IPRAS JOURNAL, 13th ISSUE, JULY 2013

13th Issue July 2013

105 National - Regional Societies ISSN: 2241-1275

The e-magazine for 37.000 Plastic Surgeons www.ipras.org/ipras-journals

Nefer by Ugo Dossi

Issue 13 www.ipras.org IPRAS Journal 3

C O N T E N T S

PAGE70

PAGE312nd ISPRES Congress

Sir Archibald McIndoe

PAGE62Argentinean Society History

• IPRAS Front Page Nefer by Ugo Dossi . . . . . . . . .4

• President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . .5

• General Secretary’s Message . . . . . . . . . . . . . . . . . .7

• Honorary Editor in Chief’s Message . . . . . . . . . . . .9

• IPRAS Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

• Senior Ambassador . . . . . . . . . . . . . . . . . . . . . . . . 13

• Pioneer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

• Rising Star . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

• 10th IQUAM Position Statement . . . . . . . . . . . . 22

• ISPRES Section . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

• 2nd ISPRES Congress Surveys . . . . . . . . . . . . . . . 36

• Educational programs . . . . . . . . . . . . . . . . . . . . . . 50

• National Associations’ & Plastic surgery

organizations’ News . . . . . . . . . . . . . . . . . . . . . . . . 56

• Historical Accounts . . . . . . . . . . . . . . . . . . . . . . . . 61

• Sir Archibald McIndoe . . . . . . . . . . . . . . . . . . . . . 70

• National & co-opted societies future events . . . . 71

• Industry news . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

• IPRAS Website . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

• IPRAS past General Secretaries . . . . . . . . . . . . . 86

• IPRAS Benefits for National Associations

& individual members . . . . . . . . . . . . . . . . . . . . . . 87

PAGE57Plastic Surgery Congress 2013


4 IPRAS Journal www.ipras.org Issue 13

IPRAS Front Page Nefer by Ugo Dossi About the Art of Ugo Dossi

Our Message to our Egyptian Brothers and Sisters

The art of Ugo Dossi is centered on unconscious creativity, on sensual and extra sensual perceptions. Ugo Dossi works with archetypical and collective imaginations, with automatic drawing, subliminal projections and psychic phenomena. His installations have been shown twice at Documenta (Documenta 6 and Documenta 8), at the Biennales of Venezia (1986 and 2011), of Paris (1975), of Buenos Aires (1999) and in personal exhibitions in numerous international museums. The hologram series Nefer was shown in numerous museums, e.g. the Museum of Modern Art in Vienna and the Egyptian Museum in Berlin.Ugo Dossi‘s work deals with systems and images that open up spy-holes onto the intuition of the infinite and they appeal to the part of us that would be capable of peeping through for a look, if only we were capable of finding it.Henry Martin, Cat. The mechanic of Fascination, Gall. Maeght Zurich 1979Time and again in his artwork, Ugo Dossi uses images and metaphors of endlessness to seduce and induce the viewer to immerse in a realization of the infinite. His tools of seduction seem also of unlimited spectrum, ranging from tiny objects in small boxes, which he calls “Worldmodels”, to large sculptures in architectural space, to enormous “Art-Fields” in the landscape. In his installation for Documenta 6,

he used the puzzling beauty of mathematical forms to show what he called “the relative freedom”, and for Documenta 8, he penetrated the world of the subconscious imagination, through subliminal projections.

Throughout the many facets of his work, irradiates the light of a single spirit, searching for expression in so many forms; we perceive this spirit as an intense and all-pervading echo of infinity.Dossi s programmatic new approach changes art into a metaphysical tool, into a metachemical agent. His concept contains a promise of inconceivable significance: Art can supply the

subconscious artificially and artfully with those associative elements, catalysts and stimuli, which are indispensable for a more complete functioning of the psychic metabolism. (R. Pontecorvo, Isomorphy, Brochure Biennale Venezia 1986) Even in an era, in which the concept of avantgarde has turned into an ideology that promotes innovation and the practice of permanently exceeding beyond Iimits, Dossi s ‘border crossings‘ retain their irritating radicalism. They are continuing to venture into regions that lie outside the boundaries set by our conventions on art. (Manfred Schneckenburger, Cat. Ugo Dossi, Hagen Verlag München, 1990)

See also www.ugodossi.com

Niefer in Ancient Egypt was the Goddess of Perfection, representing beauty, goodness, truth, maturity, strength, health and eternity.

Ugo Dossi combines it in this image with an embryo: the embryo symbolizes the growing power inside of us, alive but notyet delivered.

We could not find a better symbol for our message to our Egyptian brothers and sisters:

Egypt, the eternal beauty, carries a constantly growing power inside, alive but notyet delivered. Rely on your inheritage from your ancestors: beauty, goodness, truth, maturity, strength, health and eternity will take over again and carry you into a bright future.

We are proud of you and accompany this process with our wishes and prayers and love for you and your unique country.

Your IPRAS family


Cordially yours

Marita Eisenmann-KleinIPRAS President

P R E S I D E N T ’ S M E S S A G E

Board of Directors

PresidentMarita Eisenmann-Klein - Germany

General SecretaryNelson Piccolo - Brazil

TreasurerBruce Cunningham - USA

Deputy General SecretaryYi Lin Cao - China

Deputy General SecretaryBrian Kinney - USA

Deputy General SecretaryAhmed Noureldin - Egypt

Deputy General SecretaryAndreas Yiacoumettis - Greece

ParliamentarianNorbert Pallua - Germany

Executive DirectorZacharias Kaplanidis - Greece

Dear colleagues,it did not come as a surprise to us: the efficiency of training in plastic surgery, evaluated by the IPRAS Trainees Association, revealed that there are deficits in aesthetic surgery training in most parts of the world. Exceptions are found in South and Central America with Brazil and Mexico being outstanding role models for the rest of us.Aesthetic surgery everywhere in the world is not a specialty of its own, it cannot be sparated from reconstructive surgery. And we cannot ignore the fact that other specialties, too, have the right to perform regional aesthetic surgery.With the foundation of the IPRAS Academy for Aesthetic Surgery Training we did the first step into the right direction and we are eagerly awaiting our first Academy course immediately after and in conjunction with the Balkan Association congress in Montenegro on September 8th this year.Our hard working young colleagues on the IPRAS Trainees Association EXCO encourage exchange programs and their congresses, too, with the next congress upcoming in Mumbai on November 30, will promote exposure to aesthetic surgery as well.And time has come to create more interfaces between other specialties and ourselves: in regenerative surgery, as ISPRES has started very successfully, in Laser treatments, where Katharina Russe-Wilflingseder has prepared the ground with her outstanding Laser Innsbruck congresses and in craniofacial surgery, where excellent cooperations with maxillofacial surgeons, neurosurgeons and pediatric surgeons have been established in many centers throughout the world. These cooperations are based on confidence and mutual respect.Intermingling with other specialities, driven by commercial interests, however, endangers the future of our specialty.Once more, our trustee and founding member of IPRAS, Ivo Pitanguy, has proven to be a visionary: his post-graduation courses in Plastic Surgery with the inclusion of other specialties, started as early as 1960 at Pontifical Catholic University in Rio, - a perfect role model for more university training programs throughout the world.In the first issue of the IPRAS Journal Ivo Pitanguy wrote:“In my almost 50 years of experience in teaching, I have accompanied the evolution of the International Confederation for Plastic Reconstructive and Aesthetic Surgery (IPRAS), attending each and every one of its meetings. Our goals are the same: to emphasize the importance of training in all fields of plastic surgery, in its broadest sense: AESTHETIC AND RECONSTRUCTIVE, following sound basic surgical principles, which are then further developed into new and innovative procedures.As a final word, I should state that the strength and the will to spread the knowledge that I have acquired has come from the interaction with my pupils and peers. The field of knowledge that we have persued, deals with human being’s most intimate desires and the never ending quest for harmony, well-being and identification with one’s own self image.I congratulate IPRAS, its leaders and its members in persuing our common philosophy, which is train surgeons who will be capable of practicing plastic surgery, with its diverse and mutiple subspecialties, taking our experience to the world. This has been motivated by love for the human being and the sharing of knowledge, which, it is my belief, is the true meaning of the Hippocratic oath, the essence of medicine.”

Prof. Marita Eisemann-KleinPresident of IPRAS


• To promote the art and science of plastic surgery

• To further plastic surgery education and research

• To protect the safety of the patient and the profession of Plastic, Reconstructive and Aesthetic Surgery

• To relieve as far as it is possible the world from human violence or natural calamities through its humanitarian bodies

• To encourage friendship among plastic surgeons and physicians of all countries

A I M S A N D S C O P E


Dr. Nelson PiccoloIPRAS General Secretary

G E N E R A L S E C R E T A R Y ’ S M E S S A G E

Dr. Nelson PiccoloIPRAS General Secretary

to Berlin, this June, to show the state of the art in fat usage. These experts meet under a name – ISPRES, the International Society for Plastic Regenerative Surgery.Sydney Coleman was the President of ISPRES Berlin 2013 - together with Norbert Pallua , local host in Germany and Gino Rigotti ( from Italy ), President of ISPRES, under the auspices of IPRAS and its President, Marita Eisenmann-Klein, and they were able to put together a major meeting, with tens and tens of presentations who brought us basic science, and from basic science to the operating room table and to the Office, wheresatisfied patients want more, and more, and more...There was even a terminolgy consensus panel when these same experts took a look at the bulk of the related published material to see how we have been naming these findings andthis progress, and how we could implement a more “uniform language“ when we publish or discuss our progress in this field of Plastic Surgery. We have been living in the internet age for a little over 20 years now. Search engines are a part of our everyday life. These engines have an ability, after being given a key search term, to “choose” the most frequently related search terms for that specific subject, and multiply the area of searchenormously. If we were able to use a uniform set of terms on our future discussions and publications, besides “speaking the same language” with the consequently obvious benefits forthe Specialty, there would also be a gain in how our research and our results could be found and distributed. As another bonus from ISPRES Berlin 2013, IPRAS and ISPRES is creating a task force to promote guidelines for standardization of terminology of the emerging adipose derived technology and techniques (including fat grafting, adipose stem cells and SVF).We are always happy to see Plastic Surgeons from around the world working on improving the ways we practice, bringing new benefits to our patients– we are always happy to seePlastic Surgery at its best!!!

As technology and techniques evolve, Plastic Surgeons around the world are continuously presented with an ever-growing number of options to be offered to their patients. Although sophistication and/or simplicity obviously vary in the choices we have today, I consider the current use of fat grafting one of the more sophisticated, as well as one of the simplest, techniques that we can use.It is simple because it is right there, anywhere, everywhere!!! The patients have been asking us to remove and to replace fat since Professeur Illouz first showed us how to aspirate iton the early 80´s. Techniques and suggestions for techniques having gone through the natural history of evolution, and the good ones were established with time.It is sophisticated because it carries a wealth of options and benefits !!!The relatively recent finding of these cells having specializedtissue, or tissue which could turn into a specific lineage ofcells, has turned our minds into different directions, when we use fat as a filling, or as grafting.Benefits are being shown by the day, with hundreds of papersalready published on this subject. Experts and exponents appear in several corners of the world.The good news - we know who they are! These experts came

Dr. Nelson Piccolo, IPRAS General Secretary, Dr. Sydney Coleman, ISPRES General Secretary, Dr. Ahmed Adel Noreldin,

IPRAS Deputy General Secretary

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The subject of these comments is not to bring the History of Plastic Surgery to our readers, which has been already reported in many text books with extreme detail regarding authors, dates and contributions.It is common knowledge that Plastic Surgery has continuously evolved since ancient times into the modern era, being that the First and the Second World Wars were great “contributors” to major surgical improvements in this Specialty. This crescent curve, also noted at the end of the 20th century, with its consequent yield of new technologies and research results will allow for future generations to obtain incomparably better results than we could achieve in the recent past and today. There is no limit to human imagination and creativity.Although the information I am writing in this report is well known by the vast majority of plastic surgeons around the world, I believe it may be useful for the new generation as well as for the senior surgeon, in which category I am included.Plastic Surgeons around my age will remember that in the ‘50s there was a reduced number of Plastic Surgery National Societies as well a limited number of professionals dedicated to our Specialty. The Latin-American Society was founded in Brazil by our pioneers in 1941, and the Brazilian Plastic Surgery Society was founded in 1949. At that time, there were no more than 70 members in the entire country. By that time, surgeons in the United States were already well organised, with surgeons performing all sort of plastic surgery procedures and publishing their results in specific journals, as well aspioneering several programs.Even in those days, for one to become a member of a National Society, there was a mandatory requirement for specific training in General Surgery, followed by twoto three years of training in Plastic Surgery in specificdepartments. What we now call Reconstructive Surgery was an integral part of any training program. Like today, training in this area included all the malformations, hand surgery, burns, dermatological procedures, and later on, craniofacial surgery – only after this training would the

surgeon be allowed to perform aesthetic procedures, although when one considers the aesthetic plastic surgery results of that time, one could not really compare them to what is done today.Plastic Surgery procedures were usually sought after by high economical class people, most frequently by those who lived by the ocean areas and/or tropical regions where more frequently there would be a desire for exposure of one´s body. As a sign of the times, the reverse occurs today in many countries where religion or cultural reasons will forbid it, despite improvements in global communication. Also, aesthetic plastic surgery was then considered with a certain taboo – frequently, when one was asked about having had facial surgery, the reply would be that it was done for cosmetic reasons. Regardless, vanity has always been present in human culture.Expressive changes have slowly but continuously occurred in the Plastic Surgery World as well as in other specialties as a consequence of a progressively higher consuming world population. In these present times, I consider that we could summarize these new behaviors as follows:1. Medicine and Surgery have evolved to socialization

in many countries, with governments handling care directly to patients – Plastic Surgery was not included in these programs, so there was a boom in the number of Plastic Surgeons, as a natural consequence. The World Health Organisation determines that there should be a plastic surgeon for every 50,000 inhabitants. In Brazil, in general, we are now 1: 41,000 – in reality the overall distribution is extremely disproportional. In the city where I live, in the inland of the State of São Paulo, there is 1 plastic surgeon for every 9,500 inhabitants ( 1:9,500 ). Market law is pretty obvious and ubiquitous: when there is a larger offer of a product, the price will drop. Currently, one can even find a plastic surgeonwhom will receive payment in ten or more monthly installments…

2. The secretive attitude of patients of the past, maintaining the fact that they had a plastic surgical procedure almost

Ôhe past, the present and the future of the Plastic Surgery

Ricardo Baroudi

H O N O R A R Y E D I T O R - I N C H I E F ’ S M E S S A G E


as a “state secret”, slowly changed completely, with every patient telling all friends that he or she had had a procedure performed, as having plastic surgery done slowly became a status symbol. This evolved to a point where future patients and patients whom already were operated upon frequently meet socially to compare results, while also discussing who performed this or that surgery, so to chose his or her future surgeon. The name of the surgeon is always shared, even after a bad operation, so he can be chosen or avoided.

3. Plastic surgeons are continuously selected by the patients according to the quality of their results. In time, most surgeons will be sought after for a minimal number of surgical procedures, which may involve one or two regions of the body. Similarly, on publications, the surgeons become known for specifictypes of operations. As every surgeon knows that repetition brings practice and speed, it has become very rare to find a surgeon who will perform a largevariety of procedures, being that this type of surgeon has practically disappeared.

4. Also, as a reality, Plastic Surgery had its limits fragmented. In other words, without making rhetorical comments and without discussing the reason for this, it is common knowledge that today´s specialists from neighbor Specialties are performing plastic surgery on their patients. The main reason for this : money – one´s income is directly proportional to one´s number of cases – the more you operate the more money you make. We must be extremely concerned, above all, that ethical and moral principles and respect for the patient are kept at the highest standards at all times and that we do not sell out our profession cheap so to get more patients and/or to perform more procedures.

5. Blade x Needle . It is another borderline activity in use in recent decades to improve the quality of the results. Soon enough, plastic surgeons around the world understood that a needle is less dangerous than a blade, and many of them have substituted almost all their surgical procedures for dermatological treatments or are combining both in the same or different stages. Plastic surgeons have also turned to minimally invasive or non-invasive treatments (the latter previously “belonging” to the dermatologists) in attempt to improve their results and of course, also to improve their cash inflow.

6. In the past, unacceptable results left patients unhappy. Patients would go to another plastic surgeon to repair/solve the problem and also talk badly about the one who did not perform a good job. Recently, however, the situation is different and more complex: patients still do the same (changing surgeons etc ) but they also sendtheir lawyers to talk to the surgeon whom originally performed the procedure. This lawsuit industry grew fast, to a point where some physicians are only covered by insurance on specific procedureswhch they perform most. Even so, surgeons from other specialties are continuously performing procedures

previously considered to be within plastic surgery limits. Typical examples of this boundary being lost are breast aesthetic operations done by mastologists, dermatologists performing liposuction, gynecologists performing all sorts of aesthetic procedures on the torso and so on.

When I look to the future, I fear that all or most limits of Plastic Surgery may disappear completely within a progressive transitional model. I hardly believe that these will be for good. The natural competition among physicians, with different specialties, has no limits nor frontier. This competition will continue, and, not surprisingly, those with best results will prevail, regardless of their specialty. All of us have seen one or more excellent results of procedures done by a non Plastic Surgeon – like blepharoplasties performed by ophthalmologists, for example – and there is no magic formula to reverse this situation.In Brazil , and in many other countries, the Constitution is clear in stating that any physician legally registered on the Medical Council can perform any and all sort of medical, interventional and surgical procedures. However, in recent times, if a complication occurs and a lawsuit ensues, one without a specialist title has a stronger probability of been considered guilty. This has always existed, and I believe, it will continue to be so.In conclusion, I believe Plastic Surgery is an Art, and as we do more and more of the same procedure, we improve our performance as well as the procedure itself, and, of course, we get better results. Countless examples in our practice will easily demonstrate this fact. Most important is to maintain the highest principles of ethical behavior, always triaging the patients to one´s expertise. Our armamentarium is continuously being improved through the recent progress of nano-engineering activities and the constant appearance of new apparatuses, improved suture materials and instruments, modern implants and transplant materials. The eventual “fall” of the homo transplantation barrier, with total face transplantation already in its initial stages, will keep open these new frontiers and Plastic Surgery will continue to evolve – it will always be a “non-stop” evolution.Medical evolution is a continuum, where techniques are created, modified, improved and some even abandoned- It has also been called the science of momentary truths. It has been so and it will continue to be this way. One may want to criticize our professors of forty years ago, but I am sure that we may also be criticized forty years from now…As I selected messages to bring to this Editorial, I felt sorry that I was possibly not bringing any news to our readers, at least, nothing that you did not already know. As I mentioned above, these messages were aimed at the future generations who will continue to bring new techniques and technologies to this unlimited evolution of our Specialty. To conclude, I would like to be one of them, but I will leave that opportunity for my grandson…


I P R A S M A N A G E M E N T O F F I C E R E P O R TThe IPRAS Board of Directors informs

Our financesIPRAS until 2006 was financed almost exclusively by the membership dues from the national societies. This resulted in a very small amount of working capital to fund the missions of the largest international society of Plastic Surgeons. Only one world congress to 2006 had resulted in a contribution to the sponsoring organization IPRAS: in 1999 after the world congress in San Francisco the American Society of Plastic Surgery ASPS donated 55 000 US-Dollar to IPRAS. This is a very unsatisfactory outcome for any organization sponsoring large educational meetings, and instructed us that IPRAS had to gain control of the finances for their most important events: International Congresses.But we had visions and dreams: a communication forum with the individual members, more educational support for developing countries, more IPRAS representation in national congresses, more assistance in founding new national societies, more support for our young generation....After multiple brainstorming session of the members of the newly elected Board of Directors in 2007 we realized that the only solution was to establish a cooperation with a congress organization which would allow IPRAS financial control of its future, and guarantee a profit from the congresses.After two years of unsuccessful negotiations with various congress organizers we initiated an international bidding process. From 5 companies, which turned in a proposal, we selected the three finalists whose bids seemed to be affordable and invited them to Seattle for interviews.Zita congress was the only company willing to work with us under the outlined conditions: a guaranteed income of 300.000 Euro from the international congresses, to be paid in advance of the congress, with consistent revenue, on a biannual basis. There was also the potential for splitting the revenue in excess of specific financial targets between ZITA, IPRAS, and the local hosting Society. This arrangement afforded IPRAS the working capital for projects, as well as not requiring the Society to secure significant loan debt in order to finance future congresses. In effect, ZITA took the risk for future Congresses, instead of IPRAS. This arrangement has allowed IPRAS to sponsor excellent Congresses, and to develop programs that support plastic surgeons and patients throughout the world.ZITA Congress financial elements and annual balance sheets are officially audited and published in at least 2 financial newspapers every year and from 2012 are obligatory uploaded

on the ZITA Congress official website.The annual financial reports and budget have to be approved by the Executive Committee each year, and are reviewed periodically. The finances of our confederation are audited by official bodies. The tax accounts are prepared by an accounting firm in the United States, and annual filings are made by IPRAS to the American Internal Revenue Service.After the Santiago World Congress, we sent the congress income-expenses balance sheet to 104 national societies. Whoever read it carefully saw, that ZITA provided services in the range of 200.000 €, which exclusively burdened Zita’s profit

without affecting the finances of IPRAS, e.g. the additional costs of the simultaneous translations into Spanish and Portuguese, the extensive decoration with large banners about the history of IPRAS, the rich buffets during the business lunches instead of lunch boxes, the covering of all Board of Directors travel expenses and the mobile telephone applications providing attendees with the congress program.Zita also financially supported the non-profitable

regional congresses which have been organized since 2010 under the auspices of IPRAS. In five of these congresses ZITA closed with deficits that ranged from 15.000 € to 35.000 €. These financial losses have been confirmed by the auditors. IPRAS, according to the contract with Zita, did not have to share these losses nor did the national societies or sections.For ZITA’s management and all its services to IPRAS, which includes the management of the IPRAS Journal and the creation and continuous updating of the social media, ZITA is remunerated with approximately the amount of 85.000 € annually.This means that the cooperation with Zita Congress enabled us to keep the annual dues for the national societies as low as they were 50 years ago, - 6 US-$ per member for developing countries, 12 US-$ per member for developed countries.Besides the moderate travel budgets for Board of Directors members , which is similar to the reimbursement of most scientific societies such as the ASPS in America, the Directors have spent and continue to spend huge amounts of money from their own pockets for participation in congresses and conferences, as do all EXCO and Committee members.Since its partnership with ZITA, IPRAS, for the first time in its history, can rely on an income that enables the confederation to finance and achieve its humanitarian and educational goals.

Marita Eisenmann-KleinPresident

Nelson PiccoloGeneral Secretary

Norbert PalluaParliamentarian

Bruce CunninghamTreasurer

Ahmed NoreldinDeputy General

Secretary

Andreas YiacoumettisDeputy General

Secretary

Brian KinneyDeputy General

Secretary

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S E N I O R A M B A S S A D O R

Homage to Dr Henry K. Kawamoto By Seth Thaller M.D., D.M.D., Luigi Clauser

D.D.S., M.D. and Mimis Cohen M.D.

During the final weekend of December 2012, formerfellows and friends of Dr. Henry Kawamoto held a surprise celebration at the Bel-Air Bay Club, in the PacificPalisades, California, to thank their beloved mentor for his contributions to their education and careers. This event did not justly define the extent of his contributionsto our specialty of craniofacial surgery. It rather signaled a change of the direction that Henry will undergo as a preeminent educator, and hopefully he will continue to impart his vast clinical experience on future generations of plastic and craniofacial surgeons.Henry completed his medical and dental degrees at the University of Southern California. This was followed by a full training in General Surgery at Columbia Presbyterian Medical Center and Plastic Surgery training under the tutelage of Dr. John Converse at the Plastic Surgery Institute at New York University. Upon completion,

he went to Paris to learn the infant sub-specialty of Craniofacial Surgery from the pioneer Dr. Paul Tessier. From this point on the young mentee became a world-acclaimed surgeon, teacher and leader in the field. Heserved as a clinical Professor at the Division of Plastic Surgery at the University of California in Los Angeles and director of the Craniofacial Surgery fellowship of the Institution.Henry also became a founding member of the International Society of Craniofacial Surgery and was instrumental in expanding the horizons of Craniofacial Surgery through constant technical improvements and innovations. His academic impact includes authorship of numerous seminal peer reviewed articles and book chapters as well as infinite visiting lectureships in every corner of theworld. These activities have resulted in a vast array of awards and honors.

Dr Kawamoto among a group of former craniofacial fellows.


His most impressive achievement, however, remains his effort and dedication to the education of young surgeons through his Craniofacial fellowship at UCLA. Henry was able to create a unique educational environment which allowed him to share and pass on his tremendous clinical expertiseto his trainees. Over the years, he mentored a distinctive group of 32 fellows and fostered the importance of mentoring surgeons to ensure optimal care for their patients.These former fellows owe the success of their academic plastic surgery careers to their “samurai” leader and a number of them have gone on to become leaders and mentors in their own right. This unparalleled contribution will serve as Henry’s most important enduring legacy to our specialty.Dr Kawamoto has always been very proud of his former fellows and their achievements. In the introduction to the book Craniofacial Surgery, published in 2008, Dr. Kawamoto wrote among others: “The UCLA Craniofacial Fellows represent a special breed.” And followed: “The word mentor is derived from Greek mythology and the epic tale, of Odyssey. However, the Fellows’ accomplishments are no myth. Each has developed a successful practice in plastic surgery and, as is the hope of all mentors, they have superseded their training.”

You have been without question a great teacher. What is the secret of your incredible success? I never thought myself as a "great teacher", which makes this question thought provoking. I believe the "secret" is the great luck in picking the right person. And, how is this done? Right off the bat the applicants are told not to waste their time applying if they are not going into academic surgery. The second is to get accurate feedback from those who wrote the letters of recommendation ... not an easy task. Thus, we sent a mandatory questionnaire to all who wrote letters with a note stating that the application would be considered incomplete without its return. If we didn't get a response from the letter writer, we would inform the applicant that their application was incomplete and they would not be considered ... that always led to a response from the recommender!Lastly, interviews were conducted only on one day by the selection committee. Those who could not make the selected date were told there were no exceptions ... we considered this the first cutoff. Selection was by a democratic vote.I also felt that the Fellowship should start in mid July rather than on the first of July. It gave the new fellow time to move and settle down. In actual fact, they were also

so compulsive that they came on the 1st of July anyway. The advantage of this is that they got an idea of what was expected and it eased their transition into the program. It also created a bond between them. As you know, there is a tremendous camaraderie between all the Fellows, which I believe started with the overlap program. Once into the training program, we allowed the Fellow to work to their capacity. This was increased as they gathered experience and they proved themselves. Fellows were told at the initial interview that the senior resident always had first shot and they were there to assist and learnwhich eventually also made better teachers out of them. I would chew out a resident but never the Fellow in front of others; it was done on the side but rarely needed. Based on many years of experience what advice would you give to the new generation of Plastic surgeons? Seek the best training that they can get. Read, especially of the history of a procedure.What in your opinion will be the new frontier for craniofacial surgery? Regenerative surgery. We have gone through the other "R's": Recognition, Resection, Repair, Reconstruction and now in Replacement.What should active plastic surgeons do to better prepare themselves for retirement? I don't know. Knowing when to retire should just come to the individual. Active people will remain active by seeking active things to do.

Dr Kawamoto will universally remain one of the most influential plastic and craniofacial surgeons of our era.The significance of Dr. Kawamoto’s career is not simplya matter of his exceptional talent and contribution to surgery and his positive impact on the life of his patients. His legacy will continue since he was, is and will remain a great educator and a shining example to all his peers and colleagues.


P I O N E E R

Background: I was the fourth daughter in a family of six children, the first in my family to have a universityeducation, and I still live and practice in the city where I was born and raised. Education: I received my medical degree from the Federal University of Paraná in 1976, followed by my general surgery and plastic surgery residencies. After working for 10 years at a Burn and Emergency Unit, and taking time to start my family, I returned to more active academic and scientific pursuits, and was invited to do additionalfellowships abroad. These included becoming a Visiting Fellow at University of California San Francisco Medical School (UCSF), under Stephen J Mathes, a fellow to Dr. Bert Brent, a reconstructive ear specialist, in 1994-1995, followed by a Plastic Surgery Fellowship with Prof. Wolfgang Mühlbauer, in Munich, and in 1996, met our own father of plastic surgery, Dr. Ivo Pitanguy, who remains my dear friend and inspiration these many years later. I have worked with the Residents Program at UFPR, for 21 years now, and during this time, I became inspired to pursue my own higher academic degrees, and completed my Masters in plastic surgery in 2000 and my doctoral dissertation in 2001, also in plastic surgery. At this point, I began formally teaching, and in the past 11 years have evolved from substitute and volunteer professor in plastic surgery to Adjunct Professor of Plastic Surgery at UFPR. A true highlight of my career was to be invited in 2009 by John Persing as Visiting Professor of Plastic Surgery at Yale University.

In parallel to my academic and teaching careers, my life participating in international congresses and societies to a greater degree began, largely due to being noticed by Tom Biggs at a congress in Fortaleza, Brazil, where I presented over 1000 breast reductions. He visited me the next year to observe my surgeries, (I think to see if I was doing a good job…) and as then-President of ISAPS, he invited me to speak at some congresses, and with his encouragement and support, helped me share my techniques for breast augmentation and mastopexy through co-publishing with him. After this “launch” into the international world of speaking and publishing, I was invited to submit more articles, speak, teach, perform demonstration surgeries all over the world, sit on editorial committees for our most prestigious journals and hold offices including thatof the Secretary of ISAPS for Brazil, representing our country worldwide, and enter a world where the most interesting, innovative ideas are encouraged, critiqued and shared for our mutual advancement. I was recently invited by Carlos Uebel and Nazim Cerkes to be part of the scientific committee of ISAPS organizing courses inall Latino America.Why surgery/plastic surgery: During medical school, I first spent every spare hour working with a group ofanesthesiologists, where I discovered my passion for surgery, then working with a group of general surgeons to pursue this. In my final year, as on-duty physician atHospital Cajurú, I turned my focus to major and emergency surgeries, including hand and facial reconstruction,

Ruth Graf


thus leading me to plastic surgery as a specialty. My surgical and plastic surgery residencies allowed me to perform dozens of reconstructive and aesthetic surgeries, confirming my choice of plastic surgery as my passion.Pivotal events in my life:• When I received my medical degree, of 180 students

in my class, there were only 20 women. Now, women comprise more than 50% of graduating doctors. Even so, I have found more acceptance abroad as a woman who excels in surgery than in my own country and city. My long quest to become president of our regional chapter of the Society of Brazilian Plastic Surgeons was only achieved in 2004. I proudly served for 2 years, with the most significant achievements being bringinga conference on small incision procedures to our region, and raising funds for our own headquarters in Paraná.

• My family’s experience abroad during my foreign fellowships opened not just my mind, but the minds of my entire family, with my daughters participating in international exchanges, and speaking English fluently.Our lives were irrevocably changed and greatly enriched by these fellowships.

Plastic surgery now: It is a more egalitarian specialization now in Brazil, and perhaps worldwide, and our focus has moved much more toward the wellbeing of the patient on the whole, including the pursuit of ever-safer and ever more natural looking procedures. Many practices include nutritional and fitness counseling, skin care andother health and beauty related services. Regenerative medicine, including the use of fat and stem cells, is on the near horizon as studies are being carried out to evaluate their long term benefits.Future: The future is here and now, as we move along this continuum toward less invasive, more natural, more rejuvenating treatments for people who are living longer and want to live more healthily, more beautifully. Balance: In addition to balancing my academic and scientific pursuits, operating a large private clinic thatalso serves as a teaching clinic, and devoting time to my growing family, as my children have my grandchildren, I always make time for physical exercise and recreation, especially biking and swimming with my husband. Plastic surgery is not a career for the weak-bodied, and these sports can be enjoyed with family.


R I S I N G S T A R

Did you ever consider a different career than Plastic surgery? If yes, what other options were you considering and what made you finalize your selection?I considered a career as a veterinarian when I was growing up. As I got older - I realized I would be happy just to have a few pets and that human medicine would be a better fit. I seriously considered international health as my interest in medicine came from my years as a Peace Corps volunteer in Honduras after college.I fell in love with plastic surgery when I did the rotations in medical school. I saw a TRAM breast reconstruction and thought it was the most ingenious operation - and that solidified it.You are a visionary: did you ever have doubts that the break-through for your pioneer work will come?When you are doing research in the lab, you so often fail. And it is so hard to get all the moving parts ‘right’. I think dusting yourself off after things not working in the lab to do it all over again is always hard - yet usually in the end - worth it. I think anyone in scientific research has to have an element of faith that things will work out.Did you feel disappointed or discouraged about the skepticism which the majority of plastic surgeons showed towards fat grafting for a long time? Fat grafting is now generally accepted, but I think a healthy skepticism towards any technique is appropriate. We need to prove things scientifically in addition to clinically. And when we say something works clinically - we need to be rigorous about how we prove that. Some disappointing moments during your professional life?Disappointing moments? Many! But far more high moments!Mistakes you could have avoided?Mistakes? I think a mistake many young doctors make at an Academic medical center - is that they get pulled in too many different directions. You are asked to do so many things for so many people that it’s easy to lose focus and not do what you are truly interested in. I wish I had gotten involved in the medical missions much earlier in my career - Women for Women - as it has been one of the most gratifying experiences for me.Is there something you regret not having pursued?

Alexis Hazen

No regrets yet - I still have time to pursue things I haven’t completely mastered or projects I haven’t completed!Which results of your research projects do you consider to be most important?I think the things I am most proud of is creating animal models that allow us to study human lipoaspirate. The radiation model and the fat transfer model I think are helpful additions to the scientific community. Briefly describe your current position and the variety of patients you treat on a daily basis.I am an Associate professor in Plastic Surgery. I am the Director of the NYU Aesthetic Surgery Center. My practice is largely breast surgery - reconstruction and cosmetic. My research interests are in lipoaspirate and 3D animations as a vehicle for training surgeons and educating patients. So far, what were the highlights of your career?The highlights of my career have been going on surgical missions with Women for women, and being a host on doctor radio. Both are not aspects of a career that I would have thought about at the onset - but both are gratifying and interesting.What are your goals for the next few years?I would like to be able to spend more time on my areas of research in the next years. I also think plastic surgeons should become involved in the development of new technology - and I think that is intimately tied to the long-term health of the profession.What is the future of Plastic surgery in the US?I think that the future is bright in plastic surgery - though there are rocky roads ahead. The changes in reimbursement will make the endless training and the expense of medical school seem untenable - and to some extent it will be. I think medicine is a little broken right now - but plastic surgery is always a great field!What do you like to do in your free time; hobbies/sports? What is your favorite book?In my free time - I like hanging out with my children. I play golf with my son, and paint with my daughter. I love to read - most recently a book called ‘Give and Take’ by Adam Grant. I am recently getting into yoga and meditation - midlife crisis?






IQUAM issues its 10th Position Statement, which is for use and reference by practicing physicians worldwide, and by international healthcare 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.1-8

1. Alloplastic 1.1 Breast implantsA. 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 9-11, continue to be widely used internationally for breast implantation, with the implant types varying by geographic region.

B. Some reports show that the textured surface covered implants may have lesser incidence of capsular contracture 12-13

C. Additional clinical 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.14

D. Between 2000 and 2010 a French company PIP produced breast implants filled with industrial gelinstead of medical grade gel. These implants, marketed under PIP implants, “M”- implants or “TiBreeze”- implants, are associated with higher rupture rates and inflammatory tissue reactions (15-17).

E. Case reports about incidents of Anaplastic Large Cell Lymphoma formation in capsular tissue raise more and more concerns. Although the number of patients is still low (currently 130 reports worldwide), the identification of risk factors for this rare diseaseshould be given highest priority 18--22.

F. 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.

1.2. 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.A. When implanted, Acelluar Dermal Matrices (ADM)

can undergo one of the following: - Regeneration / integration - Resorption - Encapsulation Only those products that have been demonstrated to

10th POSITION STATEMENT November 4, 2012

Manuel Garcia-Velasco MDVice-President

Vialidad de la Barranca SN-550Huixquilucan Mexico City MEXICO 52763

Phone 5255 52469551E mail:[email protected]

THE INTERNATIONAL COMMITTEE FOR QUALITY ASSURANCE, MEDICAL TECHNOLOGIES AND DEVICES IN PLASTIC SURGERY

Constance Neuhann-Lorenz , M.D. PresidentTheatinerstrasse 180333 München, DEUTSCHLAND Phone: 49 89 348123 - Fax: 49 89 25540933E-mail: [email protected]


regenerate and integrate with the host tissue are to be recommended for implantation.

B. ADM’s must be stored, handled and prepared according to the manufacturer’s recommendations. They also require appropriate surgical technique by adequately trained surgeons. 25

1.3 Other materials There is no currently available non autologous material that satisfies safety and efficacy requirements for breastenlargement or volume replacement.

2. AutologousSurgical 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. 23-27

2.1 Fat grafting

Fat grafting for soft tissue defects has been performed for over 40 years with low complication rates. Ongoing studies show promising results of fat 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 as well as eventual side effects of vacuum application.28-31

3. Clinical Recommendations for Breast Augmentation and ReconstructionA. IQUAM believes it is important to advise patients

of potential hazards and risks, the possible need for re-operations, 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 for aesthetic 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.

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

E. No definite period of time has yet been defined for the longevity of breast implants and recommendations for routine replacement should be given under a careful individual risk/benefit evaluation. The indications for replacement should be based on specific patient indications.

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

G. Advertising of breast implant procedures should be restricted to the aspects of the surgery, and presented in a professional dignified way and without exaggerated claims.32-40

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.

LiposuctionThe proper processing of multiple-use cannulas is especially important considering the recent reports of mycobacterial infections related to liposuction and fat injections. 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 labor-intensive process, which requires meticulous attention to detail particularly with regard to the non-visible surfaces. Autoclaving should always be performed. Thorough cleaning of all exposed and hidden surfaces followed by removal of all cleaning agents is essential before autoclaving. The autoclave must be used at appropriate settings to eliminate bacteria and minimize mycobacterium, prions and biofilms.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.41-51

Minimally invasive laser-assisted lipolysis and skin tightening is FDA approved. The emitted laser light induces lipolysis and new collagen formation resulting in thickening and tightening of skin. An optical flexible fiberis guided through a temperature sensing cannula into the tissue. The interstitial temperature should be measured and recorded to a screen at any time of the procedure to ensure safety and efficacy of the procedure.52-57 Non-invasive laser and energy based devices for body


contouring to improve skin laxity, subcutaneous fatty tissue and cellulite deformities are available. The efficacyof non-invasive fat removal is limited. Numerous devices as lasers alone or in combination with vacuum suction, cryolipolysis, focused ultrasound, radiofrequency and radial shockwaves are still under review for safety and efficacy, some are FDA approved. 58-62

Tissue Engineering and Wound HealingTissue 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.Regenerative medicine is a promising road for future advancements in plastic surgery. Laboratory cultured constructs must consist of safe components before implantation in patients.63-66

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.National regulations for the use of adipose tissue derived stem cells vary considerably.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.67-72

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. Notifies bodies issuing CE-mark certifications should be aware of this.73-74

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. 75-77

Injectable Therapies1.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 double ‘off label’ (indication and application subcutaneously) for dissolving fat in aesthetic applications. Data concerning the efficacy, outcome and the safety of its use for aesthetic indications in the subcutaneous tissue have not yet been established. Further basic science and clinical trials, such as PMA trials underway are needed.78-81

2. Botulinum Toxine

Botulinum Toxine 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.

3. 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 non-resorbable fillers, as recommended by many national health authorities or academic societies. Furthermore, IQUAM stresses that degradability should be discerned from resorbability.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. 82-85

3.1. Collagen FillersCollagen 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.86-88

3.2. Hyaluronic Acid Filler

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 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. 89-95

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.96-100

3.3. Cross Linked Polyacrylamide HydrogelPermanent 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. 101-10

3.4. PolyMethylMethAcrylate /Collagen Injectable FillerIn 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.110

4. Gold ThreadsThe 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 111

5. General recommendations regarding injectable therapiesIQUAM urges governments to pass legislation to prohibit the use of non-certified products and to protect patients

from untrained physicians and non-medical 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.

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I S P R E S S E C T I O N

A paradigm shift has occurred in plastic surgery and related specialties: the emergence of regenerative surgery. The International Society of Plastic Regenerative Surgery (ISPRES) was created to help the world share advances in the science and clinical practice ofadipose-based regeneration. The second annual Congress of ISPRES convened June 6-9, 2013 in Berlin, Germany.

What is Regenerative Surgery?Regenerative surgery involves the manipulation of our own body’s tissues to treat and cure conditions, rather than using drugs and more invasive, non-natural procedures. This regenerative approach is no longer a dream of the future, but has rapidly become part of our current clinical practices.

How was the content of ISPRES Berlin 2013 determined?The Scientific Committee and the OrganizingCommittee devised the framework of ISPRES Berlin 2013 by nominating speakers and presenters from every corner of the world. Each invited speaker was asked to share his or her most clinically significantresearch and/or relevant, recent clinical experiences. We combined scientists with surgeons from around the world to provide a fresh understanding of adipose derived stem cells (ADS), stromal vascular fraction (SVF) and fat transplantation. The program was not just at the cutting edge of science, but also full of clinical knowledge which surgeons can implement into their practices.

2nd ISPRES CONGRESS, BERLIN, GERMANY

JUNE 6-9, 2013

Sydney ColemanCongress President

ISPRES General Secretary

From the left: Dr. Tsai-Ming Lin, Taiwan, Dr. Brian Kinney, US, (in front) Dr. Peter Rubin, US, Dr. Sydney Coleman, US, Dr. Marita Eisenmann-Klein, Germany, Dr. Nelson Piccolo, Brazil, Dr. Ahmed Adel Noureldin, Egypt, Dr. Kotaro Yoshimura, Japan, Dr. Roger

Khouri, US, Dr. Gino Rigotti, Italy


How was ISPRES different from other meetings?ISPRES Berlin 2013 and its predecessor, ISPRES Rome 2012, were meetings that taught attendees by sharing information about fat grafting and adipose-related technology from every corner of the world. Instead of having instructors teaching the audience, the meeting focused on the sharing of innovations, or even revelations, in the clinical use of fat grafting, stromal vascular fraction, adipose derived stem cells and growth factors. Research presented was primarily of a translational nature that will most likely influence plastic surgery clinical practicesin the near future. Invited lecturers and faculty formed the foundation of the meeting, but we relied heavily on submitted abstracts. This combination of presenters gave the attendees of ISPRES Berlin a truly international perspective of adipose technology and regeneration, with 88 presenters from 45 countries: Argentina, Armenia,

Initial SessionsAfter the opening ceremonies, the Congress launched immediately into a review of the history of fat grafting in plastic surgery by Riccardo Mazzola. The first sessionsof ISPRES Berlin 2013 provided the attendee with a new understanding of how adipose derived stem cells work. The early sessions laid the groundwork so the audience

Conference Hall

Australia, Austria, Belgium, Brazil, China, Costa Rica, Czech Republic, Denmark, Egypt, Estonia, France, Germany, Greece, Hungary, India, Israel, Italy, Japan, Kuwait, Latvia, Mexico, New Zealand, Nigeria, Norway, Peru, Philippines, Poland, Romania, Russia, Saudi Arabia, Serbia, South Africa, South Korea, Spain, Switzerland, Taiwan, The Netherlands, Turkey, UK, Ukraine, United Arab, Emirates, USA, Venezuela.

Dr. Magalon Guy, France, Dr. Peter Vogt, Germany, President of the German Society of Plastic, Reconstructive and Aesthetic

Surgery, Mrs. Vogt, Dr. Anthony Joseph, Japan

Dr. Mimis Cohen, IPRAS Chair of the Scientific Advisory Board, Mr. George A. Oram Executive Vice President, Sales and Marketing of MTF, Dr. Gregory Evans, President of ASPS, Mr. Bruce W. Stroever, President and Chief Executive Officer of Musculoskeletal Transplant Foundation MTF, Mr. Patrick Gostomski, International Sales and Marketing Manager at MTF

could appreciate the revolutionary clinical studies presented throughout the remainder of the Congress.Gino Rigotti, ISPRES president, began the first scientifictalk with a discussion of the newly recognized entity, the POSTADIPOCYTE, and its potentially integral role in fat grafting. Brian Kinney foreshadowed the importance of nomenclature in a brief talk that followed. Hans Hauner, the first scientist who isolated and cultured humanpreadipocytes, was our keynote speaker this year. The following sessions began with descriptions of how fat grafting affects the tissues into which it is placed. Sydney Coleman related his early experiences in the 1980’s and early 90’s of witnessing improvement in the quality of skin, diminution of wrinkles decrease in pore size and improvement in skin color. He was the first tonotice and communicate to the world, the improvement in scarring and radiation damage after fat grafting. Ali Mojallal, Eckhard Alt and Wolfgang Wagner further highlighted the dramatic changes in aging skin treated with fat grafting. Following that, much attention was devoted to understanding the regenerative effect of adipose derived stem cells and growth factors. Particular attention was paid to the addition of stem cells and SVF to fat.

Understanding Adipose Derived Stem CellsConsiderable time was devoted to the understanding of ADSC. Peter Rubin, Norbert Pallua, Dennis Von Heimburg, Eckhart Alt, Lee Pu, Kotaro Yoshimura, Renata Sonnefeld, Patricio Centurion, Degheidly Tamer, Cheng Nai-Chen, Ramon Llull andFeng Lu all presented insights into ADSC and approaches to understanding their contribution to regeneration.


Maximizing Fat GraftsBeginning on the first day, we had important sessions ondifferent methods for maximizing donor and recipient sites for clinical fat grafting. Kotaro Yoshimura began with an overview of enhancing regeneration after fat grafting, and discussed many factors over the course of the meeting that might enhance fat graft take. Ali Mojallal discussed the effect of the size of the lobule on fat graft survival. Peter Rubin reviewed experimental studies that analyzed fat graft survival. Lee Pu gave a comprehensive review of the recent advances in research, focusing on the technical maneuvers for harvesting and placement.

External ExpansionDennis Orgill from Boston joined us to present several talks on the effect of mechanical forces on living fat, and teamed up with Roger Khouri and Yvonne Heit to discuss the effect of external volume expansion and Brava on fat graft survival. Discussions of this technology continued throughout the presentations of fat grafting in the breast.

Can additives improve fat grafting?Valerio Cervelli and Pietro Gentile presented a large positive experience with the use of PRP to enhance fat grafting. Peter Rubin, Aldel Noreldin of Egypt, Dana Jianu of Romania and many others expressed similar positive effects of growth factors. Willemsen Joep demonstrated that PRP added to facial fat grafting not only improved the results, but also reduced recovery time.

Stromal Vascular FractionStromal Vascular Fraction was highlighted at ISPRES Berlin 2013 as an evolving technology that deserves the utmost attention. Discussion of fat grafting was the only topic, which was discussed more often than SVF. In fact, SVF was discussed to some extent at almost every session in the entire congress. Carlo Tremolada, Camillo Ricordi, and others from Italy discussed the rationale and potential clinical uses of “LipoGems”. This new technology was presented as a miraculous method of concentrating adipose derived stem cells. However, many in the audience sharply criticized LipoGems during the animated discussions that followed the presentationsDavid Daehwan Park from Korea, Sundar Raj Swathi from

India and Jae-Ho Jeong presented automated methods of extraction. Florian Lampert presented an alternative view of the technology of SVF.The status quo was well represented by John Fraser from California who gave an informative update on the SVF clinical studies underway using the Celution® System. He combined forces with Steven Cohen, also from

Dr. Peter Rubin, ISPRES founding member

Conference dinner at the German Parliament.

California,and Guy Magalon from Marseilles to analyze what is in SVF and how to determine the varying contents.We had sessions on the use of SVF- enriched fat for an amazing array of indications: for instance, rejuvenation, combat injuries, scars, burn wounds, scleroderma, diabetic ulcers, open fractures and many breast indications.We also spent much time discussing potential problems with the use of SVF, including safety issues, potential complications, and government regulation of SVF.

Prof. Coleman, ISPRES Congress President, ISPRES General Secretary and Prof. Eisenmann-Klein, ISPRES President during the conference dinner thanked Musculoskeletal Transplant

Foundation MTF for their contribution.

Fat grafting to the breastsSix hours of ISPRES 2013 were devoted to the use of fat in the normal breast (Kolasinski Jerzy, Abboud Marwan, Wettstein Reto, Amin KalaajiandDaniel Del Vecchio). Extended sessions continued with presentations of fat grafting in the reconstructed breast (Nolan Karp of USA, Ali Mojallal, Paulo Leal of Brazil, Kosovac Olivera, Gino Rigotti, Roger Khouri, Harder Yves and Broer Niclas). The use of SVF enriched fat was then presented in extensive talks by Kotaro Yoshimura, Pietro Gentile, Ramon Llull, Aris Sterodimas of Greece, and Dan Del Vecchio.


Correction of Chronic Conditions Perhaps the most revolutionary sessions of the meeting were devoted to the correction of previously difficult to treat or untreatable chronic conditionswith fat grafting and SVF. Talks about systemic or localized sclerosis were given by Guy Magalon of France, Gino Rigotti, Caviggioli Fabio, and Isabella Mazzola of Italy. Sandeep Sharma of India and Stasch Tilman presented the use of SVF in diabetic ulcers. Roger Khouri presented the use of fat grafting for the correction of Dupuytren’s Contracture. Other talks addressed the treatment of Lichen Sclerosis of the Vulva (Casabona Francesco), radiation injuries (Vasilyev and Alessandra Marchi) and even stress incontinence (Florence Rampillon) with fat grafts.

Tissue EngineeringTo obtain a glimpse into the future, many tissue-engineering presentations were given. Aris Sterodimas of Greece showed us three-dimensional scaffolds used to engineer an ear. Jorg Witfang presented combining bone with stem cells for enhanced bone regeneration. Bosetti Michela, P.Bauer-Kreisel, Feng Lu,Radke Christine, Uysal Cagri, Dennis Orgill and Sin-Daw Lindescribed methods for repairing tissue defects with fat grafting combined with scaffolds.

Fat StorageLee Pu, Norbert Pallua, John Fraser, Jeffrey Hartog, Lamblet Hebert, Skorobac Asanin Violeta, andCarelli Stephanagave conflicting views of the efficacy of freezing fat.

Glass dome at the German Parliament.

Can Fat Grafting Affect Breast Cancer?The final session of the breast section was devotedto safety. The effect of fat grafting on breast cancer occurrence anddetection was discussed extensively by Ramon Llull, Joern Kuhbier, Alessandra Marchi, and Qing Feng Li. Norbert Pallua gave a thorough summary of the worldwide experience so far with breast cancer and fat grafting.

Craniofacial/ Maxillofacial Applications These sessions began with Riccardo Mazzola tracing the use of fat grafting in war injuries from WWI to today. Mazzola’s talk was a great introduction to Peter Rubin, who spoke on the treatment of craniofacial war injuries and painful amputations with fat grafting. Ewa Siolo offered up her extensive experience in the use of fat grafts in craniofacial and cleft surgery. Fernando Molina demonstrated his considerable experience in using fat injections in craniosynostosis and syndromic craniofacial deformities. Riccardo Tieghi of Italy presented an overview of the application of structural fat grafting in patients with congenital craniofacial deformities.

Aesthetic Facial Fat GraftingFive hours were devoted to aesthetic facial fat grafting. Especially interesting were the talks on the use of SVF to supplement facial fat grafting given by Seung-Kkyu Han, David Daehwan Park, Aris Sterodimas, Steven Cohen and Gontijo de Amorim Natale of Brazil. The simpler, more traditional uses of facial fat grafting were presented by one of the first users of fat grafts, Abel Chajchir, as well asFernando Molino, Lin Tsai-Ming and Kotaro Yoshimura.


Regulations & Ethics concerning Fat Transplants, SVF, ADSC & Growth FactorsToward the final moments of the meeting, perhaps oneof the most interesting sessions was on government regulation and ethics. Brian Kinney continued his discussion from the first day, talking about the onlinemarketing of fat grafts and stem cells. Gino Rigotti posed the alarming question,“Can Fat Grafting be Regulated Like a Drug?” Greg Evans, current President of ASPS, gave an update on the FDA and other regulatory agencies. Rick D’Amico gave an update on the ASPS task force on regenerative medicine. A lively discussion followed.

Pre-Meeting A course entitled “Fundamentals of fat grafting: complementary and conflicting techniques” took place onJune 6, 2013, the afternoon before the Congress began. This was a basic course comparing the varying techniques that have evolved in fat grafting, contrasting the many techniques that have developed for different indications, looking at how they contrast with and complement each other. The presenters were Roger Khouri of the US, Daniel Del Vecchio from the US, Gino Rigotti of Italy, Sydney Coleman, Nelson Piccolo of Brazil and Ewa Siolo from South Africa. The differences and similarities of each technique were highlighted.

Dr Mauro André Arguello, Brazil, Dra Fabiana Corio, Brazil, Dr. Alessandra Marchi, Italy, ISPRES Assistant General Secretary, Dr. B. Venkata Ratnam - Vice President of the Emirates Plastic Surgery Society, Prof. Gino Rigotti, ISPRES President, Dra. Natale Gontijo de Amorim, Brazil, Dr. Romulo Mene, Brazil, Dr. Monica Piccolo, Brazil, Dr. Nelson Piccolo, Brazil, IPRAS General Secretary, Prof.

Riccardo Mazzola, Italy, IPRAS Historian

We also presented some of the fundamentals of the preparation of SVF using different methods and devicesat the pre-meeting. Also during that pre-meeting, we there was a specificcourse by Lance Lancerotti of Italy,with the purpose of educating practicing physicians about the nomenclature of Cell Biology, which has rapidly become a part of the plastic surgery literature. Another course, presented by Peter Rubin of Pittsburgh, was a thorough guide to help attendees understand and interpret scientific studies moreintelligently.

Conference dinnerA spectacular conference dinner took place at the German Parliament on Saturday the 8th of June where ISPRES had the chance to thank the Musculoskeletal Transplantation Foundation (MTF), our major sponsor, for its generous contribution to ISPRES Berlin 2013. Participants had a fantastic time at this breathtaking venue with delicious gourmet meal at the restaurant where only members of the parliament are usually allowed to enter. The stunning panoramic view over the city of Berlin from the glass dome was astonishing. The amazing venue not only gave attendees an amaz–ing culinary and visual experience, but also was a great time to socialize. ISPRES 2014 will take place in New York City. Stay tuned for updates.


Introduction/Purpose:Systemic sclerosis (scleroderma SSc) is a chronic multifactorial systemic disease of connective tissue, characterized by fibrosis and widespread vasculopathy. According to the extension of cutaneous thickening the disease is classified in diffuse (dcSSC) or limited systemicsclerosis (lcSSc). LcSSc, in which sclerosis is confined tothe extremities and face, tends to have an insidious onset. Digital ulcers, a typical feature of the hand's cutaneous manifestations, occur either distally or over the bony prominences, whereas in the face at a perioral level. The aim of this paper is to report our experience by treating these affected areas with autologous fat transplantation.

Material and Methods: From 2010 to 2012, 15 patients (14 women and 1 man, mean age 65 years) for a total of 37 digital ulcers and 9 perioral regions have been treated.An extensive debridement of the digital ulcers and concurrent fat grafting with autologous adipocytes previously centrifugated is performed. 1-2 ml of pure adipose tissue is injected in the dorsal surface of the finger with 18G blunt cannulas, whereas 3-5ml with 21Gcannulas in the perioral area. Patients are allowed normal hand use from the first postoperative day.

Results: Improvement of scleroderma with fat grafting was particularly significant with a total healing of 19 digitulcers at 3 months after one procedure. The remaining 18 ulcers showed a noteworthy decrease of their diameter and accelerated rates of wound healing. Functional disability of perioral regions showed an immediate improvement and all patients reported a considerable reduction in the local pain in the affected regions of the hands and face. No complications were observed.

Autologous fat transplantation: an adjuvant treatment for Limited Systemic Scleroderma

Mazzola I, Confalonieri PL, Musumarra G, Del Bene M.Department of Plastic, Hand Surgery, and Reconstructive Microsurgery,

Ospedale San Gerardo, Monza, ItalyCorresponding author:

Dr. Isabella Mazzola: [email protected]

2 n d I S P R E S C O N G R E S S S U R V E Y S

Right hand Left hand

Intraoperative technique


Conclusions: Current treatments (systemic and local) are only moderately effective in reducing the severity of the vascular manifestations caused by Scleroderma. Autologous fat transplantation provides substantial benefit in terms of healing or prevention of digital ulcers.This safe and minimally invasive technique, as additional therapy, facilitates wound healing and reduces drastically recovery time.

Dorsal side of both hands

Category: Acute, subacute and chronic conditions treated with fat grafting

Disclosure: No conflict of interest

Volar side of both hands


Building on findings from in-vitro and in-vivoexperiments that suggest a supportive role of ADSCs on their surrounding cells in autologous fat transplantation, the so-called „Cell-assisted-Lipotransfer“ (CAL) has been invented to ameliorate the clinical outcomes of autologous fat transplantation. Despite of encouraging data from basic research, evidentiary clinical data for these interventions is barely provided, neither is information on security issues such as the risk of inadequate differentiation or the development of malignancies.In order to remedy such unsatisfactory tendencies, we conducted a systematic review in collaboration with the German Cochrane Center. A thorough search strategy was conducted in eight major scientific databases.3161 publications were obtained. These were screened by two independent scientific reviewers, leading to

228 potentially relevant publications, out of which 78 were judged relevant after full text examination by the two reviewers (Fig. 1). Of the latter, only 14% (11 publications) were clinical studies (Fig. 2). Out of these, only two studies met Evidence-Level III criteria. The remaining publications had an Evidence Level of IV or V. Considering all studies, a total of only 184 CAL-procedures is described. No follow-up exceeded 42 months, neither adequate data on oncological safety is provided -especially alarming with regard to patients who receive the procedure after oncological treatment, e.g. for breast reconstruction.

“Cell-assisted Lipotransfer” A critical Appraisal of Yet Another “Stem Cell Therapy”

Lampert FM, Grabin S, Torio N, Stark GB

Corresponding author:Dr. Florian M. Lampert, M.D.

[email protected]

None of the authors has any financial relationship or affiliation with any businesses whose products or services arerelated to the subject matter of the presentation topic

In summary, not a single proof of the superiority of CAL in comparison to the conventional method of fat transplantation could be brought to light; security issues are completely neglected or only inadequately referred to.Prior to the implementation of this unquestionably extremely promising technique into the armamentarium of Plastic Surgery, we have to gain possession of substantiated, high-grade evidence for its efficacy as wellas on safety issues. It is up to us as the serious exponents of our discipline to provide this evidence.


Introduction: Autologous fat grafting (lipofilling) from processed lipoaspirate is widely used to correct contour deformities and volume asymmetries after reconstructive surgery of the breast. Newer studies indicate that lipofilling of the breast is associated with low morbidity, an almost unaffected radiological follow-up and a predictable resorption rate. [1-5] One currently assumes that active smoking and irradiation of the breast after Breast Conservative Treatment (BCT) respectively the skin and the thoracic wall after mastectomy decrease the engraftment rate of the fat due to impaired perfusion conditions and limited angiogenic response. The study aim was therefore to evaluate the resorption rate of the fat in healthy irradiated and non-irradiated patients as well as in smokers.

Material and Methods: We concluded a consecutive analysis of 82 lipofilling-procedures in 40 patients (56 cases; 64 reconstructions; 8 BCTs; 7 healthy breasts) during a 30-month period. Demographics and risk factors (smoking, diabetes radiotherapy of the thoracic wall and/or or breast ± axillar crease) were collected. After infiltrationof tumescence-solution, liposuction of the fat was performed into a closed system. Thereafter the fat was filled into 10ml syringes to be centrifuged for 2 minutesat 3’000RPMs. The fat was then injected in a multi-layer and multidirectional way, sparing glandular tissue. Documentation included a questionnaire (assessment of shape, contour, symmetry and consistency of the breast), standardized photography and volumetry (3-D surface scan: Konica-Minolta®/Geomagic®) before and after surgery, according to a given timeline: preoperative and postoperative 3 days, 4 weeks, 3, 6, 12 and 18 months. Resorption rate was assessed in 4 different groups healthy patients (n=12); smoking (n=10); radiotherapy:

(n=12); smoking and radiotherapy: (n=7)) as well as between lipofilling-procedure 1 and 2 (interval 1: n=20)and lipofilling-procedure 2 and 3 (interval 2: n=12).

Results: The mean BMI of the patients was 25kg/m2 body surface (19-36). 33% of the patients were active smokers, 43% had received neo- or adjuvant radiotherapy previous to lipofilling. The mean injection volume per session was151ml (30ml-490ml). The overall resorption rate of the fat at 18 months (n=7) was 41% (37%-52%: Fig. 1A). The resorption rate at 12 months of the 4 groups: healthy patients: 43%; smokers: 41%; irradiated breasts: 43%; smokers with irradiated breast: 41%; n.s. (Fig. 1B). Also, no difference was observed with regard to the resorption rate in patients receiving multiple lipofillings(Fig. 1C). The procedure was associated with following morbidity: Perioperative: None (infection, hematoma). Postoperatively, we observed 4 palpable, painless fat necroses. At the donor-site, contour deformity (“denting”) and paraesthesia in the dermatome of the lateral cutaneous nerve of the thigh was observed in 1 case each (Fig. 2A). 97%-100% of the patients reported an excellent or a good degree of satisfaction for shape, symmetry and consistency, whereas only 3% reported a moderate degree of satisfaction (Fig. 2B-D, 3 & 4).

Conclusion: Surgical refinement with injection of autologous fat afterreconstructive surgery of the breast is a safe method of addressing contour deformities and asymmetries. Fat grafting is associated with a very low complication rate and a very high patient satisfaction. Fat resorption does not seem to be influenced, neither by active smoking norby irradiation of the recipient site. Follow-up studies including more patients are needed to confirm both thistrend and the safety of the procedure.

Surgical Refinement with Autologous fat grafting following reconstructive

surgery of the breast: The influence of smoking and radiotherapy

Yves Harder, Allan A. Allan, Daniel Müller, Maximilian Eder, Laszlo Kovacs, Hans-Günther Machens, Jan-Thorsten Schantz

Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Germany


Fig.�2

[%]

[%]

[%]

[%]

Fig. 2: Perioperative morbidity of the procedure showing neither infection (Inf) nor hematoma. 4

palpable, painless fat necroses were observed in the 82 procedures (FN). 1 dent respectively 1

transient paraesthesia (lateral cutaneous nerve of the thigh) occurred (HS: A). Patient satisfaction at

12 months for shape (B), symmetry (C) and consistency (D: n=40) was very high with only 3%

satisfactory results.

A B

A B

Fig. 2: Perioperative morbidity of the procedure showing neither infection (Inf) nor hematoma. 4 palpable, painless fat necroses were observed in the 82 procedures (FN). 1 dent respectively 1 transient paraesthesia (lateral cutaneous nerve of the thigh) occurred (Par: A). Patient satisfaction at 12 months for shape (B), symmetry (C) and consistency (D: n=40) was very high with only 3% unsatisfactory results.

Fig. 1: Fat resorption over 18 months shows a constant volume decrease over 6 months that slows down over another 3 months. Only then, stable conditions are reached with a resorption rate of ~40% (=engraftment rate of ~60%). Note the initial volume increase with regard to baseline (preop), resulting from slight overcorrection and swelling (A). Fat resorption at 12 months in healthy individuals, 2 x smokers, patients with a history of radiotherapy and active smokers that have been irradiated previous to lipofilling. Note that the resorption rate of ~40% is similar in all 4 groups (B). Also, resorption rate between lipofilling no. 1 and no. 2 (interval 1) and lipofilling no. 2 and no. 3 (interval 2) is ~40% (C).

Fig.�1

[%]

[%]

[%]

Fig. 1: Fat resorption over 18 months shows a constant volume decrease over 6 months that slows

down over another 3 months. Only then, stable conditions are reached with a resorption rate of

~40% (=engraftment rate of ~60%). Note the initial volume increase with regard to baseline (preop),

resulting from slight overcorrection and swelling (A). Fat resorption at 12 months in healthy

individuals, active smokers, patients with a history of radiotherapy and active smokers that have

been irradiated previous to lipofilling. Note that the resorption rate of ~40% is similar in all 4 groups

(B). Also, resorption rate between lipofilling no. 1 and no. 2 (interval 1) and lipofilling no. 2 and no.

3 (interval 2) is ~40% (C).

A

B

C

Fig.�1

[%]

[%]

[%]









A

B

C

Fig.�1

[%]

[%]

[%]









A

B

C

Par


Fig. 3: 56-year old patient after BCT and adjuvant radiotherapy of the left breast with a contour deformity in the upper inner quadrant particularly visible on the oblique view and the surface scan (A). 2 years after 2 lipofilling-procedures of 100ml and 67 ml respectively, the deformity has been completely corrected (B).

Fig. 4: 42-year old patient after failed secondary breast reconstruction with pedicled latissimus dorsi flap and implant. Contour deformity of the upper outer quadrant and volume defect after implant removal due to infection (A). 1 year after 2 lipofilling-procedures of 303ml and 160ml of the entire breast and nipple reconstruction. Note the symmetrization (B).

Fig.�3

Fig. 3: 56-year old patient after breast conservative treatment and adjuvant radiotherapy of the left

breast with a contour deformity in the upper inner quadrant particularly visible on the oblique view

and the surface scan (A). 2 years after 2 lipofilling-procedures of 100ml and 67 ml respectively, the

deformity has been completely corrected (B).

A

B

Fig.�3

Fig. 3: 56-year old patient after breast conservative treatment and adjuvant radiotherapy of the left

breast with a contour deformity in the upper inner quadrant particularly visible on the oblique view

and the surface scan (A). 2 years after 2 lipofilling-procedures of 100ml and 67 ml respectively, the

deformity has been completely corrected (B).

A

B

Fig.�4

Fig. 4: 42-year old patient after failed secondary breast reconstruction with pedicled latissimus dorsi

flap and implant. Contour deformity of the upper outer quadrant and volume defect after implant

removal due to infection (A). 1 year after 2 lipofilling-procedures of 303ml and 160ml of the entire

breast and nipple reconstruction. Note the symmetrization (B).

A

B

Fig.�4

Fig. 4: 42-year old patient after failed secondary breast reconstruction with pedicled latissimus dorsi

flap and implant. Contour deformity of the upper outer quadrant and volume defect after implant

removal due to infection (A). 1 year after 2 lipofilling-procedures of 303ml and 160ml of the entire

breast and nipple reconstruction. Note the symmetrization (B).

A

B


References:

1. Petit JY, Lohsiriwat V, Clough KB, Sarfati I, Ihrai T, Rietjens M, Veronesi P, Rossetto F, Scevola A, Delay E. The oncological outcome and immediate surgical complications of lipofilling in breast cancer patients:a multicenter study: Milan-Paris-Lyon experience of 646 lipofilling procedures. Plast Reconstr Surg 2011; 128(2): 341-346.

2. Rubin JP, Coon D, Zuley M, Toy J, Asano Y, Kurita M, Aoi N, Harii K, Yoshimura K. Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg 2012; 129(5):1029-1038.

3. Veber M, Tourasse C, Toussoun G, Moutran M, Mojallal A, Delay E. Radiographic findings afterbreast augmentation by autologous fat transfer. Plast Reconstr Surg 2011; 127(3): 1289-1299.

4. Herold C, Ueberreiter K, Cromme F, Busche MN, Vogt PM. [The use of mamma MRI volumetry to evaluate the rate of fat survival after autologous lipotransfer].Handchir Mikrochir Plast Chir 2010; 42(2): 129-134.

5. Herold C, Ueberreiter K, Busche MN, Vogt PM. Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg 2013; 37(2): 380-387.

Disclosures: None of the authors have any disclosures.

Conflict of interest: None

Funding: None

Financial or ethical concerns: None. Prospective data acquisition has been approved by the local ethical review committee of the hospital. All patients sign an informed consent that allows using all pre- and postoperative photographs and scans for scientific purposes.

Corresponding author:

Prof. Dr. med. Yves HarderSenior consultantDepartment for Plastic Surgery and Hand SurgeryKlinikum rechts der Isar, Technische Universität München (TUM)Ismaningerstrasse 22D-81675 München, GermanyTel: +49(0)89 4140 2171 secretariat; (-5536) officeFax: +49(0)89 4140 4869E-Mail: [email protected]

Category of the abstract:

1. Maximizing and Understanding Results of Clinical Fat Grafting:

2. Fat Grafting to the Breast


Background:Stromal Vascular Fraction (SVF) cells derived from adipose tissue have demonstrated clinical utility in regenerative medicine and plastic and reconstructive surgery. Adipose derived stem cells (ASC) and endothelial progenitor cells present in SVF have shown therapeutic efficacy in conditions requiring angiogenesisand adipogenesis, particularly for soft tissue repair and augmentation. Supplementation of fat grafts with autologous SVF is thus becoming an important strategy in such procedures. Isolation of SVF requires fat to be harvested by liposuction, washed, enzymatically digested and centrifuged to recover the cells. Manual processing requires skilled technicians, expensive infrastructure and laboratory with GMP and GCP compliance, which are not available with most healthcare units. Isolation in a certified external laboratory entails storage, handling,logistic hurdles, and multiple patient visits. These challenges can be overcome with a point-of-care, aseptic and automated device to isolate and concentrate SVF cells from a given volume of fat at the clinic in a matter of hours for autologous application.

Aim of the study: The objective of the study was to develop a stand-alone, fully automated, closed-system, aseptic device for isolation of clinical grade SVF cells at the point of care.

Methods: Human lipoaspirate tissue was obtained with informed consent from individuals undergoing elective cosmetic surgery, following approval from the institutional committee for stem cell research and therapy, and the institutional ethics committee.For the purpose of automation, a proprietary process for cell isolation was developed wherein the SVF was separated from the aqueous fractions of digested lipoaspirates using filtration technology. Briefly, lipoaspirate tissuewas washed and digested with collagenase enzyme. The aqueous fraction of the digest was then separated from the lipid fraction by phase separation and the SVF in the aqueous fraction was recovered by sequential filtrationthrough multiple filters. The filter materials and pore-

sizes were standardized to optimize flow rate, SVF yield,viability and composition. The main operational modules of the cell isolation system namely the tissue digestion chamber, heating and agitation mechanism, and filtration unit were thendesigned based on the process and assembled to develop a prototype device controlled by a programmable user interface. The SVF isolated using the device was then rigorously validated for yield, viability, composition and functionality, in comparison with the manual centrifugation-based process.

Results: We have established a proprietary process for SVF isolation, comprising enzymatic digestion of lipoaspirate; phase separation and extraction of SVF into the aqueous phase of the digest; and recovery of SVF by retention on membrane filters. The efficiency of this process wasfound to be equivalent to the conventional centrifugation method in terms of SVF yield and viability, and was scalable from a volume of 50 ml to 500 ml of lipoaspirate. The proprietary process was successfully automated in the prototype device. The maximum processing capacity of the prototype was found to be 500 ml of lipoaspirate tissue where the SVF yield and viability were equivalent to the manual process of isolation. Composition of SVF obtained by the automated process included CD34+CD31- ASC, CD34+CD31+ endothelial progenitor and CD34-CD31+ mature endothelial cells, and the relative percentages of the different cell types was comparable to SVF isolated by the manual centrifugation-based method. The functionality of the SVF isolated by the automated process was demonstrated by the ability to form colony forming units (CFU-F) representing self-renewal capacity of the ASC in the SVF. Gene expression analysis confirmed the presence of endothelial and progenitorcells from the expression of CD31, CD34, VE-cadherin and Von Willebrand factor. Production of angiogenic and apoptotic growth factors was also confirmed fromexpression of VEGF and IGF in the SVF.

Conclusion: We have successfully demonstrated proof-of-concept for fully automated isolation of SVF using the prototype

Development of an Automated Device for Point-Of-Care Isolation of Stromal Vascular Fraction Cells from Adipose Tissue Lipoaspirate

Authors: Swathi SundarRaj*, Nancy Priya, Abhijeet Deshmukh, Murali Cherat and Anish Sen Majumdar

Affiliation: Stempeutics Research Pvt. Ltd., Bangalore, India*Author email: [email protected], [email protected]


device. Concentration of clinical grade SVF cells without the use of a centrifuge would significantly reduce theunit cost and footprint, and ensure gentle cell isolation. Following successful prototype testing, we are currently working towards development of a beta unit that is compliant for testing in the clinic. Such a device is expected to greatly facilitate the penetration of affordable SVF-based therapy in hospitals and clinics in all parts of India and other markets.

Acknowledgements: We sincerely thank the following plastic surgeons for their expert opinion and consultancy: Dr. Anantheshwar YN, Dr. Ashok BC, Dr. Prashantha Kesari and Dr. Gunasekar Vuppalapati.

Disclosure: This study was completely funded by Stempeutics Research Pvt. Ltd. All authors are employees of Stempeutics Research Pvt. Ltd. and have no other financial affiliations or conflicts of interest related to thesubject matter of this presentation topic.


Chronic ulcus, pre-op

Purpose: Aim of this case series was to assess the healing progress of chronic, non-healing lower-limb wounds in diabetic patients following peri-lesional autologous fat grafting.

Background: Chronic ulceration of the foot is one of the most challenging conditions to treat for plastic surgeons. While autologous fat grafting has been shown to improve the quality and regenerative potential of chronically scarred tissues (1), the effect on wound healing of chronic wounds has only been reported on sporadically.

Methods:In this prospective case series, 19 patients with deep, non-healing chronic foot ulcerations in mostly diabetic patients had previously been unsuccessfully treated at the hospitals foot clinic using traditional methods for a mean of 11 months (range, 2-60). In all patients, peripheral vascular perfusion had been optimized if possible. 2 patients were excluded from the statistical analysis because wound size exceeded the inclusion criteria (wound should be <10 cm2). In 11 men and 6 women with an average age of 53 +/11 years, ulcers were debrided and the lipoaspirate gained from the abdomen in all patients, using the LipoVage® system. The non-processed lipoaspirate (mean 7 +/-4 ml) was then transferred into the wounds using a closed system, with peri-lesional infiltration into the edges andbase of the chronic wounds. Operating time averaged 29 +/-8 min. The wound was covered with a PVA foam and negative pressure applied (VAC-System) for 5 days, in order to keep the wounds moist and clean, and to keep the patient off weight-bearing. Thereafter the wounds were regularly assessed and measured and covered with Suprasorb H® dressings until healing was complete. Healing was defined as complete reepithelialisation ofthe wound. Wound sizes were measured and analysed using digital photography. Patients were kept non weight bearing until stable tissues had formed. Subsequently, they were allowed to ambulate using special orthopaedic support shoes in order to avoid pressure points.

Results:Wound size after debridement averaged 4,45 +/- 2,02 cm2. 15/17 wounds (88%) of wounds healed completely within a mean of 10 weeks. In 2 patients with particularly

Autologous fat grafting (lipofilling) for chronic ulceration on the diabetic foot improves wound healing

T. Stasch, J.Hoehne, T.Huynh, R.Baerdemaker, S.GrandelLuisenhospital Aachen, Department of Plastic and Reconstructive Surgery, Aachen, Germany

Main author: Dr. Tilman Stasch [email protected]

deep ulcera, another session of lipofilling lead to completewound healing after another 4 weeks. 2 wounds did not heal completely after 10 weeks: one successfully received a skin graft, the other one absconded. All patients were followed up for at least 4 months after wound healing which showed stable tissues in all.

Healed foot after 8 weeks, one lipofilling sessions

Discussion:Chronic ulcers on the lower limb pose a particularly challenging situation with a high morbidity for the patient often associated with recurrent surgical debridements and eventually amputations in a compromised vascularized environment. This study shows the enormous effects of autologous fatgrafting on wound healing as a relatively easy to perform and well tolerated procedure.

Conclusion:Autologous fat grafting (lipofilling) has been shown toallow wound healing in chronic, previously non-healing ulcers in diabetic patients within 2-3 months resulting in stable tissues. Integral to the healing process is the protection of granulation tissue by minimizing weight bearing on the wounds by use of special orthopaedic shoes or inlays. The study has also shown that wounds > 10 cm2 can still benefit from lipofilling by allowing formation ofgranulation tissue which can later be skin grafted.

References:1. Coleman SR, Plast Reconstr Surg. 2006 Sep;118(3 Suppl):108S-120S.


Abstract Background & aim: Mechanical forces modulate biological responses, including cell proliferation and angiogenesis. Mechanical forces effect tissue expansion, and we showed that tensile forces induced cellular proliferation and vascular remodeling using in vivo models. Recently, mechanical forces were proposed to account for the beneficial effectsin wound care of the Vacuum-Assisted Closure Device. Fat grafting has re-emerged as an attractive approach for soft tissue augmentation/reconstruction. Result variability may be associated with techniques used or characteristics of the donor or recipient site. An External Volume Expansion device (EVE) was employed clinically to stimulate breast enlargement (Brava System®) [1]. Del Vecchio and Bucky employed this device to prepare recipient sites for fat grafting with pre-operative EVE; they reported a 60-200% increase of human breast volume by quantitative Magnetic Resonance Imaging (MRI) that persisted long-term [2].We hypothesized that mechanical stimulation affects the structure, vascularity and metabolism of fat deposits. We designed an in vivo mouse model and fabricated the necessary apparatus to test this.

Methods: A dome-shaped rubber device with diameter 1 cm and internal volume 1.0 ml was fabricated, and connected to a suction pump (VAC Instill, KCI, San Antonio TX) settled at a constant pressure of -25 mmHg (Fig.1.).

Study model. Adult female wild-type mice (Jackson Laboratory, Bar Harbor, ME) were treated with suction device (S, n = 10) or occlusive dressing (Tegaderm; C, n = 10). Mice (n = 6 per group) were treated for 28 days continuously, then euthanized; treated tissues were harvested en bloc, fixed in 10% formaldehyde, embedded in paraffin and cut into 5 µm sections (Fig.1.).

Magnetic resonance imaging. Magnetic resonance imaging (MRI) of the treated area was performed for 4 mice of the suction group and 4 of OD group on day 0, 7, 14, 21 and 28 using a 3-tesla MR system under anesthesia.

Histo/immunohistochemistry. Slides were stained with H&E for cytology, and separately subjected to immunohistochemistry for proliferation with antibody for PCNA, and neovessel formation with antibody for CD31 (PECAM-1).

Morphometry. Various parameters were assessed: 1) dermis and subcutaneous tissue thicknesses were measured following H&E staining of sections (10X photographs) of treated areas; 2) the number of adipocytes in columns from the panniculus carnosus muscle was calculated using Image J software (NIH, Bethesda, MD); 3) cell proliferation was assessed by counting in the number of positively stained cells 40X fields (3/sample) of treated areas and expressed as ratio PCNA+ /total nuclei; and 5) blood vessel density was measured and expressed as the number of PECAM-1+ vessels present in 40X fields (3fields/sample).

External Volume Expansion Increases Subcutaneous Tissue Growth

Yvonne I. Heit, MD1,2, Luca Lancerotto, MD1,3, Ildiko Mesteri, MD4, Maximilian Ackermann, MD5, Maria Navarrete, MD1,6, Collin T. Nguyen, MSc1, Srinivasan Mukundan Jr, MD, PhD7,

Moritz A. Konerding, MD5, Daniel A. Del Vecchio, MD8 and Dennis P. Orgill, MD, PhD1

1Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Brigham & Women’s Hospital and Harvard Medical School, Boston, USA

2Department of Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University of Magdeburg, Germany3Institute of Plastic Surgery, University of Padova, Italy

4Clinical Institute of Pathology, University of Vienna, Austria5Institute of Functional and Clinical Anatomy, University Medical Center of the

Johannes Gutenberg-University Mainz, Germany6Department of Surgery, Pontificia Universidad Católica de Chile, Chile.

7Dept. of Radiology, Brigham & Women’s Hospital and Harvard Medical School, Boston, USA 8Back Bay Plastic Surgery and Massachusetts General Hospital – Harvard Medical School, Boston, USA

Corresponding author: Y.I. Heit – [email protected]: The Biology of Adipose Tissue, Stromal Vascular Fractions, Adipose Derived Stem Cells and Growth Factors

None of the other authors have any commercial or financial interests to disclose. This study did not receive any external financial support.

Figure 1: Animal model and timeline


Figure 2: Day 28: a) Tissue Swelling in area subjected to suction (arrow). B) Swelling seen in MRI section (white arrow); notice the presence of the rubber dome-shaped device. C) Histological demonstration of increased thickness of the subcutaneous tissue obtained with suction stimulation (arrow), corresponding with the “swelling” observed macrospopically. D) At quantifications, suction treatment (rhomboid) induced significant increase of both subcutaneous tissue thickness and number of adipocytes piled in columns at comparison with controls (circle).

Figure 3: Proliferation rate: external mechanical stimulation induced significant increase of proliferation rate in the subcutaneous tissue of stimulated areas


Figure 4: Vessels remodeling. a) Corrosion casting of treated areas in stimulated and control mice on day 7, same magnification. Mechanical external stimulation induced intense remodeling of vessels with reorganization, orientation, and major increase of lumen diameter. b and c) External mechanical stimulation induced significant increase of vessels density on the subcutaneous tissue of stimulated areas.

Corrosion casting 4 mice of the suction group and 4 controls were perfused on day 7 under anesthesia. Vascular access was established by cannulating the ascending aorta after systemic heparinization and thoracotomy with an olive-tipped needle. After flushing with pre-warmedsaline and fixation with 10 ml of 2.5% glutaraldehyde inRinger’s, the vascular system was perfused with ~15 ml of a polyurethane-based casting resin (PU4ii; VasQTec). After polymerization, the dorsum of the mouse was immersed in 5% KOH for tissue dissolution around vessel casts. After freeze-drying, specimens were mounted with conductive bridges on stubs, coated with gold, and observed using a Philips XL30 ESEM microscope.

Results:Macroscopic observations. Treated areas demonstrated local swelling by 21 days, which was not seen in the control group and was without infection or tissue damage. MRI at 28 days confirmed development in experimentalanimals of swelling compatible with fat growth (Fig.2.).Histological analysis. EVE induced in a 2-fold increase in fat layer thickness (p<0.01), with an average 2-folds increase in the number of adipocytes arranged in columns (p<0.05). Dermis thickness was unaffected by treatment (Fig.2.).Cell proliferation. EVE with 25 mm Hg continuous suction for 28 days resulted in a significant 2-foldincreased ratio of proliferating nuclei/total nuclei in the subcutaneous tissue (p>0.05) that was increased 1.9-fold in epidermis (p=0.08) vs. controls (Fig.3.).Vascular remodeling. Subcutaneous tissue blood vessel density was increased 1.9-fold in suction-treated tissues compared to controls (p=0.01). 3D corrosion casting of the vascular network of treated areas revealed that mechanical stimulation produced vessel remodeling. With treatment, vessels assumed an increased luminal diameter and were re-oriented (Fig.4.).

Discussion: With our novel EVE device, we reproduced in a mouse model the mechanical stimulatory conditions observed clinically. Our results showed that subjecting subcutaneous tissue to mechanical strain improves the grafting environment. Importantly, we also showed that EVE stimulated thickening of the subcutaneous fat layer.

Conclusion:EVE induced activation of cell proliferation and vessel remodeling leading to an increase in the abundance of adipocytes and the amount of subcutaneous tissue. Moreover, of greater importance to the success of fat grafting, EVE increased microvessel density improving the recipient site quality. Thus, pre-expansion may be an important tool for improving the reliability and effectiveness of fat grafting. Further work is needed to define the mechanisms, explore contributing factors, andoptimize parameters for clinical use [3].[1] Khouri, R.K., et al., Nonsurgical breast enlargement using an external soft-tissue expansion system. Plast Reconstr Surg, 2000. 105(7): p. 2500-12; discussion 2513-4.[2] Del Vecchio, D.A. and L.P. Bucky, Breast augmentation using preexpansion and autologous fat transplantation: a clinical radiographic study. Plast Reconstr Surg, 2011. 127(6): p. 2441-50.[3] Heit YI, et al., External volume expansion increases subcutaneous thickness, cell proliferation, and vascular remodeling in a murine model. Plast Reconstr Surg, 2012. 130(3): p. 541-7.The figures were originally published in:Heit YI, Lancerotto L, Mesteri I, Ackermann M, Navarrete MF, Nguyen CT, Mukundan S Jr, Konerding MA, Del Vecchio DA, Orgill DP.External volume expansion increases subcutaneous thickness, cell proliferation, and vascular remodeling in a murine model. Plast Reconstr Surg, 2012. 130(3): p. 541-7.


International Society of Plastic Regenerative Surgery (ISPRES)

Application For Membership

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As physicians and plastic surgeons in the United States, we are aware of the many changes in the practice of medicine. In addition to the clinical innovations that have been emblematic of our specialty, significant paradigmshifts in our practice include transitioning from physician autonomy to being a collaborator on a care team, using evidence-based data in clinical care, and recognizing that patients often are proactively involved in decisions related to their care. In addition, there are new approaches in the accreditation process for graduate medical education programs and their sponsoring institutions. The following paragraphs provide an overview of the New Accreditation System (NAS), its rationale and the ways in which it will aid in producing plastic surgeons ready to practice in the 21st century.The Accreditation Council for Graduate Medical Education (ACGME) was established in 1981 and is the sole accrediting body for allopathic graduate medical education (GME) in the United States. Its mission is to “improve health care by assessing and advancing the quality of resident physicians’ education through exemplary accreditation”. The ACGME accomplishes this by assuring that both core and specialty/subspecialty requirements, established by each of the twenty-six specialties, are applied to 9600 accredited residency and fellowship programs and more than 700 institutions sponsoring these programs. In the system in effect through June of 2013, accreditation was given for a specific time frame, with cycles ranging from 1-5 years,depending on the Residency Review Committee’s (RRC) decision regarding the program’s substantial compliance with its published accreditation standards. This traditional approach to accreditation created a substantial administrative burden which was largely focused on documentation and preparation for periodic site visits by

an ACGME Field Representative. The accreditation standards were prescriptive, producing compliance through strict confirmation and opportunitiesfor innovation by programs was limited. Other attributes of the system included program directors that were forced to manage problems rather than mentor residents, burnout among overburdened program leaders was common, passive involvement of many faculty and, educational standards which, in many areas, lagged behind delivery-system changes. To address these problems in accreditation the ACGME established the New Accreditation System (NAS) in 2010.1

The aims of the NAS are threefold: “1. to enhance the ability of the peer-review system to prepare physicians for practice in the 21st century, 2. to accelerate the ACGME’s movement toward accreditation on the basis of educational outcomes, and 3. to reduce the burden associated with the current structure and process based approach.”1 The NAS is being introduced in 7 of 26 accredited specialties in July, 2013; the remaining specialties, including Plastic Surgery, will enter the NAS July, 2014. A key element of the NAS is the development and use of educational milestones that have been established in each specialty. The milestones are developmentally based, specialty-specific, observable achievements that describea trajectory of progress from novice to proficient to expert. Determination of residents’ progress on the milestones will be accomplished by using existing evaluation tools and faculty observations. This information will be aggregated and used by a Clinical Competency Committee, to be established in each program and which will triangulate each resident’s progress. Aggregated, identified milestone data will be sent to theACGME semi-annually, and will be one data element used in the NAS. Other data programs will supply

Educating the Plastic Surgeon in the 21st Century

David L. Larson, MD, FACSProfessor Emeritus of Plastic Surgery

Department of Plastic Surgery Medical College of Wisconsin

ACGME Field Staff Representative

E D U C A T I O N A L P R O G R A M S


annually include changes in leadership, scholarship of the faculty and residents, board pass rate on a 3-5 year rolling average, data from the ACGME’s resident and faculty surveys, and data on residents’ procedures and clinical experience. There will also be an annual program evaluation (APE) involving all stakeholders of the program (residents, faculty, etc.). Using these annual evaluations and an aggregate of data for the preceding years, each residency and fellowship program will conduct a self-study every 10 years, which will culminate in a scheduled ACGME self-study site visit. Program’s first self-study cycles are being determined bytheir RRC’s, based on the current cycle length and date of the next scheduled site visit. Unless a program has issues or trends that are identifiedfrom the annual data submission and review by the RRC, the 10 year scheduled visit will be the only site visit a program will receive. This will eliminate more frequent site visits for good programs, and focus on site visits for programs having specific problems or demonstratingtrends concerning to the RRC. These site visits will allow the team to provide advice and guidance to programs, including the sharing of best practices identified via theaccreditation process. Programs that demonstrate high quality outcomes will be free to innovate.At the completion of their training, residents will have achieved specialty-specific milestones to a level thatallows them to enter unsupervised practice. This process moves the competencies “out of the realm of the abstract and grounds them in a way that makes them meaningful to both learner and faculty”.2

Another important element of the NAS is a requirement that residents be actively involved in quality improvement

activity or a project addressing patient safety. This will make the trainee aware of the lifelong, ongoing need to be aware of the importance of both these activities for their entire professional career.Another important element of the NAS is the Clinical Learning Environment Review (CLER) program, which entails a site visit to sponsoring institutions every 18 months with an emphasis on the quality and safety of the learning environment of the institution in which residents learn and participate in care. The CLER program was developed out of a recommendation for added assessment of the quality of the learning environment that became a key dimension of the 2011 program requirements. Over time, the CLER process will generate national data on effective approaches to promote quality and safety in teaching institutions intended to have a “salutary effect on quality and safety on learning settings and ultimately on the quality of care rendered after graduation”.1

In summary, the NAS will provide annual, prospective information on all training programs and their institutions using specialty specific milestones. In this way, residentsand faculty alike can monitor educational progress at any point in time, including suitability to enter unsupervised practice at the completion of training.

Bibliography1. NascaTJ, Philibert I, Brigham T, Flynn TC. The next

GME accreditation system—rationale and benefits.NEJM 2012;366:1051-1056.

2. Green MI, Aagaard EM, Caverzagie KJ, et.al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ 2009;1:5-20.






NATIONAL ASSOCIATIONS’ & PLASTIC SURGERY ORGANIZATIONS’ NEWS

“April in Melbourne”

“April in Paris”, the classic 1952 musical film starringDoris Day and Ray Bolger, was the inspiration for many tourists to explore the wonders of that beautiful European city. By any measure, Paris is a magnificent city, but whileits streetscapes shiver in April as temperatures hover below 10 degrees celsius, on the other side of the world, Melbourne Australia shimmers throughout April with the temperature averaging a balmy 22 degrees Celsius. The slow April transition into our southern hemisphere’s Autumn brings subtle changes to the landscape as it

shifts from the incandescence of summer to subdued tones of winter. Against this backdrop, the city of Melbourne was the perfect setting for our Plastic Surgery Congress,21 -27 April 2013, jointly hosted by the Australian Society of Plastic Surgeons and the New Zealand Association of Plastic Surgeons.

Our prestigious list of international guest speakers included: Nazim Cerkes (Turkey), Gregory Evans (USA), Jeffrey Fialkov (Canada), Joseph Gruss (USA), Gabrielle Kane (USA), Roger Khouri (USA), Peter Neligan (USA), Michael Neumeister (USA), Julian Pribaz (USA), Bryant Toth (USA) and Michael Yaremchuk (USA) .More than 850 delegates, the largest number of participants to attend our national congress to date, enjoyed the hospitality of Melbourne. The Melbourne Convention Centre (MCEC), a high tech convention facility with its sweeping architectural lines, accommodated the main

congress program as well as the workshops, symposiums, forums and an expansive exhibition area. Four cadaver labs were also held at the College of Surgeons anatomy labs. In 2013 we introduced the inaugural Wound Management Forum, which proved to be enormously popular and successful. Held in collaboration with the Australian and New Zealand Burns Association and the Australian Wound Management Association, the Forum offered a multidisciplinary exploration of wound care. A distinguished panel of expert International and Australian faculty represented the full spectrum of research, academic practice and clinical practice.With a wealth of international speakers, the Congress attracted broad media interest, giving us the opportunity to highlight our new Breast Device Registry and the International Collaboration of Breast Registry Activities (ICOBRA). Effective media engagement resulted in the publication of 39 news articles, 3 radio reports and one TV interview. The total circulation reached over 20 million unique viewers. Other relevant issues addressed included medical tourism, face transplantation and cosmetic surgery reform. The Congress also marked the official launchofthe Australasian Foundation for Plastic Surgery Limited (the F o u n d a t i o n ) on Thursday 25 April 2013. As part of its launch, the Foundation was proud to present face transplant pioneer Julian Pribaz as the i n a u g u r a l

Tony KaneChairman Continuing Professional

Development Committee,Australian Society of Plastic Surgeons

June 2013

Dr Geoff Lyons, President Australian Society of Plastic Surgeons, delivers the Sonnet for ANZAC Day, 25 April 2013, Ceremony of Remembrance

Dr Tony Kane, Chairman CPD Committee, Australian Society of Plastic Surgeons, welcomes delegates to the Gala Dinner, 24 April 2013


Foundation BK Rank Visitor. Dr Pribaz is one of the world leaders in face transplant surgery, and, together with his Harvard Medical School affiliated team at Brigham andWoman’s Hospital in Boston, he has performed fivefacial transplants including the first full facial transplant.The Foundation BK Rank Lecture is held biannually in honour of Sir Benjamin Keith Rank, a world leader in the field of plastic surgery and considered by many to be thefather of plastic surgery in Australia.The Australasian Foundation for Plastic Surgery Limited (the Foundation) also hosted the official signing of aMemorandum of Understanding for the International Collaboration of Breast Registry Activities (ICOBRA). Seven national PRS Societies signed the MoU with the objective of adopting a standard minimum data set for breast registries. The objective of the Agreement is to establish a minimum data set, made up of standardised and epidemiologically sound data, that is internationally comparable. At the heart of the Agreement is the core ethic and commitment to improving patient outcomes.As the Congress coincided with ANZAC Day, the anniversary of the first major military action foughtby Australian and New Zealand forces during the First World War and a national day of remembrance, a special Ceremony of Remembrance was organised. Convened by Air Vice-Marshall Hugh Bartholomeusz OAM, Surgeon General of the Australian Defence Force Reserves, the Ceremony allowed all Australians, New Zealanders and international attendees to pay tribute to those who served our countries in times of war.

As a Specialty, the Ceremony had particular significance asit commemorated the men and women who made ground breaking contributions to the craft of Plastic Surgery during periods of conflict. We were honoured to have theparticipation and support of our special guests, including Brigadier General W. Bryan Gamble MD, Deputy Director, TRICARE Management Activity (TMA).

Program SnapshotOverall, the scientific program consisting of plenary andconcurrent sessions was varied and engaging covering both the reconstructive and aesthetic components of plastic surgery. Surrounding the core program, the Congress also included:• Intensive Facial Aesthetic Cadaver Workshop;• Advanced Facial Injecting Symposium;• Intensive Facial Aesthetic Surgery Symposium;• Wound Management Forum;• Advanced Rhinoplasty Symposium;• Rhinoplasty Cadaver Workshop;• Private Practice Staff Forum;• Craniofacial Approaches Cadaver Workshop;• Registrars’ Conference.Our next Plastic Surgery Congress is 6-10 May 2015 in the tropical paradise of Brisbane. Each Australian capital city has a unique personality and landscape. We welcome you in 2015. Save the date now!

Twilight skyline and a reflective moment, Melbourne Convention Centre, PSC 2013.


The Emirates Plastic Surgery Society, the national association of Plastic Surgeons of the United Arab Emirates, has recently elected its new Board of Directors, whose tenure will be for a period of three years, from 2013 to 2015. Their Board of Directors members are the following:President: Dr. Marwan Al ZarouniVice President: Dr. B. Venkata RatnamSecretary: Dr. Jamal JomahScientific Committee: Dr. Luiz ToledoCultural Committee: Dr. Khalid Abdulla Al AwadhiEPSS has already organized two general meetings. The firstone was on April 25th 2013 held at JW Marriott Marquis Hotel and the second was on May 27th at Habtoor Grand

Beach Resort & Spa, Jumeirah Beach. They will be holding their general meetings on a monthly basis.

For further information, please do not hesitate to contact us.Emirates Plastic Surgery SocietyTelephone: +971 4 380 6063Fax: +971 4 346 6069E-mail: [email protected]: https://www.facebook.com/EmiratesPlasticSurgerySociety


The academic activities of our Congress began dramatically with pre-congress courses on Tuesday and the national competition of residents. On this ocasion we selected the following courses: Pre-Congress Facelift Course, coordinated by Dr. Ramon Vila-Rovira and Pre-Congress Course in Dehiscence Management in Plastic Surgery, Complex Wound and V.A.C. Therapy coordinated by Dr. Eugenio Rodriguez Olivares.

The National Resident Competition "Dr. Fernando Ortiz Monasterio" took also place. There we saw ideas and innovations that allow us to say that Mexican plastic surgery is on the vanguard.

Simultaneously, the Certification and RecertificationExamination of the Mexican Council took place, led by the President of the Mexican Council of Plastic, Aesthetic and Reconstructive Surgery, Dr. Jesús María Rangel Flores.

We had national and international teachers from Argentina, Austria, Brazil, Canada, Colombia, Spain and the United States and as a special guest for the closing keynote we had the famous Bachelor ARMANDO AGUIRRE SOURCES better known as “CATON”.

As is the tradition, AMCPER members came together for the annual meeting, which gives us the opportunity to share scientific news of our specialty and to affirm thebonds of friendship that unite us through coexistence while different social cultural activities adorned our congress. This time we came together in Puerto Vallarta, where we were greeted by the familiar hospitality and a pleasant climate that allowed a large number of activities.

Like every year we broke the record of attendance. In the city of Merida there were registered 1062 attendants. Now we had 1253 registrations, a true record of attendance. This demonstrates the union, harmony and interest of the members in a great partnership. Puerto Vallarta is a true jewel: peaceful, clean, tidy, renovated, growing and especially, secure. It is the ad hoc convention center for this type of events.

The conference itself began on Wednesday in 2 spacious lounges filledwithtopicsofinterestonbothReconstructiveand Aesthetic Surgery. The inauguration ceremony took place at 3 pm with the presence of naval government representatives and our AMCPER authorities headed by Dr. Jose Luis Haddad, while Dr. José Guerrerosantos was the representative of the governor of Jalisco.

The Council Dinner, was organized by Dr. Rangel at the “CAFE DES ARTISTES”, restaurant famous for its excellent food and service, where a number of former presidents of this council as well as advisors and guests showed up, and turned it into a very pleasant evening.

Review of the XLIV National Congress of Mexican Association of Plastic, Aesthetic and Reconstructive Surgery (AMCPER) Puerto Vallarta, Jalisco

Left to right José Luis Haddad, M. D. (President), Alfonso Vallarta, M.D. (Vice president), Eric Santamaria, M. D. (Treasurer)

Left to right Déctor Jiménez, M.D., Pilar Rivera, M. D., Ma. Del Mar Vaquero and her husband (Spain)

The Opening Dinner was a great event in an elegant hotel on the beach of the hotel “LAS VELAS”. All domestic and foreign attendees enjoyed a delicious dinner and a very nice party in the rhythm of marimba, mariachi and a folk group. Rightly, Dr. Haddad with his directive placed the evening groups separated from the evening of Teachers,which gave us the opportunity to meet both commitments.

The groups chose their places and enjoyed the camaraderie that students and alumni can experience. The faculty


dinner was mystical, as it it took place in the CASA VELAS, adjacent to the hotel with the same name, in a beach house where we saw a sunset dream and the place

José Mena, M.D. , Calixto Hárada, M. D. (General Secretary), Alfonso Vallarta, M.D. (Vice President)

was bathed in multicolored lights! There was romantic music by the Trio Boleros, an excellent dinner, dessert and coffee by the sea, where the following honorees were mentioned: Dr. Mario Becerra Caletti and Dr. Sergio Zenteno, and comments from several foreign teachers followed under the leadership of Dr. Haddad.

The business session was smooth and as relevant points the following sites were chosen: LOS CABOS for 2015 and VERACRUZ for 2016. Dr. Arturo Ramirez Montanyana won for Mexico an ISAPS course in LOS CABOS in 2014.

We especially appreciate the participation of the business (commercial) houses! Thanks to their support and willingness our event was truly enhanced.

The Closure of the XLIV Congress was characterized by the tributes to distinguished members of our association. The tribute to Dr. Mario Becerra Caletti was given by Dr. Teresita Silva and the tribute to Dr. Sergio Zenteno was given by his son Sergio Zenteno. At the closing a remembrance of Dr. Fernando Ortiz Monasterio was presented by Dr. Eric Santamaria.

Mr. ARMANDO FUENTES or"CATON" made us laugh and think, thus closing the academic activities. At night we took our Gala dinner in the Vallarta Hall of Hotel Casa Magna, of the MARRIOTT Hotel in Puerto Vallarta, with excellent organization, dinner, environment, measured speeches and lots of dancing.

Thanks to all members for their presence. See you next year in Mexico City!

On May 30th - 31st the Nicaraguan Association of Plastic, Reconstructive and Aesthetic Surgery organized the ”Endoscopic Facial Rejuvenation symposium” with the Institute of Medical Sciences and Nutrition Salvador Zubiran from Mexico DF and doctors Martin Iglesias and Patricia Butrón. The honorable guests, Dr. Iglesias and Dr. Butrón, were the first team performing an upper limb transplant in Latin America. Their visit to Nicaragua was part of the success of the practical and theoretical symposium. Members of the Nicaraguan Association of Plastic, Reconstructive and Aesthetic Surgery (ANCP) as well as residents in plastic surgery participated at the symposium. ANCP supported the Symposium with the contribution of the private Hospital Salud Integral. We would like to thank our honorable guests for sharing the expertise with us,

Sandra GutierrezPRESIDENT ANCP

Endoscopic Facial Rejuvenation Symposium in Nicaragua

Surgical procedures during the practical and theoretical symposium with live broadcasting.

Guest professors with the symposium’s participants


H I S T O R I C A L A C C O U N T S

Argentinean Society of Plastic SurgeryThe Argentine Society of Plastic Surgery celebrated last year its 60th anniversary! It was in fact, in 1952, when the society’s founders set out to build an institution to embody the attributes of the best edifice. And so they erected overtime a stable, solid and enduring organization. They have set it upon firm and stable grounds represented by high values and profound scientific knowledge of its members.The origins of the Argentine Society of Plastic Surgery are set back in the 40s of the last century. At that time there were only few doctors who performed plastic surgery and published papers in the Bulletin of the Society of Surgeons of Argentina. However, at the beginning of that decade there was an event that would contribute to the development of the specialty: in 1940, gathered among others at the Paulista School of Medicine, in the city of Sao Paulo, Brazil, doctors Antonio Prudente and Joseph Rebello from Brazil, Lelio Zeno, Ernesto Malbec from Argentina, Rafael Alfredo Alcaino Arzua from Chile and Enrique Predo Pedemonte by Apollo from Uruguay. They were then the leaders of plastic surgery in Latin America, and at such meetings was born the intention to create a “Latin American Society of Plastic Surgery”.They realized the above idea in July 1940 at the German Hospital of St. Paul. For Argentina signed the founding act Drs. Oscar Ivanisevich, Lelio Zeno, Hector Marino, Ernesto Malbec, William Armarrino, Ramón Palacio Posse, Eduardo Allevi, Dellepiane Rawson, Cardozo Aguirre, Gonzalez Loza, Ricardo and Roberto Ferrari Finocchietto.The following year was conducted the 1st Latin American

Congress of Plastic Surgery in Rio de Janeiro, and in 1942 took place the 2nd Latin American Congress of Plastic Surgery in Buenos Aires, in Argentina.Soon after that, in 1945 Ricardo Finocchietto created within his surgery service in Ward No 6 at the Hospital Rawson, a section of plastic surgery with Dr. Hector Marino in charge. There, were trained distinguished plastic surgeons with the magnitude of Pasiman, O `Connor, Sapadafora and Niclison. Later, Ward 7 was established in Rawson Hospital, exclusively for plastic surgery.In 1949 was founded the Brazilian Society of Plastic Surgery. From 1949 began the organization of plastic surgery academies in the Argentinean hospitals with presentations involving cases of interest and reading of articles. The meetings were gaining increasing scientific audience, whichled Dr. Marino to organize them in a more systematic way. In this framework, the first Assemblies were held, and inlate 1951 was signed the draft statutes of the Argentinean Society of Plastic Surgery. On March 24, 1952 was signed the charter, and the first scientific meeting of the Society washeld on July 17th, 1952 at the headquarters of the Argentine Medical Association. The Drs. Beaux Alberto and José Viñas drew up the first society’s statutes and regulations.In 1953 took place the first Assembly of the League. Theinaugural Steering Committee was chaired by Dr. Ernesto Malbec. In 1953 the 1st Assembly united to elect the firstexecutive committee. The 1st elected President was Dr. Ernesto Malbec.

From the left: Sra Marta Benaim, Dra E Gafoglio, Dra Ayeray del Val, Dr. Abel Chajchir, Dr. Juan C Seiler, Dr. Gustavo Prezavento, Dr. Luis A Margaride, Prof. Fortunato Benaim founding member of SACREP


It is important to say that within the founders of the Argentinean Society of Plastic Surgery, not occupying any official positions but who played an important role, were DrsJack Davis, Viñas, Otermin Aguirre, Palace Posse, Sperne, Goldemberg, Jarolavsky, Kirshbaun, Ribak, Rubinstein, Schemper, and possibly others not mentioned here who earn great respect and thanks.41 years ago the Argentinean Society of Plastic Surgery

held in 1971, in Bariloche, the 1st Argentinean Congress of Plastic Surgery, presided by Dr. Hannibal Tambellael. The secretary was Dr. Eduardo Marino, executive secretary, Dr. Osvaldo Cudemo and the Treasurer was Dr. Alberto Otero. From that year on, the Argentinean Congress is being held every year without interruption. Each year achieving a higher scientific level and increasing attendance.We shall conclude this historical account with the inspiring closure interpreting the thoughts and feelings of the founders of the society, made by Dr. Martha Mogliani at the 42th Annual Congress of the Argentinean Society of Plastic Surgery in 2012: “Organizations that have an orderly conduct, members of firm convictions and strong academic ethics, are intended tolast over time and excel in their field of action. Of course,these values have to grow in the members and they shan’t ever neglect them. …If you can dream it, you can do it. Ideas are energies together. Thoughts are ideas formed. The words express thoughts. Actions are words moving, …Κeep moving always toward a promising future”.Cordial thanks to Dra. Marta Moglian, Ex-President of the society, who prepared the brief history of the Argentinean Society of Plastic, Aesthetic and Reconstructive Surgery.

Dr. Osvaldo Orduna (1993)Dr. Juan José Galli (1994)Dr. Raúl Fernandez Humble (1995)Dr. Jorge Herrera (1996)Dr. Julio Cianflone (1997)Dr. Manuel Viñal (1998)Dr. Alfredo Santiago (1999)Dr. Paulino Morales (2000)Dr. Juan Bautista Albertengo (2001)Dr. Osvaldo Cudemo (2002)Dr. Rodolfo Rojas (2003)Dr. Jorge Buquet (2004)Dr- A. Aldo Mottura (2005)Dr. Guillermo Faherty (2006)Dr. Ernesto Moretti (2007)Dr. Víctor Vassaro (2008)Dr. Carlos Perroni (2009)Dr. Carlos Reilly (2010)Dra. Marta Mogliani (2011)Dr. Luis M. Ginesin (2012)Dr. Juan Carlos Traverso (2013)

Dr. Ernesto Malbec (1953)Dr. Héctor Marino (1954)Dr. Julián Fernandez (1955)Dr. Alberto Meaux (1956)Dr. Roberto. Dellepiane Rawson (1957)Dr. Miguel. Correa Iturraspe (1958)Dr. Guillermo Armanino (1959)Dr. Jorge. Santamarina Iraola (1960)Dr. Fortunato Benaim (1961)Dr. Jorge Nicklison (1962)Dr. Cornelio O Connor (1963)Dr. Luis Monti (1964)Dr. José Spera (1965)Dr. Ángel Oghi (1966)Dr. Jaime Fairman (1967)Dr. Héctor Vieyra Urquiza (1968)Dr. Alberto G. Albertengo (1969)Dr. Jorge Quaife (1970)Dr. Aníbal Tambella (1971)Dr. Hugo Arufe (1972)

Dr. Francisco Arespacochaga (1973)Dr. Eduardo Marino (1974)Dr. Alberto Otero (1975)Dr. Héctor La Ruffa (1976)Dr. Néstor Maquieira (1977)Dr. Ulises De Santis (1978)Dr. Víctor Nacif Cabrera (1979)Dr. Leonardo Barletta (1980)Dr. Raúl Laguinge (1981)Dr. Julio Frontera Vaca (1982)Dr. Adrián Spadafora (1983)Dr. Carlos Caviglia (1984)Dr. Erdulfo Appiani (1985)Dr. Mauro Daroda (1986)Dr. Enrique Gandolfo (1987)Dr. Alfredo Pardina (1988)Dr. Pedro Mugaburu (1989)Dr. Jacobo Sananes (1990)Dr. Néstor Bravo (1991)Dr. Orlando López (1992)

Below is a list of the successive presidents of the Argentinean Society:

From the left: Dr Omar D Cucciaro Ventura, Dr Javier Vera, Prof. Fortunato Benaim, Dr. Abel Chajchir.

As the Society’s scientific activities and other affairs were getting more complex to deal with, the members decided that thePresident of the society should handle the part regarding all affairs and that the scientific part should be handled by the anotherPresident. Therefore since 1996 the Society has two Presidents: a “President of the Society” and a “President of the Meetings”.

Dr. Ricardo Yohena (2008)Dr. Claudio Ghilardi (2009)Dr. Juan Carlos Seiler (2010)Dr. Hugo Bertone (2012)Dr. Oscar Procikieviez (2013)

Dr. Roberto Suriano (1996)Dr. Luis Albanese (1997)Dr. Rodolfo Ferrer (1998)Dr. Abel Chajchir (1999)Dr. Luis Aldaz (2000)Dr. Enrique Gagliardi (2001)

Dr. Carlos Mira Blanco (2002)Dr. Pedro Dogliotti (2003)Dr. Carlos Rodriguez Peyloubet (2004)Dr. Luis Margaride (2005)Dr. Horacio Garcia Igarza (2006)Dr. Adalberto Borgatello (2007)

Past Meeting Presidents


How Finland became FinlandTo give you an idea about what our association and country represent today, I will share a few important milestones in the history of Finland. This remote country was first settled, when the last Ice age ended, around9000 BC. In 1155, missionaries arrived in Finland from the west and the country became part of the Swedish realm. After medieval times, as part of the Swedish Kingdom, the Lutheran religion dominated. In 1809 Sweden lost a war and Finland was ceded to the Russian Empire. The Czar declared Finland an autonomous Grand Duchy. Autonomy allowed Finnish nationalism to emerge: music, art and literature in the highly distinctive language blossom. Meanwhile, systematic infrastructure, government and legislation was built up, as illustrated by a painting by Akseli Gallen-Kallela. The October revolution kept the Russians busy and Finland declared independence on December 6, 1917. A tragic civil war between “red and white” ensued. Right-wing oriented whites won. Finland became a republic with a president as head of state. In 1939-1940 the Soviet Union attacked Finland and the Winter War is fought, followed by the the Continuation War 1941-1944. Even with massive superiority in military strength, the Soviet Union failed

to conquer the country. Independence, democracy and sovereignty were maintained. Territorial loss resettled an eighth of the population. The war reparations, paid to the last cent, lead to rapid industrialization and turned Finland from a war-ravaged agrarian society into one of the most technologically advanced countries in the world, with a sophisticated market economy, the lowest corruption in the world and high standard of living. In 1952, the Olympic Games are held in Helsinki. In 1955 Finland joins the United Nations and Nordic Council. In 1995 Finland becomes a member of the European Union. In 2002 The Finnish currency “markka” is changed to Euros. According to a recent poll, Finns are reluctant to join NATO.

Early times of Surgery and Plastic SurgeryThe history and geography of our country has very much reflected the history of plastic surgery. Academically,impressions from neighbouring countries around the Baltic Sea were strong .The University of Turku was founded in 1641, yet many doctors were trained in Germany, or at the University of Dorpat (Tartu) Estonia. In the 1800s, reconstructive techniques were advocated by Chief Surgeon Julius von Schymanowsky. He wrote

History of the Finnish Association of Plastic, Reconstructive and Aesthetic Surgeons

Susanna Kauhanen, MD, PhD, President 2012-2014Helsinki University Hospital

Department of Plastic and Reconstructive SurgeryContact Information:

The Finnish Association of Plastic, Reconstructive and Aesthetic Surgeons Chirurgi Plastici Fenniae ry

http://www.chirurgiplasticifenniae.fi

From the left: Kauhanen Susanna, President of the Finnish Association, Anna Höckerstedt and Pentscho Popov during the 17th IPRAS world congress, Santiago, Chile 24 Feb.-1 March 2013


a surgical textbook (in Russian),with emphasis on reconstructive techniques. The book reached a wider readership when published in German in 1870. Several drawings and techniques re-appear in the textbook of Plastic Surgery by Davis in 1919, e.g. the blepharoplasty for correction of ectropium, also known as the Kuhn-Schymanowsky technique. On request of tsar Alexander II a chair in war-surgery was established in the 1850s and Karl August Estlander was elected. Estlander published his technique of lip-plasty in 1872. The next year he performed 14 such cases. In that time, patients stayed in hospital around 6 weeks after a lip-plasty. In 1876 Estlander travelled to the US, presented his technique for a man named Abbe, who 14 years later published a slight variation on Estlander´s technique.

and other friends of the wounded in Finland“. Richard Faltin´s publications on midface trauma (traction and immobilization methods) were mainly published in Russian and Swedish. Faltin is regarded as one of the greatest Finnish surgeons throughout history. The highlight of the annual National Surgical Society in Finland is the Richard Faltin Lecture and Award. An interesting piece of history is that Richard Faltin performed the first bloodtransfusion in Finland, in the year 1913. The historical events taking place during and after World War II produced generations of surgeons that make the most of small resources, understand the need for networking, whilst still standing on their own feet and working extremely hard. This was reflected in the rapiddevelopment of plastic surgery and a fearless attitude in reconstructive surgery. Whilst surgeons were scarce in the 1800s, the number had increased to 80 in 1947 out of whom two were plastic surgeons. Plastic Surgery was officially signed toa subspeciality of surgery in 1947. The Nordic association was founded in the early fifties, but the FinnishAssociationhad to wait a few more years, until December 1957, when 7 founding members came together to form "Chirurgi Plastici Fenniae": Per- Erik Aschan, Henry Brummer, Uno Gylling, Juuso Kivimaki, Aura Pentti, Atso Soivio and Borje Sundell. Mrs Aura Pentti was the first plastic Surgeon fullytrained in Finland. She passed away only two years ago. Many of the contemporary Finnish Plastic Surgeons had the privilege to know her.

Cleft Lip and Palate The first Finnish documentation of repair of a cleftlip is in an epic song written down by the patient, Tuomas Ragnvaldinpoika in 1763. The epic is long and detailed, but the surgery was obviously successful because Tuomas lived a long life and married 3 times. Around the time of WW II the “Plastic Surgery Center” for children was founded. In a small house with wood heating, more than 2000 children with cleft lip and palate were operated during a time period of 6 years. The post-war baby-boom kept pioneers like Atso Soivio busy, yet each child´s surgery was planned individually (Picture 6). This was the beginning of systematic centralization and a multidisciplinary approach to treat cleft lip and under the leadership of Aarne Rintala, resulting in high quality outcomes in highly specialized surgery. The center was also the foundation of what developed into the Department of Plastic and Reconstructive Surgery at the University Hospital, first led by Börje Sundell and for many years by Sirpa Asko Seljavaara. Nowadays Mr

Richard Faltin, professor of surgery at the University of Helsinki 1917 - 1935, became famous for his skills in war surgery and especially facial trauma. Anecdotally, participating in seven wars (the Greco-Turkish war

of1897, The Russo –Japanese war 1904-5, World War I, from 1914-18, Abyssinian War 1936, Winter War 1939-40 and the Continuation War, 1941-44) he always found himself on the losing side. In World War I Faltin was sent by the Finnish Red Cross to establish a facial trauma Center in Lithuania, and war surgeons from all over the region came there to learn. Richard Faltin was a good

friend and student of Sir Harry Gillies. Until today, in the Department of Cleft Lip and Palate Surgery in Helsinki, a textbook by Gillies with Gillies´ own handed signature has been preserved. The dedication reads: ”To Dr Faltin

Estlander technique of lip-plasty in 1872

Richard Faltin

From Dr Faltin’s textbook

Börje Sundell


Erkki Tukiainen is both professor and head of Department. The logo of the Finnish Association was planned by the artist Erik Bruun in 1969. The well-functioning cleftlip and palate department contains nowadays also a high volume center for cranioplasties, and related research.

Sirpa Asko-SeljavaaraWhen the era of microsurgery began, Finland stood out as a pioneer country among its Scandinavian neighbours, quickly taking on and developing the latest techniques. Names like Simo Vilkki (toe to hand) and Sirpa Asko-Seljavaara (free style free flaps) are widely known.Sirpa worked hard to popularize microvascular breast reconstruction, and still in today´s Finland the use of autologous tissue is as high as 80%.Sirpa also worked very hard to create a geographically equal network of plastic surgeons in public hospitals. She has basically trained all senior surgeons in leading positions in the country, but she was also sad to see some of her well trained students “lost” to the more lucrative jobs in the private practice. The country is nowadays covered by a network of plastic surgeons in public hospitals, supply and demand in rather good balance. As a pioneer in development of modern burn care and microsurgery, Sirpa Asko-Seljavaara was rewarded with the Evans Price by the American Association of Burns and the Maliniac Price by the American Association of Plastic Surgeons. She received her professorship in 1994, but the first chair forplastic Surgery was not founded in Helsinki until 2001.

Educational ProgramsFive university hospitals train plastic surgeons at present: Tampere, Turku, Oulu, Kuopio and Helsinki. The Helsinki Department has a very international atmosphere, and is known for its numerous short/long-term visitors. Educational Programs supported by our National Association include EURAPS Young Plastic Surgeons Scholar ship, Academic Scholarship, the International Master´s Degree in Microsurgery (Sinikka Suominen), the EBOPRAS Board exam, and Emergency Burn Care Surgery (Jyrki Vuola). Helsinki and Tampere are among the recipient institutions for EURAPS Scholarships. Helsinki is also part of the regular Nordic Courses for trainees in Plastic Surgery. The Helsinki courses are famous for open-minded, candid lectures and thorough sauna-education.

MeetingsThe past decade has been busy when the Association has been trust to organize several international meetings in Finland. The EURAPS meeting in 2001, Scandinavian meetings in 2002 and 2012, The ECSAPS (nowadays called EURAPS Research Council) in 2001 and 2010 and , the European Federation for Societies of Microsurgery in Turku in 2008 and the World Society for Reconstructive Microsurgery in 2011, with more than 700 participants, which is the biggest meeting of WSRM so far. Also the Nordic Burn Meeting has been arranged. A small country can never outdo its larger peers in resources or manpower, but efforts are made (as shown in our history), to create a warm and welcoming, personal yet professional touch.Upcoming events on the international scene include the EBOPRAS board examination in 2014. The Finnish Association will also consider arranging the ESPRAS Congress in a few years time. Several members of the Finnish Association have been involved in humanitarian activities organized by the Red Cross, Interplast, Doctors without boundaries and Rotary to mention a few. Also, a few Finnish Plastic Surgeons have signed up for the IPRAS led Women for Women project. In its 56-year history the Finnish Association has grown from a small alliance to become a large society with about 100 full members (12 retired) and about 30 candidate members. Fifty percent of the members are female. Despite grand achievements by previous generations, there is still a lot of work to be done.

Board of Directors 2012 - 2013Susanna Kauhanen President [email protected] Palve Secretary [email protected] Svarvar Vice President [email protected] Jari Viinikainen Treasurer [email protected]

Board members: Ilmar AmjärvTiina JahkolaTimo PakkanenPentscho PopovIra SaarinenAnna-Liisa Vesala- Salmela

Cleft lip


The Mexican Association of Plastic, Aesthetic and Reconstructive Surgery was formed on November 18, 1948, with founding members Mario González Ulloa, M.D as president, Jorge Caraza Escobedo, M.D as secretary, Héctor Fernández Pérez, M.D as treasurer, and Jorge García M.D and Yuri Kutler as trustees. Along with these were also various other founding members, Alfonso Díaz Infante, M.D, Roberto

Nava Rojas, M.D, Joaquin D’Ηarcourt, M.D, Francisco Castillo, M.D, Cesar Laborde, M.D, Palemón Rodríguez, M.D, Gloria Kirts, M.D, Jesús Lozoya, M.D, Alejandro Velasco Zimbrón, M.D, Eduardo Stevens, M.D, Juan de Dios Peza, M.D, Isidoro Gómez, M.D, and Román Rivera Torres, M.D. During the Nineteen-Twenties and Thirties, surgeons like Doctor Dario Fernández and Velasco Zimbrón began to show interest in the restoration of skin cover and the ability to leave less surgical scars, and this was the seed of the society’s creation. It was, however, during the 1940s that Plastic and Reconstructive surgery really began to become popular with general surgeons. at the General Hospital of Mexico. In 1947, Mario Gonález Ulloa, M.D, founded the Mexican Association of Plastic Surgeons, marking the beginning of the discipline in Mexico. This made him a pioneer in this specialty and the field ofmedicine in general. Among the society´s achievements are the first successful hand transplant, and to date havingbrought together 1363 members. The society continuously supports various medical programs, both nationally and internationally, in the form of various training conventions in the foundations and theory of plastic surgery, as well as symposia and

sessions with experts via the internet. Furthermore the Society undertakes various campaigns in reconstructive surgery, in the lip, and cleft palates.The society has various upcoming events; first is the 44th National Congress of Plastic and Reconstructive Surgery, which will be held in Puerto Vallarta, Mexico, from April 16 to April 21. For information go to http://www.congressmexico.com/amcper2013. Following this we have: the 24th National and International Course in Foundations and Theoretical Developments in Plastic Surgery; The 45th National Congress of Plastic and Reconstructive Surgery, in Mexico City from April 29 to May 03, 2014(www.cirugiaplastica.org.mx); and the 20th Latin American Congress of Plastic and Reconstructive Surgery, in Cancun from September 23-26, 2014(servimed2.secure.myhosting.net/filacp2014/registro.php)At the moment the Board of Directors is comprised of: José Luis Haddad Tame, M. D, President; Raúl Alfonso Vallarta Rodríguez, M. D, Vice President; Calixto Harada Prieto, M. D, General Secretary; Eric Santamaría Linares, M.D, Treasurer; Ricardo Pacheco López, M. D, Trustee; Carlos Gmo. Oaxaca Escobar, M.D Trustee; Raymundo Benjamín Priego Blancas, M.D, Secretary; and Carlos De Jesús Álvarez Díaz, M. D. Editor.

The association would be happy for members of the specialty to contact it at:Asociación Mexicana de Cirugía Plástica, Estética y ReconstructivaFlamencos No. 74 San José InsurgentesC. P. 03900 México, D. F.(525) 5615-49-11 / toll free (Mexico) 01800-711-87-32amcper@cirugiaplastica.org.mxwww.cirugiaplastica.org.mxFacebook: amcperac - Twitter: amcper

Brief Historical Account of the Mexican Association of Plastic, Aesthetic and Reconstructive Surgery

Gonzalez Ulloa


The Polish Society of Plastic, Reconstructive and Aesthetic Surgery (PTChPRiE) is the official scientificorganization for plastic surgeons working in the Republic of Poland. The President of the Society is Professor Jerzy Struzyna MD,PhD,D.Sc.,National Consultant in the fieldof plastic surgery in Poland. Fifteen hospital departments and a great number of private clinics and cabinets of aesthetic surgery do our professional plastic surgery work. The Society brings together 200 members with 160 specialists among them. The statutory authorities are: the Board of Directors, the Revisory Commission, the Ethics

Committee, and the Arbitration of Fellow Members. PTChPRiE has delegates in IPRAS, ESPRAS, IQUAM and IPRAS-TA. The key moments in PTChPRiE history are joined with family names of pioneers and enthusiasts of this specialty such as Professor Michalek-Grodzki, and Dr Wladyslav Dobrzaniecki, after the Second World War. The firstattempts to develop Polish plastic surgery had been made by Professor Michal Krauss MD,PhD,D.Sc, who trained for a few years in Professor Frantisek Burian’s Plastic Surgery Clinic in Prague. It was the real beginning

Polish Society of Plastic, Reconstructive and Aesthetic Surgery (PTChPRiE)

the member in dynamic progress

Wojciech Witkowski M.D. PhDNational Delegate of PTCHPRiE to IPRAS

Military Institute of Medicine, Warsaw, Poland e-mail: [email protected]

ESPRAS 2009 Congress. From the left: Dr Martin del Yerro, Professor Andreas Yacoumettis, Dr Wojciech Witkowski, Dr Eric Auclair


for the plastic surgery era in Poland. Unfortunately 50 years didn’t allow for a good climate in which to quickly develop aesthetic surgery. Therefore, until after 70 years, aesthetic surgery as part of plastic surgery was the ”unwanted child” for the National Authorities. Thus Polish specialists at that time had many more difficulties training in aesthetic surgery than colleaguesin other countries. Development, however, was a fact, and primarily it was Professor Michal Krauss and then Professor Kazimierz Kobus in Polanica-Zdroj Hospital, and Professor Janusz Bardach and later Professor Jan Goldstein, who encouraged plastic surgery education, training and international contacts with leading plastic surgery at clinics in Europe and worldwide. In the year 1957 The Generative Surgery Section was established as a section of the Society of Polish Surgeons under the presidency of Professor of Surgery Henryk Kania. In 1971, the section changed its name to Section of Plastic and Reconstructive Surgery of the Society of Polish Surgeons (TChP).In 1986, the Section had been transformed into the Polish Society of Plastic and Reconstructive Surgery and three sections were formed; the Head and Neck Surgery Section, Microsurgery Section, and Burns Management

as well. Finally the name of the Society was changed in 1997 and it became The Polish Society of Plastic, Reconstructive and Aesthetic Surgery, which has existed until today. According to a recent decision of the Society Board of Directors, given December 11th, 2011, after a few months of organisational work, and confirmation bythe Society General Assembly, the Section of Aesthetic Plastic Surgery was created.The President of Section is Doctor Maciej Kuczynski, who is at the same time the Vice President of PTCHPRiE. The Section is extraordinarily active and has organized various international aesthetic surgery symposia.Since 1986 thirteen National Congresses of our Society have taken place, ten Congresses of the Society for Burns Management, thirteen Burn symposia, organized in cooperation with above listed societies by Poznan University Chair and Clinic of Traumatology, and over a dozen symposia on microsurgery, head and neck surgery and microsurgery. All the information given in this concise history of polish plastic surgery is the evidence of the relative youth of this specialty in Poland. A new era came after political changes in Europe and the world which brought about new opportunities for all

Respectable mission from Romania, visiting in June 2013. Specialists were invited by Dr Witkowski to discuss water-jet technology application in burns and other wounds debridement.


of us, incredible chances of unlimited cooperation with plastic and aesthetic surgery world leading specialist and masters of our specialty. The task of close cooperation with IPRAS and ESPRAS and other scientific societiesas well is an absolute necessity for us. The second is to join the plastic surgeons in a multidisciplinary approach for the treatment of surgical diseases. We hope all will go well. The next is the problem of joining in with European specialty courses, and it may become an educational process even to pass European specialty exams in the future. Nowadays in Poland our specialty is in fact divided by the National Health Foundation (NFZ) into two categories. The first is medical care activity, which isreimbursed by the system. The second is aesthetic plastic surgery, which is not reimbursed by the nationally funded NFZ. Official specialized health care providers like plasticsurgery wards and clinics have to perform mainly life saving procedures and treatments. Planned operations of reconstructive surgery are commonly financial losses forthe hospital. We all wait for reform of the system and hope that a wise decision will give the requested effects for our specialty. No aesthetic surgery can be done in hospitals. It is a great disadvantage for education because in my opinion the modern plastic surgeon has to be trained and widely educated, not only in private clinics of aesthetic surgery but at university and at the specialized hospital level as well. Despite problems and impediments and the disadvantages of the system our young doctors and experienced plastic surgeons are present in European and Worldwide scientific and educational activity. It is asignificant and dynamic progress for us. The Members ofPTCHPRiE present lectures, oral presentations, posters, travelling everywhere to learn news and to assimilate contemporary plastic surgery knowledge, applied technologies and skills. The most important is the good will of our colleagues and friends from abroad to share their experiences, and take part in discussion on aesthetic surgery. National Delegate of Polish Society of Plastic,

Reconstructive and Aesthetic Surgery(PTCHPRiE) to IPRAS is the decent author of this text. He is a plastic surgery specialist and former Vice President of PTCHPRiE, a long term member of the society authorities, and actually a member of the PTCHPRiE Board of Directors. Dr Witkowski is the Head of The Plastic Reconstructive Surgery and Burn Management Department in The Central Clinical Hospital of The Ministry of National Defense, The Military Institute of Medicine in Warsaw. He has been a specialist in plastic and reconstructive surgery since 1984,a combustiologist, a known expert on wound healing, especially burn and posttraumatic wound regeneration and surgical reconstructive treatment methods, new technology applications and development within wound management as well.Dr Witkowski had the opportunity for the first time in thehistory of PTCHPRiE to be the official delegate to theunforgettable Rhodes 11thESPRAS Congress 2009, being simultaneously the attendee and the Co-Chair of one of the scientific round table sessions on Biomaterials(clinicaland experimental).(Fig.1)His experience in water-jet technology application in burn wounds, and NPWT technology usage in the treatment of wounds permitted him to share clinical knowledge and understanding of the problem with respectable colleagues and plastic surgeons from Russia and Romania, which were the guests of Dr Witkowski and heard the lectures and watched clinical presentations, not excluding the life burn wound surgery performed with water-jet technology or combined technologies and techniques.Fig.2The 14th biennial Congress of the Polish Society of Plastic, Reconstructive and Aesthetic Surgery will be held on 18-19th of September 2013 in Kazimierz Dolny, located in Lublin Region. All exact information and details are accessible on the web page of the Congress: http:/www.14zjazd.ptchprie.pl.To get information in English please click the British flag at the upper rightcorner of page.


Sir Archibald McIndoeSir Archibald McIndoe, the pioneering plastic surgeon based at the Queen Victoria Hospital in East Grinstead, successfully treated in excess of 649 severely burned airmen during WWII, 62 of whom are still alive today worldwide, a testament to his skill and compassion. These men later formed the now well known Guinea Pig Club, so called because of the experimental nature of their treatment. Less well known is that McIndoe also treated casualties from other services and civilians. His wartime experiences led McIndoe to believe that were was a need for strong laboratory based research to ensure that treatments of the future were safe and effective before they went to clinic.In 1958 it was felt that the time had come to make a serious attempt to establish a Centre for Surgical Research at the Queen Victoria Hospital. It was realised that the Ministry of Health, with its sources already strained by the expansion of the National Health Service, would be unlikely to be able to provide funds for such a purpose. Mr & Mrs Neville Blond offered to donate the sum of £10,000 required to build and equip the first building and further financial supportfollowed. The East Grinstead Research Trust was formed to regulate the general policy and financial expenditure ofthis new Centre.On April 11th, 1960, the Trust sustained a shattering blow and an irremediable loss in the untimely death of Sir Archibald McIndoe, who with his driving energy and enthusiasm had been the spearhead and co-ordinator of the whole project. However, the Trustees continued and the laboratories were officially opened by the Rt Hon JEnoch Powell MBE, MP, Minister of Health on March 22nd 1961. In the course of his speech, The Minister remarked on the importance of the generosity of private individuals in sponsoring major projects of this kind and of his wish to foster and encourage that which was voluntary and independent in both medical research and treatment. The Research Unit continues to this day as the Blond McIndoe Research Foundation a registered charity, still depending entirely on charitable donations.The Blond McIndoe Research Foundation in collaboration with The East Grinstead Business Association and East Grinstead Town Council felt that a memorial to this remarkable man, his patients and the Town of East Grinstead, was long overdue and a project was launched to erect a statue to Sir Archibald in a prominent position in

East Grinstead. The chosen sculptor is Martin Jennings, probably best known for his beautiful statue of Sir John Betjeman at St Pancras Station. When approached, Martin revealed the amazing coincidence that his own father, a Tank Commander in WWII, had been severely burned and treated by McIndoe at East Grinstead.

What follows are the sculptor’s own words:

“I want to make more than just a statue of the great surgeon. McIndoe's story is inseparable from that of the

Guinea Pig Club, his burned 'boys' for whom he was a cross between compassionate parent and strict figure of authority.So I have represented him with a patient (though not a particular person) who has burns to his face and hands but still wears his RAF uniform, as McIndoe insisted his patients should be allowed to. The pilot is turning his head to look back up to the sky in which he can

no longer fly but also towards his doctor for reassurance.McIndoe's hands are on the younger man's shoulders, suggesting the communication of his extraordinary confidence - his patients always refer in their memoriesof him to his absolute certainty that they would go on to lead productive lives despite the traumas they'd suffered. Many of McIndoe's patients suffered terrible injuries to their hands and "main en griffe" (claw hands) frequently resulted. After his wartime burns, my own father's hands were fixed in a claw shape for the remainder of his adultlife. I can remember when growing up how tentatively he sometimes used to hold them and how he used to stretch them when they ached. This is something I want to record in that one small part of the statue.McIndoe encouraged the people of East Grinstead to involve themselves with the social rehabilitation of his patients. I'm proposing that the statue should have a continuous crescent of stone seating encircling it, so that when the people of the town sit down around it they will be helping symbolically to complete it. It seems to me to be important that this monument should be seen not just as a tribute to a great man but to his heroic patients as well and to the community that did so much to support them.”

For more information about The Blond McIndoe Research Foundation or the statue please visit www.blondmcindoe.org or contact [email protected].

NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS

05 - 07 Sep 2013

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

Location: Budva, Montenegro - Venue: Avala Resort and Villas Contact: Mrs. Mina Ploumpi - Telephone: +30 2111001781 - Fax: +30 2106642116

E-mail: [email protected] - URL: http://www.baprascongress2013.com/

10 - 14 Sep 2013

44th Congress of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC)

& 18th Congress of the Association of German Aesthetic-Plastic Surgeons (VDÄPC) Location: Münster/Westfalen, Germany

12 - 14 Sep 2013

Congreso de Cirugía Plástica del Cono Sur Paraguay 2013 Location: Paraguay - E-mail: [email protected]

12 - 14 Sep 2013

XV Dominican Congress of Plastic Surgery

Location: Santo Domingo, Dominican Republic Venue: Hotel V Centenario

E-mail: [email protected]

11 - 15 Oct 2013

Plastic Surgery The Meeting 2013 Location: San Diego, CA, USA - Venue: San Diego Convention Center

http://www.plasticsurgery.org/For-Medical-Professionals/ Resources-and-Education/Meetings/Plastic-Surgery-The-Meeting-.html

24 - 26 Oct 2013

Technology Innovations In Plastic Surgery /

4th International Congress of the Armenian Association

of Plastic, Reconstructive and Aesthetic Surgeons (AAPRAS) Location: Yerevan, Armenia - Venue: Matenadaran

Contact: Mrs. Irene Katti - Telephone: +30 2111001783 - Fax: +30 2106642116 E-mail: [email protected] - URL: http://www.aapras-tips2013.com/

21 - 24 Nov 2013

15th International Course on Perforator Flaps Location: New York, USA - URL: http://cme.med.nyu.edu/ICPF

E-mail: [email protected] - URL: http://www.dgpraec-tagung.de/


Connect with our professional network! IPRAS - professional page

IPRAS - group

Women for Women - group

Follow our news! IPRAS Twitter account

Share our experience! www.youtube.com/iprastv

Join our group! IPRAS Facebook page

IPRAS International Confederation

for Plastic Reconstructive & Aesthetic Surgery

Social Media Networking

ISPRES Professional pageISPRES Facebook page

ISPRES International Society of Plastic Regenerative Surgery

www.ipras.org

www.ispres-ipras.org

** Iscrizione on-line: www.fondazionesanvenero.org** On-line registration: www.fondazionesanvenero.org

Saturday, 14th September 2013

Venue Location:Centro Congressi Fondazione Cariplo

Via Romagnosi 6/8, Milano

Chairmen:R. MAZZOLA M.D., M. KLINGER M.D., S. COLEMAN M.D.

FONDAZIONE G.SANVENERO ROSSELLIFOR PLASTIC SURGERY

FAT INJECTION andTISSUE REGENARATION

The cutting edge.Where we are now.

5th INTERNATIONAL SYMPOSIUM

Syringes for fat injection. From: Miller Cb., Chicago, 1926

Using Skin derived ABCB5 cells in aesthetic medicine - A novelty of pluripotent stem cells.News from Klentze Medical Faculty in Phuket

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

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

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

A D V E R T I S E M E N T

The Rationale of Preventive and Regenerative Training for Plastic Surgeons

Plastic surgery has cemented its importance worldwide and a world without this specialty is unthinkable. In 2005, there were 10.2 million cosmetic procedures performed in the United States, an increase of 11% from 2004 and a 38% increase compared with 2000 . Men are increasingly undergoing cosmetic surgery to enhance appearance, combat the effects of aging, and improve chances for employment in competitive job markets. In spite of this excellent income potential, plastic surgeons are looking for new income sources. This is based on the situation that future development shows a decline in income, accompanied with a reduction in economic growth and an increase within competitive specialties, such as dermatology and aesthetic medicine, which work in the field of minimalinvasive surgery of aesthetic medicine. The demand for cosmetic surgery and services has diminished with fluctuations in the economy. To stay ahead, surgeons must appreciate andunderstand the challenges of a private practice. More and more plastic surgeons are switching to the field of Anti-Aging, preventive and regenerative medicine not only because it offersnew income sources but because it offers a holistic health concept for the patients of plastic surgeons. Many plastic surgical approaches may miss important health aspects. Using antioxidants and hormones; finding the exact diagnosis of aging markers of the skin and other target organsfor plastic surgery like breast gland and genitals; using regenerative techniques like cell treatments; improving the skin and subcutaneous environments of blood and nerve supply are all aspects that physicians can implement into their practices to improve patient outcomes and satisfaction. These facets of medicine are not commonly addressed in training, and will require a special education. Many of the plastic surgeons today already assign their doctors to attend education in Preventive, Regenerative and Anti-aging medicine. They learn how to diagnose aging and non-age related disorders in patients, recognize depressive disorders (frequently underlying the request for plastic surgery), and they understand how to treat the biggest organ, the skin in aging. If a plastic surgery center becomes a point of medical care for all age related problems, it will gain the trust and confidence of their patients. Customers will be turned into patients,as these physicians diagnose disorders at a very early stage. ECARE, the European Center of Aging Research and Education, offers a program of 2 years education with 8 modules, thereby teaching 80 medical protocols (PMI= Professional Medical Instructions), extremely clinically driven to ensure immediate application into the clinical practice of Plastic Surgeons worldwide. Modules run continuously allowing physicians the flexibility to join at any time.

Professor Dr. Michael KlentzeChief Scientific Medical OfficerKLENTZE MEDICAL FACULTYREFERENCES: CONTACT AUTHORContact [email protected] for more information.


Using Skin derived ABCB5 cells in aesthetic medicine - A novelty of pluripotent stem cells.News from Klentze Medical Faculty in Phuket

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

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

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



INTERNATIONAL

Pan African6th

CONGRESSOF PLASTIC AND RECONSTRUCTIVE SURGERY

i n c o n j u n c t i o n w i t h t h e W i n t e r M e e t i n g o f t h e E g y p t i a n S o c i e t yo f P l a s t i c a n d R e c o n s t r u c t i v e S u r g e o n s ( E S P R S )

www.panafricanps2013.com

datesplace

March 2014 El Gouna, Hurghada - Egypt

s t a y t u n e d f o r m o r e i n f o r m a t i o n


Plastic Surgery The Meeting features education that reaches across the specialty

The laid-back atmosphere and welcoming climate of San Diego will provide a uniquely positive contrast to the dynamic, cutting-edge and energized educational events offered during Plastic Surgery The Meeting 11-15 October 2013. Demonstrating the Society’s commitment to innovative education that reaches across the specialty, and with a reinvigorated focus on aesthetics, several new, original and relevant cosmetic offerings. The 2013 American Society of Plastic Surgeons/The Plastic Surgery Foundation/American Society of Maxillofacial Surgeons annual scientific meeting program will be packed withan abundance of new aesthetic offerings – 14 devoted to the breast or face – accompanied by several more courses and panels targeting craniomaxillofacial, hand and upper extremity, reconstruction and practice management. Combined with 21 new courses give international attendees the opportunity to bring home new information to improve their clinic, Operating Room (O.R.) and practice model – regardless of practice profile.The upgrades and alterations installed for Plastic Surgery The Meeting – both “reconstructive and cosmetic” – will provide the ultimate learning experience for plastic surgeons, as well as demonstrate to ASPS members that their Society works continually to improve on their behalf, according to ASPS President Gregory R.D. Evans, MD.“We’ve listened – and more importantly we’ve heard – our members as they’ve offered suggestions to improve our annual gathering of the best plastic surgeons the specialty has to offer,” Dr. Evans says. “We’re willing and motivated to launch exhaustive searches for new material, new people, new times, dates and events – and to make these extraordinary changes to the program. “I feel we’ve fully met this charge for Plastic Surgery 2013,” he adds. “Cosmetic surgery of the face, breast, abdomen and other areas as well, are featured more than ever in the educational offerings, as the speed of innovation in these areas requires us to keep pace. A two-day, dedicated Cosmetic General Session has been created for plastic surgeons looking to focus on one subspecialty area for an extended period each day – for instance, the Cosmetic Session Module: Breast

Augmentation Part I involves four distinct sections, from 8-11:45 a.m. Sunday, 13 October: “Overview and Patient Selection and Markings;” “Surgical Video Lectures;” “Improving Outcomes;” and “Preventing and Managing Complications.” The objectives are to create a symposia-like format with longer sessions, dedicated Q&A time and an opportunity for plastic surgeons to concentrate on each module – for several hours at once.In addition, Plastic Surgery The Meeting will commemorate The Republic of South Korea as its 2013 Honored Guest Nation. The complete registration brochure with information about Instructional Courses, General Sessions, Panels and Scientific Abstracts is available atPlasticSurgeryTheMeeting.com. Travel discounts are available for international travel. Each airline requires a special offer code to redeem the specials. To access the discount codes, information on registration, travel and hotel accommodations, go to PlasticSurgeryTheMeeting.com and click on “San Diego & Travel” at the top of the page. Questions about meeting registration? Please email Judy Myers, Member Services Manager at [email protected].

Presidio view

Plastic Surgery The Meeting is where the best and the brightest plastic surgeons share their expertise and research, network with ��

• Sessions on rhinoplasty, breast augmentation, facelifting and body contouring, plus non-invasive/minimally invasive procedures

• 125+ research papers presented in key clinical areas

• San Diego features 90+ golf courses and eight state-of-the-art casinos

Conference: Friday, October 11 - Tuesday, October 15 Exhibits: Saturday, October 12 - Monday, October 14

This activity has been approved for AMA PRA Category 1 Credit™�

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The Conference is expected to grantEuropean CME credits

(ECMEC) by the EuropeanAccreditation Council for

Continuing Medical Education(EACCME)

TOPICS

New Perspectives on:

Advances and Controversies in:

Photodynamic Therapy Acne/ Precancerous LesionsTreatment of Vascular Lesions Hemangiomas/ Port Wine Stains/ Venous Malformations

Treatment of ScarsTreatment of TattoosBody Contouring Fat & Cellulite - Invasive/Non Invasive - Hot/ColdSkin Tightening Lasers, Radiofrequency, Ultrasound vs. SurgerySoft Tissue Augmentation Fat or FillersResurfacing: Fractional/ Non- Fractional, Ablative/Non-Ablative

··

······

Elisabeth Russe MD


I N D U S T R Y N E W S S E C T I O N

Crisalix launches its latest feature, the Patient Access, which allows patients to see their 3D pre- and post- op images from the comfort of their home, once a surgeon enables this feature. The Crisalix Patient Access is a unique tool in the field of plastic and aesthetic medicine.It benefits surgeons as well as patients. Patients are nowable to see their professional 3D simulations from home , can show it to friends and partner and even share it on social networks and beauty platforms.

A tool designed for sharingWe are living in times of the revolution of online tools. They already play a crucial role in daily activities of companies and people around the world. Crisalix, aware of the importance of these needs, has launched the Patient Access enhancing the use of its state-of-the-art 3D technology for professionals in the medicine / aesthetic surgery field and anybody interested in performing aplastic surgery procedure.

Crisalix Patient Access from home

Thanks to this new feature cosmetic surgery patients can see their simulations at home and via internet. This way they can share their 3D imaging with their friends, asking for their opinions and, in conclusion, take well informed decisions on their procedures. The new patient viewer application allows for easy screenshots and social sharing on platforms like Facebook, Twitter, Pinterest or Realself.

Tele-consultation on the horizonConsidering altering the physical image is a process that makes questions, doubts and insecurities show up in patients’ minds. It is normal to expect that patients look for the support of a professional to find answers about thedecision they are about to make. In order to help patients to find answers and set their minds at ease the CrisalixPatient Access opens the door for the practice of Tele-consultation. Many doctors experience the phenomenon of patients not living in the cities where they practice. The Crisalix Patient Access creates a direct channel of communication between the surgeon and the patient. Tele-consultation is a field of ICT (Information andCommunications Technology) on the rise because it makes easier to evaluate the patient needs and optimize the time doctors are spending on each patient. In addition, patients save time and money originating from transfer fees and generally the medical services provided are improved and so is patient’s level of satisfaction.

Higher satisfaction, optimizing time and better resultsWith all this, the result is no other than the possibility to offer a more detailed and customized service for each individual who is interested in an aesthetic procedure. Patients will be able to eliminate doubts about implant sizes from the comfort of their homes, which ultimately increases the consult to surgery conversion ratio.


Take advantage of the opportunity to upload free and easy, your scientific profile at the IPRAS website. Gain the benefits of being under the IPRAS umbrella. Sign up on www.ipras.org and follow the following steps:1. Create an account by clicking “Member’s

login” on the top right-hand corner and then select the “Create new account” tab.

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

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

4. Once all account details have been added, click on “Create new account” button. Then you click on “EDIT” and then on “DOCTOR PROFILE”.

This is the section where all the information of your scientific profile can be uploaded. You may complete the fields with the information that you prefer such us: Personal Picture, Hospital Position, Affiliation, Special Field of Interest, Contact Details, Memberships, Topics of Special Interest, Publications etc. At the “EDIT” section you may proceed to the appropriate corrections at your account such us to change your password or to update personal information. When you complete the aforementioned steps there will be one last step remaining for your details to be uploaded on the IPRAS website. The application

JOIN YOUR COLLEAGUES The first website that gives you the opportunity

to upload your scientific profile for free!!

www.ipras.org

must be approved by the National Association you are a member. The application will be sent at the Association of the country that you have declared, ensuring that only IPRAS members of good standing and high ethical principles are able to upload their personal details. As soon as your Association verifies you as a member, your profile will automatically be uploaded at the website’s, “Find a doctor” option in the “Members”section. It is also up to you to decide whether your profile will be classified as “private” or visible to all visitors of the IPRAS webpage. Our aim, besides facilitating communication among colleagues, expands to allowing patients to verify the good standing and high ethical principles of the doctors’ profiles hosted, allowing them to choose qualified IPRAS members for needed procedures. There are two new Sections at the IPRAS website.

• IPRAS-TA section where you may find more information concerning the Trainees Association

• Congress Registry section where you may find the all the plastic surgery related congresses.

If you face any difficulties please do not hesitate to contact us at: [email protected]

Always at your disposal! IPRAS Management Office

I P R A S W E B S I T E


I P R A S P A S T G E N E R A L S E C R E T A R I E S

Tord Skoog (Sweden)

1955 - 1959

David N. Matthews (U.K.)

1959 - 1963

Thomas Ray Broadbent (USA)

1963 - 1967

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

John Watson (U.K.)

1971 - 1975

Roger Mouly (France)

1975 - 1983

Jean-Paul Bossé (Canada)

1983 - 1992

Ulrich T. Hinderer (Spain)

1992 - 1999

James G. Hoehn (USA)

1999 - 2006

Marita Eisemann-Klein (Germany)

2006 - present


IPRAS BENEFITS FOR INDIVIDUAL MEMBERS AND NATIONAL ASSOCIATIONS

• Immediate information about safety warnings on devices, drugs and procedures

• Information regarding the proper use of all materials, substances and techniques related to Plastic, Reconstructive and Aesthetic Surgery through IQUAM (the International Committee of Quality Assurance and Medical Devices in Plastic Surgery) General Consensus statement, with an update every 2 years

• Free electronic receipt of the IPRAS JOURNAL

• Information regarding harmonization of training

• Information regarding accreditation of Plastic Surgery Units

• Promotion of Patient Safety and Quality Management (in cooperation with WHO)

• Protection of the Specialty and Promotion of its image world-wide

• Promotion of Individual Members of National Associations by uploading their scientific profile on the IPRAS website

• Exchange of ideas, views, thoughts and proposals through the IPRAS website and its FORUM section

• Certificate for Individual Members to display their IPRAS Membership

• Right to participate in all events organized by National Societies and IPRAS

• Strengthening ties of professional cooperation and friendship with colleagues beyond national borders all over the world

• Information regarding the developments of plastic surgery worldwide

• Association support for educational and research purposes

• Association legal & ethical advice according to international law and practices and assistance with crisis management

• Promotion of local or regional news and Historical Accounts of IPRAS National Associations through the Journal

• Information, promotion and reports of local or regional events, organized by other National Societies and IPRAS, through the official IPRAS management office

International Confederation for Plastic Reconstuctive and Aesthetic Surgery

IPRAS Management OfficeZITA CONGRESS SA

1st km Peanias Markopoulou AveP.O BOX 155, 190 02 Peania Attica, Greece

Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216URL: www.ipras.org • E-mail: [email protected]

Executive Director: Zacharias Kaplanidis E-mail: [email protected]

Assistant Executive Director: Maria Petsa E-mail: [email protected]

Accounting Director: George Panagiotou E-mail: [email protected]

Association Management Director: Labrini Nikolopoulou E-mail : [email protected]

Commercial Director: Gerasimos Kouloumpis E-mail: [email protected]

Next issue: October 2013

DISCLAIMER:IPRAS journal is published by IPRAS. IPRAS and IPRAS Management Office, its staff, editors authors and contributors do not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this journal. The information provided on the IPRAS JOURNAL is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on this journal is for general information purposes only. IPRAS, IPRAS Management Office and its staff, editors, contributors and authors ARE NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS JOURNAL. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS JOURNAL.

While every effort has been made to ensure accuracy, neither the publisher, IPRAS, IPRAS Management Office and its staff, editors, authors and or contributors shall have any liability for errors and/or omissions. Readers should always consult with their doctors before any course of treatment.

©Copywright 2010 by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery. All rights reserved. Contents may not be reproduced in whole or in part without written permission of IPRAS.

Not for sale. Distributed for free.

IPRAS Journal Management Editor: IPRAS Honorary Editor-in-Chief: Ricardo Baroudi, MD Editorial board: Marita Eisenmann-Klein, MD Nelson Piccolo, MD Andreas Yiacoumettis, MD Mimis Cohen, MD Chris Khoo, MD Zacharias Kaplanidis, Economist GS Print: Diastasi E-mail: [email protected] Post Editing: William Greenall Photographer: Julian Klein

13th Issue July 2013

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IPRAS JOURNAL, 13th ISSUE, JULY 2013

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