocked and horrified to discover at the Regional Public Provincial Hospital such a great amount of burn young patients, agonizing in the corridors of the wards, without nearly any care… Everyday more and more of these cases where admitted at the hospital, and no one was really treating them. The decision was immediately taken by the HumaniTerra team to organize a proper treatment for those patients, and all the other burn patients.

In 2003, Political and working meetings were organized with the local authorities, including the famous war lord Ismael Khan, who offered us his complete support.

National Health Administration was also of course included in the process, and the coalition forces, under the leadership of the US army helped us to raise money for the construction of a true Pilot Burn Hospital.

The architectural planning of the three floor burn centre was done by HumaniTerra, 36 beds, including an acute burn unit for women, an other one for men, a unit for burn sequellae, a unit for rehabilitation (given to Handicap International), an outpatients unit, a specific double operating theatre with a very modern sterilisation unit, a department for teaching on the third floor, and a unit for burn prevention and for psycho-social problems…

Picture 1: 2002, two young women lying in the corridors of the old hospital, after suicide by flame.

The hospital was built under the control of the NGO’s architects, and after three years of meetings, discussions, training, controls… the first patients could be admitted in October 2007 The European Union participated to the furbishing and medical and administrative training of local doctors and nurses. Other donors helped us to insure the daily material and consumables

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less than that. Young girls were not taught nor educated… they had absolutely no rights. There was no music, no papers, no life… everything was to be rebuilt.

We have built, we have educated, we have tried to give them sustainability, we have saved lives, we have put them back to a decent live…

Picture 2: 2007, the three floor new Pilot Burn Hospital in Herat, Afghanistan

The total cost of the pilot burn hospital was evaluated to 2 millions dollars.

In 2010, 1250 burn patients are admitted every year, including out patients. Afghanistan, is not a very peaceful country, and life is still dangerous there if very severe security rules are not strictly respected.

Permanent medical teams of HumaniTerra are living there, all year long, locals and Europeans. Besides

We have taught doctors, technicians, and health officers how to run hospitals, operating theatres, medical and surgical wards… One of them, Doctor Homayoun Azizi, who has been invited four times to France for specific training, is now an important minister of the afghan government in Kabul. All together, from Afghanistan, more than 20 hospital directors, regional health directors, surgeons, anaesthetists, nurses… have been fully invited and taken in charge in France and Europe, for training, congresses, international meetings… Some of them have even been participating, sponsored by our NGO, to the wonderful world ISBI meeting organised by our friend Nelson Piccolo in Brazil, speaking, together with an other good friend Rajeev Ahuja, about burn suicides in women, for a round table that we had organized, on that occasion.

But this not enough… more must be done. Even if it is still very difficult, even if danger is still there, even if it costs a lot of money…

In 2008 we have set up a regional campaign against violences to women, traumatic aggressions, acid attacks, and of course burn suicides and self immolations… this campaign, with the help of the EU funding, was done on a population of 20 000 persons, including women, men and children. 52 sessions for Women, 24 sessions for men were organized in the only province of Herat with the help of a local NGO, Voice of Women. Since then the incidence of burn suicides admitted at the Herat Burn Hospital

Picture 3: 2007, one of the acute burn ward

this, eight to ten surgical teams are going on the field from Europe, every year, for training, teaching, administrative tasks, operating, rehabilitation…

HumaniTerra has decided to share this activity on the field, with other European or international surgical teams, through the European humanitarian network SHARE (ESPRAS) and the world surgical cluster HUGS (IPRAS) A lot of work still needs to be done…

When I first led the initial surgical team there, in 2002, there was nothing but desolation, misery, and sadness.

Women were considered as animals, and sometimes 24

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Picture 4: 2008, active physiotherapy in the new burn hospital

decreased from 45% of the total burn patients in 2003 to 15% in 2009! A good success… but not enough yet…

A second burn suicide prevention campaign will be starting in the early weeks of 2011, with funding from the French ministry of foreign affairs, UNICEF, and other donors… And the help, we hope of IPRAS… Fighting for women rights is also our goal… it must be the role of everyone. Many NGOs among our Networks, such as Women For Women-IPRAS, are really willing to follow this way. A good example is, for instance, the recent cooperation established between HumaniTerra / Women for Women / Acid Survivors Foundation / Frienship International, in Bangladesh…

All this is the promise of collaboration and good understanding between the numerous surgical NGOs members of SHARE and HUGS…

Burn care is a whole thing… We must absolutely never forget to have a holistic approach of this dreadful pathology, particularly during our surgical camps in poor countries, or our proposals for new burn units in less developed countries.

Physiotherapy, for instance is very important…. There is no success in burn surgery without a good physical rehabilitation. Our missions always bring everywhere a good physio with the surgical team; in Afghanistan, a specific training has been provided during months and a big part of the Burn Hospital is now run by Handicap International. Psycho-social problems also have to be taken into account… our patients must return to a normal life… this is the role of our social workers teams or the task of local NGOs that we hire there to insure the job…

Picture 6: 2004, somewhere in the countryside… war is never far…

Surgery is not enough…! We must also think of what happens before… and after…

Picture 5: 2007, operating a burn patient in Afghanistan, the surgeon on the right is now a Member of the government in Kabul

In Afghanistan, much more can be done for civilian burn patients. A proposal of a burn unit in Kabul has been done by local authorities, including Medecins du Monde, with the expertise of HumaniTerra… this should be one of our next goal… together with the help of teams coming from different countries of the world, through IPRAS/ HUGS. In Phnom Penh, Cambodia, the first “National Plastic Surgery and Burn Department” will be set up in 2013, under the leadership of HumaniTerra, but it will be opened to all teams of the world willing to participate…

In Haiti, an other Burn Department is on its way, build

by Europeans teams, together with HumaniTerra, Interplast Germany, Interplast France …all members of SHARE…

What has been done in Afghanistan is a good example for a holistic approach of humanitarian burn care. It has not been done in the easiest and the most quiet place of the world… but I have the strong feeling that we can, all of us, SHARE this, and make it better, there, and in other parts of the world, in order to give our warmest HUGS to the ones who need our help, I mean to the poorest of the poorest, on our fantastic Earth…

A happy, peaceful, and fruitful new year to all…

Christian Echinard President, HumaniTerra Chairman ESPRAS/SHARE (Surgical Humanitarian Aid Recourses Europe) Co-chairman IPRAS/HUGS (Humanitarian Union for Global Surgery) Issue 3

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HUMANITARIAN WORK

6th Women for Women Camp

in Chilmari, Kurigram in the north of Bangladesh 28th of November until December 5th In collaboration with HumaniTerra by Christian Echinard and Friendship by Mrs Runa Khan and Yves Marre

The place The sixth Women for Women camp took place in Chilmari in the district of Kurigram in the north of Bangladesh. The infrastructure was set up by Friendship, a value-based organisation by Runa Khan (executive director of Friendship) , who provide health care in the most remote areas of the country on well established floating hospital boots on the Brahmaputra River. A permanent medical team of physicians and nurses run the hospital. The floating hospital is a platform to provide healthcare to 4 million of Bangladesh’s most marginalised people. The hospital targeted the people living on the shifting islands at the mouth of the Brahmaputra River, that get flooded during heavy rains. In this areas medical and surgical services for women are extremely scarce as in addition the environmental reasons mentioned above, women, unlike men do not travel to the main land annually for work where medical services are located, as men from these areas do.

The teams The mission was set up out in cooperation with another surgical team by HumaniTerra. who supply health care on the boots in up to 6 subsequent missions

of different medical specialisations (orthopedics, gynecology, plastic surgery, anesthesiology etc.) per year. The team of HumaniTerra consisted of 5 people, 2 anestesiologists (Dr. Boris LePladec and Dr. Carola Levasseur) , a nurse (Christiane Gardet) and a physiologist (Aurore Mambriani). Dr. Christan

Echinard, President of the ESPRAS SHARE (Surgeons’ Humanitarian Aid Resource Europe) programme from Marseille, focused on the treatment of the male patients that presented during the mission.

With his long-standing experience of missions on Friendship boots, he coordinated the mission and was mediating between the local doctors and the Women for Women team prior to the mission.

The WomenforWomen team consisted of Dr. Constance Neuhann-Lorenz (President Women for Women Committee, Munich Germany), PD Dr. Marta Markowicz (Fellow in the department of plastic surgery, Caritas Hospital Regensburg) and Dr. Sarah Lorenz (Resident Dept. of Plastic, Reconstructive Surgery, Hospital Munich Bogenhausen, Munich).

The surgical teams were accompanied by the famous Italian photographer Shobha (http://www. motherindiaschool.it), who had received the World Press

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Photo Award 1998 and 2002 together with her student Davide Grotta. We are very proud that she agreed to join us and provide us with her photos and a video documentation for fundraising and educational purposes.

The mission The surgical camp on the Friendship hospital boot from 29th of November until the 4th of December. The were two operations theatres available, which where run by the two anesthesiologists of Humaniterra Dr. Boris LePladec and Dr. Carola Levasseur. Patient selection and partially transport was carried out by the local medical team of friendship. Due to delayed flights and foggy weather the Women for Women team had to catch the amphibious aircraft by MAF Bangladesh from Dhaka to Chilmari one day later than intended. The Women for Women team with the two photographers arrived in Chilmari on November 29th. Therefore Dr. Echinard, who arrived a day earlier

took over the screening of the patients that were appropriated for treatment by Women for Women and HumaniTerra. The patients that presented showed severe burn contractures of the cervical, axially, breast region, the lower extremities and hand contractures.

The cause for the burns seemed to be mainly accidental due to open fires. Since in these remote areas the patients had hardly received any treatment the showed a massive extent of these contractures. All patients were screened according to the “Women for Women Screening-Sheets” and gave their informed consent on “Women for Women Screening-Sheets”.

The operations started the 29th of November in two teams. The Women for Women team treated the female patients and Humaniterra focused on the male patients. Women for Women operated on 16 female patients on which multiple procedures were performed.

The screening sheets and informed consent sheets hereby serve to record the diagnoses and procedures performed.

Postoperative examinations and change of dressings took place on December 3rd and 4th under appropriate analgesia. The wounds showed good healing and excellent graft-take. The postoperative treatment plan was strictly fixed on the postoperative treatment sheets and discussed with the local staff and the Humaniterra pysiotherapist Aurore Mambriani, who ensured further follow up care by staying an additional week and handing over the patients to the next Humaniterra team. Aurore supported the surgical work by adjusting splints and mobilisations by physiotherapy of the released contractures where possible and medically viable. The collaboration of HumaniTerra and Women for Women, proved to be a medical success. Everyone gave a hand, which created a powerful synergy and a fruitful work environment for the local staff, the HumaniTerra and the Women for Women Team.

Visit by Runa Khan, executive director of Friendship We were honoured by the visit of the executive director of Friendship, Mrs. Runa Khan on December the 3rd Issue 3

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and 4th who personally introduced her organisation which had expanded from providing primary and secondary healthcare to education, income generation, relief and rehabilitation programmes, and, most recently, interest-free loans and savings schemes.

Together with Mrs. Khan we visited schools for education of women and children in the remote villages in the beautiful landscape of the islands along the Brahmaputra River.

Meeting with the ASF

in people’s faces. The overwhelming majority of the victims are women. The victims are attacked for many reasons that are often a result of family and land dispute, dowry demands or a desire for revenge. The aim of ASF is to eliminate acid violence Bangladesh.

They support victims of acid attacks with physical reconstruction, support for reintegration into society and legal assistance. Due to their successful work, the number of acid attacks has decreased in the past years, however acid attacks still in Bangladesh still take place every two days….

On December 5th the WomenforWomen team together with Dr. Christian Echinard and Mrs. Runa Khan had a meeting in Dhaka with Monira Rahman the executive director of the ASF (Acid Survivors Foundation, http:// www.acidsurvivors.org/).

Future vision

Acid violence is a particularly vicious and damaging form of violence in Bangladesh where acid is thrown

Sponsoring:

The four NGOs discussed a common effort to establish a floating acute burn division in Bangladesh to provide the victims with better treatment options in the future…

Medical supplies were donated by B. Braun Melsungen, Asclepios Medizintechnik Gutach Germany and Gabriele Rapp, Medizintechnik Brannenburg, Germany.

Lufthansa provided free transport for the 100 kg of medical equipment, coordinated by Mr. Robert Salzl, Munich.

Mr . Johann Schauer donated € 500.- for extra expenses throughout the mission.

Dr. Sarah Lorenz Resident Dept. of Plastic, Reconstructive Surgery, Hospital Munich Bogenhausen, Munich 28

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WORLD HEALTH ORGANIZATION

Dear Colleague, In the recent edition of the WHO Patient Safety newsletter, we talked about checklists as quality and safety tools and gave you an update on the WHO Surgical Safety Checklist. New evidence published this week in the NEJM and results from a study in the US support earlier WHO findings that a surgical safety checklist could prevent at least half a million deaths per year.

Dr Atul Gawande, External Lead of the Second Global

Patient Safety Challenge on Safe Surgery in the WHO Patient Safety Programme, called the results of the new studies “remarkable validation. It is clear that the WHO Surgical Safety Checklist has already saved many thousands of lives since its introduction. We need to keep the pressure on health care facilities around the world to ensure adoption of the checklist so that hundreds of thousands more lives can be saved.”

To view the WHO Patient Safety statement on this, please visit our website at http://www.who.int/ patientsafety/en/ The WHO Patient Safety Team

Surgical Safety Checklist Before induction of anaesthesia

Before skin incision

Before patient leaves operating room

(with at least nurse and anaesthetist)

(with nurse, anaesthetist and surgeon)

(with nurse, anaesthetist and surgeon)

Has the patient confirmed his/her identity, site, procedure, and consent?

Yes Is the site marked?

Yes Not applicable Is the anaesthesia machine and medication check complete?

Yes Is the pulse oximeter on the patient and functioning?

Yes Does the patient have a: Known allergy?

No Yes Difficult airway or aspiration risk?

No Yes, and equipment/assistance available Risk of >500ml blood loss (7ml/kg in children)?

No Yes, and two IVs/central access and fluids planned

Confirm all team members have introduced themselves by name and role.

Confirm the patient’s name, procedure, and where the incision will be made.

Has antibiotic prophylaxis been given within the last 60 minutes?

Yes Not applicable Anticipated Critical Events To Surgeon: What are the critical or non-routine steps?

How long will the case take?

What is the anticipated blood loss?

Nurse Verbally Confirms: The name of the procedure Completion of instrument, sponge and needle counts Specimen labelling (read specimen labels aloud, including patient name) Whether there are any equipment problems to be addressed To Surgeon, Anaesthetist and Nurse: What are the key concerns for recovery and management of this patient?

To Anaesthetist: Are there any patient-specific concerns?

To Nursing Team: Has sterility (including indicator results) been confirmed?

Are there equipment issues or any concerns?

Is essential imaging displayed?

Yes Not applicable

This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged.

Revised 1 / 2009

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© WHO, 2009

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Safe SafeSurgery SurgerySaves SavesLives Lives Newsletter Newsletter December 2010 December 2010

Association Between Implementation of a Medical Association Between of aUnited Medical Training Program and Implementation Surgical Mortality, Training Program and Surgical Mortality, United States States The Veterans Health Administration (VHA) implemented a The Veterans a formalized teamHealth trainingAdministration program in 74(VHA) of theirimplemented facilities formalized team training program in 74 of their facilities that included the use of a surgical checklist. The surgical that included theutilized use of abysurgical checklist. surgical checklist that was VHA teams helpsThe to ensure checklist thatpatient was utilized VHA teamswas helps to ensure that necessary specificbyinformation that necessaryverbally patient amongst specific information communicated the surgical was team prior to communicated verbally The amongst the surgical team prior to every surgical procedure.

74 facilities that participated 2 surgicalexperienced procedure. The 74 facilities participated in every this program an 18% reductionthat in mortality . in this program experienced an 18% reduction in mortality2.

The VHA Training program required that surgical teams The VHA Training teams attend a one day onsiteprogram learningrequired session that surgical trained surgical The Checklist in Action attend one day onsite learning session that teams to acommunicate better as a cohesive unittrained and to surgical Thethe Checklist Actionnew evidence has been published Over last threeinmonths teams to communicate better as a cohesive unit and to effectively use the surgical checklist in the operating demonstrating use ofnew a surgical checklist in published Over the last that threethemonths evidence has been Q: Howtheatre.

The use VHA two articles on their effectively thepublished surgical checklist in the operating operating theatresthat canthe dramatically reducechecklist morbidity demonstrating use of a surgical inand A:Q: WeHow you experiences implementing the checklist and their surgical theatre. The VHA published two articles on their mortality. studies have been instrumental in showing operatingThese theatres can dramatically reduce morbidity and A: We youtraining program. Please click on the below links to team experiences implementing the checklist and their surgical themortality. value of checklists in the operating theatre and in showing These studies have been instrumental learn more. team training program.

Please click on the below links to overwhelmingly demonstrate the use theatre of a surgical the value of checklists in thethat operating and learn more.

2. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, Mazzia LM, checklist is vital to demonstrate improving surgical a press overwhelmingly that thesafety. use of aInsurgical Paull DE, Bagian JP. Association between implementation of a medical team issued on 11toNovember the United Kingdom’s release 2. Neily J, Mills PD, Young-Xu Y, Carney BT, West Berger DH, Mazzia LM, checklist is vital improvingby surgical safety.

In a press training program and surgical mortality.

JAMA. 2010 OctP,20;304(15):1693-700.

Paull DE, Bagian JP. Association between implementation of a medical team National Safety Agency, Sir Donaldson, issued on 11 November byLiam the United Kingdom’s release Patient training mortality.

JAMA. 2010 Oct 3. Paull DE,program Mazzia and LM,surgical Wood SD, Theis MS, Robinson LD,20;304(15):1693-700.

Carney B, Neily J, Chairman the WHO Patient Safety said Nationalof Patient Safety Agency, Sir programme, Liam Donaldson, Mills PD, Bagian JP. Briefing guide study: preoperative briefing and “Hospitals not using a surgical safety checklist are 3. Paull DE,debriefing Mazzia LM, Wood in SD, MS, Robinson LD, Carney B, Neily J, Chairman of the WHO Patient Safety programme, said postoperative checklists theTheis Veterans Health Administration medical Mills PD, Bagian JP.Am Briefing preoperative briefing and endangering safety.

If I were to need an operation, I team training program.

J Surg.guide 2010study: Nov;200(5):620-3.

“Hospitals patient not using a surgical safety checklist are postoperative debriefing checklists in the Veterans Health Administration medical would want to be treated somewhere a surgical endangering patient safety.

If I wereusing to need an operation, I team training program. Am J Surg. 2010 Nov;200(5):620-3. checklist.”

ThetoWorld Health Organization also issued a would want be treated somewhere usinghas a surgical statement describing the Health impact Organization of these studies. the a Does a Surgical Safety Checklist Improve Patient checklist.”

The World has To alsoread issued WHO statement please click here .

Safety andSafety Outcomes, Stanford University, statement describing the impact of these studies. To read the DoesCulture a Surgical Checklist Improve Patient United States WHO statement please click here.

Safety Culture and Outcomes, Stanford University, Recently, Stanford University presented their findings at Effect of a Comprehensive Surgical Safety System on United States theRecently, 2010 American of Surgeons Annual Clinical at Patient Outcomes, Netherlands StanfordCollege University presented their findings Effect of a Comprehensive Surgical Safety System on Congress held in Washington D.C. Researchers at Stanford The November 10th, 2010 edition of the New England the 2010 American College of Surgeons Annual Clinical Patient Outcomes, Netherlands found that the observed/expected mortality ratio declined Journal of Medicine thhighlighted the impact that the Congress held in Washington D.C. Researchers at Stanford The November 10 , 2010 edition of the New England from .88 in quarter one to .80 in quarter two with the use of SURPASS Checklist had in six hospitals in the Netherlands. found that the observed/expected mortality ratio declined Journal of Medicine highlighted the impact that the a modified version of the WHO Surgical Safety Checklist.

Researchers developed a 100-item Checklist that spans the from .88 in quarter one to .80 in quarter two with the use of SURPASS Checklist had in six hospitals in the Netherlands. surgical pathway and includes checks that address a modified version of the WHO Surgical Safety Checklist.

Researchers developed a 100-item Checklist that spans the Moreover, they found that the use of the Checklist medications, marking of the correct operative site, and surgical pathway and includes checks that address increased the frequency in which staff reported "Patient postoperative instructions. Compared to controls, the test Moreover, found thatthe thenumber use of the Checklist medications, of the correctreduction operative in site, and Safety Never they Events" while of Patient Safety hospitals had a marking greater than one-third increased the frequency in which staff reported "Patient postoperative instructions.

Compared to controls, the test Never Events that were related to errors or complications complications and achieved an almost 50% reduction in Safety Never Events"towhile theOverall, numberthe of Patient Safety 1 one-third reduction in hospitals a greater than decreased from 35.2% 24.3%.

Checklist has deaths (fromhad 1.5% to 0.8%) . They measured checklist Never Events that were related to errors or complications complications and achieved an almost 50% reduction in not only impacted outcomes, but it has also improved adherence and found tight correlation between using the 1 decreased from 35.2%the tosurgical 24.3%. Overall, Checklist deaths (from 1.5% to 0.8%) . TheyThis measured checklist communication among team, andthe thus quality has checklist and achieving the results. publication is 4 not only impacted outcomes, but it has also improved adherence and found tight correlation between using the of care. available online and can be accessed by clicking here. communication among the surgical team, and thus quality checklist and achieving the results. This publication is 4 4. Tsai Thomas, Boussard Tinna, Welton, Mark, Morton, John. Does a surgical of care.

1. de Vries EN, online Prins HA,and Crolla RM,be den Outer AJ, van G, vanhere Helden available can accessed byAndel clicking . SH,

Did You Know?

Did You Know? � 3,925 hospitals representing 122 � 3,925 hospitals representing 122 countries have registered as Safe Surgery countries registered as Safe Surgery Saves Lives have Participating Hospitals.

Is Saves Lives Participating Hospitals. your hospital registered with us? If not,Is yourhere hospital registered with us? If not, . click click here. � 25 countries have mobilized resources to � implement 25 countries resources to the have WHOmobilized Surgical Safety implement WHO level.

Surgical Safety Checklist at athe national To see a full a national level.

To see a full listChecklist of these at countries click here. list of these countries click here.

Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA; the SURPASS Collaborative Group. Effect of a Comprehensive 1. de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Surgical Safety System on Patient Outcomes. N Engl J Med. 2010 Nov Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, 11;363(20):1928-1937.

Boermeester MA; the SURPASS Collaborative Group. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med. 2010 Nov 11;363(20):1928-1937.

safety checklist improve patient safety culture and outcomes? [Abstract]. In: American College of Surgeons Annual Clinical Congress. 2010 October 3-7; 4. Tsai Thomas, Boussard Tinna, Welton, Mark, Morton, John. Does a surgical Washington D.C. Journal of American College of Surgeons. safety checklist improve patient safety culture and outcomes? [Abstract]. In: American College of Surgeons Annual Clinical Congress. 2010 October 3-7; Washington D.C. Journal of American College of Surgeons.

www.who.int/safesurgery www.safesurg.org Email us at: safesurgery@hsph.harvard.edu www.who.int/safesurgery www.safesurg.org Email us at: safesurgery@hsph.harvard.edu

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IQUAM Position Statment 2010 as decided to 9th IQUAM consesus conference during IQUAM General Assembly meeting THE INTERNATIONAL COMMITTEE FOR QUALITY ASSURANCE, MEDICAL TECHNOLOGIES AND DEVICES IN PLASTIC SURGERY

9th POSITION STATEMENT OF IQUAM 26 September 2010 Constance Neuhann-Lorenz, M.D., President Theatinerstrasse 1 - 80333 München, DEUTSCHLAND Phone: 49 89 348123, Fax: 49 89 25540933 E-mail: dr.neuhann-lorenz@t-online.de

IQUAM issues its 9th Position Statement, which is for use and reference by practicing physicians worldwide, and by international health care and governmental organizations: IQUAM, the International Committee for Quality Assurance and Medical Devices in Plastic Surgery, is a professional medical and scientific organization committed to the surveillance of existing and new technologies and devices in Plastic Surgery. IQUAM serves as the clearinghouse committee of IPRAS, the International Confederation for Plastic, Reconstructive and Aesthetic Surgery. IQUAM is dedicated to the safe use of medical devices, technologies and procedures in plastic surgery, and to the guarantee of patients’ safety. IQUAM reviews and evaluates updated literature and studies, scientific data, and recommends standards of treatment for new devices or technologies.

IQUAM proscribes potentially deleterious use of products, devices and technologies, or their unintended application or application for unsuitable indications.

Breast Augmentation and Reconstruction The purpose of breast augmentation and reconstruction is to improve the psychological and physical condition of the patient. The breast augmentation method should be chosen depending on the needs of the patient and the compatibility in the individual case. 1-5 1. Silicone Breast Implants.

A. Since IQUAM’s previous declarations, silicone implants filled with either silicone gel or saline, textured by various methods or smooth surfaced, or covered by polyurethane, continue to be widely used internationally for breast implantation, with the implant types varying by geographic region.

B. Additional medical studies have not demonstrated any association between silicone-gel filled breast implants and carcinoma or any metabolic, immune or allergic disorder. These studies re-affirm prior data. 6-11

Daniel Marchac, M.D., Secretary-General 130, Rue de la Pompe - 75116 Paris, FRANCE Phone: +33147274431, Fax: +33147276515 E-mail: danielmarchac@hotmail.com

Recent case reports about incidents of lymphoma formation in capsular tissue need further work-up C. Silicone-gel filled breast implants do not adversely affect pregnancy, fetal development, breast-feeding or the health of breast-fed children, based on current data.12-15 D. Acellular Dermal Matrices In breast surgery there is accumulated evidence that some ADMs are safe to use in the breast and in association with breast implants and tissue expanders.

Those ADM’s that have literature based safety and efficacy profiles should be used preferably 1. When implanted, Acelluar Dermal Matrices (ADM) can undergo one of the following: - Regeneration/ integration - Resorption - Encapsulation Only those products that have been demonstrated to regenerate and integrate with the host tissue are to be recommended for implantation.

2. ADM’s must be stored, handled and prepared according to the manufacturer’s recommendations.

They also require appropriate surgical technique by adequately trained surgeons. 16-18 2. Autologous breast reconstruction Surgical methods for breast reconstruction with autologous tissue such as microsurgical tissue transfer, pedicled flaps and local flap techniques undergo constant re-evaluation and are well established for individual indications and conditions. They have been employed in combination with silicone breast implants without specific inherent complications reported. 19-23 3. Autologous fat grafting and augmentation techniques Fat grafting for soft tissue defects has been performed for over 40 years with low complication rates. Ongoing studies show promising results of fat Issue 3

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grafting procedures for breast reconstruction and augmentation. There is evidence that the volume of the fat grafts and its take can be increased by the preoperative and postoperative use of an external vacuum device. No negative effects for mammography have been found . More studies are encouraged to further evaluate the efficacy and optimal duration of vacuum application .24-27 4. Other Alternatives for Breast Augmentation New materials and methods, such as exogenous injectable materials, including potentially fully resorbable products such as stabilized hyaluronic acid are under review.28 5. Clinical Recommendations for Breast Augmentation and Reconstruction A. IQUAM believes it is important to advise patients of potential hazards and risks, the possible need for reoperations, as well as the benefits of breast augmentation or reconstructive surgery. A detailed and updated Patients Information and Consent Form must be provided and discussed with the patient prior to surgery.

B. A reasonable period of time should be allotted following consultation as a cool-off period before decision and performance of surgery.

C. It is recommended to postpone breast augmentation surgery for other than reconstructive indications until after the age of eighteen. Such procedures in teenagers require in depth evaluation of motivation and maturity before considering surgery, even in medically indicated cases.

Liposuction The proper processing of multiple-use cannulas is especially important considering the recent reports of mycobacterial infections related to liposuction and fat injections.31-41 Cannulas used for the removal and the placement of fatty tissue can be multiple-use or single-use.

The reprocessing of multiple-use cannulas is a laborintensive 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.

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.

Tissue Engineering and Wound Healing

D. Patients with breast implants should be encouraged to have regular and long term follow-up, preferably by the operating surgeon.29,30

Tissue engineering holds the promise of generating tissues de novo. Adipose tissue is an ideal soft tissue surrogate to redefine body contour defects due to its intrinsic plastic characteristics.

E. No definite period of time has yet been defined for the longevity of breast implants, and routine replacement is not recommended. The indications for replacement should be based on specific patient indications.

Regenerative medicine is a promising road for future advancements in plastic surgery. Laboratory engineered constructs must consist of safe components before implantation in patients. Institutions, such as C.E.N., are setting strict standards 42-45

F. IQUAM calls for continuous clinical and scientific research, for documentation and monitoring of breast implants and patients and international coordination of national registries.

1. Stem Cell Therapy One of the most exciting frontiers in medicine today is the use of stem cells. Unlike the controversial evaluation of embryonic stem cells, adult stem cells deriving from adipose tissue are easily available without ethical controversy. Respecting the guidelines that - the injections are performed in the same operative session as the liposuction procedure to remove the fat - the stem cells have been only minimally manipulated and - the therapeutic use of autologous stem cells is not submitted to drug therapy regulations.

G. Advertising of breast implant procedures should be restricted to the medical aspects of the surgery, and presented in a professional dignified way and without exaggerated claims.

H. IQUAM calls for the approval of medical grade silicone gel filled breast implants according to national and international standards and certifications for clinical use and unrestricted availability to all patients.

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Reinjection of autologous stem cells in a separate session therefore is not recommended.

For over a decade now it has been shown that successful autologous fat grafting is highly dependent on the techniques used for extracting (liposuction at low negative pressure), processing (centrifugation and decanting of the extracted fat) and reinjection to result in a high concentration of adult stem cells, producing long lasting results and even therapeutic effects in injured tissues.

Indications of stem cell containing adipose tissue transfer under the above conditions include augmentation of the subcutaneous layer, e.g. for defects after liposuction complications and other acquired tissue defects e.g. burns Under investigation to date are treatments of radiotherapy injuries and breast reconstruction after cancer. Stimulated by encouraging experience with fat grafting, numerous basic laboratory and animal model studies are underway in many parts of the world.46-51 2. Growth Factors An increasing number of growth factors are becoming commercially available for a wider range of indications, either as a therapeutic agent or as an element of tissue engineered constructs. IQUAM is concerned that application of growth factors may occur before potential adverse effects (uncontrolled cell divisions, malignancies) have been diligently, adequately studied. Notified bodies issuing CE-mark certifications should be aware of this and grant only temporary CE-marks, while awaiting longer term studies.52, 53 3. Shock Wave Therapy Recent studies suggest that Extra Corporal Shock Wave Therapy originally developed for resolution of kidney stones, is useful in the treatment of chronic wounds, burns and tendon adhesion. More studies are needed to evaluate the optimal techniques for application and duration. 54-56

Injectable Therapies Lipolysis or Lipodissolve Injections by Phosphatidylcholine Derivatives.

Phosphatidylcholine has been used for prevention and treatment of fat embolism for many years, but is currently being used ‘off label’ for dissolving fat in aesthetic applications. Data concerning the efficacy, outcome and the safety of its use for aesthetic indications in then subcutaneous tissue have not yet been established. Further basic science and clinical trials, such as PMA trials underway are needed. 57-60

1. Botulinum Toxin A Botulinum Toxin A (BTxA) has been used extensively for aesthetic purposes. BTxA in high dosages has been used in various therapeutic clinical applications with minimal reported significant adverse effects. Current clinical data confirm the safety of BTxA’s for aesthetic indications when used by experienced doctors under sterile office environment. Patients should be provided with detailed information, and a signed informed consent should be obtained prior to performing the procedure [Addendum III].

2. Injectable fillers Today more than 35% of the procedures performed by plastic surgeons are no longer purely surgical. The use of resorbable substances is preferable to the use of nonresorbable fillers, as recommended by many national health authorities or academic societies. Furthermore, IQUAM stresses that degradability should be discerned from resorbability.

Permanent fillers (excluding autogenous tissue) can give a definitive correction, but have been reported to be associated with long-term irreversible complications and should be used with extreme caution. Risks depend on the nature of the implant, volume, depth and site of the injection especially in permanent substances, but also in resorbable products.

The patient’s history and the long-term follow up are important for documenting allergic or late reactions.

IQUAM recommends reporting complications of fillers to regulatory bodies and mandatory registration of adverse effects associated with injection of fillers to better estimate the extent of complications.61-64 3. Collagen Fillers Collagen derived soft tissue fillers from bovine origin that are in use for soft tissue augmentation lately have reduced clinical impact and have few chemical or manufacturing changes. Most of the available products can be employed only after a negative allergy skin testing at least 6 weeks before injection. This is not the case for a porcine derived product where the local complication rate like infection, granuloma , nodule formation, visibility or allergies have not been reported so far. 65-67 4. Hyaluronic Acid Fillers Commercially available HA’s have a wide variety of properties which have an impact on their use and clinical outcomes. Combining objective factors that influence filler chemistry with clinical experience will improve patient care, make optimal results more likely, and should decrease complications. Regulation of these injectables varies widely from country to country and Issue 3

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approval is often gained after short term studies of one year or less. To avoid confusion in the use of materials, IQUAM recommends that users verify the validation of the CE-mark or FDA approval prior to clinical use. 68-74 Continued long-term post-marketing surveillance by both industry and Notified Bodies is essential.

Physicians should stay alert to detect late adverse events and report these to the competent authorities.

Patients and users need to be given updated information on the risks of these materials. Supply of injectables should be limited to trained physicians.75-79 5. Cross Linked Polyacrylamide Hydrogel Permanent fillers based on acrylamides have been in clinical use for more than 15 years. The current European manufacturer has attained CE certification, with remaining monomer content below 2 ppm, which is considered a non-carcinogenic level; and claims superior production standards compared with earlier acrylamide products, especially from non-E.U. countries.

Used strictly subcutaneously and in small volumes by experienced surgeons this hydrogel has shown efficacy, and comparable complication rates as resorbable fillers in a European multicenter 8- year follow up study.

Removal of the gel is possible, but will require a surgical setting and an experienced surgeon. 80-88 6. PolyMethylMethAcrylate /Collagen Injectable Filler In 2008 the FDA issued the first approval for a permanent dermal filler for nasolabial folds.

The approved product has undergone multiple additional cleaning processes (Suneva Medical).

IQUAM emphasizes that this approval does not include substances with similar or “comparable� components from other manufacturers. Indications,

contraindications need to be regarded and injection by experienced physicians are essential. 89 7. Gold Threads The implantation of thin gold threads in flaccid facial cutaneous areas has been developed by Caux 50 years ago. Histologically the absence of foreign body reaction with no macrophage cells or allergic reactions used as eyelid correction for facial palsy or odontologic treatments is proven. Only limited creation of reticulin fibers can be observed.

However plication, rupture, palpability and migration of the threads due to the mobility of the face are frequent. Efficacy has not been proven and therefore these devices cannot be considered as standard for facial rejuvenation 90 General recommendations regarding injectable therapies IQUAM urges governments to pass legislation to prohibit the use of non-certified products and to protect patients from untrained physicians and nonmedical personnel injecting or implanting materials for various indications. Based on past experience IQUAM states that CE-marks and FDA approvals are required steps in establishing the safety of medical devices, but are not necessarily sufficient. Post market surveillance revealing new adverse information should lead to reconsideration of the approval status. IQUAM will continuously monitor the short and long term outcomes to protect the safety of patients.

Objective medical and media reports contribute to the reassurance of patients. IQUAM will continue to provide updated information about medical devices in general, implants in particular, injectables and new technologies.

Addendum

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References 1. Postoperative complications after breast implantation. Chekaroua K, Trevidic P, Foyatier JL, Comparin JP, Delay E:. Ann Chir Plast Esthet, 2005 Oct, 50(5):544-53 2. The non-perfect results of breast implants.

Dionyssopoulos A:. Ann Chir Plast Esthet, 2005 Oct, 50(5):534-43 3. The fate of breast implants: a critical analysis of complications and outcomes. Handel N, Jensen JA, Black Q, Waisman JR, Silverstein MJ: Plast Reconstr Surg, 1995 Dec, 96(7):1521-33 4. Complications leading to surgery after breast implantation. Gabriel SE, Woods JE, O´Fallon WM, Beard CM, Kurland LT, Melton LJ 3rd:. N Engl Med, 1997, Mar 6, 336(10):677-8

8. European Parliament Directorate General for Research, Scientific and Technological Options Assessment (hereinafter STOA) “Health Risks Posed

by Silicone Implants in General with Special Attention to Breast Implants – Final Study,” p22-23. European Parliament Resolution on the petitions declared admissible concerning silicone implants (Petitions Nos 470/1998 and 771/1998) (2001/2068[INI]) www.europarl.eu.int 9. Health Council of the Netherlands (hereinafter Netherlands) “Gezondheidsrisico’s van siliconen– borstimplantaten – Health Risks of Silicone Breast Implants” English Executive Summary, 1999, p11. www.gezondheidsraad.nl 10. The Mentor Study on Contour Profile Gel Silicone MemoryGel Breast Implants.Cunningham B. Plast Reconstr Surg. 2007 Dec;120(7 Suppl 1):33S-39S.

5. An analysis of complications after implantation of saline-filled silicone prosthesis for augmentation mammaplasty in 294 cases. Zhu H, Lin W, Quan G:.

Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi, 1995 Jul, 11(4):248-50

11. Inamed silicone breast implant core study results at 6 years. Spear SL, Murphy DK, Slicton A, Walker PS; Inamed Silicone Breast Implant U.S. Study Group.: Plast Reconstr Surg. 2007 Dec;120(7 Suppl 1):8S-16S; discussion 17S-18S.

6. Safety of Silicone Breast Implants, Report of the Committee on the Safety of Silicone Breast Implants, Bondurant S, Ernster V, Herdman R (eds). Division of Health Promotion and Disease Prevention, Institute of Medicine (hereinafter IOM). National Academy Press, Washington, D.C., June 22, 1999, p187. Internet address: www4.nationalacademies.org/news.nsf

12. Safety of Silicone Breast Implants, Report of the Committee on the Safety of Silicone Breast Implants, Bondurant S, Ernster V, Herdman R (eds). Division of Health Promotion and Disease Prevention, Institute of Medicine (hereinafter IOM). National Academy Press, Washington, D.C., June 22, 1999, p204. Internet address: www4.nationalacademies.org/news.nsf

7. United Kingdom Report of the Independent Review Group (hereinafter IRG) “Silicone Gel Breast Implants,” 2008, p25. www.silicone-review.gov.uk

13. United Kingdom Report of the Independent Review Group (hereinafter IRG) “Silicone Gel Breast Implants,” 2008, p24. www.silicone-review.gov.uk

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14. European Parliament Directorate General for Research, Scientific and Technological Options Assessment (hereinafter STOA) “Health Risks Posed

by Silicone Implants in General with Special Attention to Breast Implants – Final Study,” p25-26. European Parliament Resolution on the petitions declared admissible concerning silicone implants (Petitions Nos 470/1998 and 771/1998) (2001/2068[INI]) www.europarl.eu.int 15. Health Council of the Netherlands (hereinafter Netherlands) “Gezondheidsrisico’s van siliconen– borstimplantaten – Health Risks of Silicone Breast Implants” English Executive Summary, 1999,p34. www.gezondheidsraad.nl 19. Comparison of superior gluteal artery musculocutaneous and superior gluteal artery perforator flaps for microvascular breast reconstruction. Boyd JB, Gelfand M, Da Lio A, Shaw W, Watson JP. Plast Reconstr Surg. 2009 Jun;123(6):1641-7 20. Superficial inferior epigastric vessels in the massive weight loss population: implications for breast reconstruction. Gusenoff JA, Coon D, De La Cruz C, Rubin JP. Plast Reconstr Surg. 2008 Dec;122(6):1621-6.PMID: 19050514 21. Alternative autologous breast reconstruction using the free microvascular gracilis muscle flap with horizontal skin island. Schirmer S, Warnecke IC, Frerichs O, Cervelli A, Fansa H. Handchir Mikrochir Plast Chir. 2008 Aug;40(4):262-6 22. Breast reconstruction with the TRAM flap: pedicled and free Serletti JM.J Surg Oncol. 2006 Nov 1;94(6):532-7.

23. One hundred free DIEP flap breast reconstructions: a personal experience. Blondeel PN.Br J Plast Surg.

1999 Mar;52(2):104-11 24. Fat grafting to the breast revisited: safety and efficacy. Coleman SR, Saboeiro AP. Plast Reconstr Surg. 2007 Mar;119(3):775-85; discussion 786-7 last Reconstr Surg. 2002 Nov;110(6):1593-5; author reply 1595-8.

25. Initial experience with the Brava nonsurgical system of breast enhancement. Smith CJ, Khouri RK, Baker TJ. Plast Reconstr Surg. 2000 Jun;105(7):2500-12; discussion 2513-4.

26. The Brava external tissue expander: is breast enlargement without surgery a reality? Schlenz I, Kaider A. Plast Reconstr Surg. 2007 Nov;120(6):16809; discussion 1690-1.Comment in: Plast Reconstr Surg.

2008 Sep;122(3):989-90.

27. Bicompartmental breast lipostructuring Zocchi, M. L.; Zuliani, F.. Aesthetic Plast Surg 32:313- 328; 2008.

28. Body shaping and volume restoration: the role of hyaluronic acid. Hedén P, Sellman G, von Wachenfeldt M, Olenius M, Fagrell D. Aesthetic Plast Surg. 2009 May;33(3):274-82 29. European Parliament resolution on the communication from the Commission on community and national measures in relation to breast implants (COM(2001) 666 - C5-0327/2002 - 2002/2171(COS) 30. European Parliament Texts Adopted by Parliament Provisional Edition : 13/02/2003 Breast implantsP5_ TA(2003)0063 A5-0008/2003 31. From the Centers for Disease Control and Prevention. Rapidly growing mycobacterial infection following liposuction and liposculpture, Torres, J. M., L Bofill, et al.-Caracas, Venezuela, 1996-1998 JAMA 281: 504-505, 1999.

32. Mycobacterium fortuitum infection following neck liposuction: A case report. Behroozan, D. S., Christian, M. M., Moy, R. L. Dermatol Surg 26: 588590, 2000.

33. Skin and Wound Infection by Rapidly Growing Mycobacteria: An Unexpected Complication of Liposuction and Liposculpture ,Murillo, J., Torres, J., Bofill, L., et al.. Arch Dermatol 136: 1347-1352, 2000.

34. An outbreak of Mycobacterium chelonae infection following liposuction. Meyers, H., Brown-Elliott, B. A., Moore, D., et al. Clin Infect Dis 34: 1500-1507, 2002.

35. Outbreak of Atypical Mycobacteria Infections in U.S. Patients Traveling Abroad for Cosmetic Surgery.

Newman, M. I., Camberos, A. E., Clynes, N. D., et al.

Plastic and Reconstructive Surgery 115: 964-965, 2005.

36. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling Dessy, L. A., Mazzocchi, M., Fioramonti, P., et al. Aesthetic Plast Surg 30: 717-722, 2006.

37. Mycobacterium fortuitum abdominal wall abscesses following liposuction Al Soub, H., Al- Maslamani, E., Al-Maslamani, M.. Indian Journal of Plastic Surgery 41: 58-61, 2008.

38. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling ,Dessy, L. A., Mazzocchi, M., Fioramonti, P., et al.. Aesthetic Plast Surg 30: 717-722, 2006.

39. Liposuction Suspended in all of Espirito Santo, Brazil, (after death from infection after liposuction, Feliz, C.). News article in MedNetBrazil, 2008.

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40. Treatment of cutaneous infections due to Mycobacterium fortuitum: two cases, Regnier, S., Martinez, V., Veziris, N., et al., Ann Dermatol Venereol 135: 591-595, 2008.

41. Mycobacterium chelonae wound infection after liposuction. ,Kim, M. J., Mascola, L. Emerg Infect Dis 16: 1173-1175, 2010.

42. Adipose-Derived Mesenchymal Stem Cells: Past, Present and Future. Gino Rigotti Æ Alessandra Marchi Æ Andrea Sbarbati, Aesth Plast Surg (2009) 33:271– 273.DOI 10.1007/s00266-009-9339-7 43. Adipose-derived stem cells for soft tissue reconstruction Cherubino, M.; Marra, K. G.. Regen Med 4:109-117; 2009 44. Adult stem cell plasticity: fact or artifact? Raff, M. Annu Rev Cell Dev Biol 19:1-22; 2003 45. Origin and potential of embryo stem cells, Stem cells today: A. Edwards, R. G.. Reprod Biomed Online 8:275-306; 2004.

46. Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery. Mojallal, A.; Foyatier, J. LAnn Chir Plast Esthet 49:419-425; 2004.

47. Collagen matrices from sponge to nano: new perspectives for tissue engineering of skeletal muscle.

Beier JP, Klumpp D, Rudisile M, Dersch R, Wendorff JH, Bleiziffer O, Arkudas A, Polykandriotis E, Horch RE, Kneser U., BMC Biotechnol. 2009 Apr 15;9:34 48. Adult bone marrow stem/progenitor cells (MSCs) are preconditioned by microenvironmental “niches” in culture: a two-stage hypothesis for regulation of MSC fate. Gregory, C. A.; Ylostalo, J.; Prockop, D. J. Sci STKE 2005:pe37; 2005 49. Human clinical experience with adipose precursor cells seeded on hyaluronic acid-based spongy scaffolds..

Stillaert FB, Di Bartolo C, Hunt, Rhodes NP, Tognana E, Monstrey S, Blondeel PN. Biomaterials. 2008 Oct;29(29):3953-9 50. Adipose tissue induction in vivo. Stillaert FB, Blondeel P, Hamdi M, Abberton K, Thompson E, Morrison WA. Adv Exp Med Biol. 2006;585:403-12JA 51. An arteriovenous loop in a protected space generates a permanent, highly vascular, tissueengineered construct.. Lokmic Z, Stillaert F, Morrison WA, Thompson EW, Mitchell GM. FASEB J. 2007 Feb;21(2):511-22 52. New therapeutics for the prevention and reduction of scarring. Occleston NL, O’Kane S, Goldspink N, Ferguson MW. Drug Discov Today. 2008 Nov;13(21-22): 973-81.

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53. Prevention and reduction of scarring in the skin

by Transforming Growth Factor beta 3 (TGFbeta3): from laboratory discovery to clinical pharmaceutical.

Occleston NL, Laverty HG, O’Kane S, Ferguson MW. J Biomater Sci Polym Ed. 2008;19(8):1047-63.

54. Soft Tissue Treatment. Giménez Garcia MC, Lliorente de la Fuente A In Coombs R, Shade W, Zhou S (edg), Musculoskeletal Shockwave Therapy, Greenwich Medical Media Ltd, London: 25-32, 2000 55. Clinical outcome of ESWT for selected chronic tendinopathies in physically active subjects. Goh P., 3rd Congress of the ISMT - Naples. Abstract: 82, 2000 56. Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. Schaden W, Thiele R, Kölpl C, Pusch M, Nissan A, Attinger CE, ManiscalcoTheberge ME, Peoples GE, Elster EA, Stojadinovic A., J Surg Res. 2007 Nov;143(1):1-12.

57. Treatment of lower eyelid fat pads using phosphatidylcholine: clinic trial and review. Ablon G, Rotunda Am. Dermatol Surg 2004;30:422-7.

58. Fat dissolving’ substance injects CCs of controversy.

Bates B. Skin Allergy News 2003; 34:1.

59. Lipostabil: the effect of phosphatidylcholine on subcutaneous fat. Young VL.. Aesth Surg J 2003;23:413-7.

60. A new method to quantify the effect after subcutaneous injection of lipolytic substances. Klein SM, Prantl, Berner A, et al.,, Aesthetic Plastic Surgery 2008, Jul; 32 (4): 667-672.

61. Normal and pathologic tissue reactions to soft tissue gel fillers. Christensen, L., Dermatol Surg, 33 Suppl 2: p. S168-75.2007.

62. Facial dermal fillers: selection of appropriate products and techniques. Dayan SH, Bassichis BA Aesthet Surg J. 2008 May-Jun;28(3):335-47.

63. Reversible vs. nonreversible fillers in facial aesthetics: concerns and considerations. Smith KC., Dermatol Online J. 2008 Aug 15;14(8):3 64. Understanding, avoiding, and managing dermal filler complications. Cohen JL. Dermatol Surg. 2008 Jun;34 Suppl 1:S92-9 65. Porcine filler for facial lipoatrophy associated with human immunodeficiency virus treatment. Reytan N, Rzany B.,J Drugs Dermatol. 2008 Sep;7(9):884-6.

66. The use of injectable collagens for aesthetic rejuvenation., Matarasso SL. Semin Cutan Med Surg.

2006 Sep;25(3):151-7.

67. A two-stage phase I trial of Evolence30 collagen for soft-tissue contour correction. Monstrey SJ, Pitaru S, Hamdi M, Van Landuyt K, Blondeel P, Shiri J, Goldlust A, Shoshani D. Plast Reconstr Surg. 2007 Jul;120(1):303-11 68 Comparison of smooth-gel hyaluronic acid dermal fillers with cross-linked bovine collagen: a multicenter, double-masked, randomized, within-subject study.

Baumann LS, Shamban AT, Lupo MP, Monheit GD, Thomas JA, Murphy DK, Walker PS; JUVEDERM vs. ZYPLAST Nasolabial Fold Study Group. Dermatol Surg. 2007 Dec;33 Suppl 2:S128-35.

69 Facial dermal fillers: selection of appropriate products and techniques. Dayan SH, Bassichis BA Aesthet Surg J. 2008 May-Jun;28(3):335-47.

70 Effectiveness of Juvéderm Ultra Plus dermal filler in the treatment of severe nasolabial folds. Lupo MP, Smith SR, Thomas JA, Murphy DK, Beddingfield FC 3rd.,Plast Reconstr Surg. 2008 Jan;121(1):289-97.

71 The science of hyaluronic acid dermal fillers Tezel A, Fredrickson GH..: J Cosmet Laser Ther. 2008 Mar;10(1):35-42.

72 Synthesis and Characterization of a Novel Double Crosslinked Hyaluronan Hydrogel, Zhao, XB, Fraser, JE, Alexander, C Lockett C, White BJ, J. of Materials Science: Materials in Medicine 13: (2002) 11-16.

73 The Polysaccharide of the Vitreous Humor, Meyer, K and Palmer, JW J. Biol. Chem. 107 (3): (1934) 629-634.

74 Campoccia, AD, Doherty, P, Radice, M, Brun, P, Abatangelo, G, Williams, DF, Semisynthetic Resorbable Materials From Hyaluronan Esterification Biomaterials 19(23): (1998) 2101-2127.

75 DeBelder, AN, Malson, T US Patent 4,886, 787, 1989.

76 Zhao, XB, Alexander, C Fraser, J, US Patent 7, 226, 972, 2007.

77 Kablik, J, Monheit, G, Liping, Y, Chang, G, Gershkovich, J. Comparative Physical Properties of Hyaluronic Acid Dermal Fillers, Dermatol. Surg. 35: (2009) Suppl 1: 302-12.

78 U.S. Food and Drug Administration, Restylane Injectable Gel – P020023, Labeling Information and Approval Letter December 12, 2003.

79 U.S. Food and Drug Administration, Juvéderm 30, Juvéderm 24HV and Juvéderm 30HV Injectable Dermal Filler – P050047, Labeling Information and Approval Letter, June 2, 2006.

80. Complications of breast augmentation with injected hydrophilic olyacrylamide gel Cheng, N.X., Y.L. Wang, J.H. Wang, X.M. Zhang, and H. Zhong. Aesthetic Plast Surg, 26 (5): p. 375-82.2002.

81. Normal and pathologic tissue reactions to soft tissue gel fillers. Christensen, L., Dermatol Surg, 33 Suppl 2: p. S168-75.2007.

82. Biocompatibility and tissue interactions of a new filler material for medical use. Zarini, E., R. Supino, G. Pratesi, D. Laccabue, M. Tortoreto, E. canziani, G. Ghisleni, S. Paltrinieri, G. Tunesi, and M. Nava, Plast Reconstr Surg, 114 (4): p. 934-42.2004.

83. Biocompatibility of two novel dermal fillers: histological evaluation of implants of a hyaluronic acid filler and a polyacrylamide filler. Fernandez-Cossio, S. and M.T. Castano-Oreja, Plast Reconstr Surg, 117 (6): p. 1789-96.2006.

84. Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2-year clinical experience. De Santis, G., V. Jacob, A. Baccarani, A. Pedone, M. Pinelli, A. Spaggiari, and G. Guaraldi, Plast Reconstr Surg, 121 (2): p. 644-53.2008.

85. Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation in a 2-year follow-up: a prospective multicenter study for evaluation of safety and aesthetic results in 101 patients. von Buelow, S. and N. Pallua, Plast Reconstr Surg, 118 (3 Suppl): p.

85S-91S.2006.

86. Unacceptable Results with an Accepted Soft Tissue Filler: Polyacrylamide Hydrogel Manafi, A., A.H. Emami, A.H. Pooli, M. Habibi, and L. Saidian.

Aesthetic Plast Surg.2009.

87. Augmentation of the malar area with polyacrylamide hydrogel: experience with more than 1300 patients. Reda-Lari, A., Aesthet Surg J, 28 (2): p.

131-8.2008 88. Complications from repeated injection or puncture of old polyacrylamide gel implant sites: case reports. ElShafey el, S.I., Aesthetic Plast Surg, 32 (1): p. 162-5.2008.

89. ArteFill: a long-lasting injectable wrinkle filler material--summary of the U.S. Food and Drug Administration trials and a progress report on 4- to 5-year outcomes. Cohen SR, Berner CF, Busso M, Gleason MC, Hamilton D, Holmes RE, Romano JJ, Rullan PP, Thaler MP, Ubogy Z, Vecchione TR. Plast Reconstr Surg. 2006 Sep;118(3 Suppl):64S-76S. 90. The “golden thread lift”: radiologic findings. Stark GB, Bannasch H. Aesthetic Plast Surg. 2007 MarApr;31(2):206-8.

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CERTIFICATE OF MEMBERSHIP

To All Plastic Surgeons Members of IPRAS

For many years since the founding of IPRAS, many of our members have requested repeatedly a proof of membership and now is the time to fulfill their wish in the best and most official way. This “certificate” can be proudly displayed wherever you wish as a proof of belonging to our largest Organization of the world. It may be hung on the wall of your office or used as an extra document in your Curriculum Vitae.

In order to send your application for the certificate you should get in touch with the Executive Management Office at: Maria Petsa - IPRAS Executive Office (maria. petsa@zita-congress.gr ) and pay the 100 € fee which covers the cost of design, shipping & management.

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Once your National Society has verified your active membership, it will be sent to you by courier. A complementary “lapel pin” bearing the IPRAS logo, will also be sent to you at no extra charge.

To send your application please click on: http://reservations.zita-congress. gr/PackReservation.php?PackCode =F1010007&RegOnly=Y

It is important to all of us to display our Specialty to the public at large, promoting at the same time the image of Plastic Surgery worldwide.

With our most sincere regards, Andreas Yiacoumettis Parliamentarian

Marita Eisenmann-Klein General Secretary 40

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Zacharias Kaplanidis Executive Director

IPRAS WEBSITE

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

www.ipras.org Now it is very simple to upload your scientific profile and gain the benefits of being under the IPRAS umbrella.

Try it…!!

Sign up on www.ipras.org and follow the following steps: 1. Create an account by clicking “Member’s login” on the top right-hand corner and then select the “Create new account” tab.

2. Fill out your “Username”, “Email” and “Password”, as required.

3. Select the option “Doctor” and your country, under the section “If you are a doctor, complete the following”.

4. Once all account details have been added, click on “Create new account” button.

Then you click on “EDIT” and then on “DOCTOR PROFILE”.

This is the section where all the information of your scientific profile can be uploaded.

You may complete the fields with the information that you prefer such us: Personal Picture, Hospital Position, Affiliation, Special Field of Interest, Contact Details, Memberships, Topics of Special Interest, Publications etc.

At the “EDIT” section you may proceed to the appropriate corrections at your account such us to change your password or to update personal information.

When you complete the aforementioned steps there will be one last step remaining for your details to be uploaded on the IPRAS website. The application must be approved by the National Association you are a member.

The application will be sent at the Association of the

country that you have declared, ensuring that only IPRAS members of good standing and high ethical principles are able to upload their personal details.

As soon as your Association verifies you as a member, your profile will automatically be uploaded at the website’s, “Find a doctor” option in the “Members”section.

If you face any difficulties please do not hesitate to contact me at: maria.petsa@iprasmanagement.com .

It is also up to you to decide whether your profile will be classified as “private” or visible to all visitors of the IPRAS webpage. Our aim, besides facilitating communication among colleagues, expands to allowing patients to verify the good standing and high ethical principles of the doctors’ profiles hosted, allowing them to choose qualified IPRAS members for needed procedures.

In conclusion, I want to emphasize the usefulness of the IPRAS website FORUM. A section you will gain access to, as soon as your profile has been accepted and uploaded. Only verified plastic surgeons can use it and read its contents. Therefore, you will have the opportunity to exchange ideas, news regarding plastic surgery techniques, news from your National Association, alerts and all other information you would like to share with your peers.

Don’t miss the opportunity to make the IPRAS website twice as useful to you!

Always at your disposal!

Maria Petsa IPRAS Assistant Executive Director

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Report about the IQUAM Meeting of Bratislava 23rd – 26th September 2010 Stem cells.

New technologies especially laser and ultra sound.

Standard in aesthetic surgery.

The ninth bi-annual meeting of the IQUAM was held in Bratislava from 23rd to 26th September 2010 under the presidency of Constance Neuhann-Lorenz. It was organized by the local host and secretary general of the IQUAM Josef Fedeles.

The scientific program was supervised by Daniel Marchac and Brian Kinney.

There was 130 participants especially from adjacent countries: Austria, Slovakia, Czech Republic, Germany.

The congress was held in the Carlton Radisson Hotel, very nice old style palace in the historic center of Bratislava.

The meeting started at Thursday afternoon and finished at Sunday noon.

The main subjects discussed were: Fillers and their complications.

Breast prosthesis and especially the problem of the defective silicone used in PIP prosthesis.

Fat grafting and development of the Coleman technique.

Dr Daniel Marchac

On Saturday there was a first joint meeting with CEN European Normalisation Authority.

On Sunday morning the General Assembly was followed by the redaction of the consensus declaration.

During this assembly Constance Neuhann-Lorenz was reelected as president of the IQUAM. Josef Fedeles, secretary of IQUAM, having finished his term, Daniel Marchac has been elected as a new secretary general of the IQUAM. This 2010 Bratislava meeting with its large attendance and very stimulating program will be well remembered.

The next meeting will be held in Athens first through fourth of November 2012.

The consensus declaration is transmitted to all the Ministries of Health of various countries and to the national societies. It can be consulted on website of the IQUAM (www.iquam-ipras.org).

Ancien chef de clinique a la faculte Ancien chirurgien att. consultant de l’hopital necker Professeur Associe au College de Medecine des Hopitaux de Paris Chirurgie Plastique Reconstructrice et Esthetique Chirurgie Cranio-faciale

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130, Rue de la Pompe 75116 Paris Tel. 01 47 27 44 31 Fax. 01 47 27 65 15

IPRAS Pan African Section Board Meeting Nairobi, Kenya, Thursday October 14, 2010 Started at 2 pm, Eleven attendees heads headed

by IPRAS Sec. gen; Marita Eisenmann-Klein and Pan African sec (IPRAS ) chairman; Ahmed Adel Noreldin. Nine (9) countries were represented by Nine representatives: Kenya, Egypt, Libya, Ghana, Nigeria, Ethiopia, South Africa, Uganda and Sudan “See attended signatures” The attendants expressed their deep gratitude to the Kenyan society of plastic surgeons (KSPRAS) for the success of the 4th Pan African meeting in Nairobi 13-16 October 2010 which was attended by 93 delegates from 23 countries (10 African nation) who offered 85 presentations in 13 scientific sessions covering most important issues in both reconstructive and aesthetic issues. The IPRAS Executive Committee and Board of Directors were represented by the attendance of an impressive number of eight (8) EXCO members in the meeting

Bernard Githae (President of Organizing Committee and CoChairman of Scientific Committee of the Pan African Congress), Marita Eisenmann-Klein (IPRAS General Secretary) Ahmed Noreldin (President Pan African Section)

The following countries agreed to form local societies according to IPRAS By-Laws so they can apply for IPRAS membership: Ghana, Ethiopia. Uganda & Sudan A policy for local regional courses and workshop endorsed by IPRAS in certain destinations in Africa was suggested and agreed upon. This will decrease the financial efforts of local scientists to get more experience by travelling abroad so often.

Training workshops in training centers of universities will be arranged especially in Egypt, Libya and South Africa for junior trainees.

Photograph from the Pan African Congress

The location for the next Pan African Section meeting in 2012 was discussed and all attendants agreed to be in Egypt.

The idea of holding the IPRAS 2021 congress in Africa was discussed, for possibility of applying to the bid in 2015.

Meeting ended at 3.15pm

Chairman PAPRS Prof. Ahmed Adel Noreldin

Polytech booth: Bernard Githae (President of Organizing Committee and Co-Chairman of Scientific Committee of the Pan African Congress), Ahmed Noreldin (President IPRAS Pan African Section), Marita Eisenmann-Klein (IPRAS General Secretary), Mohammed Sobhi Ahmed Zaki (IPRAS EXCO member), Oleary Patrick (Chief Executive Officer of POLYTECH Health & Aesthetics), Andreas Yiacoumettis(IPRAS Parliamentarian),

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Report on 18th The Pan Arab, 8th GCC Plastic Surgery meetings with Endorsed IPRAS 2010 Doha- Qatar 11-15 December 2010

In the Warmth of the Beautiful Arabian Gulf winter weather in December Doha the capital of Qatar has opened here heart well coming all guests of Qatar coming from all over the world.

Arab world national representations from Qatar Dr. Habib AL-BASTI president of Arab Plast 2010 president Of Gulf plast, Dr. Reda Franka (Lybia) the past President Arab Plast, Dr. Ali Numairy (UAE) Gen. secretary of the Gulfplast and Dr. A.Aziz Nefzi (Tunesia) President Elect Arab Plast 2011, and representations from Saudi Arabia, Iraq, Kuwait, Bahrain, Oman, Yemen, Syria, Egypt, Sudan, Lybia, and Board director of IPRAS presented by Marita Eisenmann-Klein the General secretary, Andeas Yiacoumettis the parlimantarian of IPRAS, Dr.Mustafa AL-ZAIDI, Mohamed Sobhi Zaki, Ahmed Nooredin, and other all Board Members and Mr. Zacharia Kaplinidis representing Zeta group the sponsoring organizer of IPRAS.

surgeries, head and neck Reconstructions, Breast aesthetics and Reconstruction, Facial aesthetic and fat grafting, limb reconstruction and microsurgeries in addition to various body reshaping countering .

There are also session on congenital facial and ear reconstruction in addition to an extensive session on the recent advances on Stem Cell and various advances on Bioengineering and tissue reconstruction.

On day 14 there was a public day in which interaction between public and medical professionals was done with excellent arrangements.

In Addition to the Fruitful scientiďŹ c program the guests has an entertainments tours around the city of Doha and social traditional dinner.

Finally all guests has a Gala dinner in the present of Dr. A.Wahab AL-MUSLEH the ass. Director of Qatar Health, Dr. Habib AL-BASTI, the president of Arabplast and Gulfplast and Chairman of the congress and presents of all Arab and Gulf members and Marita Eisenmann gen. secretary of IPRAS, Dr.Habib Al-BASTI has distributed a memorial trophies as gifts from the Qatar Health and Qatar society of the plastic surgery.

The meeting extended over 4 days started on day 11 dec. with registration and in the morning followed in the afternoon with two sessions on abdominoplasty and body contouring and two workshops on Botox and Fillers.

Days 11-14 had an intensive sessions in different hot topics in plastic surgeries including Craniofacial 44

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Dr. Habib AL-BASTI, FRCS Chairman of the Congress

XX ISAPS Congress in San Francisco There are congresses and congresses all over the world.

But ISAPS Congress has always been something special and unique, particularly this 20th one when this Society celebrates forty years of promoting aesthetic plastic surgery worldwide. Since then every relevant decision about new materials, every new operative technique couldn’t escape close monitoring of the ISAPS experts who traveled all around the world, mostly on their own expenses, to promote and teach.

Founded in 1970. in the United Nations in New York ISAPS has taken the leading role in aesthetic surgery, being one of the most relevant bodies in this field of surgery and medicine.

Foad Nahai successfully concluded his position as a President and Jan Poell from Switzerland took over the position until the next Congress in Geneva in 2012.

Biennial Business Meeting confirmed the positions of the leaders of the Society, The Board of Directors, for the coming period. National Secretaries Meeting gathered representatives from the different parts of the world of the big ISAPS family, now having 90 countries of the world. They elected new NS Chair, dr Lina Triana from Colombia.

ISAPS Board of Directors 2008-2010

Scientific part of the Congress was a superb work of the Educational Council Chair Renato Saltz from the USA, who managed to put together most interesting panels with internationally renowned Faculty. For the first time ever the Panel on Cosmetic Medicine was included in the program, with the latest techniques and achievements on fillers, toxins, lasers, STEM cells technology, lipolysis etc. with Chairman of the Panel dr Miodrag Colić. Not giving these procedures to the noncore physicians and showing our expertise in this field is the main purpose of keeping our leadership position.

The first day of the Meeting, Global Summit on Patient Safety, was also exceptional because it was dedicated

Foad Nahai’s final report in the SF Opera House

medical tourism, patients’ safety and other medico-legal issues of the growing concern. As Foad Nahai stated we never wanted medical tourism, but it is here to stay and we must do everything to protect our patients on the broad international basis, otherwise we will be blamed for the failures in our profession. Global regulations, Medical Procedures Abroad (MPA™) and the ways to achieve global patients’ safety was discussed. The four facets of the ISAPS Patient Safety Diamond: the patient, the procedure, the facility and the surgeon was introduced and discussed in depth.

What we always enjoy the best during our congresses is the social part being so marvelously organized by our local hosts from San Francisco, Bryant Toth and Bernard (Bud) Alpert and their wives. From the grand Opening Ceremony in the Opera House, Faculty Dinner in the Pacific Union Club to the Gala event in the extraordinary building of the California Academy of Sciences in the Golden Gate Park. Ladies’ program was under the perfect organization of the first lady of the Congress, Shannaz Nahai, and finally everything flavored by another exceptional personality, Foad’s father Rohollah.

That is why we call ourselves an ISAPS family, because everything has a deep personal touch in all we do and that is what keeps us forward in aesthetic leadership for so long.

Miodrag Colic ISAPS Secretary General Issue 3

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COM ING

MEETINGS

Canadian Society of Plastic Surgeons (CSPS) The Vancouver IPRAS meeting really is shaping up to provide participating plastic surgeons the world’s best reconstruction and the world’s best aesthetics.

There will be over 50 free master classes, invited talks, and panels from the likes of Daniel Marchac, Sydney Coleman, Yilin Cao, Brian Sommerlad, Phillip Blondeel, Kiyonoro Harii, Ron Zuker, Rod Rohrich,

Bahman Guyuron, Fu Chan Wei, and many others.

There are no additional fees for any of the education at this meeting. For a full list of invited speakers, go to http://www.ipras2011vancouver.ca/scientificprogram_ faculty.html or read the list that is included at the following page of this edition of IPRAS Journal.

We have had over 20 submissions for the best papers of the world sessions. These are papers which have won

prizes for the best papers of 2010 in their own countries.

These sessions will be clearly outstanding as well. The competition for submitted abstracts has been fierce with over 600 presenters. The best will appear on the podium.

There will be a wonderful resident presentation session with prizes for the Best International Basic Science, Clinical, Epidemiology/Biostatistics Presentation by a resident. We have organized great international resident social events as well which include the resident’s night out, and the great resident race. These events will generate international camaraderie which will last a life time.

The meeting will take place on Vancouver’s beautiful 5 sail convention center on the waterfront overlooking the mountains and the ocean.

There are float plane rides available right beside the convention center to see Vancouver from the air.

Running trails and a multitude of excellent restaurants are available just outside the hotels. Many social events will give you a real flavor of Vancouver and Canada.

Book your hotel now as they are filling up. There are 4 hotels that offer rooms at less than $150/night for those on a careful budget. http://www.ipras2011vancouver.ca/ On behalf of the organizing committee, the Canadian Society of Plastic Surgeons, and IPRAS, we welcome you to the meeting of a lifetime you will not forget.

Dr Don Lalonde Chairman of the Organizing Committee Issue 3

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IPRAS 2011 VANCOUVER Confirmed Faculty (as of November 2010)

ARGENTINA Claudio Angrigiani Aldo Mottura AUSTRALIA Gerard Bayley Peter Callan Daniel Kennedy Warren Rozen Howard Webster AUSTRIA Manfred Frey Helmut Hoflehner Peter Kompatscher Christian Papp Gerhard Pierer Erwin Scharnagl Anton Schwabegger BELGIUM Phillip Blondeel Paul Guelinckx Moustapha Hamdi Stan Mostrey Koen VanLanduyt Paul Wylock BRAZIL Patricia Erazo Marcus Castro Ferreira Ewaldo DeSouza Pinto Paulo Leal Nelson Piccolo CANADA Dimitri Anastakis Oleh Antonyshyn James Bain Tom Bell Trevor Born Patricia Bortoluzzi Erin Brown Mitchell Brown Edward Buchel Louise Caouette-Laberge Wayne Carman Nicholas Carr Howard Clarke Douglas Courtemanche David Fisher Christopher Forrest Bing Siang Gan Nick Guay Betsy Hall-Findlay Patrick Harris Tom Hayakawa Stefan Hofer

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David Jewer Leila Kasrai Donald Lalonde Peter Lennox Lucie Lessard Frank Lista James Mahoney Damir Matic Nancy McKee Steven Morris Kenneth Murray Gerald Moysa Peter Neligan James O’Brien Justin Paletz Walter Peters Andrea Pusic Gloria Rockwell Douglas Ross John Semple Claire Temple Achilleas Thoma Edward Tredget Nancy VanLaeken Cynthia Verchere Richard Warren Gordon Wilkes Bruce Williams Scott Williamson Kenneth Wilson Ronald Zuker CHINA Yilin Cao Shuzhong Guo Xiaoxi Lin Yuanbo Liu Jie Luan Maolin Tang Xing Xin Ru-Hong Zhang Yixin Zhang COLOMBIA Manuela Berrocal EGYPT Mohamed Elshazly Ahmed Adel Noreldin Mohamed Sobhi Zaki FINLAND Sinikka Suominen FRANCE Fred Kolb Daniel Labbé Laurent Lantieri Daniel Marchac

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GERMANY Gunter Germann Milomir Nincovic Dirk Richter Michael Sauerbier

MALAYSIA Sukari Halim

GREECE Apostolos Mandrekas Andreas Yiacoumettis

OMAN C Thomas

HOLLAND Marc Mureau INDIA Rakesh Khazanchi Gosla Reddy Raja Sabapathy IRELAND Michael Early ISRAEL Aharon Amir Eyal Gur ITALY Cristina Garusi Gino Rigotti JAPAN Hidekazu Fukamizu Kiyonoro Harii Ichiro Hashimoto Masao Kakibushi Katsuya Kawai Shigehiko Kawakami Kyoichi Matsuzaki Satoru Nagata Takashi Nakatsuka Yuzaburo Namba Rei Ogawa Hideaki Rikimaru Hiroyuki Sakurai Katsuhico Takushima Hiroshi Yasuda Takatoshi Yotsuyanagi KOREA Jong Woo Choi Jeong-Tae KIM Kyung S Koh Yoon Hoo Lee KRYZIGSTAN Musa Mateev LEBANON Bishara Atiyeh

MEXICO Eric Santamaria

PERU Julio Daniel Kirschbaum SAUDI ARABIA Manaf AlAzzawi Mohammed AlQuattan SINGAPORE Colin Song SOUTH AFRICA Anil Madaree SPAIN J. Enriquez deSalamanca Jaume Masia SWEDEN Per Heden SWITZERLAND William Gunn Daniel Kalbermatten Dirk Schaefer TAIWAN Hung Chi Chen Philip Chen Yu-Ray Chen Ming-Huei Cheng David Chuang Yur-Ren Kuo Chung-Sheng Lai Chih-Hung Lin Jean-Yin Lin Sin Daw Lin Lun-Jou Lo Jeff (TB) Sun Phoebe Tang Fu Chan Wei Jiu-Yung Yang TURKEY Nazim Cerkes UNITED KINGDOM Patrick Addison Jonathon Britto David Evans Brian Sommerlad

UNITED STATES Amy Alderman Al Aly Elisabeth Beahm Thomas Biggs Brian Boyd Charles Butler Kevin Chung Sydney Coleman Greg Evans Larry Gottlieb Joe Gruss Geoff Gurtner Bahman Guyuron Phil Haeck Geoff Hallock Richard Hopper Ian Jackson Jeff Janis Glen Jelks Glyn Jones Roger Khouri Brian Kinney Matt Klein William Kuzon Scott Levin Joan Lipa Bill Magee Jeff Marcus Michele Masellis David Mathes Mike McGuire Tom Mustoe Mike Neumeister Barry Noone Malcolm Paul Julian Pribaz Lee Pu Andrea Pusic Debra Ann Reilly Rod Rohrich Michel Saint-Cyr Joe Serletti Maria Siemionow David Song Aldona Spiegel Helena Taylor Robert Walton Steve Warren Peirong Yu Nicholas Vedder

European Association of Plastic Surgeon

SOCIAL PROGRAM OPENING CEREMONY & WELCOME COCKTAIL (Thursday June 2, 2011)

Congress Secretariat

Mrs. Chrysa Kontololi ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116 E: euraps2011@zita-congress.gr http://www.euraps2011.gr/

MEETING DINNER (Friday June 3, 2011) DELOS HALF DAY EXCURSION (Saturday June 4, 2011) FAREWELL PARTY (Saturday June 4, 2011)

LIMITED NUMBER OF ROOMS!!!

You may book your room from 105â‚Ź Please book your room as soon as possible.

June is a high season for Mykonos and there is a limited availability of rooms.

You may book your room on line at: www.euraps2011.gr

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www.aapras2011.com

Congress Secretariat

Mrs. Chrysa Kontololi ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116

E: chrysa.kontololi@zita-congress.gr www.zita-congress.gr

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Dear colleagues, honorable guests, and friends, We have the great pleasure of welcoming you to the 3rd Congress of the Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (AAPRAS) being organized under the auspices of the IPRAS and ESPRAS. This is a scientific event called “Unfavorable Results and Complications in Plastic Surgery” with the main objective to avoid the mentioned complications and in case problems arise during their right treatment.

The Congress will take place on 28-30 of June 2011 in Yerevan State Medical University, Yerevan, Armenia.

We anticipate the participation of renowned community of plastic surgeons, as well as students and clinical residents for whom the analysis and the best possible solutions of the above mentioned complications will serve as groundwork for future treatment procedures. We hope that plastic surgeons from USA, Russia, Georgia and the Eastern European countries will attend and participate in this important event including the representatives of Armenian Diaspora of Plastic Surgeons.

The Congress is being organized in the summer which can be characterized as one of the best periods of the year in Armenia.

Usually, this time of the year is excellent to explore the city and visit the sights outside of it. The Congress social program includes sightseeing and many other opportunities for enlarging the scope of knowledge pertaining to Armenian cultural values.

We are looking forward to meeting you in Yerevan, Armenia promising unforgettable memories and live experiences.

Sincerely yours,

At a Glance

When: 28-30 of June 2011 Where: Yerevan, Armenia

Congress Venue: Yerevan State Medical University

Important Dates

March 15th, 2011 Abstract Submission Deadline March 31st, 2011 Last Day for Early Registration June 24th, 2011 Last Day for Late Registration

• • • • • • • • • • • •

Dr. Yaghjyan Gevorg MD, PhD President of 3rd Congress of AAPRAS

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Scientific Topics

Face Rhinoplasty Breast Body Contouring Reconstruction / Microsurgery Hand / Peripheral Nerve Surgery Tissue Engineering Burns Skin Tumors / Melanoma Plastic Surgery Training Innovation in Plastic Surgery Satellite symposium in Dermatocosmetology

www.hespras2011.gr Dear Colleagues,

At a Glance

Dates: August 29th-30th 2011 Place: Kos Congress Venue: Kypriotis Conference Centre

Important Dates Last Day For Low Cost Registration: May 31st 2011 Last Day For Abstract Submission: April 29th 2011 Abstract Acceptance Date: May 16th 2011

The Board of Directors of the Hellenic Society of Plastic, Reconstructive and Aesthetic Surgery (HE.S.P.R.A.S.) and the Organizing Committee, are very glad to announce to you the organization of the 9th Pan-Hellenic Congress of Plastic, Reconstructive and Aesthetic Surgery that, as decided by the HE.S.P.R.A.S. Board of Directors, will take place at the beautiful island of Kos, in the Congress facilities of the Kipriotis Hotels, from August 29th to August 31st 2011.

The large success of all past congresses challenges and urges the HESPRAS Board of Directors to make every possible effort to organize one more successful congress. The Scientific and Organizing Committee aspire to cover a large variety of subjects such as Trauma and Rehabilitation, Hand Surgery, Burns, Microsurgery Techniques, Breast Surgery, Aesthetic Surgery and many more, in order to boost the contemporary scientific knowledge in the field of Plastic, Reconstructive and Aesthetic Surgery and also of Health in general.

Our target is for all participants to benefit by expanding their knowledge through a high standard scientific programme in all fields of contemporary Plastic Surgery. For this reason we anticipate you to participate actively by submitting your abstracts in order to exchange opinions and reports on scientific achievements.

The island of Kos, besides the scientific presentations during the congress, offers large potential to all participants for additional cultural activities and recreation possibilities.

Being confident that your presence will be dynamic, we send you our warmest regards and look forward to seeing you in Kos for the most important event of our Society.

The President of the Congress Dimosthenis Tsoutsos

Congress Secretariat

Mrs. Maria Petsa ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116

Sponsors

E: maria.petsa@zita-congress.gr www.zita-congress.gr

Issue 3

Topics: • Trauma & Rehabilitation • Skin & Soft tissue Oncology • Hand Surgery • Burns • Congenital Malformations • Chronic Ulsers • Microsurgery Techniques • Breast Surgery • Aesthetic Surgery • Fat Grafting • Tissue Transplantation • Biotechnology – New Methods in Plastic Surgery • Training in Plastic Surgery • Medical Responsibility in Plastic Surgery

The Congress will Include: • • • • •

Round Tables Oral Presentations Posters Lectures Educational Courses

Invited Speakers Phillip Blondeel Mimis Cohen Sydney Coleman Peter Cordeiro Michel Costagliola Marita Eisenmann-Klein Ralph William Gilbert Peter Neligan Nelson Piccolo Julian Pribaz Julia Terzis Spero Theodorou Patrick Tonnard

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2nd International Meeting on Aesthetic and Reconstructive Facial Surgery (IMAFR)

www.imafr2011.org Dear Colleagues, On behalf of the Board of the Hellenic Society of Plastic Reconstructive and Aesthetic Surgery (HESPRAS) and the Board of the Hellenic Association for the Treatment of Maxillofacial Cancer (HATMC), it is an honor and a pleasure for us to invite you to participate to the 2nd International Meeting on Aesthetic and Reconstructive Facial Surgery (IMAFR) that will be held again in Greece, in the birthplace of Hippocrates, the island of Kos in September 1-3, 2011.

On May 2009 the 1st meeting was held in the island of Mykonos and more than 400 colleagues around the world had the opportunity to enjoy a very active scientific event and a joyful social program.

We chose another famous Greek island, the island of Kos, in the Dodecanese archipelagos, equally beautiful, with many attractions, the biggest of which is being the land were Hippocrates, the father of Medicine, instituted 25 centuries ago the first hospital and medical school in the world. The lessons we learned from the organization of the 1st meeting will certainly help us to provide an even better academic program that will cover all aspects of aesthetic and reconstructive facial surgery from Fillers and Botulin Toxin A to the most sophisticated approaches for facial rejuvenation, rhinoplasty, facial implants, fat transfer, endoscopy as well as microsurgery, aesthetic facial reconstruction, head and neck cancer and facial allotransplantation. A distinguished faculty from around the world will cover the full scope of facial surgery. The intention of the 2nd meeting will again be threefold.

Educational, scientific and recreational. Educational for the young and the older, scientific for the inventing and inquiring minded and recreational, for all of us.

We are confident that we will prepare a memorable scientific event for the years to come.

Congress Secretariat

Mrs. Maria Petsa ZITA CONGRESS Tel: +30 211 1001783 Fax: +30 210 6642116 E: maria.petsa@zita-congress.gr www.zita-congress.gr

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One that will broaden our scientific horizons and strengthen our cultural ties through the social program in a way that the everlasting Hippocratic values that have dominated our noble profession for more than 2500 years will remain alive and unchanged from the passing of time, enlightening our path in life, family and society.

Looking forward to see you in Kos next September.

With our warmest regards, Apostolos Mandrekas, Alexander D. Rapidis Issue 3

Faculty (already confirmed) Honorary President: Marita Eisenmann-Klein Congress Chairman: Apostolos Mandrekas Greece Alexander D. Rapidis Greece Members: Wolfgang Gubisch, Germany Mutaz B. Habal, USA Firas Karmo, USA Andrew J. Kaufman, USA Brian M. Kinney, USA Daniel Marchac, France Peter Neligan, USA Milomir Ninkovic, Germany Pier Francesco Nocini, Italy Norbert Pallua, Germany Wolfgang Gubisch, Germany Mutaz B. Habal, USA Firas Karmo, USA Andrew J. Kaufman, USA Brian M. Kinney, USA Daniel Marchac, France Peter Neligan, USA Milomir Ninkovic, Germany Pier Francesco Nocini, Italy Norbert Pallua, Germany Nelson Piccolo, Brazil Jan G. Poëll, Switzerland Julian Pribaz, USA Oscar Ramirez, USA Pierre Saadeh, USA Julia Terzis, USA Spero Theodorou, USA Patrick Tonnard, Belgium Carlos Oscar Uebel, Brazil

Gold Sponsor

Sponsor

Issue 3

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NATIONAL & CO-OPTED SOCIETIES FUTURE EVENTS 29 - 02 Jul 2011 WSRM 2011 Congress Location: Helsinki, Finland Venue: Marina Congress Center Telephone: +358 9 4542 190 Fax: +358 9 4542 1930 E-mail: info@congcreator.com URL: http://www.wsrm2011.org

14 - 17 Oct 2011 APRSSA congress (Association of Plastic and Reconstructive Surgeons of Southern Africa) Location: Spier Wine Estate, Cape Town

27-30 October 2011 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery Beijing, China

04 - 05 Nov 2011 International Education Symposium: «ESTHETIC SURGERY AND COSMETOLOGY FOR FACE AND PERIORBITAL REJUVENESCENSE» Location: Institute of Surgery n.a. A.Vyshevsky, B. Serpukhovskaya, 27 E-mail: info@plastickafedra.com URL: http://www.plastickafedra.com/

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NATIONAL ASSOCIATIONS & PLASTIC SURGERY ORGANIZATIONS NEWS

Sociedad Argentina de Cirugía Plástica, Estética y Reparadora (SACPER) Dear Colleagues, The Fortieth First Argentine Congress of Plastic Surgery will be developed in Iguazú Falls, considered one of the 7 wonders of the world located in the Province of Misiones, from March 30th until April 2nd of 2011. Place that we shared with our neighbours of Brazil and Paraguay that it invites to jointly consolidate with the towns of South America and Scientific Academic Participation with all the International Societies of Plastic Surgery.

More information: http://www.41congresoargentino.com/ Nice Regards Dr. Enrique Pedro Gagliardi

Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (ÁÁPRAS) Residency Training Program on Plastic Surgery in Armenia The training of medical specialists is organized through the system of postgraduate education at Yerevan State Medical University and National

Institute of Health (NIH). The healthcare sector in Armenia is characterized by a disbalance between specialists and generalists, inherited from the Soviet model with its emphasis on secondary care. This is reflected in the high number of different specialties officially recognized by the State, which is currently 89, compared to only 33 specialties recognized in the EU (World Bank 2004b). Training requires from two to four years, depending on the particular specialization and is provided by the specialized clinical centers, university hospitals and services, which are specifically accredited to provide such training. Each specialization is supervised and closely monitored by the institutional administration and academic board, made up of representatives of the relevant clinical departments, faculty and university teachers, as well as health professionals. Postgraduate training programs in different specialties require approval from the Ministry of Health. In general, any healthcare institution, whether public or private, may apply for accreditation of specialist training programs, provided they comply with existing standards.

However, since most training facilities still belong to the public sector, this is rarely an issue. There is no limitation on the number of graduate students admitted, provided they pass the entry tests. The duration of training is set according to the specialty.

Officially Residency program in Plastic Surgery was adopted in 1999 by Armenian Ministry of Health.

Following rapidly changing worldwide requirements and guided by new adopted concept of education development, we have made changes in the methodological structure of Plastic Surgery residency programming. The important fact is that the second revision of the program was prepared by the educational committee of Armenian Association of Plastic and Reconstructive Surgery, and was openly discussed during one of the Association Meetings being adopted after some amendments had been made. At this moment both Institutions - Yerevan State Medical University and National Institute of Health use a standardized four-year curriculum for training. The curriculum was based on the following principles - medical knowledge, patient care, practice-based learning, system-based practice, professionalism, interpersonal and communication skills. The whole syllabus of the Armenian Plastic Surgery Residency program is available in the link from AAPRAS web site http://www.aapras.org/en/ ?module=publications&id=2 Issue 3

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Moreover, changes and updates are going to be sustainable based on periodical evaluation of the whole residency program in general and its components in particular.

The final qualification exam includes 3 phases:

As a matter of fact, we would list some of the innovations which are being implemented. The arrangement and implementation of Journal Clubs per month within Departments is obligatory within the residency program, aimed at developing and improving the residents’ skills in studying literature, interpreting clinical reports/outcomes analytically and critically.

• During the second phase the residents should undergo testing. The clinical tests that include all the parts of the program for educating the particular specialist in the residency program should correspond to the level and content of the program.

Also, once in a month, faculty and residents deliver lectures/presentations on a certain topic within their interest. These activities develop communication skills; enhance critical questioning and answering abilities.

To evaluate the practical skills obtained in each Department as well as ensure standardized approach to clinical skill acquisition, check-lists are developed and applied, which contain the required minimum of procedures to be performed by each resident during the training year.

The concept of patient log-books for each resident where they collect data about their education and training process is implemented. Night-shifts (up to 5 per month) are mandatory and account for credits. Likewise, credit system is established for all components of the residency program, promoting better coordination and organization of residency programs.

Also a reward system for the best residents has been developed, allowing remuneration options for residents in the final years of study in the form of either paid night-shifts at university hospitals or reduced tuition fees.

Summer and Winter Resident schools have started since last years. During the 2-3 days faculty and resident spent in some resort and covered the subject which is difficult to provide during the trainings in hospitals. Last training was done in February 13th-14th in winter resort Tsakhadzor.

Upon graduating clinical residency program, the graduates take exams on qualification, tests, and situational problems as well as undergo an interview to obtain a degree of specialized doctor, which enables them to practice medicine independently.

Before starting the state exams, particular department presents information about the typical educational plan and program to the State examination committee that should be completed by the student, as well as the diary of specialized doctor, and description of the activities of the resident during studying at clinical 56

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residency program.

• During the first phase the resident should make a case presentation.

• On the third phase of State exams, the State examination committee takes final interviews. The ability of the examinee to use his/her acquired knowledge, competencies and practical skills is checked for solving professional tasks. Tests of various types and levels are used either paper-based, or computer assisted.

Summarizing the results of the three exams the final grade by the particular specialization is obtained. Depending on the results of the exam, the committee decides to issue or refuse the certificate of specialization by open vote.

The residency program has used questionnaires to evaluate residents, instructors and education process, however, due to some reasons, the results have not always been analyzed and taken into account in decision making process. Currently, a pilot system of self-evaluation and evaluation is being developed which will independently and impartially evaluate residents’ perceptions and opinions on the study process and instructors as well.

American Society of Plastic Surgeon (ASPS) An amazing, interactive and customizable educational program is being prepared for the ASPS, PSEF, ASMS annual meeting. Plastic Surgery 2011, September 23-27 in Denver Colorado will allow you to personalize your educational experience, target your needs and get the most out of your time. Some of this year’s highlights include:

Subspecialty reconstructive discussion forums Interactive surgical video presentations Educational product demonstration theaters Engaging panels covering complications management Invited papers from around the world Evidence based medicine and performance improvement strategies Networking opportunities with peers in your same career path If you’d like to participate in Plastic Surgery 2011, abstracts for an oral presentation or e-poster on your latest scientific research will be accepted through January 31, 2011. If your presentation is selected for this year’s program it will also be published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons.

Topics for abstracts include: Breast, Cosmetic, Cranio/Maxillofacial/Head and Neck, General Reconstruction, Hand and Upper Extremity, Practice Management, Research, and Technology/Innovations.

To submit an abstract or for further information go to plasticsurgery2011.org.

Exciting changes are also being planned for the Plastic Surgery 2011 Exhibit Hall, the epicenter of the meeting. Located inside the exhibit hall, the Plastic Surgery Plaza will include registration, lounges to relax and network, an information desk, CME kiosks, cyber stations and much more. This area will serve as a convenient place for attendees to find everything they need and stay connected.

Australian Society of Plastic Surgeons (ASPS)

2011 Plastic Surgery Congress 2011 Surgery 6-10 July Plastic 2011, Gold Coast, Congress 6-10 July 2011, Gold Coast, Queensland, Australia Queensland, Australia Together with New Zealand Association of Plastic Together with the Newthe Zealand Association of Plastic Surgeons (NZAPS), Australian Surgeons Australian Society line of Plastic Society of Plastic(NZAPS), Surgeons (ASPS) will host an outstanding up of international and local speakers and cover topics will enhance your professional and Surgeons (ASPS) willthathost an outstanding linedevelopment up continuing medical education. of international and local speakers and cover topics that will enhance your professional development and

We also welcome the participation of Australasian Society of Aesthetic Plastic Surgery; continuing medical education.

Australia and New Zealand of Ophthalmic Plastic Surgeons; and Australian Hand We also thecontributors participation of Australasian Surgery Societywelcome who are major to our scientific program.

Society of Aesthetic Plastic Surgery; Australia and

TheNew comprehensive will include a special focusSurgeons; on rhinoplasty,and breast and hand Zealandprogram of Ophthalmic Plastic surgery.

Australian Hand Surgery Society who are major

contributors to our scientific program.

International speakers include The program will include a special � Drcomprehensive Glenn Jelks M.D, Seattle, Washington Educational product theaters - Showcasing new � Dr Phil Haeck, M.D, Seattle, Washington focus on rhinoplasty, breast and hand surgery. products and services � Dr Wolfgang Gubishch, M.D, Stuttgart, Germany International speakers Private Physician/Vendor Meeting Rooms � Dr Rod Hentz M.D, Redwood,include California � Dr David Coleman, M.D, Oxford, UnitedWashington Kingdom - Dr Glenn Jelks M.D, Seattle, Residents Lounge - Participating board-certified plastic � Prof.

Moustapha Hamdi, M.D, Gent, Belgium surgeons will mentor residents - Dr Phil Haeck, M.D, Seattle, Washington � Dr Venkat Ramakrishnan, M.D, Essex, United Kingdom

International Delegate Area - Welcome, gather and network with international colleagues ASPS Resource Center Extended dedicated exhibit hours

Denver, an outdoor-lovers paradise, has many exciting activities for attendees to participate in after classes adjourn. Explore all Denver has to offer before and after the meeting including biking, hiking, golf , fishing, rafting and more. To learn more about Denver and to plan your trip, visit denver.org.

For the latest information on Plastic Surgery 2011 including updates on the program and social events visit plasticsurgery2011.org. Registration will open Mid-May 2011.

- Dr Wolfgang Gubishch, M.D, Stuttgart, Germany

Call for Rod Abstracts - Dr Hentz M.D, Redwood, California Authors of research papers who wish to have their abstracts considered for inclusion in Dr David Coleman, Oxford, the- scientific program must submitM.D, their abstract(s) viaUnited the websiteKingdom - Prof. Moustapha Hamdi, M.D, Gent, Belgium (www.plasticsurgerycongress.org.au ) by the close of business Monday, 28 February 2011.

- Dr Venkat Ramakrishnan, M.D, Essex, United Submission details and abstract guidelines are available via the website Kingdom www.plasticsurgerycongress.org.au.

Call for Abstracts Authors of research papers who wish to have their abstracts considered for inclusion in the scientific program must submit their abstract(s) via the website (www.plasticsurgerycongress.org.au) by the close of business Monday, 28 February 2011.

Submission details and abstract guidelines are available via the website www.plasticsurgerycongress.org.au.

The 2011 PSC Organizing Committee looks forward to seeing you at the Gold Coast!

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presentations of work for grant awards and 235 electronic posters.

Brazilian Society of Plastic Surgery (SBCP)

At the association, the organization held eight meetings very important for the conduct of its activities over the coming years and the social program offered a solemn opening session in which the desk officer had the presence of great personalities like Marita Eisenmann-Klein, president

47th Brazilian Congress of Plastic Surgery The Brazilian Society of Plastic Surgery (SBCP) in conjunction with its regional SBCP-Espírito Santo held the 47th Brazilian Congress of Plastic Surgery, in 11 to 15 November 2010, the city of Vitoria, located in Espírito Santo, in Brazil.

The meeting brought together national specialty national and international participants, totaling 2017 people between full members of the SBCP, residents and guest lecturers. More than 15 foreign lecturers presented their classes and about 800 national offered his knowledge to present.

The scientific program of the event was varied with modules on rhinoplasty, blepharoplasty, mammoplasty, Face, Tummy, Surgery Post-Bariatric, Baldness, Eyelid Orbit, Patient Safety Forum, Liposuction, Rhytidectomy, Medical Legal, Otoplasty, non-surgical procedure, Gluteoplastia, Body Contouring, Minimally Invasive Procedures, etc..

In addition, Congress might elect to perform from more than 20 parallel courses that teach new techniques and surgical procedures, choose to attend the presentations of 145 papers, 31 roundtables, 10 surgeries edited video, 40 video sessions, 174 videos about the various surgical subspecialties, four conferences, eight workshops, Continuing Education, panels, test preparation course for specialist and member proves that member for the SBCP, 32

of IPRAS; Jose Tariki, president of FILACP, Prof.

Ivo Pitanguy, patron of the Brazilian Plastic Surgery, Sebastião Nelson Edy Guerra, president of SBCP. On the occasion of the greats were honored surgery in Brazil, including Farid Hakme, president of honor of the 47th Congress. We also commented on the very presence of Phillip Haeck, president of ASPS, and Patricia Hewitt, former Secretary of State for Health in England.

The organizing committee also offered a welcome cocktail, suggested options for tours and travel for companions and closed the event with a wonderful Presidential’s Dinner in the Exhibition Hall of Carapina, a nearby town. One of the highlights was the Mutirão Plastic Surgery Skin tumors was carried out throughout the day on Nov. 10, one day before the Congress, in three hospitals in Victoria that plastic surgeons in Brazil could serve more than 170 preselected patients.

Source: Department of Communication, SBCP Renata Donaduzzi - Responsible Journalist

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A. Nerobeev (Russia), J. Fedeles (Slovakia), Z. Saylan (Turkey), K. Takasu (Japan), G. Blugerman (Argentina) and others.

Society of Plastic, Reconstructive and Aesthetic Surgeons of Georgia (GeoPRAS) The 4th International Congress of Plastic, Aesthetic Surgery and Dermatocosmetology of Georgia and Armenia. Tbilisi, 2010 Annual meetings of plastic, reconstructive and aesthetic surgeons, as well as of experts in medical cosmetology, became permanent and traditional in the capital of Georgia, Tbilisi.

Opening ceremony of clinic “Total Charm”

Every time during the congresses master-courses on “Elimination of aging signs by methods of minimally invasive aesthetic surgery and dermatocosmetology” were carried out and show cases were presented.

Participants noted the high professional level of both theoretical and practical studies, as well as the excellent arrangement of meetings. They were also satisfied with the social program offered by Congress organizers.

To the 4th Congress, which was held on October 8-10, 2010 along with our Georgian friends - the regular participants of these meetings – was invited not a less dignified group of visitors, world-famous experts: G. Fischer (Italy), M. Eisenmann-Klein (Germany), R. Datiashvili (USA), G. Perks (UK), A. Borovikov (Russia) and others. This time scientific

P. Fournier makes his presentation

The 1st International Congress, held in July 2007, was dated for the official opening of clinic Total Charm.

After a year the 2nd Congress was held. Last year, in 2009, The 3rd International Congress of Plastic, Aesthetic Surgery and Dermatocosmetology was organized in Yerevan with our Armenian friends in cooperation with The Conference of Plastic, Reconstructive and Aesthetic Surgeons of Armenia.

More than 600 doctors from 32 countries took part in these meetings. Their achievements presented such world-known experts as are P. Fournier, M. Costagliola (France), O. Panova, A. Adamyan,

G. Fischer on a rostrum

program of the meeting was interesting as well.

Reports on reconstructive surgery and microsurgery, mammoplasty, treatment of aesthetic signs of ageing both by surgical and dermatological methods were innovative and interesting. Much prominence was given to complications and problematic cases.

Moreover, hospitable land of Georgia offered to the delegates interesting tours in Tbilisi and its surroundings, and arranged an event which they will remember for a long time (On October 10 the delegates took part in winemaking in Kakheti, the picturesque valley of Alazani).

Picture 3. Trip to Kakheti

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is based at the Royal College of Surgeons in Dublin.

Training of new Plastic Surgeons is under the auspices of the Royal College and is organized and done by the Association’s members.

European Association of Plastic Surgeons (EURAPS) EURAPS-JPRAS Affiliation Since 2010 the European Association of Plastic Surgeons (EURAPS) has an official affiliation with the Journal of Plastic, Reconstructive & Aesthetic Surgery (JPRAS).

As part of the EURAPS-JPRAS agreement, we offer 85 free subscriptions to JPRAS for plastic surgeons from East European Countries.

The Association meets twice a year, and has an active scientific programme at which visiting speakers participate in addition to original papers being presented by the members and trainees. The most recent meeting was held in Dublin in November. Mr David Evans, Consultant Hand and Plastic surgeon from London, gave a number of talks on his areas of special expertise, including carpal instability and his personal ideas and prejudices in Hand surgery. Original papers included reports on Collagen Fibres Modified with Polysialic Mimetic Peptide are a Suitable Material for Use as a Synthetic Peripheral Nerve Graft from Galway and Paediatric Dupuytrens Diseasefrom New Zealand. The next meeting will be held in Galway on the 5th and 6th May 2011.

The society’s web site is www.plasticsurgery.ie

If you are interested in obtaining a free subscription, please contact the EURAPS Central Office by mail: euraps@umcutrecht.nl and provide us with your full address and a short CV. Best regards, Moshe Kon, M.D., Ph.D. EURAPS Secretary General

IAPS

IRISH ASSOCIATION OF PLASTIC SURGEONS

Irish Association of Plastic Surgeons (IAPS) President: Michael J Earley Secretary: John Kelly Treasurer: Kevin Cronin The Irish Association of Plastic Surgeons (IAPS) is the professional representative body for plastic and reconstructive surgeons in the Republic of Ireland and 60

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21st Congress of ISAPS

Congress location: Geneva, Switzerland Venue: Centre International de Conferences Geneva Congress dates: 03 September 2012 - 07 September 2012 Contact: Catherine Foss Tel: 1-603-643-2325 Fax: 1-603-643-1444 HomePage: http://www.isapscongress2012.org e-mail: isaps@conmx.net

Nicaraguan Society of Plastic Surgery (SNCP) On October 7 and 8 of 2010, the Nicaraguan Society of plastic surgery was engaged in the II CONGRESS NICARAGUAN COSTARRICENSE OF PLASTIC SURGERY, at touristic city of Granada, Nicaragua.

During the conferences, 8 international professors gave their input including Dr Jose Tariki FILACP’S President, Dr Romulo Guerrero Pas president FILACP. The scientific program covered advancement in plastic surgery with an emphasis on prevention and security.

Dra Sandra Gutierrez.

President.

Nicaraguan Society of Plastic Surgery (SNCP)

Second Congress partipants.

Dr Romulo Guerrero, Dr Jose Tariki FILACP president, Dra Sandra Gutierrez SNCP President and Dr Alberto Arguello ACCPRE president.

Dra Sandra Gutierrez SNCP president opening the Second Nicaraguan Costarricans Congress. Dr Romulo Guerrero (Ecuador) FILACP, Dr Fidel Morales ,nicaraguan professor, Dr Alberto Arguello (Costa Rica) ACCPRE president, Dr ALfonso Pares SNCP vice president.

Japan Society of Plastic and Reconstructive Surgery (JSPRS) The 54th Annual Meeting of Japan Society of Plastic and Reconstructive Surgery President: Hideki Nakanishi (The University of Tokushima) Date: April 13-15, 2011 Place: Tokushima, Japan Secretary Office: Department of Plastic and Reconstructive Surgery, The University of Tokushima Graduate School URL: http://www.convention-w.jp/jsprs54/index.html E-mail: keisei@basic.med.tokushima-u.ac.jp

The 20th Research Counci Meeting of Japan Society of Plastic and Reconstructive Surgery President: Katsueki Watanabe (Tokyo Medical University) Date: October 6-7, 2011 Place: Tokyo, Japan Secretary Office: Department of Plastic Surgery, Tokyo Medical University URL: http://jsprs20.umin.jp/ E-mail: jsprs20@tokyo-med.ac.jp Issue 3

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It is currently being recommended to be offered in all succeeding OSAPS conferences.

Oriental Society of Aesthetic Plastic Surgery (OSAPS) 12th Congress of the ORIENTAL SOCIETY OF AESTHETIC PLASTIC SURGERY “Toward the Safe and Reliable Surgery” The 12th International Congress of the Oriental Society of Aesthetic Plastic Surgery (OSAPS) was successfully held last November 1-3, 2010 in Shinagawa Prince Hotel, Tokyo, Japan. With much gratitude to the efforts of Professor Yoshiaki Hosaka and the rest of the Japan Plastic Surgery Society, the 12th Congress brought together around 300 delegates from its 10 member countries. OSAPS is an international Plastic Surgery society composed of 10-member countries Oapan, Singapore, Thailand, China, Malaysia, Taiwan, Hong Kong, Korea, Indonesia, and the Philippines).

In the following days in the Congress, various panel discussions were held on Blepharoplasty, Rhinoplasty, Face Lift, Liposuction & Lipoinjection, Facial Contouring, Wound Healing, and Facial Rejuvenation.

Indeed, the Congress was a very intellectually stimulating event to share much insight, wisdom and various techniques with fellow plastic surgeons.

The Oriental Society of Aesthetic Plastic Surgeons was born in 1988 under the helm of Dr. Seiichi Ohmori.

The leadership of the society was turned over to his son Dr. Kitaro Ohmori in 1990. Dr. Ohmori has carried the society for the last twenty-two years, cultivating and enriching the vision of his father. The society has played

a formidable role in the formation of oriental plastic surgeons and has provided a platform for its members to be recognized internationally.

The Congress’ Course Director, Dr. Susumu Takayanagi, created a very diverse and comprehensive scientific program which included the premiere offering of the ISAPS Symposium. Dr. Takayanagi also brought together more than 60 international faculty for the Congress from Australia, Brazil, Canada, China, Ecuador, France, Germany, Hong Kong, India, Indonesia, Malaysia, the Philippines, Romania, Serbia, Singapore, South Korea, Taiwan, Thailand, Turkey and the United States. This day-long symposium held last November 1 included various topics such as “Fillers, Laser & Plasma,” “Breast and Body,” “Breast,” “Eyelid,” and “Facial Rejuvenation & Fat.” The addition of the ISAPS symposium in the scientific program of the Congress was a welcome addition to the Congress.

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Another first for the Congress, is the appointment of the new Secretary-General, Dr. Florencio Lucero from the Philippines. Dr. Lucero humbly accepted the responsibility from Dr. Ohmori to bring the society to new grounds focusing on better integration with international societies such as the ISAPS and the IPRAS. Dr. Lucero, a founding member of the OSAPS, and a senior plastic surgeon in the Philippines for the last 30 years, was also part of the international faculty for the ISAPS symposium in the 12th OSAPS Congress.

Apart from the exchange of medical ideas and innovations, the OSAPS Congresses have always been warm, hospitable, gracious and undeniably, gastronomical. Experiencing the best of Japan’s culinary wonders, cultural traditions, and sincere camaraderie was a welcome delight! From the bento boxes to the sumptuous buffets and the lovely entertainment, our Japanese hosts truly organized an impressive experience for all its delegates.

We all look forward to meeting again, sharing stories and techniques, come October 2012 in Seoul, Korea.

friendship relations between us and our wish and hope to share together the joy of seeing again and working to more and more scientific and social events.

The Romanian Association of Plastic Surgery wishes you a happy new year together with the most sincere wishes of health and happiness.

Romanian Association of Plastic Surgeons (RAPS)

Honorary President, Executive President, Prof. Ioan Lascar, Prof. Ioan Petre Florescu

Dear colleague, We have the honor and the privilege to inform you about the new leading structure of the Romanian Association of Plastic Surgeons: Honorary President: Prof. Ioan Lascar, MD, PhD Executive President: Prof. Ioan Petre Florescu, MD, PhD First Vice-president: Prof. Tiberiu Bratu, MD, PhD Vice-president: Prof. Theodor Stamate, MD, PhD Prof. Ion Bordeianu, MD, PhD General Secretary: Ileana Boiangiu, MD, PhD

The Romanian Association of Plastic Surgeons encompasses the following Societies: • Plastic and Reconstructive Society: President: Prof. Ass. Nicolae Antohi, MD, PhD Vice-president: Marek Valcu, MD, PhD

• Hand Surgery Society: President: Silviu Marinescu, MD, PhD Vice-president: Cristian Nitescu, MD, PhD

• Microsurgery Society: President: Prof. Dan Georgescu, MD, PhD Vice-president: Radu Jecan, MD, PhD

• Burns Society: President: Prof. Dan Enescu, MD, PhD Vice-president: Marcel Albean, MD, PhD

• Aesthetic Surgery Society: President: Prof. Tiberiu Bratu, MD, PhD Vice-president: Prof. Toma Mugea, MD, PhD In order to bring up to date the data base, the new contact address of the Romanian Association of Plastic Surgeons is: Bagdasar-Arseni Clinical Emergency Hospital Plastic Surgery and Reconstructive Microsurgery Clinic Berceni Avenue 10-12, 4th District, Bucharest, Romania Email address: acpr2005@yahoo.com The Romanian Association of Plastic Surgeons, represented by its new leading team, wants to assure you about the continuation and development of the good,

Philippine Association of Plastic Reconstructive & Aesthetic Surgeons (PAPRAS) Dear Colleagues, I would like to inform you that the National President of the Philippine Association of Plastic Reconstructive & Aesthetic Surgeons (PAPRAS) for the year 2011-2012 is DR. ALEXANDER G. DE LEON. Dr Francisco C. Manalo had become our immediate past president and one of our advisers.

Below, is the list of our new set of Officers and Board of Trustees: The officers of PAPRAS wish to announce the new set of Officers and Board of Directors for 2011-2012.

President: Alexander G. De Leon, MD Vice-President: Rene C. Valerio, MD Laurence T. Loh, MD Secretary: Treasurer: Aser S. Acosta, MD P.R.O.: Glen Angelo S. Genuino, MD Directors: Eric E. Arcilla, MD Joselito Rosauro J. Cembrano, MD Jose Joven V. Cruz, MD Melvin M. Sibulo, MD Gerald C. Sy, MD Ma. Irene B. Tangco, MD Immediate Past President: Francisco C. Manalo, MD Thank you very much.

Sincerely yours, Val Corpus Administrative secretary Issue 3

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Russian Society of Plastic Surgery (RSPS) February, 4- 5, 2011 - International Education Symposium

«Esthetic Surgery and Cosmetology for face and periorbital rejuvenescense» Lectures are given by the world known surgeons: Glenn and Elizabeth Jelks (USA), Michael Yaremchuk (USA), Alain Fogli (France), Dirk Richter (Germany).

Moderator: Tom Biggs (USA) February, 5, 2011 COSMETOLOGY, LAZERS, NEW TECHNOLOGIES, REHABILITATION. AUTHORS TECHNOLOGY OF THE REGIONAL LEADERS: I. Yutskovskaya, О. Banizhe, D. Bubkin, А.Sybel, E. Timoshenko.

President of the Conference: Professor, chairman of the Moscow Society of the Plastic Surgeons, Academician of Russian Academy of Medical Sciences - А.

Adamyan Chairman: S. Nudelman Organizational Committee: professor К. Pshenisnov (chairman), N. Manturova, I. Khrustaleva, Т. Biggs. А.

Borovikov, I.Yutskovskaya.

Content: • lectures • discussions • live surgery with the on-line broadcast • the Exhibition of the instruments and materials for the plastic surgery and cosmetology Location : Institute of Surgery n.a. A.Vyshevsky, B. Serpukhovskaya, 27 For more information see: www.plastickafedra.com Org. Committee: info@plastickafedra.com

round tables devoted to the most up-to-date topics: from the latest advances on burns, to lymph node surgery.

A book on “Outer Ear Surgery” (the official presentation of the Congress),will be published and distributed to the attendees. We think there is no other publication in Spanish on this topic.

As usual, there will be outstanding international professors who will discuss new topics and give remarkable lectures. As a novelty, there will be a room devoted to Workshops, where the pharmaceutical companies participating in the conference, will have the opportunity to show in a practical way, their latest leading products.

We have made a great effort to lower registration fees, as well as prices for the commercial booths.

The city of Murcia has a population of nearly half a million inhabitants, and its exceptional weather allows us to stroll around its historical streets. Murcia is also proud of its cuisine and products. The vegetables and fruits are outstanding thanks to the privileged geographical location.

The social program is also full of charming places such as the Visit to Cartagena and its important port and superb Roman Theater or the Visit to “La Manga del Mar Menor” (a unique place in the world due to its “two seas”). Besides, you can also take the opportunity to go sightseeing during the weekend, either within the Congress social program or on your own.

If you wish further information kindly check the conference website : www.secpremurcia2011.com On behalf of the Organizing Committee, I am pleased to invite you to come to Murcia and participate in the meeting. I am sure it will be very profitable stay not only for the scientific level, but also for its culture and leisure.

Looking forward to seeing you in Murcia, receive my best regards,

Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) Dear colleagues, It is an honor for me, to be the Chairman of the SECPRE National Congress to be held in Murcia on 2nd-3rd June, 2011.

The scientific program will take place at the Auditorium and Congress Center of Murcia. There will be eighteen

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Francisco J. Pedreño Ruiz, MD Chairman of the Organizing Committee

Candidate Application All candidates will be required to submit: 1. A letter from the candidate describing their proposed program and academic/educational interests 2. A Current Curriculum Vitae 3. Two letters of recommendation from surgeons in the candidate’s national society

American Association of Plastic Surgeons (AAPS) For the fourth consecutive year, the American Association of Plastic Surgeons is pleased to announce the John D. Constable International Traveling Fellowship in Plastic Surgery. True to its original mission, the award provides a unique opportunity for an international plastic surgeon to study and train with AAPS members and leaders in American plastic surgery.

Over the past three years, plastic surgeons from Iraq, China, and Egypt have been selected as recipients and have benefited from this exceptional experience. In their final reports, they have all expressed a profound gratitude for the knowledge and experience gained and the sense that the experience has indeed, changed the course of their lives and careers. They have returned to their respective countries with an enhanced ability to treat patients and train their colleagues.

The fellowship invites an international plastic surgeon to America under the auspices of the American Association of Plastic Surgeons. The goal is to improve the fellow’s understanding of American plastic surgery and to promote good will and academic interchange among the international and American surgical communities. The chosen fellow will be in the United States as an observer for a period of 6-12 weeks under the sponsorship of members of the American Association of Plastic Surgeons.

The Association is proud to have established an endowment supporting an international plastic surgery fellowship in honor of Dr. Constable, who has made significant contributions to plastic surgery education in India, Egypt, Vietnam and Newfoundland.

Eligibility Candidates must be fully trained in their respective country in plastic surgery, a member in good standing of their national society, and have been in practice in their country for a minimum of 5 years. They must be able to communicate well in both written and spoken English and must be sponsored by two members of their national society where appropriate.

Application from Host Institutions Institutions interested in hosting a Constable International Traveling Fellow will be required to submit: 1. A planned curriculum for the visiting fellow 2. Availability of personal support (housing/food) during the visit One fellowship in the amount of $7,500 per year will be awarded. The funds provided are intended to cover the international and national transportation obligations for a successful fellowship. The Chair of the Constable Committee will make notification of acceptance of the fellowship to the applicant and to the host institutions. Applications should be submitted no later than January 28, 2011. The recipient will be required to provide a written report at the conclusion of the fellowship that will be submitted to the Board of the American Association of Plastic Surgeons. The content of this report will not only outline the details of the learning process and content but also suggestions to the committee as to how to better the educational and social opportunity for the future fellows.

John D. Constable Fellowship Committee Bryant A. Toth, MD, Chair James W. May, Jr., MD John D. Constable, MD Michael Moses, MD Scott Bartlett, MD Riccardo Mazzola, MD Candidate and Institution required documentation should be submitted to: American Association of Plastic Surgeons 900 Cummings Center, Suite 221-U Beverly, MA 01915 USA www.aaps1921.org Tel: 978-927-8330

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INDUSTRY NEWS

Lasers and Medical equipments ABALASE LTD is a member of AKAN GROUP existing since 1962. ABALASE is serving the Greek and international markets with a wide range of medical lasers.

Our head office is in Athens and we have two branch offices, which is based in Thessaloniki and Cyprus.

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Product Line • IPL • Fractional lasers • RF equipements • Fraxpeel devices • CRYO equipments • Lipolysis laser • Products are CE and FDA approved.

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Post Liposuction Compression Garment Comparison: Is there a Difference?

Background: Compression garment style selection in postoperative patients is one of many variables to be determined before or after surgery. The current market for these devices is often convoluted by the number of manufacturers using different fabrics to make these garments. Little research has been done today that allows the patient to be more informed about the quality of different compression garments. The authors in this study compared two popular compression garments made out of different fabrics in order to determine which fabric provided the patients a better experience and compliance with recovery protocol postoperatively.

Methods: A total of 50 patients underwent suction assisted lipectomy of abdomen and thighs: 20 of these patients (40 percent) had other minor liposuction on areas such as the face, neck, back, knees, and arms.

All patients received an experimental “F5” garment and a standard “Powernet” garment to be changed every 24 hours for a period of 30 days after surgery.

Surveys were performed on all patients following 66

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their last consultation to inquire about overall garment performance, how many experienced different comfort sensations, and how many preferred a different garment postoperatively.

Results: Ninety four percent of completed surveys were 100 consistent across all questions, validating the responses as being very accurate. Respondents rated the experimental fabric as good or better on all measures of stretch, compression, aesthetics, softness, comfort and healing.

Conclusions: Experimental “F5” compression garment wearing patients were more satisfied than controls and 82 percent of the participants were more interested in wearing this new fabric postoperatively.

Late Amado Ruiz-Razura, M.D., F.A.C.S., F.I.C.S. Paul F. Fortes, M.D., F.A.C.S., F.I.C.S. German Newall, M.D., F.A.C.S. Christopher K. Patronella, M.D., F.A.C.S. Henry A. Mentz, M.D., F.A.C.S.

Breast Implants Range

Created in 1993 and located in Northern France (90min from Paris by train), Cereplas became a recognized leader in the aesthetic and reconstructive surgery field thanks to a considerable innovation and the development of the CEREFORM® breast implants range. While designing and manufacturing a wide

Currently distributed in more than 40 countries, the CEREFORM® range shows a growing success. With more than 90 employees and fully integrated in a growth perspective, CEREPLAS goal is clearly to provide a high quality product to focus on the patient’s health security.

To achieve best warranty, Cereplas chose to automatize its production line and is able to offer a constant quality result from one implant to the other. Cereplas has developed a new production unit located near the ParisBrussels motorway that will produce by January 2011 in order to meet the growing demand.

Flexibility clearly became the Cereplas footprint. Indeed, through a massive R&D investment, the company keeps on innovating and offering new ranges to perfectly fit its customer needs.

range of pressure garments providing post operative support, CEREPLAS diversifies in 2004 by addressing the scar management market thanks to CEREDERM® silicone dressing. This product, entirely manufactured in Cereplas, consists in a first step for mastering the silicone material. Indeed, from June 2004, Cereplas decided to develop a Class III medical device: CEREFORM® cohesive silicone gel pre-filled breast implants. Following this new promising range, Cereplas obtained the NF EN ISO 13 485 certification in February 2006 and the CE mark by the LNE-GMED (French notified body).

CEREPLAS Actipôle 2 59554 Sailly lez Cambrai FRANCE Tel : +33 (0)3 27 83 69 57 Fax : +33 (0)3 27 83 70 42 Email : export@cereplas.com

The launch of CEREFORM® breast implant on the national and international markets in February 2007 significantly modified the company profile.

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Crisalix releases the new version of its revolutionary 3D breast augmentation simulator “Special price conditions for the IPRAS members and readers at the end of the article”

Crisalix launches e-Stetix v3.0, a breakthrough new version of its exclusive 3D simulator for breast augmentation. This new development brings 3D simulation possibilities towards the patients to its highest level. The leading R&D University spin-off, inventor of the first worldwide 3D physical simulator for plastic surgery using only 2D photos, has launched this exclusive technology using proprietary codes combined with the most advanced research in this field. V3.0

PHOTO-GEOMETRICAL 3D MODELER

Photo-Geometrical: transformation of pixel information into geometric parameters based on body measures and photos from different angles.

3D Modeler: accurate geometric parameters together with an efficient statistical model allow e-Stetix to create the 3D model of the torso in a user friendly and ergonomic way.

ULTRA-FAST 3D EMV SIMULATOR Ultra-fast: the new engine simulates physical interactions between millions of 3D particles to provide the surgeon with the best result in less than 7 seconds.

EMV: stands for Elastic-Mass-Volumetric analysis, the core of the new version of the e-Stetix simulator. An extremely precise engine that models physics dynamics to get the most realistic simulation ever seen.

In addition to these two major improvements of the core, e-Stetix v3.0 introduces new developments and functionalities: 68

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e-Planning provides dynamic measuring tools to allow surgeons to calculate asymmetries and make anatomical measurements. The intuitive and user-friendly approach of e-Planning makes the consultation even more interactive, allows more in-depth education of the patient and increases the patient’s confidence in the surgical act.

Multi-Simulator: e-Stetix generates instantaneously four simultaneous simulations based on the generated diameter with different projections. Among others, this solution allows the patient to have a clearer view of her personal expectations and a higher common understanding between surgeon and patient. One of the main advantages of this new feature is to reduce the consultation time.

From the left: Nelson Piccolo(IPRAS EXCO member), Fabian Wyss (Chief Marketing & Sales Officer), Hassan Badran (President Organizing Committee of Pan African Congress), Eisenmann-Klein Marita(IPRAS General Secretary), Andreas Yiacoumettis(IPRAS Parliamentarian), Ahmed Noreldin (President IPRAS Pan African Section), Mohammed Sobhi Ahmed Zaki (IPRAS EXCO member), Bernard Githae (President of Organizing Committee and Co-Chairman of Scientific Committee of the Pan African Congress).

About Crisalix Initiated after a research that started in 2006 with the support of the Computer Aided and Image Guided Medical Interventions Network in Switzerland, Crisalix is a spin-off of the Institute for Surgical Technology and Biomechanics from the University of Bern and l’Ecole Polytechnique Fédérale de Lausanne. Crisalix is supported by a Medical Board of surgeons with outstanding experience and leading international

reputation, including Thomas Biggs (Editor-in-Chief of IPRAS Journal), Yves-Gérard Illouz (Inventor of the liposuction), Foad Nahai (Past President of the ISAPS) to name a few.

“Compared to traditional methods such as bra and sizers or even morphing by computer simulation, this is a fantastic revolution for the patient as well as for the surgeon.” Jan Poell, President of the ISAPS. Crisalix PSE-A 1015 Lausanne Switzerland info.crisalix.com

IPRAS members and readers have a special 10% discount on e-Stetix annual subscriptions until December 2010. To benefit from this offer, please visit https://estetix.crisalix.com/ and proceed to “sign up”. Use the following code in the “Promotional Code” field:

e056b6db9477

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Keller Medical, Inc. Receives Approval to Launch Breast Implant Delivery Device in Canada The Keller Funnel™ Will Launch in Other International Markets in 2011

STUART, FL—Unveiled as a new technological advancement in the delivery of silicone gel implants for breast augmentation mammoplasty in August 2009, the Keller Funnel™ has rapidly been adopted by plastic surgeons throughout the United States and now is approved and available for sale within Canada.

On November 2, 2010, the privately-held Keller Medical, Inc. was granted a medical device license for its Funnel by Health Canada as a Class 2 Device. In addition, the company received its ISO certification and is in the final stages of obtaining its CE mark, which certifies a product has met European Union consumer safety requirements. Keller Medical is actively seeking international distribution partners with specific expertise in the plastic surgery field.

In its first 12 months of sales, Keller Medical generated $1.1 million in revenue, exceeding first year sales goals, and has continued to grow at a rate of 40 to 50 new customers each month. An ongoing, third party administered customer survey program indicates that 96% of surgeon respondents say they will or have recommended the product to their peers.

“In my twenty years of developing medical devices, without exception, this is the most exciting product I have ever had the pleasure of commercializing,” said Keller Medical CEO, Howard Preissman. “The overwhelming response from our surgeons taking the survey who indicated they will recommend the product to their peers is fantastic. There is no more valuable

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endorsement than from a fellow surgeon. We are absolutely delighted!”

Originally conceived by Board Certified plastic surgeon Kevin Keller, M.D., the Keller Funnel™ is a cone-shaped and hydrophilically coated nylon device.

Designed to facilitate silicone breast implantation, the Keller Funnel™ also offers surgeons a no-touch technique which eliminates contact of the implant with a patient’s skin, potentially reducing the occurrence of capsular contracture, a painful and common complication of breast implant surgery. Additionally, the Funnel permits physicians to use smaller incisions typical in saline procedures and can reduce the localized force imparted by the surgeon’s fingers on the implant shell.

Keller Medical, Inc. was co-founded by Kevin Keller, M.D. and Howard Preissman, a medical device executive and biomedical engineer. Both U.S. and international patents are pending.

For more information about The Keller Funnel™ visit www.kellerfunnel.com or call 772.219.9993 Keller Medical, Inc. 609 Central Parkway Stuart, FL 34994 CONTACT: Michele Vongerichten (772) 219-9993 michelev@kellerfunnel.com

Company Profile LIDS Medical ltd (www.lidsmedical.gr) was founded on 2006 managed, in a very short period of time, to lead the market of aesthetics and aesthetic medicine, due to its high standard of expertise in clinical and technical support.

The company is focusing in imports, exports and trading of medical technology, equipment and supplies in the sector of aesthetics and aesthetic medicine.

The company has succeeded in consistently and continuously covering all sectors of clinical and technical support, and is addressed to physicians, medical centres, beauty and wellness institutes, health spa, gyms and other relevant environments.

LIDS Medical is the exclusive representative in Greece, Cyprus and FYROM of the following companies:

LPG

For more than 25 years, LPG Systems has developed exclusive and patented technologies (such as Endermologie®, Lipomassage® and Endermolift™) for the treatment of the human body with one objective in mind “to help people live better and longer lives”. The devices designed for health and beauty professionals are used in fields ranging from rehabilitation, sport, wellbeing, anti-aging to the beauty of the face and body. The LPG technologies are scientifically recognised for their effectiveness. www.lpgsystems.com

ALMA Lasers

Alma Lasers™ is a global developer, manufacturer and provider of laser, light-based and radiofrequency devices for aesthetic and medical applications. Alma Lasers expertise lies in the winning combination of the ability to innovate bringing unique new technologies to the global aesthetic market, balanced by a strategic depth of clinical knowledge and industry experience.

Each day, thousands of plastic surgeons, dermatologists, obstetricians, gynaecologists and general physicians in 45 countries depend on Alma Lasers to deliver visible results that improve lives. www.almalasers.com

Medical & Technology

EPOREX by Medical & Technology launches a new generation of transdermal delivery systems, bringing about the synergy of already known techniques such as Ionophoresis, Iontophoresis, and Electroporation, through an innovative method for “active” molecular transcutaneous transport that is called: “ISOPHORESIS”. EPOREX offers needle-free mesotherapy treatments without pain or bruising. www.medical-technology.it

INVASIX

BodyTite, created by INVASIX, is a sophisticated device using patented radiofrequency assisted liposuction (RFAL™) technology for effective body contouring and significant skin contraction. The first and only RFAL device on the market, BodyTite, combines adipose tissue and blood vessel coagulation, simultaneous aspiration with precise dermal heating to achieve fast, safe, consistent and uniform results. www.invasix.com

Cryo-Lip by CRYO SAVE

Cryo-Lip by Cryo-Save (Europe’s biggest stem cell bank) is the first opportunity for liposuction patients to store some of their own stem cells for future therapeutic use. Adipose-derived stem cells and their secretory factors are cryopreserved also for short- or long-term future use of skin aging therapy. www.cryolip.com

Sperian

The two largest manufacturers of laser eye protection - Glendale Protective Technologies (Glendale) and Uvex - have joined together to become the leader in manufacturing and design of laser eyewear and specialty filters. www.glendale-laser.com

LCA

LCA’s main product Ηyaluderm® is an intradermal, non-cross-linked, viscoelastic structuring biogel, composed of high molecular weight sodium hyaluronate, It comes in a single-use, luer lock, glass syringe, pre filled to 0.5 ml, 1 ml & 2 ml, sterilised by steam autoclave, in an individual sterile protector. www.lca-pharma.com Issue 3

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International Aesthetic Holidays 2011 Sharm El-Sheik, March 11-13

Dr. Klaus Hoffmann, Ruhr University Bochum, has accepted our invitation to have two additional lectures at the next NETWORK event. He will speak about lipo laser devices and he will give an interim report about a first study to test the numerous ultrasound devices for fat reduction.

All trainings during the meeting are company independant and present objective information.

(lipomata) and patients who don’t want to undergo surgery for aesthetic reasons should be added,too.

Top countries amongst the Plastic Surgeons are the US and Canada for IL treatments. If other faculties would be part of the statistics Germany probably would be the No. 1 country with IL treatments.

Prof. Ahmed Nour El-Din, University of Cairo, will speak at the same event about the huge differences in quality of all Phosphatidylcholine products sold on the market.

Further information you will find at http://www.network-lipolysis.com/index.php?id=1995 ISAPS statistics: Plastic Surgeons treated more than 65,000 patients with Injection-Lipolysis in 2009 The Plastic Surgeons alone have treated in 2009 more than 65,000 patients with injection-lipolysis. In comparison to liposuction (1,600,000 treatments) IL shows a huge growth potential.

In the future we expect a ratio of 80:20. IL is the first option for small fat depots, correction of irregularities after liposuction, or when liposuction is uncomfortable for the patient like in facial treatments or dorsal bulges. Indications where IL is clearly the first choice

Germany: Dermatologists profit more than Plastic Surgeons from growth potentials in minimal invasive aesthetic treatments The actual trend that patients prefer more and more minimal invasive treatment options rather than operations has changed the market position of German Dermatologists in the aesthetic field. Fillers, Botox, Peelings, Radio Frequency, Injection-Lipolysis, Mesotherapy, Lasers and Fractional Lasers are becoming more important in the aesthetic field all around the globe. It could be useful for some plastic surgeons to revise their strategies partly and follow more their patient requests rather than their own passion for surgical procedures.

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Company Profile POLYTECH Health & Aesthetics GmbH, founded in 1986, is one of the leading manufacturers of silicone implants in Europe. The product range presently consists of more than 1500 different implants and expanders. The company’s focus is on breast implants for women; other soft-tissue implants produced are, for example, chest implants for men, implants for the calf and the bottom. 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.

available in 4 projections, i.e. low, moderate, high and extra-high o Diversity of surfaces: each implant type available in 2 surfaces, i.e. with POLYtxt® textured surface or with Microthane® coating (Même® implants also with smooth surface)

Breast Implants & Corresponding Expanders Available: 1376 products – diversity for female individuality • NEW: Diagon/Gel® 4Two o Innovative two-gel filling: softer EasyFit Gel at the back for smooth fit to rib cage and natural motion, firmer Shapar Gel with maximum projection at 25% at the front for push-up tissue support o Compact product range:  4Two RR: round base, dome-shaped profile, available in 6 sizes, each in medium and high projection, with POLYtxt® textured or Microthane®-coated surface  4Two AR: round base, anatomical profile, available in 7 sizes, each in high and extrahigh projection, with POLYtxt® textured or Microthane®-coated surface  4Two AO: shorter base, anatomical profile, available in 7 sizes, each in high and extrahigh projection, with POLYtxt® textured or Microthane®-coated surface • Sublime Line®: optimal shape control through maximized filling with firmer gel o Diversity of shapes  Même®: round base, dome-shaped profile  Replicon®: round base, anatomical profile  Opticon®: short base, anatomical profile  Optimam®: oblong base, anatomical profile o Diversity of sizes: each implant type available in 18 base sizes o Diversity of projections: each implant type

• Modular System (same types as Sublime Line): concave back, natural feel and motion through filling with soft Formory® gel • Mammary expanders: wide range of round and anatomical expanders corresponding to the various sizes and shapes of the Modular System and Sublime Line breast implants • Sizers: silicone-gel filled, re-sterilizable, smooth sizers corresponding to all shapes and sizes of the three product lines Diagon/Gel 4Two, Sublime Line and Modular System • Microthane®: implant coating consisting of micropolyurethane foam, known for its reliability and compatibility. Studies have shown that implants with this surface produce a much reduced rate of capsular contracture, i.e. 0–3% (1) which is 30% less if compared to smooth implants (2). (1: Handel, 1991; Gasperoni, 1992; Pennisi, 1990; Shapiro, 1989; Baudelot, 1989; Artz,1988; Hermann, 1984; Eyssen, 1984; Schatten, 1984; Hester et.al., 2001; Vázquez, 2007. 2: Handel, 2006)

Breast Implant Warranty Program Implants of Excellence: An extended warranty program granting lifetime free exchange implants in Issue 3

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case of rupture for all implants, in case of rotation or dislocation for Microthane® implants, plus a 10-year replacement period in case of capsular contracture for Microthane® implants.

Body Contouring Implants Facial implants, male chest implants, calf implants, testicular implants, gluteus implants

Tissue Expanders Anatomical mammary expanders: Modular System/ Sublime Line expanders, MeshForce expanders, differential multi-compartment expanders Skin Expanders: various sizes of round, rectangular, and crescent-shaped expanders; self-inflating expanders

Saudi Sultan Medical Company (SSMC) was established by its Kuwait based mother company “Bader Sultan & Bros. Co.” to be its primary vehicle for expansion into the G.C.C countries.

SSMC will apply in the region the same mission & vision that BSBC has upheld in Kuwait, namely: Backed up by its 50 year old mother co. & its 200 strong team of professionals promoting the healthcare products of over 150 leading internationally renowned principals , as well as its own nucleus team of 15 highly trained and qualified sales force, SSMC aims at capturing a significant share of the G.C.C market in all fields of health care.

SSMC is acting as an exclusive agent and distributor for a large number of international firms for top quality

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Additional products - Liposuction: irrigation pump, lipoaspiration handpieces and accessories, canulas - Micropigmentation/dermabrasion: BPS-1001 and BPS-3000 systems and accessories (incl. color dispensers) - Post-operative care: compression bustiers, silicone gel and silicone sheets for scar treatment Implants made by POLYTECH – Quality made in Germany POLYTECH Health & Aesthetics GmbH Altheimer Str. 32 | 64807 Dieburg | Germany phone +49.6071.9863-0 | fax +49.6071.9863-30 eMail info@polytechhealth.com www.polytech-health-aesthetics.com

products and equipment that cover the whole spectrum of the scientific and medical business.

SSMC anticipated the worldwide is heading towards an era where beauty and luxury dominate. SSMC invested in related equipment that would position it to be a leader in providing international world class aesthetic & cosmetic – Derma products: Zerona - The “Laser” Diet - is a low level laser that melts fat without any pain or heat sensation; Thermage is a radiofrequency system that smoothes, tightens and contours skin with a single treatment; Fraxel (fractional laser) that stimulates the production of younger, smoother, healthier skin; acne light treatment by Isolaz; Water-Jet assisted Liposuction device from Human Med; Zeltiq is a revolutionary procedure that uses a precisely controlled cooling method to target, cool & eliminate fat cells without damage to neighboring tissue; Spashape is a totally non-invasive treatment dedicated to treat the fat cells area (in belly, hips and legs regions); Mesomega is the perfect tool for practicing professional and safe mesotherapy; Network Lipolysis is a form of cosmetic medical procedure involving the subcutaneous injection of a special formula of Phosphatidyl Choline to get rid of undesirable fat in an easy, targeted & permanent way; Kelocote is 100% Silicone for effective scar reduction and abnormal scar prevention; Revitalash is a unique eyelash conditioner that will help to achieve the beautiful look of Longer, Thicker & Fuller eyelashes; Fallene and Solar products that provide complete protection under the sun; Aptos for face and body lifting using minimally invasive techniques, to name a few.

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3rd Issue January 2011

IPRAS Journal Management Editor:

IPRAS

Editor-in-Chief: Thomas Biggs, MD Editorial Board:

Page Layout: e-mail: IPRAS Management Office ZITA CONGRESS SA 1st km Peanias Markopoulou Ave P.O BOX 155, 190 02 Peania Attica, Greece Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216 URL: www.ipras.org E-mail: zita@iprasmanagement.com Executive Director: Zacharias Kaplanidis E-mail: zacharias.kaplanidis@iprasmanagement.com Assistant Executive Director: Maria Petsa E-mail: maria.petsa@iprasmanagement.com Director of Accounting: George Panagiotou E-mail: george.panagiotou@zita-congress.gr Congress Organizer: Gerasimos Kouloumpis E-mail: gerasimos.kouloumpis@zita-congress.gr Director of Marketing: Kostas Chamalidis E-mail: kostas.chamalidis@zita-congress.gr

Next issue: April 2011

Marita Eisenmann - Klein, MD Andreas Yiacoumettis, MD Constance Neuhann-Lorenz, MD Zacharias Kaplanidis, Economist “In Tempo” Athens Greece panos@intempo.gr

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.