© Quality Medical Publishing - W Aesthetics Plastic Surgery

Official Newsletter of the International Society of Aesthetic Plastic SurgerySWENSPASI SWENSPASI

January-April 2008 Volume 2 � Number 1

AESTHETIC SURGERY TRENDS IN ASIAChin-Ho Wong, MBBS, MRCS(Ed), MMed(Surg) (Chinese Taipei)Fu-Chan Wei, MD (Chinese Taipei)

Cosmetic surgery is becoming increasingly popular throughout the world, and Asia is noexception to this trend. Once regarded largely as a frivolous pursuit of the privileged fewin the upper echelons of society, cosmetic surgery has taken off in a big way. All across Asiacosmetic surgery is rapidly gaining acceptance in mainstream society. Several factors haveworked in tandem to promote this: improved socioeconomic conditions, shifting culturalnorms, and exposure to Western cultures through the media and frequent travel, amongother things.

The perspective of Asians seeking cosmetic enhancement is generally quite different fromthe outlook among Westerners. Asians tend to be more reserved when discussing such pro-cedures, and discretion is an important consideration. Most patients seeking cosmetic en-hancements today desire a natural result that is in harmony with their ethnic features. Thisis in contrast to the Westernizing procedures that were popular in the 1970s and 80s. Theso-called natural look is, of course, difficult to define, but most patients would be dissat-isfied if friends could spot that they had had cosmetic surgery. They would be most satis-fied if friends notice a favorable improvement in appearance but could not pinpoint whatwas done.

In Asia, as elsewhere, there is a trend toward min-imally invasive and non-invasive procedures, because theyminimize or even eliminate downtime. The desire for subtle enhancements with minimal or no telltale signs of cosmetic surgery falls nicely within the ability of theseprocedures to deliver. The use of botulinum toxin (Botox)injections, skin rejuvenation with lasers or IPL, skin tight-ening with radiofrequency, thread lifts, and fillers has in-creased exponentially in recent years and has surpassedthe number of invasive procedures performed. Becauseof their relative simplicity, minimally invasive proceduresare also being performed by non-plastic surgeons. It isimportant to inform patients of the limitations of suchminimally invasive procedures and what they can real-istically achieve to avoid disappointment later.

The number of surgical procedures nonetheless hasalso continued to increase steadily in recent years. Blepharoplasty, rhinoplasty, face lift, lipo-suction, breast augmentation, mastopexy, breast reduction, and body contouring are themost common surgical procedures performed. Asian blepharoplasty continues to be in de-mand, and technical preference has shifted toward a lower placement of the upper eyelidcrease and more conservative fat removal. Although suture techniques continue to be pop-ular, the open incision technique is experiencing a renaissance because of the permanenceand stability of the crease thus created. The open technique is also more versatile for man-aging upper eyelid fat by fat removal or redistribution.

Rhinoplasties currently performed in Asia usually involve placing silicone implants. Ithas been widely held that the thicker nature of the nasal skin and the weaker nasal carti-lages make suture and nasal grafting techniques less suitable. However, many surgeons areincreasingly rediscovering the versatility and advantages of autogenous materials such as

Continued on p. 13

HIGHLIGHTS

Stem Cells and the 4Regenerative Potentialof Transplanted FatSydney R. Coleman, MD

Mastopexy After 5Massive Weight LossJ. Peter Rubin, MD

Current Status of 6Injection Lipolysis forFat RemovalV. Leroy Young, MD

Ten Commandments 8for Practice SuccessMarie Czenko Kuechel, MA

An Update on Fillers 10Henry Delmar, MD

The Koala Kampaign 12of 2007Catherine B. Foss

WHAT’S INSIDE

From the Editor-in-Chief 2

Presidentʼs Message 3

About Your Practice 8

Features 10

The Human Face 14of Plastic Surgery

ISAPS News 15

Committee Reports 16

Letter to the Editor 16

ISAPS Committees 19

Meeting Calendar 20

New Members 22

List of Advertisers 26

2 ISAPS NEWS � Vol. 2 � No. 1

ISAPS EXECUTIVE OFFICE

EXECUTIVE DIRECTORCatherine B. [email protected]

DIRECTOR OF COMMUNICATIONSTony Staffieri [email protected]

DIRECTOR OF MARKETINGJodie [email protected]

DIRECTOR OF ACCOUNTINGBecky [email protected]

MEMBER SERVICES MANAGERBruch [email protected]

SPECIAL PROJECTSKaren Barnes [email protected]

ISAPS EXECUTIVE OFFICES45 Lyme Road, Suite 304Hanover, NH 03755Phone: 1-603-643-2325Fax: 1-603-643-1444Email: [email protected]: www.isaps.orgCongress website:www.isapscongress2008.org

BOARD OF DIRECTORS

PRESIDENTBryan C. Mendelson, MDToorak, Melbourne, VIC [email protected]

FIRST VICE PRESIDENTFoad Nahai, MDAtlanta, GA United [email protected]

SECOND VICE PRESIDENTCarlos Uebel, MD, PhDPorto Alegre, RS [email protected]

THIRD VICE PRESIDENTElie Abdelhak, MDBeirut, [email protected]

SECRETARY GENERALRenato Saltz, MDSalt Lake City, UT United [email protected]

TREASURERJan Poëll, MDSt. Gallen, [email protected]

ASSISTANT TREASURERDaniel Knutti, MDBiel, [email protected]

HISTORIANThomas Davis, MDHershey, PA United [email protected]

PAST PRESIDENTJoão Carlos Sampaio Góes, MD, PhDSao Paulo, SP [email protected]

PARLIAMENTARIANAndrea Grisotti, MDMilan, [email protected]

NATIONAL SECRETARIES CHAIRMiodrag Colic, MDBelgrade, [email protected]

ASSISTANT NATIONALSECRETARIES CHAIRTheodore Voukidis, MDAthens, [email protected]

EDUCATION COUNCIL CHAIRSusumu Takayanagi, MDOsaka, [email protected]

TRUSTEESThomas M. Biggs, MDHouston, TX United [email protected]

Abel Chajchir, MDBuenos Aires, [email protected]

FROM THE EDITOR-IN-CHIEFRuth Graf, MD, PhD (Brazil)Editor-In-Chief

I am delighted withthe many positive re-sponses we have re-ceived from the read-ers of the previous is-sue of ISAPS News,which was publishedin collaboration withQuality Medical Pub-lishing. We are thrilled that this part-nership allows us to provide a first-classpublication—one filled with news on the latest developments and techniquesin plastic surgery, information about ISAPS-sponsored educational programs,and other topics of interest—for ourreaders. This issue of ISAPS Newsmaintains the quality that was estab-lished with the first issue; like the first,it will also initially be distributed in aprinted format, followed by a dynamiconline version that will allow the pub-lication to reach an even larger inter-national audience. With this newsletter,our goal is not only to educate plasticsurgeons about ISAPS, but to providethem with practical and timely infor-mation that will be useful as they treattheir patients.

A main focus of this issue is the ISAPS Congress, scheduled to take placein February 2008 in Melbourne, Aus-tralia. Catherine Foss, our Executive Di-rector, and Dr. Bryan Mendelson, ourPresident, are leading an amazing groupof people who are all dedicated to mak-ing this a truly outstanding meeting—

complete with a top-notch scientificprogram planned by Dr. SusumuTakayanagi, a terrific faculty of world-renowned experts, and a number ofwonderful social activities for all atten-dees. This will certainly be an event toremember.

In addition to the ISAPS Congress,this issue contains a number of fasci-nating feature articles on new develop-ments in plastic surgery. Dr. SydneyColeman contributes an article on stem cells and the regenerative effect oftransplanted fat, Dr. Leroy Young offersinsights into injection lipolysis and thecurrent state of FDA investigations,and Dr. Peter Rubin writes on dermalmastopexy. We also have articles by Drs.Fu-Chan Wei and Chin-Ho Wong, whoreport on the state of aesthetic surgeryin Asia, and by Dr. Henry Delmar, whoexamines a variety of fillers and their sta-tus around the world. There are a num-ber of reports on humanitarian efforts,Mini-Symposia and Congresses, memberhonors, and other events and accom-plishments of interest. Finally, we arepleased to announce that a new columnis making its debut in this edition, of-fering useful advice and tips to help keepyour aesthetic practice running smoothly.

This newsletter succeeds because ofyour involvement. Feel free to submit ar-ticles on topics you think would be of in-terest to your plastic surgery colleagues.Guidelines for submitting an article or a brief report are available on page 26or online at isapsnews.com. While youare visiting the site, please take a momentto complete our survey, and to providecomments and suggestions for the nextnewsletter. �

have 84 member countries contributingto our educational efforts. This is agreat benefit; however, it is sometimesdifficult to incorporate all of the con-tributions that we receive. This is par-ticularly true for the forthcoming ISAPSBiennial Congress in Melbourne. With14 panels and only 63 free papers se-lected for podium presentation, oppor-tunities are limited for representationfrom established member countries.

We understand the disappointmentexpressed by members who perhapsfeel that their countries have not beenproportionally represented on the aca-demic program for the ISAPS BiennialCongress. Let me assure you that everyeffort has been made to provide broadrepresentation from the different coun-tries. The ultimate decisions, however,are based on the quality of the paperssubmitted. We have only selected ma-terial that represents the highest aca-demic standards for our Society and its members. Those who attend ourCongresses expect nothing less. For thisreason the Education Council, and par-ticularly the Scientific Program Com-mittee for the Congress, take this aca-demic responsibility most seriously.

The Scientific Program Committeeis working to encourage the higheststandards in papers for the Congress;we are also seeking to provide an op-portunity to identify and recognize ex-cellent presentations. Accordingly, themost outstanding of the free papers pre-sented at the podium during the Con-gress will be determined by a panel ofjudges and will be presented to allmembers at the Grand Finale ScientificSession. Members from each countryshould be aware that, in addition tosubmitting abstracts for selection bythe Program Committee, they shouldalso focus on providing world-class pre-sentations.

Furthermore, any papers not se-lected by the Judging Panel for podiumpresentation are reviewed for inclusionin the E-Paper sessions. The best E-Papers will be selected for podium pre-sentation at the Grand Finale Session.Additionally, the editorial team for theISAPS journal, Aesthetic Plastic Sur-gery, will be looking for excellent pa-pers to publish in the journal. Thusmembers have a number of opportuni-ties to demonstrate academic excellenceat the forthcoming Congress.

By the time you receive this issue ofISAPS News there will be only a fewshort weeks left to sign up for the ISAPSCongress in Melbourne. If you are notalready registered, I urge you to do so.The scientific program is extraordinary,with superb contributions that reflectthe diversity of outstanding aestheticsurgery practiced by our membersaround the world. Early registrationsfor this meeting have been exceptional,with an unprecedented number of com-panies signing up to exhibit. This is go-ing to be a remarkable event. The wordis out about ISAPS and the importanceof its Congresses. �

ISAPS NEWS � Vol. 2 � No. 1 3

PRESIDENT’S MESSAGE Bryan C. Mendelson, MD

(Australia)ISAPS President

It is once again mypleasure to be ableto communicate withyou through themedium of ISAPSNews. We received avery positive re-sponse to our previ-ous issue, whichmarked the beginning of our partner-ship with Quality Medical Publishing(QMP). We hope that this issue willproduce a similar level of enthusiasm.Because of the connections that QMPaffords us, we are now able to transmitISAPS News online to more than 14,000plastic surgery colleagues worldwide.

One of the most important waysfor members to give us input is throughinvolvement with the ISAPS commit-tees listed on page 19 of this issue.These committees represent the diver-sity of ISAPS and help us meet the in-herent challenges encountered by anyinternational organization when re-gional representatives bring differentcultural and social backgrounds to thetable. However, the benefits of incor-porating the experiences from differentplastic surgery cultures are beyondmeasure and greatly enrich our inter-actions.

The success of any organization de-pends on the involvement of good people who actively contribute to theorganization’s effectiveness. The com-mittee system provides an ideal vehiclefor aesthetic plastic surgeons aroundthe world to get involved and reach out to the next generation of plasticsurgeons.

Service on an ISAPS committee is a privilege and a responsibility, and wehonor those who currently serve ascommittee members. To ensure thatthese committees are functioning ef-fectively with full accountability, thechairs are asked to provide committeemember evaluations and recommendwhether individuals should continue toserve on committees or advance to newroles in the ISAPS leadership.

ISAPS has experienced tremendousgrowth over the past 5 years. We now

NOMINATIONS FOR ELECTION AT THE ISAPS BIENNIAL BUSINESS MEETING IN MELBOURNE

President:Foad Nahai, MD (United States)

President-Elect:Jan G. Poëll, MD (Switzerland)

First Vice President:Carlos Uebel, MD, PhD (Brazil)

Second Vice President:Susumu Takayanagi, MD (Japan)

Third Vice President:Angel Papadopulos Escobar, MD

(Mexico)

Secretary General:Miodrag Colic, MD (Serbia)

Treasurer:Daniel Knutti, MD (Switzerland)

Assistant Treasurer:Dirk Richter, MD (Germany)

Historian:Riccardo Mazzola, MD (Italy)

Trustee:Andrea Grisotti, MD (Italy)


STEM CELLS AND THE REGENERATIVE POTENTIAL OF TRANSPLANTED FAT Sydney R. Coleman, MD (United States)

Even though promising applications forembryonic stem cells have been on thehorizon for more than a decade, andthe world has spent trillions of dollarson research, we have not yet developedany clear-cut clinical applications forembryonic stem cells. On the otherhand, plastic surgeons have recentlydiscovered actual cures for such patho-logic conditions as scarring, radiationburns, and vocal cord paralysis using autologous human fatgrafts. The most likely mechanism for these cures is the pres-ence of stem cells or repair cells inherent in the transplantedfat and the effects of these cells on surrounding tissue.

sue. However, what actually happens when fatty tissue istransplanted in humans has yet to be confirmed. Studies areneeded to delineate the role of adipose-derived stem cellsand pre-adipocytes in the repair of damaged tissue both innormal physiologic conditions and after free transplantationof fat.

INTERNATIONAL PERSPECTIVE

I have had a unique opportunity to follow the worldwide ex-perience with fat grafting over the last decade because of closecommunications with plastic surgeons and other physiciansfrom all over the world who have shared their knowledgewith me. My international experience began in 1995, whenDr. Guy Magalon, the director of the largest plastic surgerydepartment in France, visited me to observe my fat-graftingtechnique. In 1998, Dr. Magalon and I organized a large,well-attended symposium in Marseilles about fat grafting.This symposium effectively introduced my technique for fatgrafting to Europe, especially France. Since then, the Frenchhave been actively grafting fat, and they refer to successful fatgrafting as “Coleman” fat grafting. In 2006, the French So-ciety of Plastic Surgery presented 18 scientific papers on fatgrafting in its general session. Of particular interest are theFrench experiences using fat grafting to treat subacute traumaand chronic ulcers of the legs.

Recently, Italian plastic surgeons have achieved re-markable clinical results using this fat-grafting technique fortreating pathologic processes. Dr. Rigotti has been treatingend-stage radiation dermatitis and breast scarring with fatgrafting. A craniofacial surgeon in Los Angeles, Dr. Kawa-moto, has reported favorable healing of irradiated ulceratingskin after treatment with fat grafts.

At New York University, we have developed murinemodels to study the effects of transplanted human fat on ir-radiated skin. Our initial studies have shown that ulcersfrom radiation burns heal within 2 weeks after treatmentwith human fat.

A recent report by an otolaryngologist, Dr. GiovannaCantarella, working with a plastic surgeon, Dr. RiccardoMazzola, in Milan, shows remarkable recovery of paralyzedor scarred vocal cords in dozens of cases after injecting fat di-rectly into the cords using the Coleman technique. Drs. Maz-zola and Cantarella will soon publish their research on vocalcord tissue regeneration mediated by mesenchymal stem cellsin adipose tissue.

In 2006, Dr. Mazzola, president of the European Asso-ciation of Plastic Surgery, organized a 2-hour panel that fo-cused on the regenerative aspects of fat grafting. Because ofthe success of that event, we have subsequently organizedtwo additional symposia in Milan with the same focus, andwe are now planning to collaborate on a book, Fat Injec-tion: From Filling to Regeneration, which will focus on theworldwide clinical experience of the regenerative uses of fatgrafting.

Guest Columnists

Sydney R. Coleman, MD

Continued on p. 11

Plastic surgeons have discovered actual curesfor scarring, radiation burns, and vocal cordparalysis using autologous human fat grafts.

PIVOTAL OBSERVATION: THE EFFECTS OF FAT GRAFTINGON SURROUNDING TISSUES

In the early to mid 1990s, I began noticing that fat appearedto be doing more than simply providing volume when trans-planted. My initial observation was that there seemed to bean improvement in the quality of the tissues into which fatwas grafted. For example, fat placed into damaged musclefibers precipitated not only an increase in volume, but also arecovery of muscle strength. I also noticed that there usuallywas a gradual, long-term improvement in skin quality. Wrinkles softened, pore size decreased, and pigmentationimproved for up to 10 years after fat grafting. About 1995,I noticed that fat grafted under depressed scars not only re-lieved the depression, but also softened or even completelyeliminated the specific scar tissue, making it look like normalskin. I began routinely treating depressed scars, acne scars,and even old chemical burns by grafting fat.

In the last 4 years, Dr. Gino Rigotti, Dr. Henry Kawa-moto, and I have reported that grafted fat repairs skin andother tissues damaged by therapeutic irradiation. I have re-cently observed remarkable healing of recently traumatizedtissue after fat grafts.

ADIPOSE-DERIVED STEM CELLS: A PLAUSIBLEEXPLANATION FOR THE EFFECTS OF FAT

We now know that fatty tissue has the highest percentage ofadult stem cells of any tissue in the body. The repair cells(stem cells) in transplanted fat may be restoring damaged tis-


MASTOPEXY AFTER MASSIVE WEIGHT LOSSJ. Peter Rubin, MD (United States)

Patients undergoing massive weight lossoften present with severe breast deformitiessuch as volume loss with skin deflation,loss of skin elasticity, medialized nipples,and a prominent lateral skin/fat roll thatcan obscure the aesthetic border betweenthe breast and upper back. Many existingmastopexy techniques fall short of pro-ducing a good aesthetic result in this pa-tient population. We have developed atechnique that achieves a youthful breast shape in this patientpopulation using dermal suspension and parenchymal re-shaping.1 This technique is not only durable; it has had a veryhigh rate of patient satisfaction in nearly 100 patients. Im-portantly, it allows autologous tissue from the lateral chest to be used for augmentation without prosthetic implants.

This technique builds on the important work of other sur-geons who have developed ways of securing breast tissue toadjacent structures to achieve better projection. Graf andBiggs,2 Frey,3 Qiao et al,4 and Gulyás5 have all made notablecontributions in this area. Additionally, Holmström and Loss-ing’s lateral thoracodorsal flap for breast reconstruction af-ter mastectomy documents previous success with transposingchest wall tissue into the breast mound.6

The procedure is based on a Wise marking pattern andpreservation of a central pedicle. The lateral portion of theWise pattern is extended posteriorly to encompass the axil-lary skin roll and provide additional autologous tissue forbreast volume. The Wise pattern can be extended to the pos-terior axillary line and beyond, depending on the extent of thelateral skin roll and the amount of tissue desired for autolo-gous breast augmentation.

The robust blood supply of the lateral thoracic region allows a significant amount of tissue to be safely mobilized to the breast. The entire region within the Wise pattern is de-epithelialized.

The breast parenchyma is then completely degloved byraising a 1.5-cm thick flap overlying the breast capsule. Oncethe chest wall is reached, undermining continues above thepectoralis major fascia to the level of the clavicle. Medial andlateral flaps of breast tissue—representing the “wings” nor-

mally excised in a Wise pattern breast reduction—are un-dermined and mobilized. The central dermal extension issuspended on the chest wall with a 0-braided permanent su-ture secured to the periosteum of the second rib.

The lateral breast flap is then suspended and secured tothe chest wall by tacking it to the periosteum, usually that ofthe third rib, in a similar manner. This creates a discrete lat-eral curvature to the breast and replaces the unsightly blend-ing of breast tissue with the lateral chest. The medial breast

J. Peter Rubin, MD

Lateral extensionbased on size of

skin roll and/or lateral flap desired

Extent of de-epithelialization is

based on size of flap foraugmentation and neednot include entire Wise

pattern

Wise patternDe-epithelialized

area

Entire Wise pattern de-epithelialized

Midline suture purchases ribperiosteum

Central dermalextension

Lateral breast flap

Medial flap secured tochest wall and dermal

plication initiatedDashed lines indicateareas to be plicated

Lateral flap secured to chest wall

flap is then suspended and secured to the chest wall in a fash-ion similar to the lateral flap. Control of the parenchymalshape is gained through plication of the broad dermal surfacearea with running absorbable sutures.

We have found that the exact pattern of plication is dif-ferent in each patient and is dictated by the desired breastshape. During skin closure, it may be noted that the nipple is

These images show a clinical example of this technique both pre-operatively and at 10 months post-operatively.

Continued on p. 11


CURRENT STATUS OF INJECTION LIPOLYSIS FOR FAT REMOVALV. Leroy Young, MD (United States)

For the past few years, the media havebeen reporting on an injection that “dis-solves” fat deposits. News about this treat-ment was disseminated on the Internet asthe hype for fat-reducing methods grewexponentially. Businesses were launched inthe United States to take advantage of thepopular demand for this treatment. Someplastic surgeons advocated the treatment,and injection lipolysis with phosphatidyl-choline (PPC) and deoxycholate (DC)—often referred to aslipodissolve in the United States—has been a hot topic at major plastic surgery meetings.

During 2007, however, the tide shifted against injectionlipolysis as the news organizations and magazines that hadpreviously promoted the procedure began to report that in-jection lipolysis was not approved by the U.S. Food andDrug Administration (FDA) for any application. Further-more, injection of these ingredients was not an off-label use,and claims that this use was off-label were incorrect.

Media reports of dissatisfied patients also surfaced in2007. Patients were interviewed who had undergone a seriesof injections with little or no results and great discomfort.Many of the clinics and spas offering these treatments in-cluded a money-back guarantee, but patients had great dif-ficulty receiving refunds. These problems led groups such asthe Better Business Bureau to issue warnings to the publicabout these practices. Moreover, there were reports of pa-tients who received their injections without ever seeing aphysician, let alone being treated by one. Some of these in-dividuals were not good candidates for injection lipolysis, be-cause they had more generalized fat rather than the small lo-calized fat deposits that this therapy was intended to treat. Stillother patients were told that the injections would be effectiveonly if a regular exercise and diet program was undertaken.

GOVERNMENT RESPONSES

Not surprisingly, governmental agencies have recently tried toregulate injection lipolysis treatments. However, this is not aneasy task, because practitioners are able to obtain the inex-pensive and readily available ingredients from compoundingpharmacies, and the FDA does not regulate the pharmaciesor the PPC and DC ingredients. Any effort to monitor all theplaces that order injectable PPC/DC in bulk shipments wouldbe prohibitively expensive.

It is important to note that the FDA has never approvedsubcutaneous injections of PPC, DC, or their combination forany purpose. According to FDA spokeswoman Karen Riley,“the practice of using injection lipolysis . . . is not FDA ap-proved. . . . In fact, there are no FDA-approved drugs withan approved indication to dissolve fat.” According to theagency, injection lipolysis is a “new drug because there is notsufficient evidence that the product is generally recognized assafe and effective for its intended use. Since the product is anew drug it may not be marketed in the United States with-out an approved new drug application.”

Why, then, are so many businesses in the United Statescontinuing to market PPC/DC injections for fat reduction?According to the FDA, doctors can prescribe a compoundeddrug formulated with ingredients from approved drugs aslong as doctors do so on an individual patient basis.

State governments are also starting to get involved. TheMissouri State Board of Healing Arts recently began a reviewof PPC/DC injections, and the Kansas Board of Healing Artstried to limit PPC/DC injections to studies that have receivedInvestigational New Drug (IND) approval from the FDA.

Governments other than the United States are also grap-pling with this issue. Several years ago, ANVISA, the Brazil-ian equivalent of the FDA, banned the cosmetic subcutaneousinjection of Lipostabil, an intravenous PPC manufactured inFrance. Although not approved for medical use in the UnitedStates, Lipostabil has been available for more than threedecades in Europe, South America, and South Africa for IVtreatment of hyperlipidemia, hypercholesterolemia, athero-sclerosis, diabetic angiopathies, angina pectoris, hypertensionof sclerotic origin, and fat embolism.

Health Canada, that country’s regulatory agency, re-cently ordered physicians to stop marketing and administer-ing PPC products for fat removal. In the United Kingdom, theMedicines and Healthcare products Regulatory Agency(MHRA) issued consumer warnings stating that it is illegal toadvertise PPC for fat removal, because insufficient data ex-ist regarding its safety and efficacy. They also made it clearthat unlicensed drugs may not be imported without approvalfrom UK government agencies. In all these countries, it is unclear how well these regulatory efforts are working. How-ever, the UK has withdrawn malpractice coverage for physi-cians using PPC for cosmetic fat removal. This was the firsttime ever that coverage for a treatment was withdrawn by thegovernment.

V. Leroy Young, MD

“. . .there are no FDA-approved drugs with an approved indication to dissolve fat.”

RESEARCH IS THE KEY

Although the FDA in the United States cannot regulate thecompounding pharmacies that mix PPC/DC subcutaneous in-jections, the agency does regulate the ability to conduct re-search studies with these ingredients. Only research can de-termine whether injection lipolysis is safe and effective.Furthermore, the mechanism of action for injection lipolysisto reduce fat cells is not understood. Some proponents ofPPC/DC injections claim that the fat cells dissolve, and theircontents are simply excreted, but this scenario is implausible.Some animal research shows evidence that the DC componenthas direct toxic effects on adipocyte membranes that lead tocell necrosis. Others theorize that the surfactant effects of PPClead to apoptosis as the primary mechanism of action. Whilewe wait for an understanding of PPC/DC mechanisms andguidance regarding their safety, thousands of people are stillsigning up to receive these injections.

After working for more than a year to meet FDA re-quirements, one group of researchers has finally received ap-


proval for an IND application to study injection lipolysis withPPC/DC.* The protocol allows for the enrollment of 20 pa-tients who will have one side of the lower abdomen injectedup to four times with a formulation of PPC/DC that was ap-proved by the FDA specifically for this IND and will be pre-pared by an approved compounding pharmacy. InstitutionalReview Board (IRB) approval is required by the FDA, andstudy subjects will be medically screened and must meet spe-cific inclusion criteria, including localized fatty deposits in thelower abdomen and a body mass index no greater than 30kg/m2. The list of exclusionary criteria is lengthy, and partic-ipants will be specifically asked not to change their regulareating or exercise habits during the study.

Subjects will receive a minimum of two and maximum offour treatment sessions, at 4-week intervals, on one side of the lower abdomen. The non-injected side will serve as a con-trol. Subjects will undergo the final set of medical tests 8weeks after the final treatment, and will be seen 24 weeks after the final treatment session for evaluation of results,side effects, complications, and satisfaction. After the finalmedical tests are performed, those subjects who are pleasedwith the treatment will be allowed to have the same injectionson the control side.

The study protocol requires multiple techniques tomeasure results. Standardized abdominal photographs willbe obtained throughout the study, with abdominal circum-

ference and skin fold thickness measurements taken at astandardized level. These data will help evaluate the efficacyof the treatment. Study subjects will also be given a diary torecord side effects and complications. Before the injectionsbegin and 8 weeks after the final treatment session, subjectswill have an MRI to quantify the thickness and volume ofabdominal adipose tissue mass as well as show any post-treatment scarring or granuloma formation. Dual energy x-ray absorptiometry (DEXA) will be performed to deter-mine total body fat and fat-free mass at the beginning andend of the study.

Blood samples and subcutaneous adipose tissue biopsieswill be collected at three intervals: before treatment, 1 weekafter the first treatment, and 8 weeks after the final treatment.Biopsies will investigate the effects of PPC/DC on the meta-bolic function of adipose tissue. Specifically, the study willlook for markers of gene expression to determine whether thetreatments inhibit adipocyte proliferation, alter adipocytecellular function, and/or increase production of inflammatorycytokines and macrophage infiltration. Plasma lipid profile,glucose, and insulin levels will be measured from blood samples, and tissue and blood will be evaluated for effects onsystemic markers of metabolism, inflammation, and adipokines(including C-reactive protein, leptin, IL-6, and TNF-�).

Although this clinical trial is small, it has been designedto apply scientific methods rather than anecdotal observationsto the question of whether injection lipolysis treatments are*Dr. Leroy Young is the Principal Investigator for this research project, which

is funded by the Aesthetic Surgery Education and Research Foundation. Continued on p. 24

explore

deve lop We invite you to learn about the Mentor Experience.

As the dedicated breast implant and aesthetics

company, we design excellence not only into our

products, but into every aspect of our business.

Drop by our booth during ISAPS 2008 for a

first-hand look at the difference Mentor makes.

© August 2007 Mentor 0704005.01 Rev A

Excellence every step of the way.create

insp i reCohesive it is. New it isn’t.

Innovative breast implant products, the Spectra™ Adjustable Gel Implant and the Ultra High Profile Round Gel Implant.

Mentor has recently partnered with Genzyme Corporation to develop a robust pipeline of science-based products designed to rejuvenate every layer of skin, from the inside out.

�NEW!

�NEW!


TEN COMMANDMENTS FOR PRACTICE SUCCESSMarie Czenko Kuechel, MA (United States)

Today’s aesthetic surgeon is faced withmyriad changes and challenges in the mar-ketplace: from the global economy to thelocal economy; from the growth of cos-metic medicine to the influx of providers(many unqualified); from the very focusedmeans of communicating with patientsaround the world to the very diverse andoften unqualified information about aes-thetic procedures (and possibly about you)on websites, blogs, and in chat rooms. Intrying times, the ten essential laws of practice managementwill help you not only to endure, but to prosper.

1. Know your market. Define your patients clinically anddemographically. Know the procedures they are hearingabout, talking about, and considering; know the aestheticissues that concern them. Define the age groups, the in-come groups, the ethnic groups, and the socioeconomicgroups in which your patients fall. Consider their per-sonal interests (fashion or fitness), desires (beauty oryouth), limits (time, pain, or money), and influences,both positive and negative. Relate to your patients notjust in terms of aesthetic surgery or aesthetic medicine,but also in terms of lifestyle. Craft a scientific answer tothe statement, “My patients expect. . .” and live by thoseexpectations. Define your brand (who you are) and iden-tity (how you serve) based on your market.

2. Forget cookie-cutter strategies. Just because everyoneelse is offering email consultations, buying time on tele-vision, or building a medi-spa does not mean these areright for the patients you attract. Strive for marketing andcommunications that highlight your visibility and educatepotential patients about the services you offer. Present evidence of outcomes. Use marketing and communica-tion strategies that complement your market—their buy-ing habits and lifestyle preferences.

3. Educate your referral sources and stay connected. Thebest patients are those who come to you already educatedand familiar with your work. Make certain your referralsources (physicians and patients) are always up to dateon information about you and your services. Keep themwell stocked with your business cards, biography, and pa-tient education. Make it a point to connect with them atleast twice each year, whether with a personal note, a tele-phone call, a brief email newsletter, or even a holidaygreeting.

4. Avoid guerilla marketing. Sensationalism, urgency, spe-cial deals, special prices, discounts, and unrealistic out-comes will surely result in one of two fatal errors: a re-volving door (prospective patients are in and out quickly,never to return) or a price war.

5. Get organized and stay polished. Strive for the best. Thisdoes not mean opulence; it means excellence. My grand-mother used to say “never trust the shoemaker who hasholes in his shoes.” Take a look at yourself, your staff,your office, and the entire patient experience from theoutside in. What does your website look like? How effi-cient, personal, and private is scheduling, the consulta-tion process, your paperwork, and your pre-operativeand post-operative procedures? In a competitive worldyou are measured not only by outcomes but also by thevalue, process, and experience that you and your staffprovide.

6. Assign a staff member to manage everything but theclinical details. Whether you call this person a “patientcoordinator,” “counselor,” or “concierge,” the aestheticsurgeon must be the surgeon, and someone else must per-sonally, professionally, and individually manage the pa-tient process for each patient in your care.

7. See conflict as an opportunity to learn, improve, andgrow. Do not look for quick fixes; look for causes, andconsider all the potential effects of conflict resolution. En-list a trusted team to evaluate conflicts from all sides, andmake decisions for the future together.

8. Put salesmanship aside. Your tactics will earn you the pa-tients you deserve. Overstate outcomes and you’ll havepatients with unrealistic expectations. Sell someone thehottest new laser treatment because it’s “hot” and “new”and soon you’ll be cold and old—no one will be callingyou, because news of false promises spreads fast.

9. Strive for total patient satisfaction, not a pre-definedrevenue stream. Happy patients naturally generate fi-nancial rewards. Pre-conceived financial goals naturallygenerate salesmanship.

10. Your relationship with your patients is cyclical. For aslong as you are in practice, and for as long as your pa-tients are alive, find a way to stay in touch. Whether theycome back for another procedure, refer someone to you,or simply remind you that you are first and foremost aphysician, your reason for being is the happy patients youhave acquired. �

About Your Practice

Marie CzenkoKuechel, MA

QANTAS is the Official Airline forISAPS Melbourne 2008!

If you are attending the ISAPS Congress, you areeligible for Special Airfare Discounts in both business

and economy classes. For more information visit www.isapscongress2008.org/tours.asp


Providing innovative products such as BOTOX® treatment and

JUVÉDERM® injectable gel, Allergan is a specialty pharmaceutical

company that continues the advancement of cosmetic medicine

worldwide. We are constantly striving for medical advances through

our research and development, discovering and developing new

products for the eyecare, neuromodulator and skin care markets.

In over 100 countries we deliver value to customers, and support

medical professionals in improving people’s lives.

Allergan Australia Pty Ltd. ABN 85 000 612 831. 77 Ridge Street, Gordon, NSW 2072. ALL0681

face valueA company you can take on


migratory. In addition, the agent must provide predictable,persistent correction through reproducible implantation tech-niques. Finally, the substance, agent, or device must be ap-proved by the United States Food and Drug Administrationand European conformity, which ensure purity, safety, and ac-cessibility, as well as provide much-needed information re-garding use.

Different fillers can be classified as follows:� Non-permanent, semi-permanent, or permanent � Organic or inorganic � Autologous or heterologous

Non-permanent fillers include: � Collagen implants: Animal-derived (Zyderm [Aller-

gan/Inamed, Irvine, California]) and human-derived(CosmoDerm [Inamed Aesthetics, Santa Barbara, Cal-ifornia]). Their actions are based on the creation of aninflammatory reaction in the dermis. They can becombined with hyaluronic acid.

� Hyaluronic acid: Animal-derived (Hylaform; InamedAesthetics, Santa Barbara, California) or bioengineered(Restylane [Q-Med AB, Uppsala, Sweden], Surgiderm[Corneal Group, Paris, France], Hydrafill [Inamed Aesthetics, Santa Barbara, California], Juvederm [Allergan/Inamed, Irvine, California], Isogel [Labora-toires Filorga, Paris, France]). Their actions are basedon their hydrophilic potentials. The bioengineeredproducts do not require allergy testing, making themeven more attractive to patients. — Non-reticulation hyaluronic acids are useful in

mesotherapy; they can be injected with 32-gaugeneedles (Restylane Vital [Q-Med AB, Uppsala,Sweden], NCTF 135 [Filorga Laboratories, SouthAfrica]).

— Mild reticulation hyaluronic acid is useful for su-perficial lines (Restylane Fine Line [Q-Med AB, Upp-sala, Sweden], Surgiderm XP24 [Corneal Group,Paris, France], Hydrafill 2 [Allergan/Inamed, Irvine,California], Prevelle [Genzyme; marketed and dis-tributed by Mentor Corporation, Santa Barbara,California]). This acid has long-lasting effects, witha duration of approximately 6 months.

— Deep dermal hyaluronic acids, such as Perlane (Q-Med AB, Uppsala, Sweden), Surgiderm XP30(Corneal Group, Paris, France), Hydrafill 3 (Al-lergan/Inamed, Irvine, California), and Puragen(Mentor Corporation, Santa Barbara, California)are indicated for deep wrinkles and should be in-jected deeply. They are long-lasting, with a dura-tion of around 12 months or more when the in-jection is deep on the periosteum or along thenasolabial fold. The filler can be used to enhancethe lips, can be injected along the superior orbitalrim, or can be used on the periosteum, where it cantreat tear trough deformities.

Features

Continued on p. 18

AN UPDATE ON FILLERS Henry Delmar, MD (France)

Advances in industrial and medical technologies for facial re-juvenation have contributed to increased growth and interestfor non-invasive therapies. Short recovery times with minimaldowntime, proven effectiveness, low morbidity, and fast re-sults have made non-surgical treatments popular among pa-tients. For these reasons, 20% to 25% of a plastic surgeon’saesthetic practice can be—and I strongly think should be—devoted to these techniques, if the plastic surgeon is truly tobe considered a specialist in medical rejuvenation.

The primary morphologic aspects of the aging process—including volume loss in the face and the structural modifi-cation of skin associated with muscle contracture—can beimproved with a combination of botulinum toxin type A andfillers. Fillers can also be used for younger patients to enhancethe shape of their lips and for other facial contouring.

The three main indications for the use of fillers are:1. Wrinkles. The morphologic aspects of wrinkles are

multifactorial, but these can be classified by theirmain results: � Hypertonic muscular basal tone. Fillers are useful

when botulinum toxin type A is not sufficient, aswith glabellar, frontal, and perioral wrinkles.

� The anatomic relationship between skin and thedeepness of folds, such as with the nasolabial foldand mandibular fixed point. Fillers can accuratelyand effectively fill these areas.

� Structural modification of the skin, such as theameliorating wrinkling of the cheek, malar, andchin areas.

2. Volume of the face. The tear trough, cheekbone, chin,and temporal depression areas are enhanced withsome fillers.

3. Skin rejuvenation with mesotherapy. Facial mesother-apy represents a variety of minimally invasive tech-niques in which medications are injected directly intothe dermis of the face. The injections are done with32-gauge needles, 4 to 13 mm long. The zone that istreated is squared every 5 mm; injections are per-formed manually, rarely with a “gun.” Mesotherapyas a treatment for aging skin is reserved for the face,neck, décolleté (low neckline), and hands. The med-ications are a complex of cell-culture solutions (mul-tivitamins, amino acids, and minerals) and a shortchain of hyaluronic acid.

REGULATION OF FILLERS

For a substance or device to be amenable for medical soft tis-sue augmentation, it must meet certain criteria. It must haveboth a high use potential—producing cosmetically pleasingresults with a minimum of undesirable reactions—and havea low abuse potential in that widespread, incorrect, or indis-criminate use would not result in significant morbidity. Thefiller must be non-teratogenic, non-carcinogenic, and non-


Mastopexy After Massive Weight Loss—cont’d from p. 5

Surgeons in the rest of Europe, South America, Korea, Japan,mainland China, and Africa are also reporting noteworthyclinical experiences in similar situations, such as the suc-cessful treatment of chronic ulcerations with fat grafting, theuse of adipose-derived stem cells to aid bone growth, and theuse of fat grafts to aid the healing of skin grafts and theirdonor sites.

FUTURE

We have an abundance of clinical evidence that fat graftingmay accelerate healing processes. Grafted fat has the poten-tial to improve the quality of scarred skin and heal radiationdamage and chronic ulcers. Just how grafted fat causes thesechanges remains unanswered. We know that fat can per-form amazing feats in a glass tube and in some animal mod-els; however, we have little insight into what happens to fatwhen it is grafted from one part of the human body to an-other part.

My 20-year experience with grafting fat is full of anec-dotal evidence of the regenerative effects of fat grafting. How-ever, those clinical experiences are now being repeated, ex-panded, and studied at a rapid pace by other physiciansworldwide. �

Stem Cells and the Regenerative Potential of Transplanted Fat—cont’d from p. 4

tethered in an inappropriate position and/or points in an un-desirable direction. If this occurs, a cautery may be used toincise the dermis partway around the nipple to release thetethering and allow the nipple to point forward. Intradermalsutures are used to complete the closure, and suction drainsare placed in each lateral breast. Complications observedwith this procedure have been limited to wound dehiscenceand hematoma. We have seen no cases of nipple loss or de-tectable fat necrosis. �

References1. Rubin JP. Mastopexy after massive weight loss: dermal suspension

and total parenchymal reshaping. Aesthetic Surg J, 26:214-222,2006.

2. Graf R, Biggs TM. In search of better shape in mastopexy and re-duction mammoplasty. Plast Reconstr Surg 110:309-317, 2002.

3. Frey M. A new technique of reduction mammaplasty: dermis sus-pension and elimination of medial scars. Br J Plast Surg 52:45-51,1999.

4. Qiao Q, Sun J, Liu C, et al. Reduction mammaplasty and correctionof ptosis: dermal bra technique. Plast Reconstr Surg 111:1122-1130, 2003.

5. Gulyás G. Mammaplasty with a periareolar dermal cloak for glan-dular support. Aesthetic Plast Surg 23:164-169, 1999.

6. Holmström H, Lossing C. The lateral thoracodorsal flap in breastreconstruction. Plast Reconstr Surg 77: 933-943, 1986.

T H E A R T O F F A C I A L R E J U V E N A T I O N

ADODERM GmbH

Elisabeth-Selbert-Str. 5 • D-40764 Langenfeld • Germany • www.adoderm.com

...a new generation of hyaluronic acid

The Varioderm product line

offers a wide range of wrinkle-filling

and volume creation solutions.

VARIODERM FINE LINE

VARIODERM

VARIODERM PLUS

VARIODERM SUBDERMAL

...fulfilling the needs

and expectations of

the patients and doctors.


Most people who attend meetings are aware—consciously ornot—that a certain amount of work is necessary to makethese events successful. Someone has to make the coffee, after all. Anyone who has planned a meeting of any size isprobably a bit more aware of the magnitude of the details in-volved. Beginning with the previous Congress—where thestage is set for the next meeting—a virtual army of skilled, focused, professional, and very dedicated people must workfor several years to make a 4-day Congress memorable.

This has certainly been the case with the 2008 Mel-bourne Congress. Three divisions of the Program Committeehave worked tirelessly, making sure that the meetings and pre-sentations include unique and educationally valid informa-tion. These workers have ensured that the best plastic sur-geons in the world have been invited to be part of thefaculty—and that they are committed to participating. Lo-gistics planners on two continents meet every week by con-ference call (at some very odd hours) to make sure all plan-ning details are under control and are moving forwardaccording to schedule. Countless consultants have been en-listed to manage all aspects of the Congress—organizing registration materials and procedures; arranging for andmanaging meeting spaces; designing and maintaining theCongress-specific website; planning tours for registrants andtheir families before, during, and after the Congress; planningcomplicated social events for no fewer than 20 different en-tertainment groups; scripting all Congress ceremonies; de-signing, copywriting, proofreading, printing, and distributingfour different brochures; scheduling transportation; securinginvitations for members to play the Royal Melbourne GolfCourse (a rare occurrence); managing the sale of exhibitspace and sponsorship; coordinating exhibitor manual pro-duction, booth placement, import and export control, con-struction, and services to exhibit staff when the Congress isin session; generating media interest and on-site media man-agement during the Congress; fundraising and accounting;scheduling and promoting special seminars; placing adver-tisements in journals; producing videos of surgeries; coordi-

Dr. Ithamar Stocchero and friends at the Curitiba, Brazil, meeting, wear-ing their koalas. From left to right: Drs. Gustavo Stocchero; Ithamar Stocchero, National Secretary for Brazil; Marcus Ferreira; José HorácioAboudib; and Alexandre Fonseca.

nating activities for local hosts; arranging for technical sup-port before and during the Congress; and securing housingfor well over 1000 people.

2007 was a momentous year. Never before has such anextensive promotional and advertising campaign been createdfor an ISAPS Congress. We printed 35,000 four-color bro-chures, sent countless emails, enlisted the help of our NationalSecretaries, and shipped promotional materials to 37 plasticsurgery meetings around the world. We scripted, produced,filmed, edited, and distributed a very professional DVD thatfeatures President Bryan Mendelson inviting his colleagues toMelbourne. ISAPS staff and some of our Australian col-leagues attended meetings in North and South America, Europe, and Asia to promote the Congress beginning as earlyas Rio de Janeiro in August 2006. We even launched a newelectronic version of ISAPS News to encourage the world ofaesthetic plastic surgery to travel to Melbourne in Februaryfor an experience they will truly never forget.

It is entirely possible that our very best ISAPS Ambassa-dor, one who has worked tirelessly to help us get the word outabout the Melbourne Congress, is not even human. A fuzzylittle fellow about 3 inches high, our friendly koala mascotwears a blue vest and outback hat, and sometimes is seenwaving the Aussie flag. He has been found clinging to namebadges, jackets, and on various parts of our many exhibits.This tiny ambassador was also a real hit with the servers atthe Starbuck’s Coffee kiosk in New York’s Javits Center dur-ing the ASAPS meeting last April. Even these workers, whoall asked if they could have a few of the koalas, were indi-rectly marketing our Congress by wearing this cuddly littlesymbol of Australia on their green aprons.

THE KOALA KAMPAIGN OF 2007Catherine B. Foss

ko·ala Pronunciation: \kə-�wä-lə, ko-�ä-\Etymology: 1803: Dharuk (Australian aboriginal

language of the Port Jackson area):gula, gulawan�

Definition: An Australian arboreal marsupial(Phascolarctos cinereus) with a broadhead, large hairy ears, dense gray fur, and sharp claws that feeds on eucalyptus leaves—also called (incorrectly) koala bear.

Function: Noun. Alternate function: To promote the first ISAPS Congress

in Australia. Outcome: Extraordinary success.

When you arrive in Melbourne, perhaps you will belucky enough to meet a koala in person—if not in the wild,at least at the zoo. This Aussie critter has come to representour excitement and efforts for the Melbourne Congress, afriendly little reminder of our goals: to keep working to ensure that participation for this Congress exceeds antici-pated numbers, to make it the best-planned of all Congresses,and to ensure that it is the most memorable ISAPS event thatyou have ever attended. All of us, our furry mascot and hismany human counterparts, are working hard to make all thecogs in this massive machine turn on cue. We are aware howfar away Melbourne is for many of you. We are committedto making every moment of your long journey absolutelyworth it. �


Aesthetic Surgery Trends in Asia—cont’d from p. 1

Gore-Tex, with excellent and stable long-term results.

Fat injection, either as a primary oran adjunctive procedure, is increasinglybeing performed for a variety of cosmeticindications. Areas such as the upper eye-lid, nasojugal groove, nasolabial folds,and glabella frown lines are treated, withgood outcomes. Contour irregularitiesin the face and other regions of the bodyare also treated with success. This re-newed interest has followed the favor-able long-term results demonstrated bypioneers and advocates of this procedurethroughout the world. Fat injections forbreast and buttock augmentations arenewer, albeit more controversial appli-cations for this technique. Although in-creasingly being done in Asia, wider ap-plication will have to await results oflong-term follow up of these procedures.

Certain procedures that are virtuallyunknown in the West are in demand inAsia, such as the procedure used for adeformity known as radish leg, a termused to describe the bulky calves seen insome Asians. This calf deformity iscaused by a combination of the shorterbone structure and the more ovoid con-figuration of the gastrocnemius andsoleus muscles in Asians. Many tech-

niques have been attempted to addressthis problem with varying success. Bot-ulinum toxin type A gives temporary andinconsistent results. Unlike the experi-ence in the West, liposuction in thisgroup of patients is mainly an adjunc-tive procedure, because the underlyingproblem is muscle hypertrophy. Muscledebulking has been performed, but it re-sults in unsightly scars in a highly visi-ble area. Recently, excellent results havebeen obtained through the develop-ment of selective denervation of calfmuscle by cutting the nerve to the me-dial gastrocnemius and partially tran-secting the nerve to the soleus using a 1-cm incision in the popliteal fossa.Another procedure in demand in Asia isbilateral or unilateral dimple creation.A dimple can be created by inducing adhesion between the dermis and deepertissues of the cheek. This can be ac-complished using incision or suturetechniques. Such procedures are in de-mand because of different physical at-tributes and cultural preferences in Asia.

Facial contouring in Asia has tra-ditionally focused on bony osteotomies.Malar reductions, genioplasties, andmandibular angle reductions remainpopular and are commonly performed.Indeed, dramatic and excellent im-provement in facial profile can reliablybe achieved using these procedures.

However, the concept of facial reshap-ing with fillers, particularly fat grafts, isgaining popularity. Such an approach fo-cuses on balance and harmony of facialparts by selective soft tissue augmenta-tion, without needing to shift bony re-lations, and it can achieve very satisfy-ing results. Facial reshaping is appealingto patients who are not willing to un-dergo osteotomies and who want toavoid the prolonged recovery needed af-ter such major procedures. With moreexperience, facial reshaping may developinto a viable alternative to conventionalorthognathic surgery in appropriately selected patients.

Cosmetic surgery is traditionallypioneered and practiced by plastic sur-geons. As elsewhere, this lucrative field inAsia has attracted surgeons from otherspecialties and even from non-surgicalspecialties. In some less regulated areas,cosmetic surgery is even performed bynon-physicians who are clearly unqual-ified to provide such services. Althoughthis is generally accepted (or tolerated)by local communities, plastic surgeonshave a responsibility to safeguard thepublic against unrealistic claims made bysome of these practitioners. We in turnmust continue to improve our skills, tobe continuously updated on the latest de-velopments, and to occupy a core posi-tion in developing these techniques. �

CALL FOR NEWSLETTER ARTICLES

ISAPS News is published every 4 months, with the 2008-09 issues scheduled to be mailed in January, May,and September. Deadlines for submission are:

March 1, 2008June 16, 2008

We welcome article submissions. For more informationand manuscript specifications visit www.isapsnews.comor contact:

ISAPS News Editor-in-ChiefRuth Graf, MD, PhD

[email protected]

ISAPS Executive DirectorCatherine B. [email protected]: 1-603-643-1444

Quality Medical Publishing, Inc.Karen Berger, President/[email protected]: 1-314-878-9937

REACH THE WORLD’S MOSTINFLUENTIAL PLASTIC SURGEONS!

Advertise in ISAPS News!One-quarter, one-half, one-third,and full-page space is available.

Advertising deadline for the May 2008 issue is:March 24, 2008

Special pricing for multiple ads is available

For rates and information contact:Tony Staffieri, Director of Sales and Marketing,

at 1-845-252-6606 (New York Time Zone)or at [email protected]


challenge to non-governmental organi-zations that want to help; the logisticsof organizing a team of doctors in a de-veloping country is truly a daunting task.In the past, such reconstructive proce-dures were only available in developedcountries where the medical expertiseand financial resources were available.However, volunteer missions sponsoredby a number of worldwide organizationshave changed this. These volunteerteams now make regular visits to de-veloping countries to provide reconstruc-tive surgery to those who otherwisewould not receive such care. In additionto the care these dedicated plastic sur-geons provide, they also spend timetraining health care workers so that lo-cal hospitals, nurses, and doctors can be-come self-sufficient.

Facial cleft surgery is not as lucra-tive as elective aesthetic surgery—mostfacial cleft patients come from a lowereconomic sector. However the possibil-ity it offers for improving the destiny andlife of a child is amazing. Surgeonswho work in a cleft center can see howthese patients grow over time and theimpact this surgery has on their lives. Asimilar impact is felt by adult patients.Surgery of the lip or the palate may onlytake 45 minutes, but this is enough timeto improve the quality of life for thesepatients forever.

Although plastic surgery often evokesimages of famous personalities seekingto alter their appearances through elec-tive surgical procedures, plastic sur-gery also has a long history of human-itarian missions sponsored by plastic sur-gery societies. Reconstructive surgery hashad a profound impact on the quality oflives of people around the world. Manyof these patients suffer from congenitaldefects such as cleft palate or from in-juries sustained in accidents. Some dis-figurements are also caused by the effectsof disease or infection. In addition, in-dividuals with these deformities oftenbear the burden of more than just theoutward physical marks; they also havepsychological scars from loss of hope,self-worth, and acceptance by others.

The great number of congenitaland acquired deformities treated duringhumanitarian missions promotes plasticsurgery through the life-transforming results that these efforts produce. Wehave been fortunate to participate inthese missions and to witness the enor-mous good that comes from them. Whathas become very clear to us is that thepatients who are treated are able to livewith relative normalcy and hope for thefuture, with less fear of being ostracizedby neighbors and family. Furthermore,the plastic surgeons who perform theseprocedures gain greater understandingand compassion for those who sufferfrom such defects.

The high incidence of facial mal-formations—mainly cleft lip and palatein developing countries—presents a big

THE HUMAN FACE OF PLASTIC SURGERY

HUMANITARIAN MISSIONS AND PLASTIC SURGEONSRenato da Silva Freitas, MD (Brazil)Nivaldo Alonso, MD (Brazil)

Ceará, Brazil: A mother and her fourteenthdaughter.

destinations. The surgeons do not spendtheir time on the beach or in great shop-ping malls. Instead, we devote our timeto working in unconventional hospitalsthat may not even be air conditioned.

The conditions met with on thesemissions are very different from the con-ditions typically experienced by plasticsurgeons in the comfort of their practicesat home, and they can offer a great chal-lenge to young and experienced surgeonsalike. These missions are a test of a sur-geon’s skills, no matter how well-knownthe surgeon or how much training he orshe has had; it is necessary to draw onall of one’s skills to treat these patients,sometimes five or six a day, in very ad-verse conditions.

Many ask, why would someonetravel so far to perform cleft surgeries?We do not think that we will solve theworld’s problems by going on these trips,but we want to do our part. These mis-sions offer a unique opportunity for usto share knowledge with other medicalprofessionals. Furthermore, they offer awonderful opportunity for young sur-geons and other medical staff membersto gain additional training at the begin-ning of their careers. It is a wonderful

Kenya: A mother and daughter after lip repair.

Fortaleza, 2005: 560 patients waited for surgery,but only 129 received operations.

These missions offer aunique opportunity for us

to share knowledge.

Most of us have heard about surgi-cal safaris, as if these missions are con-ducted in exotic settings for pleasure. Thiscould not be further from the truth.Plastic surgeons do not go on these mis-sions for the travel experience, eventhough that is certainly worthwhile.Many of these surgeons perform cleft sur-geries and other aesthetic proceduresevery week in their practices. They par-ticipate in these missions not to see theworld, but to offer their services to thoseless fortunate. Many of the surgical sitesvisited, such as Jimma, Ethiopia, or El-doret and Kisumu, Kenya, are not tourist Continued on p. 17


the position of Assistant National Sec-retary to support the National Secre-taries as they perform their duties.

ISAPS encourages communicationamong the National Secretaries andprovides an opportunity for us to meetin person at the ISAPS Congress, heldevery 2 years. This is a wonderful chanceto share ideas with colleagues. The nextNational Secretaries Meeting is sched-uled on February 10, 2008, from 9AM

to 12PM, in the Melbourne ConventionCenter in Melbourne, Australia. AllNational Secretaries are urged to attend,because your active participation andvaluable input are needed to help us resolve many challenging issues facing ISAPS today.

Many topics will be discussed dur-ing the National Secretaries Meeting

When you become an ISAPS NationalSecretary, you join a special “aestheticfellowship,” and suddenly you realizethat your efforts to introduce new ideasto your country and to a broader world-wide audience are shared by others. Youare not alone.

Being a National Secretary has givenme an enormous opportunity to sharemy plans, ideas, and proposals with col-leagues and with other National Secre-taries throughout the world. As ISAPSgrows in prestige and membership, therole of a National Secretary becomes in-creasingly important. ISAPS is activelyproviding support to our current Sec-retaries and encouraging member par-ticipation. For example, in Brazil andChina, both with rapidly growing mem-ber populations, we have acted on thesuggestion of Brazilian National Secre-tary Dr. Ithamar Stocchero and added

REPORTS FROM THE NATIONAL SECRETARIES

NATIONAL SECRETARIES REPORTMiodrag Colic, MD (Serbia)National Secretaries Chair

in Melbourne, including the new elec-tronic membership application to be de-veloped by Catherine Foss, ISAPS Ex-ecutive Director. This electronic tool willhelp collect information needed to makedecisions on new member applications.It will also streamline the process, reducework for the National Secretaries, avoidduplication of effort, and centralizecontrol in the main ISAPS office.

We will offer three or more NationalSecretaries the opportunity to give shortpresentations highlighting their experi-ences and challenges in performing theirduties. This is an open forum, and weappreciate your input and recommen-dations. Comments and suggestions formember charity work are especiallywelcome, because this is a vital part ofwhat we do, and we take great pride inthese humanitarian efforts.

Additionally, the election of the newchair and assistant chair will be con-ducted at the end of the meeting. Yournominations are appreciated and can bedirected either to me or to the executiveoffice prior to the meeting.

ISAPS News

The ISAPS Mini-Symposia proposedby Dr. Carlos Uebel and held in con-junction with national society meet-ings have been a resounding success sincetheir inception.

I organized a Mini-Symposium inMontreux, Switzerland, in conjunctionwith the annual meeting of the Swiss Society of Plastic Reconstructive andAesthetic Surgery. It attracted approx-imately 200 attendees and had a facultyof worldwide experts, including Dr. AnaBadin from Brazil, Dr. Woffles Wu fromSingapore, Dr. Thomas Roberts from the United States, Drs. Bernard Cornettede Saint-Cyr and Claude Le Louarn fromFrance, and Drs. Daniel Knutti andChristoph Wolfensberger from Switzer-

land. All spoke about their experienceswith mid-face lifting.

The scientific program was veryinteresting, and the attendees showedgreat interest in this topic. We had a fan-tastic gala dinner that was sponsored bythe Swiss society. The faculty dinner wassuperb and was free of cost for all of usthrough the efforts of a good friend,Daniel Bourret, who is a representative forMentor (Lenoir products, in Switzerland).

A booth was also set up to promotethe forthcoming ISAPS Congress inMelbourne. The Swiss members ex-pressed high enthusiasm for this event.I gave a PowerPoint presentation out-lining the benefits of joining ISAPS andplayed a DVD promoting the Melbourne

REPORT ON THE SWISS SOCIETY MINI-SYMPOSIUMJan Poëll, MDNational Secretary of Switzerland

Congress. All the faculty members gen-erously paid for their own travel costs. Iwould like to thank them all again fortheir participation and for the greattime that we shared, an experience thatI hope to repeat in the future. I stronglyrecommend Mini-Symposia to othergroups. They are a perfect way to shareideas, educate one another, meet newmembers, and promote ISAPS and futureCongresses. �

Continued on p. 24

As ISAPS grows, the role of a National Secretary

becomes increasingly important.


When I was asked to organize a Na-tional Societies Relations Committeefor ISAPS, I had no concept of the ed-ucational impacts this new initiativecould have. Our goals were to buildbridges between ISAPS and the nationalsocieties around the world, to increasemembership, and to encourage the wide-spread development of and participationin ISAPS educational programs. TheMini-Symposium program—created byDr. Ricardo Baroudi—is one of ourmost successful educational initiatives.

In the beginning, we had some dif-ficulties launching this program andgaining international acceptance. How-ever, once people understood the ad-vantages of this endeavor, the momen-tum picked up considerably. Dr. JanekJanuszkiewicz, who joined us on theMini-Symposium Task Force, was in-strumental in helping promote this edu-cational program throughout the world.

The Mini-Symposia provide excel-lent venues for attracting new ISAPSmembers; in addition, local surgeons—those who may not always have op-portunities to share their ideas outsideof their own countries—can gain a

COMMITTEE REPORTS

NATIONAL SOCIETIES RELATIONS COMMITTEE REPORTCarlos Oscar Uebel, MD, PhD (Brazil)Committee Chair

LETTER TO THE EDITOR

RESPONSE TO LETTER BYDR. DAN KENNEDYIN APRIL 2007 NEWSLETTER

Dear Dr. Kennedy:

I could not agree more with your per-sonal thoughts on my article in the April2007 issue. Patients who have beenharmed or mistreated by “the other doc-tor” and have a real problem that needsto be addressed should be referred tosenior colleagues for an assessment andfurther treatment if necessary, espe-cially when we suspect that there is acause for action or a pending legal ac-tion against some other colleague.

The point that I wanted to empha-size in my article is that declaring a waragainst colleagues in an effort to provethat “I can do what the other doctor wasunable to accomplish,” is entirely againstthe principles of ISAPS and, franklyspeaking, does not benefit any of us. Assurgeons who operate, it is inevitablethat we will sometimes have unsuc-cessful results and even potential disas-ters. Clearly, we are all professionals andseek to avoid such unpleasant situations.Those surgeons who claim that theynever have any unfortunate results eitherare lying or never operate (as the old say-ing goes).

We are living in a society that is los-ing the faith and respect that used to ex-ist for the doctors who provide care. I’mnot saying that we doctors are totally ex-empt from responsibility for this attitude.However, it is important that we makeevery effort not to aggravate the situa-tion and to keep in mind that nobody isperfect, and sooner or later we will allfind ourselves in the unpleasant positionof being “the other doctor.” Who is go-ing to help us then?

Theodore Voukidis, MDAssistant National Secretaries Chair �

much broader audience. It is encourag-ing to see the great number of nationalsocieties who are now interested insponsoring these meetings to promoteeducation in aesthetic surgery.

Guidelines for sponsoring an ISAPSMini-Symposium are as follows:

1. The Mini-Symposium must takeplace the day before or after anational or regional meetingthat has already been scheduled.

2. The Mini-Symposium must lasteither a half day or a full day.

3. The faculty should consist ofone or two invited internationalspeakers along with one or morelocal/national ISAPS members.

4. Travel expenses are paid by thefaculty.

5. Hotel accommodations are paidfor by the local society.

6. The registration fees for the fac-ulty to attend the local society’smeeting are waived.

7. Attendance at the Mini-Sympo-sium is free for all participants.

8. The national society will permitISAPS to promote membershipand advertise future meetings.

The Mini-Symposia held in 2007 are listed below, as are those currently sched-uled for 2008. We look forward to adding additional Mini-Symposia this year.

2007� May 8 in Valencia, Spain

Director: Dr. Javier de Benito Focus: Postbariatric Surgery

� May 22 in Kusadasi, TurkeyDirectors: Drs. Miodrag Colic and Philip ChenFocus: Facial and Body Contouring

� October 6 in Montreaux, Switzerland Director: Dr. Jan PoëllFocus: Mid-Face Lifting

� November 13 in Curitiba, Brazil Directors: Drs. Ruth Graf and Antonio Carlos AbramoFocus: Aesthetic Medicine andNon-invasive Procedures

2008� January 13 in Mumbai, India

Director: Dr. Ashok GuptaFocus: Facial and Hair Restora-tion Surgery

� February 15-16 in Singapore Director: Dr. Harry FokFocus: Body and Facial Con-touring

� April 4 in New Delhi, IndiaDirector: Dr. Lokesh Kumar Focus: Facial Contouring and Rhinoplasty

� May 13 in Acapulco, MexicoDirector: Dr. Angel Papadopulos EscobarFocus: Facial and Body Contouring �

Please submit letters to Dr. Ruth Graf,

Editor-in-Chief, at [email protected]


experience to treat children with facialdeformities and to see the resultingtransformation. It is an opportunity forus to learn and to grow.

These operations are provided freeof charge and are a marvelous gift tothese children and their families. Inthese situations, the passion and dedi-cation of the surgeons and their con-nection with the patients can also helpheal wounds caused by social injuries.

Plastic surgeons can inspire andmobilize both individuals and societiesto support these efforts by letting themknow that there are a lot of children who

Humanitarian Missions and Plastic Surgeons—cont’d from p. 14

CONGRATULATIONSJ. PETER RUBIN RECEIVESPRESIDENTIAL EARLY CAREER AWARDFOR SCIENTISTS AND ENGINEERS

J. Peter Rubin, MD

hold promise because of their potentialto both actively participate in the heal-ing process and develop into differentspecialized cell types. When exposed tospecific conditions in the laboratory,fat-derived stem cells have been shownto transform into the same cell typesfound in fat, bone, cartilage, nerve,muscle, and blood vessels,” said Dr.Rubin, who is also faculty in the Mc-Gowan Institute of Regenerative Med-icine and Director of the Life AfterWeight Loss Surgical Body ContouringProgram at the University of PittsburghMedical Center.

Dr. Rubin is a Fellow of the Amer-ican College of Surgeons, and serves asChair of the American Society of Plas-tic Surgery’s Post-Bariatric Task Force.He is a founder and past president ofthe International Federation of AdiposeTherapeutics and Science (IFATS), agroup of scientists worldwide who areon the cutting edge in the study of fatstem cell biology. �

National Institutes of Health, whichhas been supporting his research granttitled, “Injectable Engineered Tissue forCancer Reconstruction.”

Dr. Rubin, who is assistant pro-fessor of plastic and reconstructivesurgery and co-director of the AdiposeStem Cell Center at the University ofPittsburgh School of Medicine, was recognized for his groundbreaking research in using fat-derived stem cellsto engineer replacement soft tissue.

“The use of stem cells to treat dis-ease or regenerate tissue is believed to

University of Pittsburgh plastic sur-geon Dr. J. Peter Rubin received the2007 Presidential Early Career Awardfor Scientists and Engineers (PECASE)on November 1 during a ceremony inWashington, DC.

The PECASE is the highest honorin the United States for scientists earlyin their research career. According tothe White House, the award is given torecognize and support researcherswhose early work shows exceptionalpromise for leadership at the frontiersof scientific knowledge. Awardeesare nominated by one of eight federaldepartments, who provide the re-searchers with up to 5 years of ad-ditional funding for further research.Dr. Rubin was nominated by the

Dr. Carlos and Elvira Navarro at the Smile TrainDinner, where he received the Smile TrainHero award.

Dr. Carlos Navarro recently receivedthe Smile Train Hero Award, the firstaward of its kind. This special honorwas given in recognition of “Dr.Navarro’s dedication, talent, and pas-sion for helping children. Under hisleadership, CIRPLAST has providedcleft surgery for more than 1000 chil-dren. Additionally he has personally

provided invaluable training to doctorsand has improved the quality of carein Peru as a result.” Dr. Navarro’s ac-complishments were recognized at theFirst Annual Smile Train Hero AwardsDinner held on Saturday, October 27,2007 in Baltimore, Maryland, where he and 11 other cleft surgeons werehonored. �

CARLOS NAVARRO RECEIVES SMILE TRAIN HERO AWARD

have no treatment. In Curitiba a fewmonths ago, we received a 74-year-oldwoman with a cleft lip and palate. Somemay ask why we would perform this sur-gery on a patient who has lived all herlife with this deformity and has siblings,grandsons, and granddaughters. Follow-ing her surgery, this patient answeredthat question in her own words: “NowI can die, because I desired that my fam-ily, one day, could look at me and see meas a normal person.”

So much is accomplished duringthese missions. During one trip, morethan 100 children were operated on inonly one week—an amazing and un-forgettable experience. It was truly re-markable to see these patients as theyviewed themselves in a mirror following

their surgery: sometimes they cried,sometimes they laughed.

Plastic surgeons have volunteeredwith international organizations dedi-cated to caring for people throughout the world for many years. They havetraveled to faraway cities and villagesand have participated in three to fourmissions each year, spending 30 to 40days each time providing non-profitwork. These humanitarian missions arevery likely under-reported, but theyrepresent an important aspect of thegood that plastic surgery can provide topeople and governments in developingcountries. We urge others to get involvedin humanitarian missions. They are asrewarding for the surgeons as they arefor the patients receiving the care. �

REPORT ON THE MELBOURNECONGRESS PROGRAMSusumu Takayanagi, MD (Japan)Scientific Program Chair and ISAPSEducation Council Chair

It is a great honor and privilege to workas the Scientific Program Chairman forthe ISAPS Melbourne 2008 Congress.

The quality of the scientific presen-tations is of the utmost importance forthe program. To that end, Dr. BryanMendelson, the President of ISAPS, andthe Program Committee members haveagreed to offer as many types of pre-sentations as possible, including dis-cussions of facial rejuvenation, breastsurgery, body contouring, liposuction,abdomen, rhinoplasty, ethics and patientsafety, hair, lasers, toxins, fillers, skincare, and Asian aesthetic surgery. In ad-


dition, we have also added a new cate-gory to the ISAPS Congress—research.Our current schedule includes four in-vited lectures, the Ohmori lecture, 14panels, 63 podium free papers, andmany E-Papers. A video session day isscheduled for February 10, which willinclude nine interactive presentations ledby two discussants.

We are delighted to have Dr.Thomas Biggs (United States) as theOhmori lecturer. Additional invited lec-turers include Drs. Foad Nahai (UnitedStates), Timothy Marten (United States),Claude Le Louarn (France), and GinoRigotti (Italy), who will not only sharetheir thoughts and ideas for the futureof aesthetic surgery, but will offer in-sights on how to help you obtain the bestresults for your patients.

Each panel will feature the highestquality moderators, co-moderators, and

panelists—all of whom have been cho-sen from all over the world; all panelswill provide information about thenewest, safest techniques and ideas foryour patients.

We have received roughly 350 ab-stracts for free papers, and the programcommittee has selected 63 of these to bepresented as podium free papers. Almostall other submitted presentations havebeen invited to be offered as E-Papers.

During the last session of the Con-gress, the Free Paper Awards will begiven to the five best podium free papersand the three best E-Papers. This sessionwill be moderated by Drs. BryanMendelson and Thomas Biggs.

The program for the upcomingCongress promises to be informative andenjoyable. We hope you can join us inMelbourne for both the presentationsand the social events! �

— Deep tissue hyaluronic acids with high reticulation,such as Voluma (Corneal Group, Paris, France)and SubQ (Q-Med AB, Uppsala, Sweden), are use-ful for soft tissue augmentation of the chin, cheek-bone, and cheek, and for temporal and mandibu-lar depressions.

� Hydroxyapatite: Hydroxyapatite is a complex of phos-phate and calcium (Radiesse, BioForm Medical, SanMateo, California). These products have a longer-lasting result than hyaluronic acid (12 to 18 months),should be injected in the deep dermis, and are partic-ularly effective in thick skin.

Semi-permanent products can result in more complica-tions than non-permanent ones, but still are important forspecific indications, such as HIV-related facial lipoatrophy.These include:

� Poly-L-lactic acid (Newfill/Sculptra [Dermik Labora-tories/Sanofi Aventis, Bridgewater, New Jersey]) is oneof the safer semi-permanent products.

� Polymethylmethacrylate microspheres (ArteFill [ArtesMedical, San Diego, California]) has less popularity to-day in France because superficial injection is associatedwith granuloma.

� Aquamid (Contura International, Soeborg, Denmark)has not achieved popularity and has been barred inmany countries.

� Acrylic hydrogel with hyaluronic acid (Dermalive andDermadeep [Dermatech, Paris, France]) was associatedwith so many complications in early 2000 that theseproducts have largely been abandoned.

Permanent fillers still pose many risks, and they do notfare well with the aging process. These include silicone oil,Bioplastique (Uroplasty BV, Maastricht, The Netherlands),and BioAlcamid (Polymekon Srl, Brindisi, Italy).

INDICATIONS AND CONTRAINDICATIONS

The use of a particular filler is dependent on the pathologicor cosmetic problem, the zone to be treated, and the productused. For cosmetic uses, the following generalizations apply.The thinner the skin is, the more visible the products will beonce injected. The level of injection depends on the thicknessof the skin, the depth of the wrinkles, and the characteristicsof the product. Hyaluronic acid, depending on its character-istics and its viscosity, can be injected in the skin, in soft tis-sue, and on/in the periosteum (orbital rim).

COMPLICATIONS

Complications can occur as a function of the anatomic lo-cation, the procedural technique, the type of defect treated,identifiable host factors, infectious processes, or the intrinsiccharacteristics of the fillers themselves (bioavailability, chem-ical composition, and degradation). Complications followingthe placement of temporary fillers often occur soon afteraugmentation, may resolve spontaneously, and are usuallyeasy to treat. Conversely, complications that occur after us-ing permanent or semi-permanent fillers can appear monthsto years after augmentation and are very difficult to treat.

Tissue fillers offer patients an opportunity for instantgratification with minimum downtime and, in general, an extremely favorable risk-to-benefit ratio. The best way to en-sure patient satisfaction is to avoid permanent fillers that maynot age well; often, as the patient ages, these fillers do notmove naturally and are unable to accurately reflect the agingprocess. �

An Update On Fillers—cont’d from p. 10


GUESS WHO?Can you guess who in the ISAPS family is pictured below?

Answer on p. 24.

Executive Committee Bryan Mendelson, Australia Foad Nahai, United States Renato Saltz, United States João Carlos Sampaio Góes, BrazilJan Poëll, SwitzerlandCatherine Foss, United States

Membership CommitteeChair: Alfonso Barrera, United States Antonio De La Fuente, SpainYukio Shirakabe, Japan

Nominating CommitteeChair: João Carlos Sampaio Góes, Brazil

Elected: Darryl Hodgkinson, AustraliaGuillermo Vazquez, Argentina

Board Elected: Spyro Joannides, GreeceGhaith Shubailat, Jordan

Alternates: Rolf Gemperli, BrazilEwaldo Bolivar de Souza Pinto, Brazil

Finance CommitteeChair: Franklyn Elliott, United StatesKirill Pshenisnov, RussiaJan Poëll, SwitzerlandDaniel Knutti, SwitzerlandRenato Saltz, United States

By-Laws CommitteeChair: Thomas Davis, United States

Public Communication Committee Chair: João Carlos Sampaio Góes, Brazil

Education Council Chair: Susumu Takayanagi, JapanVice Chair: Foad Nahai, United StatesAntonio Mottura, ArgentinaTheodore Voukidis, GreeceRenato Saltz, United States—ex officioCatherine Foss, United States—ex officio

Website CommitteeChair: Malcolm Paul, United StatesBrian Kinney, United StatesJavier De Benito, SpainAshok Gupta, IndiaFlavio Mendes, Brazil Claudio De Lorenzi, Canada

Journal Operations CommitteeChair: Renato Saltz, United States João Carlos Sampaio Góes, BrazilThomas Davis, United StatesClaude Le Louarn, FranceEditor: Thomas Biggs, United StatesStaff: Catherine FossStaff: Tony Staffieri

ISAPS COMMITTEES

Presidential Appointments, Ad Hoc Committees, and Consultants: 2006-2008Parliamentarian: Andrea Grisotti, Italy

SCOPE OF PRACTICE COMMITTEEConstance Neuhann-Lorenz, Germany

NEW PRODUCT EVALUATIONCOMMITTEEHenry Delmar, France

NATIONAL SOCIETIES RELATIONSCOMMITTEECarlos Uebel, Brazil

NEWSLETTER EDITORRuth Graf, Brazil

MARKETING AND PR COUNSELTony Staffieri, United States

Can you name the artist?

Answer on p. 24.


MAY 2008May 7-10XVI International Course on Plastic andAesthetic SurgeryVenue: Clinica Planas; Barcelona, SpainContact: Jorge Planas, MD

Tel: 34-93-203-2812Fax: 34-93-206-9989Email: [email protected] Home Page: http://clinicaplanas.com/es/

congresos/2008

May 9-1114th ASEAN Congress of Plastic SurgeryVenue: Borobudur Hotel; Jakarta, IndonesiaContact: Teddy Prasetyono, MD

Tel: 62-21-5596-0180Fax: 62-21-5596-0179Email: [email protected]

May 23-24Fresh Frozen Cadaver Course: FACE toFACEVenue: Department of Anatomy, University

of Utrecht, The NetherlandsContact: Hein ter Linden, MD

Tel: 31-38-424-6042Fax: 31-38-452-7368Email: [email protected] Home Page: www.drtulp.nl

May 26-3017th Congreso de la FILACPVenue: Quito, EcuadorContact: Wilfredo Calderon, MD

Tel: 593-2-243-5397Fax: 593-2-243-5398Email: [email protected] Home Page:

www.filacp2008-quitosecpre.com

JUNE 2008June 5-7The V International Plastic Surgery CourseVenue: Atrium Palace Hotel; Ekaterinburg,

RussiaContact: Elena Tselikova, Katherine

UshkovaTel: 7-343-371-88-24Fax: 7-343-371-88-24Email: [email protected] Home Page: www.b-med.ru/en

June 6-88th International CongressVenue: Marriott Grand Hotel; Bucharest,

RomaniaContact: Romanian Aesthetic Surgery

SocietyTel: 40-264-414-432Fax: 40-264-414-432Email: [email protected] Home Page: www.srce.ro

June 12-149th EuromicroVenue: Sigyn Hall; Turku, FinlandContact: Heli Alasaukko-oja Tel: 358 3 254 1251Fax: 358 3 260 4266Email: [email protected] Home Page: www.euromicro2008.org

June 25-28International Symposium on Plastic SurgeryVenue: University of Bologna; Bologna,

ItalyContact: Paolo MorselliFax: 39-51-636-3641Email: [email protected] Home Page:

www.plasticsurgerysymposium.info

SEPTEMBER 2008September 4-74th Annual QMP Aesthetic SurgerySymposiumVenue: The Renaissance Chicago Hotel;

Chicago, Illinois, United StatesContact: Andrew BergerTel: 1-314-878-7808Fax: 1-314-878-9937Email: [email protected] Home Page: www.qmp.com

ISAPS CALENDAR

JANUARY 2008January 9Instructional Course on Anti-Aging andMinimal Invasive Facial RejuvenationVenue: Asian Heart Institute; Mumbai, IndiaContact: Ashok Gupta, MD


January 10-133rd International Tutorials: NewerTechnologies in Aesthetic Plastic SurgeryVenue: S.P. Jain Auditorium, Bombay

Hospital Institute of Medical Sciences;Mumbai, India

Contact: Ashok Gupta, MD


January 14-15Hands-On Skill Development Course onEndoscopic Aesthetic SurgeryVenue: Ethicon Institute for Surgical

Education; Mumbai, IndiaContact: Ashok Gupta, MD


January 171st Annual Oculoplastic SymposiumVenue: Grand Hyatt; Buckhead (Atlanta),

Georgia, United StatesContact: Southeastern Society of Plastic

and Reconstructive SurgeonsTel: 1-301-320-1200Fax: 1-301-263-9025Email: [email protected]

FEBRUARY 2008February 10-13 ISAPS 19th CongressVenue: Melbourne Convention Centre;

Melbourne, AustraliaContact: Catherine B. FossTel: 1-603-643-2325Fax: 1-603-643-1444Email: [email protected] Home Page: www.isapscongress2008.org

For the most current list of educational programs, visitwww.isaps.org/meetings.php

To submit a meeting to be included in the calendar, contact Catherine Foss at isaps.sover.net


October 15-1812th Asian Pacific Association for Lasers in Medicine and Surgery; 1st Asian PacificAesthetic Plastic Surgery Symposium(ISAMLS)Venue: Severance Hospital EunMyung

Auditorium, Seoul Yonsei University;Seoul, South Korea

Contact: Jin Wang Kim, MD, PhD

Tel: 822-511-3713Fax: 822-517-3713Email: [email protected] Home Page: www.lasercongresskorea.org

SEPTEMBER 2009September 20-2611th Congress of ESPRASVenue: Rhodos Palace Hotel; Rhodes,

GreeceContact: Andreas Yiacoumettis, MD

Tel: 30-22-920-60610Fax: 30-22-920-27530Email: [email protected] Home Page: www.espras2009.gr

OCTOBER 2008October 1-57th Croatian Congress of Plastic,Reconstructive, & Aesthetic SurgeryVenue: Hotel Ivan, Solaris Holiday Resort;

Split, CroatiaContact: Zdravko Roje, MD

Tel: 385-1-6110-449Fax: 385-1-6110-452Email: [email protected] Home Page: www.studiohrg.hr/

plastic-surgery2008

October 4-62nd Annual QMP Reconstructive SurgerySymposiumVenue: The Ritz-Carlton; St. Louis,

Missouri, United StatesContact: Andrew BergerTel: 1-314-878-7808Fax: 1-314-878-9937Email: [email protected] Home Page: www.qmp.com

OCTOBER 2009October 7-910th Asian Pacific CongressVenue: Keio Plaza Hotel; Tokyo, JapanContact: Eriko KosakaTel: 81-3-6425-8671Fax: 81-3-5779-4978Email: [email protected] Home Page: http://iprasapx.umin.jp

NOVEMBER 2009November 29-December 315th World Congress of IPRASVenue: Hotel Ashok; New Delhi, IndiaContact: Rajeev Ahuja, MD

Tel: 91-11-2323-1871Fax: 91-11-2322-2756E-mail: [email protected] Home Page: www.ipras2009.org

D i s c o v e r t h e p o s s i b i l i t i e s .

Sound Surgical Technologies LLC - Call 888.471.4777 or visit www.vaser.com

Advanced Body Sculpt ing

Now one system provides you a range of treatment possibilities - from VASER LipoSelection®

of delicate to fibrous fatty tissue, to advanced contouring of areas such as the face, breast

and high definition body sculpting. The VASER System represents a major advance in the

application of ultrasonic technology to cosmetic procedures.

Courtesy Alberto Di Giuseppe, M.D.

Courtesy Alfredo Hoyos, M.D.

Courtesy Diane Duncan, M.D.


ARGENTINAEsteban H. ELENA, MD

AUSTRALIARodney D. COOTER, MD

Mark EDINBURG, MD

Allan Michael KALUS, MD

Jayashri KESARI, MD

BELGIUMNader CHAHIDI, MD

Carlo R.J. VAN HOLDER, MD

BRAZILCarlos CASAGRANDE, MD

Rogerio DOS SANTOS RAMOS, MD

Renato T. PIANOWSKI, MD*

BULGARIAAnton D. TONEV, MD

Daniel V. YANKOV, MD

CANADAWayne R. PERRON, MD

CHINAQing-feng LI, MD*Qing LIU, MD

Xiongzheng MU, MD

Zheyuan YU, MD

CHINESE TAIPEITa-Lee CHANG, MD*Da-Jeng CHEN, MD

Kwan-Wei CHEN, MD

Chia-Jung CHUNG, MD*Yi-Chun LIN, MD

Wu-Feng LU, MD

Yueh-Bih TANG CHEN, MD

Chien-Hsing WANG, MD

Gwan-Chung WANG, MD

CZECH REPUBLICVlastimil BURSA, MD

Vladimir MARIK, MD

Martin MOLITOR, MD

ESTONIAMerle SELLEND, MD

GERMANYPetra BERGER, MD

Ernst-Magnus NOAH, MD

Mirko PRZYBILSKI, MD

Dennis O. VON HEIMBURG, MD

Christopher H. WACHSMUTH, MD

GREAT BRITAINChien C. KAT, MD

HUNGARYOtto KELEMEN, MD

INDIARakesh KALRA, MD

Vipul NANDA, MD

INDONESIAIswinarno Doso Saputro

DACHLAN, MD

Linawati MAKMUR, MD

David Sontani PERDANAKUSUMA, MD, PhD

Agus Santoso Budi SOEKOTJO, MD*

IRANMohamad JALILI MANESH, MD*Hamid KARIMI ESTAHBANATI, MD

ITALYAndrea AMICO, MD*Claudio BERNARDI, MD

Marco STABILE, MD

Antonio TATEO, MD

JAPANShigehiro MURAI, MD

MEXICOJaime E. CAMPOS-LEON, MD

Jaime GONZALEZ MENDOZA, MD

Jorge LOPEZ OZUNA, MD

Victor Hugo MENDOZA, MD

Enrique OCHOA DIAZ LOPEZ, MD

Martin PEREZ VASCONCELOS, MD

Gustavo RIZO-SUAREZ, MD

Conrado E. TRAPERO VELDERRAIN, MD

Francisco WOLBERG CASADO, MD

Luis Guillermo ZUNIGA LOPEZ, MD

NETHERLANDSLaura H. ZAAL, MD*

NEW ZEALANDMurray J. BEAGLEY, MD

Tristan M.B. DE CHALAIN, MD

PERUJorge E. HIDALGO, MD

Cesar Enrique E. MORILLAS TORRES, MD*

POLANDJanusz OBROCKI, MD

QATARHabib B. Saied AL-BASTI, MD

RUSSIAOleg R. BAKHTIYAROV, MD

Ivan A. SUROV, MD

Vitaly ZHOLTIKOV, MD

SOUTH AFRICAIan MCGIBBON, MD

SOUTH KOREAAnna LEE, MD

Jeong Yeol YANG, MD, PhD

SWEDENFredrik GEWALLI, MD

SWITZERLANDPhilipp S. FALLSCHEER, MD*Rinaldo PICO, MD

Volker V.W. WEDLER, MD

THAILANDThawatchai BOONPADHANA-

PONG, MD

Piyapas PICHAICHANARONG, MD

Nond ROJVACHIRANONDA, MD

Sukit WORATHAMRONG, MD

UNITED STATESRichard A. BAXTER, MD

Bruce L. CUNNINGHAM, MD

Richard A. D’AMICO, MD

Anthony C. GRIFFIN, MD

Norberto R. MARFORI, MD

Barry H.J. PRESS, MD

J. Peter RUBIN, MD

Manish H. SHAH, MD

Jennifer L. WALDEN, MD

Wesley G. WILSON, MD

VENEZUELAGarbis KAAKEDJIAN, MD*Marisela NARCISO, MD*Douglas NARVAEZ RIERA, MD*

*Candidate Member

New Members Admitted in September and December 2007


For diamond perfect performance™

ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS®

ASSI® Breast Retractors are like Diamonds...Created for Performance

Crafted for PerfectionCut with Precision

...the way you do

ASSI •ABR 35826180x16mm wide blademolded handle, with fiber optic

ASSI •ABR 35426180x16mm wide bladewith fiber optic



ASSI •ABR 234932680x16mm wide blade,without teethwith fiber optic & suction

ASSI •ABR 218052680x16mm wide blade,with teethwith fiber optic & suction

ASSI •ABR 25926180x25mm wide bladewith fiber optic & suction

ASSI •ABR 27326150x16mm wide bladewith fiber optic & suction

ASSI •ABR 77026180x30mm wide blade,with 120˚ & 130˚ angles, with suction




accurate surgical & scientific instruments corporation800.645.3569 fax: 516.997.4948 west coast: 800.255.9378 516.333.2570

www.accuratesurgical.com

ASSI •ABR 38326180x25mm wide blade,without endoscopicscope sheath

©20

08 A

SSI®

ASSI •ABR 13726180x25mm wide bladewith 5mm endoscopic scope sheath, single stop-cock



TM

It was Dr. Seiichi Ohmori’s dream to funda lecture series to be presented at the ISAPS Biennial Congress as a mementofor his beloved plastic surgery society.

Dr. Ohmori was the 6th President ofISAPS (1981-1983) and a Charter Mem-ber of the Society. He served ISAPS as aTraveling Professor from 1985 through1987 and as local arrangements chair forseveral post-graduate courses in Japan.

Following his death in March 1989,his son Kitaro approached the ISAPS Ex-ecutive Committee at the Biennial Con-gress in Switzerland in September of that

Past Seiichi Ohmori Lecturers

1992: Nicholas G. Georgiade—Guadalajara, Mexico

1993: Jaime Planas—Paris, France

1995: Salvador Castanares—New York, New York, United States

1997: Rodolphe Meyer—Sao Paulo, Brazil

2000: Ulrich T. Hinderer—Tokyo, Japan

2002: Blair O. Rogers—Istanbul, Turkey

2004: Melvin Spira—Houston, Texas, United States

2006: Ivo Pitanguy—Rio de Janeiro, Brazil

DID YOU KNOW? THE SEIICHI OHMORI MEMORIAL LECTUREThomas S. Davis, MD (United States)ISAPS Historian

year expressing his father’s wish to cre-ate this lecture series.

A letter from the President andTreasurer requested a donation to ISAPS,with the understanding that the lecturefee for the Ohmori Lecturer would comefrom the interest generated by the do-nated fund. The appropriate funding wassecured and has been maintained in a

separate account by the ISAPS Treasurerever since.

Selecting the recipient of this honoris the privilege of the President of ISAPSand is traditionally awarded to recognizean individual’s lifetime achievementsand contributions to the field of aestheticplastic surgery. �


I would be remiss if I did not mentionanother exciting opportunity that isavailable to National Secretaries. Sur-gical Facilities Resources (SFR), a sub-sidiary of the American Association forAccreditation of Ambulatory Facilities,offers the opportunity for your surgicalfacility to receive free accreditation if itcomplies with their standards. You canalso become an SFR Inspector by com-pleting the SFR Inspector TrainingCourse, which will be offered free ofcharge in Melbourne on February 9,2008; this will allow you to inspect yourcolleagues’ facilities.

Finally, I offer my congratulationsagain to the newly elected NationalSecretaries, and I look forward to wel-coming them at the meeting. If you areunable to attend for any reason, pleasesend a substitute to ensure that your in-terests and ideas are represented. See youin Melbourne—a place to explore newideas and to connect with colleagues and friends. �

National Secretaries Report—cont’d from p. 15

GUESS WHO ANSWER

Dr. Igor Niechajev, an ISAPS memberfrom Sweden, is shown here competinglast winter in the Medical Doctors andPharmacists Ski World Cup in Cortinad’Ampezzo, Italy. Switzerland’s Dr. DanielKnutti, Assistant Treasurer of ISAPS,also competed. Dr. Niechajev was the silver medalist in the Super-G event.

ISAPS NEWS WORLDWIDE SURVEY

No other publication in plastic surgery has as large and in-fluential a worldwide audience as ISAPS News, and there arefew reliable global statistics on issues facing plastic surgeons.Therefore we are conducting an online survey with each issue, and the results of each will be published and widely cir-culated to the international media. The ISAPS News World-wide Survey is your opportunity to influence opinion by pro-viding important statistical information to the world.

Survey 2: Tracking Plastic Surgery Trends Around the World

ISAPS is often called on by news agencies, marketers, researchers,and others to provide up-to-date information about plastic sur-gery, yet there are no reliable figures on many important world-wide trends in our specialty. What are the latest trends in Asia?What is currently attracting attention in Brazil? in Belgium? inCanada?

To get a better picture of these worldwide trends, we needyour input—just a few minutes of your time will have a major impact. You can access this important survey online atthe ISAPS News website: www. isapsnews.com.

The results from the survey will be announced at the ISAPS Congress in Melbourne, February 10-13, 2008.

Your answers will help ISAPS track the trends that makenews. �

ISAPS NEWS MANAGEMENT

ISAPS Team

EDITOR-IN-CHIEF Ruth Graf, MD, PhDCHAIRMAN, ISAPS COMMUNICATION COMMITTEE

João Carlos Sampaio Góes, MD, PhDMANAGING EDITOR Catherine B. FossDIRECTOR OF SALES & MARKETING Tony Staffieri

Editorial Board

Kitaro Ohmori, MD (Japan)Jose Parreira, MD (Portugal)Elie Abdelhak, MD (Lebanon)Patrick Tonnard, MD (Belgium)Abdennasser Lahlali, MD (Morocco)Darryl Hodgkinson, MD (Australia)Renato Saltz, MD (United States)

Quality Medical Publishing Team (QMP)

PUBLISHER Karen BergerDIRECTOR OF ONLINE SERVICES Andrew BergerEDITORIAL DIRECTOR Michelle BergerDIRECTOR OF EDITING Suzanne WakefieldVICE PRESIDENT, PRODUCTION & MANUFACTURING

Carolyn ReichDIRECTOR OF ART & DESIGN Amanda BehrGRAPHICS TECHNICIAN Brett StonePRODUCTION ARTIST Carol Stonebraker

Current Status of Injection Lipolysis for Fat Removal—cont’d from p. 7

safe and effective. This investigationshould also reveal potential mechanismsof action that may be responsible for fatloss. Transmission electron microscopywill be used to identify signs of cellnecrosis and apoptosis and determinewhich process is dominant.

As this first clinical trial begins inJanuary 2008, all plastic surgeonsshould understand that the FDA hasapproved an IND for the study ofPPC/DC injections in 20 patients at onelocation. This IND plus IRB approvalallows performance of a single, tightly-regulated clinical trial. It does not meanthat others can associate themselveswith this IND or market injection lipol-ysis as having IND approval from theFDA. Completion of the study and dataanalysis should take approximately 1year, at which time the FDA and theplastic surgery community will learnthe results and will be able to more ac-curately evaluate the value, safety, andefficacy of this procedure. �

Answer: Sandro Botticelli (1444-1510)Primavera, c. 1482

Can you name the artist ?


Place holder for full page AdPossible QMP Ad


LIST OF ADVERTISERS

Mentor Corporation 7, 27

QANTAS 8

Allergan, Inc. 9

Adoderm 11

Sound Surgical Technologies LLC 21

ASSI 23

Quality Medical Publishing 25

ISAPS Back cover

DISCLAIMER

ISAPS News is published by Quality Medical Publishing, Inc., 2248 Welsch Industrial Court, St. Louis, MO 63146, USA

ISAPS News is not responsible for facts as presented by the authors or advertisers. This newslet-ter presents current scientific information and opinion pertinent to medical professionals. It does notprovide advice concerning specific diagnosis and treatment of individual cases and is not intended foruse by the layperson. The International Society of Aesthetic Plastic Surgery, Inc. (ISAPS), the editor,contributors, and Quality Medical Publishing, Inc. (QMP) have, as far as possible, taken care to en-sure that the information given in this newsletter is accurate and up to date. However, readers arestrongly advised to confirm that the information, especially with regard to drug usage, complies withthe latest legislation and standards of practice. ISAPS, the editor, the authors, and publisher will notbe responsible for any errors or liable for actions taken as a result of information or opinions expressedin this newsletter.

©Copyright 2008 by the International Society of Aesthetic Plastic Surgery, Inc., and QualityMedical Publishing, Inc. All rights reserved. Contents may not be reproduced in whole or in part with-out written permission of ISAPS or QMP.

MANUSCRIPT SUBMISSION TO ISAPS NEWS

ISAPS News publishes articles relevant to plastic surgery ineach issue, and we invite readers to submit manuscripts. Ar-ticles with accompanying figures and tables should be sub-mitted in an electronic format along with a hardcopy print-out for reference. Be sure to keep a duplicate copy of allmaterial for your files. If you are interested in submitting amanuscript, please contact:

ISAPS News Editor-in-ChiefRuth Graf, MD, [email protected]

ISAPS Executive DirectorCatherine B. [email protected]: 1-603-643-1444

Quality Medical Publishing, Inc.Karen Berger, President/[email protected]: 1-314-878-9937

ARTICLE PREPARATION

Type the article double spaced with 1-inch margins. Providea complete title, and list the names of all authors with theiracademic degrees, country of residence, and ISAPS title (if ap-plicable). Number the pages consecutively in the upper right-hand corner. Provide captions for figures and insert mentions

of figures in text. If figure citations are not appropriate, in-dicate approximate point of insertion for each figure. Pleasenote that material accepted for publication is subject to copy-righting and should not be under consideration for publica-tion elsewhere. Credit should be provided for all reproducedmaterial with written permission of the copyright holder andpatient consents.

Submissions may be made for the following article types: � Feature: Discuss current clinical topics of interest in

plastic surgery� Technique: Present a step-by-step description with il-

lustrations of a surgical procedure� About Your Practice: Discuss the business aspects of

running and marketing a practice and managing staff

Specifications:� Page Limit: 2 to 4 double-spaced pages� Bibliography: No more than 5 references� Images: No more than 4 images

ILLUSTRATION PREPARATION

Image resolution is critical for reproduction. To ensure qual-ity images, please make sure that halftone images (photo-graphs) are sized at 300 dpi at 2 � 3 inches. Line art images(drawings) must be sized at 1200 dpi at 2 � 3 inches andshould be converted to bitmapped (BMP) images before sub-mission. Please note that a color headshot photograph is re-quested from all guest columnists. �

N O W A V A I L A B L EBring the world of plastic surgery to your desktopISAPS News is also available in an electronic format. Watch forthe latest issue and experience its exciting features for yourself!

• Read expanded articles• Participate in surveys• Enjoy the animated

page-turning feature• Link directly to advertisers• Download article specifications

Issues are archived onlineat www.isapsnews.com


ISAPS Executive Offices45 Lyme Road, Suite 304Hanover, NH 03755 USA

CONGRESS

INTERNATIONAL SOCIETY OFAESTHETIC PLASTIC SURGERY

Come visit us Down Under . . .You may never want to leave!

Melbourne, Australia • February 10-13, 2008www.isaps.org • www.isapscongress2008.org

© Quality Medical Publishing - W Aesthetics Plastic Surgery

Documents

Transcript of © Quality Medical Publishing - W Aesthetics Plastic Surgery