International Conference on Plastic and Aesthetic Surgery August 08-10, 2016 Toronto, Canada

Chair

Sahar Ghannam

International Society of Dermatologic Surgery, Canada

Co-Chair

Sameer Bafaqeeh

King Saud University, Saudi Arabia

Session Introduction

Colin P White

Surrey Memorial Hospital, Canada

Title: The hybrid breast reduction: Taking advantages from both the vertical and wise pattern reductions

Biography:

Colin P White has completed his Plastic Surgery Residency from McMaster University and completed separate fellowships in hand, microsurgery, crainofacial and breast reconstruction. He has published more than 25 papers in reputed journals and has been in independent practice for 2 years in British Columbia

Abstract:

The wise pattern vs. vertical scar pattern breast reduction has been long argued. The advantages and disadvantages of each are well. A recent randomized controlled trail of the wise pattern vs. the vertical pattern reduction failed to show any drastic differences with regards to clinically outcome but it did show that the vertical type pattern was consistently shorter in operation time. We show a technique which combines the best aspects of the wise and vertical pattern reductions. In this technique, we use a typical superior medical pedicle that would be typically used in a vertical pattern and use a skin incision and tissue resection pattern of that of a wise type pattern. By doing this hybrid pattern, the surgeon is able to utilize advantages of the two well known reduction types. The hybrid reduction uses a robust and reliable superior type pedicle which also allows for a quick de epithelization and dissection of the pedicle. By using the Wise type anchor shaped skin incision a large amount of tissue is able to be harvested and the breast projection is restored and is asethetically favorable. We show step by step marking and surgical tips to conduct a surgery with a favorable cosmetic outcome. We also show surgical tips such as dealing with the dog ear from a vertical limb and also shortening pedicle length in order to give long lasting results.

Maryam Borumand

YouGlo, UK

Title: Using multi small injection sites in preference to massaging

Biography:

Maryam Borumand is an advanced Aesthetics Practitioner who specializes in non-surgical treatments. She holds a Bachelor of Science in Biomedical Science from Kings’ College London, a PhD in Biochemistry from University of East Anglia, and a Post-graduate Diploma in Physician Associate Studies from University of Birmingham. She is a member of the Royal College of Physicians and is part of the Editorial Board for the Journal of Procedural Dermatology. Since 2010, she worked in General Practice for over an year and then at a number of Clinical Research Organizations, before setting up her aesthetics business, YouGlo.

Abstract:

Dermal fillers have become an integral part of aesthetic practice. Commonly the practitioner may undertake one or two days of training in this field before they set out on their own. However, it is now becoming increasingly recognized that this short period of training may not be sufficient to equip a practitioner with the knowledge they need to provide the best practice. One of the techniques most commonly taught by injectors is massaging after injection. This knowledge is widespread in textbooks and online. However, it is important to remember that it is the special viscoelastic properties of fillers that provide augmentation of soft tissues. When injecting a dermal filler, the tissue alters in form depending on injection direction. Excessive massaging, may not only disrupt the properties of the filler, but can also disrupt the shape and form of the tissue. Previous studies have shown that the injection pressure causes the filler to flow naturally towards an area that deforms more easily i.e. the hypodermis. Deformation of the tissue matrix in this region stimulate mechanoreceptors on fibroblasts, which then convert the mechanical signal into an intracellular biochemical signal involving molecular transformations that cause changes in the biochemical parameters in the dermis such as collagen and enzymes. Small injection sites allow even distribution of multiple volumes of filler within the hypodermis, which in turn leads to uniform level of mechanical stress exerted in the dermis.

Tatjana Bogdanova

Dr. Med. E. Jurshevich’s Clinic of Aesthetic Medicine, Latvia

Title: The main causes of aesthetic and functional complications after the rhinoplasty

Biography:

Tatjana Bogdanova completed her PhD from Riga Stradiņš University in 1989 and Post-doctoral studies as an Otorhinolaringologist from Riga Stradiņs University. She works in Dr. Med. E Jurshevich’s Clinic of Aesthetic Medicine as the ENT doctor. She is a member of Latvian Otorhinolaringologists Society, ERS (European Rhinologists Society) and RhSoEu (Rhinoplasty Society of Europe). She published the abstracts for Baltic Otolaringologists Congress and annual RhSoEu members meetings.

Abstract:

Popularity of the nasal aesthetic surgery increases year by year, through this, unfortunately, grows the number of complications. The aim of this study is to systematize the complications after the rhinoseptoplasty and establish the cause-consequence bond between aesthetic and functional problems, arising after endonasal functional operations, as well as after only aesthetic interventions. 119 cases of revision rhino/rhinoseptoplasty were analyzed for period 2009-2015 in our clinic (102 female and 17 male in age range 24-63 years). 68 patients previously undergone aesthetic rhinoplasty (13 of them – repeatedly), 24 patients had functional-aesthetic operation (rhinoplasty and mainly sub-mucosal resection of nasal septum by Killian) and 27 patients undergone only sub-mucosal resection of nasal septum by Killian. 91.7% of patients were previously operated in different clinics. In result, after the questioning and objective examination (nasal endoscopy, rhinomanometry, CT scan), 38 patients had only aesthetic problems, 5 patients had functional and most of the patients (76) – had both. 68 revision rhinoplasty and 51 revision rhinoseptoplasty (18 of which by extra-corporal reconstructive septoplasty, 24 – by subtotal septoplasty, 9 – by septoplasty in situ) were made with a good result and with elimination of aesthetic and functional problems. The complications after the rhinoseptoplasty can be divided to aesthetic and functional. However, principal number of patients (according to our study) has both types of complications. It confirms the fact, that rhinoplasty is the operation, that is situated at the intersection of the plastic surgery and ENT surgery, that, unfortunately, causes a lot of problems for patients. In this way, the successful result of rhinoplasty directly depends on plastic surgeon’s skill to operate not only external nose, but also internal nose. On the other hand, during the functional procedure, it always important to understand the consequences of one or another change of the nasal support structures to the form of the external nose.

Dominik L Feinendegen,

Swiss Society for Aesthetic Surgery, Switzerland

Title: Scarless brow reduction surgery

Biography:

Dominik L Feinendegen has taken plastic surgical training at the University Hospital Berne. In 1997, he worked as the Registrar at the Mount Vernon Hospital in London. In 1998, as the Assistant Medical Director at the Bellevue Clinique in Zurich and from 1999 until 2001, he was the Head of the Department at the University Hospital of Erlangen-Nürnberg. Since 2001, he was the Founder and Director of the Institute of Plastic, Reconstructive and Aesthetic Surgery in Zurich. He was the Lecturer and Instructor for international training courses and seminars and new plastic surgical techniques, published within peer-reviewed international journals. He received awards for the development of the “subcostal artery perforator flap”: 2005 from EURAPS, 2010 from the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery. In 2012, he was the founding member of the Swiss Society for Aesthetic Surgery.

Abstract:

So far, there are no reports in the realm of medical literature which particularly describe from a surgical point of view any brow reduction technique. As up to this day, brow reduction has only be analysed and investigated from a non-surgical point of view. The following paper aims to fill into this lack of research and will introduce a new surgical brow reduction technique with less scar formation. By doing this, the paper questions the present treatment of brow forming and contributes to new insights in surgical procedures and contributes to present academic literature. The reluctance to form the brow surgically might be the prevailing medical opinion and experience of noticeable scar formation following reduction of brow fullness and brow symmetrization or direct brow lift procedures. The use of the ‘flat incision technique’ proposed in this article can alleviate these visible sequelae following incisions in the brow area. With this technique the brow can be directly reduced in size and/or simultaneously elevated, especially to feminize or harmonize the brow form. The brow rows are deliberately reduced which leads to nearly invisible scar formation. Compared to the vertical skin incision the herein described flat incision technique increases the dermal wound layers more than a double. By maximization of these dermal layers the scar quality is remarkably improved. Hair growth can be maintained through the incision line by sparing the hair follicles. This technique was prospectively evaluated in a series of 18 patients with surgery performed by one surgeon in one center. All patients showed good to excellent scar formation with exception of 2 heavy smokers. The subjective rating of the results was very good in fourteen patients, good in two patients and poor in two patients.

Break: Lunch Break @ Trillium C 13:10-13:55

Minoru Arakaki

Arakaki Plastic Surgery, Japan

Title: The new idea for controlled release PRP therapy in women hair-loss

Biography:

Minoru Arakaki has completed his PhD from Nagasaki University and Post-doctoral studies from Nagasaki University School of Medicine. He is currently the President of Arakaki Plastic Surgery. He is a certified board of JPRS and a counselor of JSAPS. He has published more than 20 papers in reputed journals. He is the specialist of Hair Restoration Therapy in Japan.

Abstract:

Recently, Platelet Rich Plasma (PRP) topical injection therapy is reported to be efficient for women hair loss but its effect is still not enough. And also the patients may fall into anemia because of repeated drawing blood. The mechanism of PRP is to provide growth factors around the cell and up-regulate cell function so they have to continue signaling to maintain cell function. Therefore concept of controlled release carrier is focused by engineers and researchers all over the world and they have developed many kinds of drag carriers but are still expensive or under research so they are not suit for clinical use. Takikawa et al reported new cheap carrier containing PRP using conventional injectable drugs. They use Dalteparin and protamine micro-particles (D/P MPs) as the carrier for PRP and investigate the duration and the enhanced effects of PRP. It can be make easily with common technique and materials in the clinic operation room. Author reports the small clinical experiences of Controlled Release PRP therapy for women hair-loss. Further investigation and improvement will be needed but the result supports the efficacy of the controlled release PRP therapy. It can be useful for not only hair growth but also rejuvenation skin therapy.

Chair

Tanongsak Panyawirunroj

Asia Cosmetic Hospital Co., Ltd., Thailand

Co-Chair

Thomas Biesgen

Mutterhaus Trier, Germany

Session Introduction

Thomas Biesgen

Mutterhaus Trier, Germany

Title: Different possibilities for reconstruction of the anal-vaginal region after large tumor excision

Biography:

Thomas Biesgen received his MD at Heidelberg University 2000 and after his training in world-known departments (e.g. UCLA, Los Angeles, University Bordeaux, Paris, Munich, Toronto), he passed the board exams 2007 in plastic, reconstructive and aesthetic surgery in Munich. During the last years, he has gained extraordinary experiences in different countries and he sub-specialized in hand surgery, reconstruction of the upper limb/reconstructive microsurgery, including breast reconstruction and aesthetic surgery, finally as Consultant at the University Hospital Cambridge, UK and University Hospital BG Tübingen in Germany. From January 2015, he become Head of the Department in Plastic, Reconstructive and Hand Surgery at Mutterhaus Trier, University Mainz, Germany. He has authored many national and international lectures as invited speaker and lectured at top-ranked international universities. He taught at several charity organizations (Interplast Germany and Interplast UK) during Interplast missions in different countries in the world (Uganda, Pakistan, India, etc.), including organizing of operation courses in third world countries.

Abstract:

The presentation shows different operative possibilities for the reconstruction of the anal-vaginal region after large tumor excision. Some reconstructions are done by VY-gluteus-flap and Gracilis-flaps to reconstruct the inguinal region and the anal area. The different techniques for the reconstruction are presented by pre-, intra- and post-operative pictures include the postoperative outcome. The advantages/disadvantages for each operative procedure will be discussed.

Claudio A Guerra

Pontificia Universidad Catolica de Chile, Chile

Title: Overview in post bariatric body contouring

Biography:

Claudio A Guerra has completed his graduation from Universidad de Chile Medical School. He got trained in General Surgery and practiced for 5 years before starting his training in Plastic Surgery. He was a research Fellow at University of Alabama from July 2009 to February 2011. He currently works at Universidad Católica de Chile in the Plastic Surgery Unit performing most of the post bariatric surgery refered to the unit.

Abstract:

Overweight and obesity have become common health problems, which has increased the number of patients undergoing bariatric surgery. After the weight loss, the last step in the comprehensive treatment of obesity is the body contouring surgery. There are different surgical techniques, depending on the area to be treated and the patient's features and expectations. The current state of post bariatric body contouring surgery will be presented, with an overview of the preoperative evaluation and planning, the timing of the procedures and the strategy to achieve good results with safe surgery. A thorough and complete preoperative evaluation is crucial to define the best time to perform post bariatric plastic surgery, and to design a surgical strategy to address adequately the needs of these patients. Obtaining an accurate history is essential to establish whether the patient is at the optimal time for body contouring surgery, with a stable weight of at least 4 months, and an adequate nutritional condition to achieve lasting results over time. A very important issue to discuss with the patient is the extent and location of scars and the postoperative course they may have. The limitations of surgery have to be clearly explained and the patient must understand these surgeries as a process, considering staged procedures as a realistic strategy in terms of safety and results. The risk of thromboembolic events, bleeding, need of transfusions, infections must be discussed so the patient has all the information he or she needs in order to make a well informed decision. A careful medical evaluation and surgical planning are important to offer procedures with predictable results keeping safety as a main concern.

Carrie S Stern

MirrorMe3D, USA

Title: 3D printing in cosmetic surgery - New paradigm to enhance consultations, conversion and surgical planning

Biography:

Carrie S Stern completed her Medical degree from New York University Medical Center and then pursued her residency training in Plastic and Reconstructive Surgery at Montefiore Medical Center of the Albert Einstein College of Medicine. Given her previous research interests in simulation and technology in plastic surgery, coupled with her entrepreneurial interests, she decided to launch MirrorMe3D, a company dedicated to bringing 3D printing to cosmetic surgery. She has co-authored 20+ manuscripts in peer reviewed journals and 50+ presentations and national and international conferences to date.

Abstract:

One of the most important parts of the plastic surgery consultation is aligning patient and surgeon goals. Plastic surgeons have been using simulation software as part of their consultation to help show patients what they might look like after cosmetic surgery. Despite the more recent use of 3D photography and simulation, patients still have difficulty visualizing proposed changes on a 2D computer screen. 3D printing, which is an emerging technology in various sectors including health care, may help bridge this gap. We have begun to incorporate 3D printing technology in the care of aesthetic patients. 3D prints are provided by MirrorMe3D, which offers products to surgeons and patient, including full face, facial subunit (i.e. nose) and breast models. 3D printing offers a number of benefits to doctors, including marketing and branding, as well as potential increased patient conversion rates. We have found the most useful procedures have been for rhinoplasty and breast augmentation. Baseline models are used at initial consultation to describe the deformity and educate patients on the goals and expectations of surgery. Baseline and simulated models can be used as an educational tool, but can also be utilized as a reference for intraoperative guidance. We have found this latter application particularly useful as it supplements, and may ultimately replace, the standard 2D photos currently used. 3D printing can add value to many aspects of a cosmetic surgery practice, including branding, marketing, education, conversion rates, and surgical planning.

J Bouguila

La Rabta University Hospital, Tunisia

Title: Complex scalp defects

Biography:

J Bouguila is Assistant Professor at La Rabta University Hospital, Tunisia. He completed Medical Doctor (MD) in Tunis-Tunisia in the year 2007; he completed Diploma of specialist in Maxillo-Facial Surgery at Tunis-Tunisia in year 2008, and Oral Implantology & Academic diploma of Microsurgery at Lyon-France during 2008-2009. He specialized in Formation Attestation in Plastic and Aesthetic surgery (SFA), Diploma of Facial Plastic and Aesthetic Surgery, Hair Transplantation & Orthognathic Surgery at Lyon-France during 2009-2010. He was the French Board of Plastic Reconstructive and Aesthetic Surgery at Paris-France during 2010-2011.

Abstract:

Introduction: Defects of the scalp may result from trauma, tumor resection, infections, congenital lesions and radiation treatment. Large and complex defects extending to bone can represent a significant challenge to the reconstructive head and neck surgeon. We here present our experience in the treatment of complex scalp defects. Material & Methods: We conducted a retrospective study of patients treated for complex defects of the scalp in the Department of Maxillo-Facial and Plastic Surgery in Sahloul Hospital (Sousse-Tunisia). Data studied were: Epidemiological (age, sex), etiologies, characteristics of the defect, surgical procedures and outcomes. Results: A total of 6 male patients have undergone reconstruction for defects in the anterior scalp subunits (forehead=1, fronto-temporal=3, parietal=1, parieto-temporal=1). The average age of patients was 53 years (min 25 years and max 81 years). The scalp defects resulted either from: tumor resection (2 patients); post-traumatic loss of the scalp (3 patients) and; electric burn (1 patient). As a surgical reconstruction; galea-aponeurotic flaps and split-thickness skin grafting were done in 2 cases, a temporal muscular flap was performed in 1 case and a latissimus dorsi free flap was performed in 2 cases. Conclusion: Scalp reconstruction represents a challenge, as the reconstructive surgeon should strive for a cosmetically appealing result as well as for durable coverage to the exposed cranium. Although local flaps have been described for the reconstruction of these defects, free flaps are the preferred choice when a significant area of soft tissue coverage is required or when the defect concerns the bone.

Troy R Hailparn

Cosmetic Gynecology Center of San Antonio, USA

Title: ThermiVa® for vulvovaginal rejuvenation-San Antonio experience

Biography:

Troy R Hailparn has done over 2000 vaginal procedures and over 750 labiaplasties, and has had extensive advanced education in cosmetic-plastic gynecology. She is an international leader in the field having participated in the historic first two scientific sessions in cosmetic-plastic gynecology at major international meetings, the first in Hainan, China at the 15th World Congress on Controversies in Obstetrics, Gynecology and Infertility (COGI) in December, 2011, and the second, at the prestigious International Federation of Gynecologists and Obstetricians (FIGO) in Rome, Italy, in October, 2012, to help recognize and validate the needs of women everywhere. She is the author of the recently released online educational eModule for her colleagues through the American College of Obstetricians and Gynecologists (ACOG) on the Labia Minora and Labia Minora Labiaplasty Procedures, and has published articles in reputed journals as well as serves as a scientific peer journal reviewer. She lectures locally and nationally, and holds courses throughout the year on Vulvar and Vaginal Cosmetic Gynecologic Procedures through the American Society of Cosmetic Physicians.

Abstract:

Introduction: The use of radiofrequency technology to treat vulvovaginal problems including incontinence, atrophic vaginitis, damage from childbirth, and aesthetic concerns of the labia majora has been introduced in the last year, and has promise as a non-surgical vaginal rejuvenation option for women. Objective: To assess the clinical and subjective effects of ThermiVa® on stress and urge incontinence, painful intercourse due to atrophic vaginitis, sensation changes from childbirth, and saggy labia majora causing cosmetic concerns. Materials & Methods: Female patients presenting for non-surgical treatment of vulvovaginal concerns from August 2015 through April 2016 were counseled on and offered ThermiVa®. Risks and complications and alternative treatments were discussed. All were offered 3 treatments 4-6 weeks apart. Consents were obtained for treatments, before and after photographs, videos and testimonials. Results: 35 patients were included. 3 had only 1 treatment, 7 have had 2 treatments and 25 have completed 3 treatments. All who had 2 and 3 treatments except one have had improvement in all of their symptoms as well as with the cosmetic appearance of their labia majora. The one patient had painful intercourse due to vaginal dryness and presented on combination hormones at the age of 44. She still complained of painful intercourse and vaginal dryness after three treatments and a discussion of changing her hormonal regimen ensued and a trial of vaginal estrogen started. Conclusion: ThermiVa® appears to positively impact the urinary, dryness, and sensation symptoms and cosmetic concerns in the majority of women treated and is an excellent non-surgical vaginal rejuvenation option for women.

Neelam A Vashi

Boston University, USA

Title: Understanding beauty and the approach to body dysmorphic disorder

Biography:

Neelam A Vashi, MD, FAAD is a board certified Dermatologist and a fellow of the American Academy of Dermatology. She is an Assistant Professor of Dermatology at Boston University School of Medicine. She is also the Director of Research in Cosmetic and Laser Medicine and the Founder and Director of the Boston University Center for Ethnic Skin. She received her Medical degree from Northwestern University Feinberg School of Medicine, where she was inducted into the Alpha Omega Alpha Honor Medical Society. After her internship at Northwestern University, she completed her dermatology residency at New York University (NYU). She is a recognized leader in medical and cosmetic dermatology. She is widely published in the peer-reviewed literature, author of several book chapters, and is a frequent lecturer at both national and international dermatology meetings. She is editor and lead author of a book entitled, “Beauty and Body Dysmorphic Disorder: A Clinician’s Guide”.

Abstract:

This lecture discusses the historical importance of beauty and offers an overview of the objective and subjective aspects of beauty to segue into a discussion of body dysmorphic disorder (BDD). The lecture will begin with an analysis of what the human eye finds aesthetically pleasing including symmetry, averageness, sexual dimorphism, skin homogeneity, and proportions. Also to be discussed are how these biologic perceptions can be reshaped through individual, cultural, and historical influences. The course will then focus on disorders of self perception, BDD, including a discussion of the history, epidemiology, symptoms, diagnosis including use of questionnaires, and implications for treating physicians. The lecture will conclude by providing an algorithmic approach to persons with suspected BDD and treatment options. BDD occurs in 1-2% of the general population and 6-15% of dermatology and cosmetic surgery patients. In a BDD cohort, 50% sought treatment from a dermatologist and 33% requested cosmetic surgery. These patients are often unhappy with results with over 90% reporting symptoms unchanged or worsened after cosmetic procedures. This disorder is under recognized and should be approached with both sympathy and empathy given the high rate of suicidal ideation in these patients. Recognition and appropriate referral key to management.

Break: Networking & Refreshments Break @ Foyer 16:15-16:30

Chair

Sameer Bafaqeeh

King Saud University, Saudi Arabia

Co-Chair

Minoru Arakaki

Arakaki Plastic Surgery, Japan

Session Introduction

Claudio A Guerra

Pontificia Universidad Catolica de Chile, Chile

Title: Combined surgery in postbariatric patients

Biography:

Claudio A Guerra has completed his graduation from Universidad de Chile Medical School. He got trained in General Surgery and practiced for 5 years before starting his training in Plastic Surgery. He was a research Fellow at University of Alabama from July 2009 to February 2011. He currently works at Universidad Católica de Chile in the Plastic Surgery Unit performing most of the post bariatric surgery refered to the unit.

Abstract:

Post bariatric patients are often interested in adressing as many possible surgical problems with the minimal amount of procedures. To plan combinations, it is important to consider the topographic proximity of the areas to address allowing the treatment of units thoroughly, for example brachioplasty and breast lift or an abdominoplasty combined with a breast lift. Another strategy is the combination of remote areas that can be addressed separetly in different surgical fields, as in a vertical lift thighs combined with mastopexy or brachioplasty. The lower body lift should be performed together, or prior to the thigh lift to get better and lasting results; and the treatment of the trunk, lateral thigh and buttocks as a single aesthetic unit. Also, the circumferential belt tummy tuck in the lower lifting and the excess tissue resection is performed in the trunk, raising buttocks and lateral thigh. Liposuction techniques generally can be used either during or after excisional procedures to achieve better contour results. When planning a combined surgery, one must visualize the postoperative period and the patient must be warned of the limitations that he or she will have in the near future, for the recovery may be long and cumbersome especially in certain combinations. The great advantage of combinations is the relatively quick solution for at least two of the most concerning issues that a patient may have. One surgery with judicious and safe combinations may be a good option for most of these patients.

Jung Su Lee

UVOM Plastic surgery, Korea

Title: Endoscopically assisted malarplasty: An L rotation technique

Biography:

Jung Su Lee has completed his MD, PhD from Korea University and Post-doctoral studies from Korea University School of Medicine. He is the President of YoutifulVom Plastic Surgery. He has published a paper in Journal of the American Society of Plastic Surgeons and papers in the Korean Society of Aesthetic Plastic Surgery about Mammoplasty, Forehead plasty and Malarplasty. Also, he has participated as a contributor of the US Plastic Surgery textbook 2nd Edition (Cosmetic Surgery of the Asian Face).

Abstract:

Introduction: Endoscopy assisted malar reduction with greenstick fracture is a treatment method for preserving body eminence and improving arch protrusion. However, there were limitations to the application when needing the malar body reduction. For the limitations, we invented a new method using endoscope without intraoral incision, which reduces body protrusion and tried to apply the method for malar reduction. Methods: We enrolled 261 patients who visited the clinic from January 2013 to December 2014. Their ages are with an average of 31. After a scalp incision, an incomplete osteotomy was done on the most prominent portion of the body of zygoma and then a complete osteotomy on the arch. Osteotomy of body was preceded from frontozygomatic angle until zygomatico maxillary suture line. This section makes a right angle with zygomatico maxillary suture and it form L-Shaped zygomatic body. The segment formed with L-shaped incomplete osteotomy and complete osteotomized arch used an inner cortex of zygomatic body as pivot and we applied inward rotation. (L-rotation Technique) Results: Among the 261 patients with the L-Rotation technique, 242 patients were given a corticotomy. From those patients, 15 patients underwent a different degree of a zygoma reduction on both sides. Most patients were satisfied with it and there were no specific complications. Conclusion: Endoscopically assisted malarplasty using ‘an L-rotation technique’ enables an arch and body protrusion to be improved and is able to control the site and numbers for corticotomy based on the zygomatic body protrusion. Surgeons, as well as patients were satisfied by the results.

Break: Networking & Refreshments Break @ Foyer 11:30-11:45

Ahmed Walaa AbouSheleib

Orange Clinics, Egypt

Title: Rhinoplasty in Middle Eastern nose

Biography:

Ahmed Walaa AbouSheleib is an Egyptian Consultant of Otorhinolaryngology, subspecialized in Rhinoplasty and Facial Plastic Surgery. He received his Post-graduate medical training at Mayo Clinic (Rochester) MN, USA. As a Visiting Physician in several USA reputable universities, he got further training with the world’s well renowned rhinoplasty –facial plastic surgeons. His practice is based in Alexandria (Egypt). He is a frequent Lecturer, Physician Educator and active Researcher. He has lectured on several topics in rhinoplasty, both nationally and internationally. Facial plastic surgery enables him to help individuals ‘reconstruct’ areas of their face as well as provide options for people who would like to make aesthetic facial changes. His close relationships with many experts in this field across Europe and the USA enabled him to provide the best medical care for his patients through collaborative consultations in difficult facial plastic surgery cases.

Abstract:

“Middle Eastern” often refers to individuals of Arabic, Turkish, North African and Persian descent. Rhinoplasty on “Middle Eastern nose” possesses an added challenge for the surgeon, owing to certain anatomical characteristics that make Middle Eastern rhinoplasty difficult. Patients may present with a heavy thick skin envelope, bulbous tip, weak alar cartilages with limited support, nostril-tip imbalance and a droopy ill-defined nasal tip. The operative plan must take into account this vast majority of Middle Eastern nasal inherited features. Independent of the surgeon’s technical approach, understanding the concerns, goals and motivations for such patients who tend to be “perfectionists” together with preservation of the patient’s ethnic identity will make nasal surgery successful.

Aaron L Shapiro,

Jefferson Volunteer Faculty Association, USA

Title: Innovative cosmetic uses of platelet rich plasma

Biography:

Aaron Shapiro,MD, After attending Williams College, Dr. Shapiro graduated from The University of Pennsylvania School of Medicine in 1987. Dr. Shapiro then completed a residency in Otolaryngology/Head and Neck Surgery at The New York Eye and Ear Infirmary. He then completed a fellowship in Facial Plastic and Reconstructive Surgery in St Louis under the direction of J. Regan Thomas,MD. Dr. Shapiro is double board certified in Otolaryngology and Facial Plastic and Reconstructive Surgery. He has been in practice in the Philadelphia area since 1993 and is on the faculty of Thomas Jefferson University Hospital. His practice and research focuses on minimally invasive facial plastic surgery, rhinoplasty, and facial rejuvenation. He has been named a “Top Doc” in Main Line Today, Philadelphia Style, and Philadelphia Magazine. Dr. Shapiro serves as the Director of Facial Plastic Surgery for the Center for Smartlipo and Plastic Surgery in Langhorne,Pennsylvania and has offices in Philadelphia and Bryn Mawr, Pennsylvania.

Abstract:

Recently Platelet Rich Plasma (PRP) and Platelet Rich Plasma with a Fibrin Matrix (PRFM) have been utilized as stand-alone treatments for rhytids, volume loss and hair loss. Combination therapy with other modalities has yielded superior results in fat transfer, micro-needling treatments and hair transplantation. Platelets have proven to be potent sources of growth factors and contain vascular endothelial growth factors, platelet derived growth factors, epidermal growth factors and fibroblast growth factors among others. These factors are crucial to stimulate endothelial budding, revascularization and new tissue formation. Fibrin is also an essential element, not only in the presentation and release of growth factors but also in providing a matrix upon which the platelets can remain and extend their action. Adding the fibrin matrix ensures the growth factors will remain in place and continue their action over many days. We will review the science of PRP and PRFM including available studies on its efficacy. We have used PRFM with fat transfer to enhance both immediate and long-term results. A histologic case study is presented showing neovascularization and the effectiveness of mixing fat with PRP. PRP has also been utilized in our practice as a volumizer and we review these results and studies on its efficacy. It has been shown to improve the nasolabial fold area, tear trough area and acne scarring. There is widespread use of PRP in combination with micro needling and we will review the improved results that can be attained. Enhancement of hair growth and hair transplantation is another exciting application that is just beginning to gain recognition. We will share our study on serial injections of PRP to the scalp in male and female alopecia as well as for male pattern baldness. We also review the current literature on this exciting new and controversial application.

Petr Stadler

Na Homolce Hospital, Czech Republic

Title: Mini-invasive robotic vascular surgery

Biography:

Petr Stadler is the Head of the Department of Vascular Surgery, Na Homolce Hospital in Prague, Czech Republic. He was certified as a console surgeon for the da Vinci surgical system in August, 2005 at the University of California, Irvine. He is a member of the Czech Association of Cardiovascular Surgery, the ESVS, the ISMICS, the SRS and a founding member of the International Endovascular and Laparoscopic Society. He has also received a few prestigious honors from the Czech Association of Cardiovascular Surgery for the best publications in 2004 and 2006, the Letter of Appreciation from Korean Society of Endoscopic and Laparoscopic Surgeons in May 2008, the price of the Czech Society of Angiology for the publication in the year 2007 and the best audiovisual presentation in 2009 in USA (ISMICS) and in 2013 in USA (SCVS). He performed also the robot-assisted vascular operations in South Korea, Russia, Poland and India.

Abstract:

Objectives: The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively unknown. The feasibility of laparoscopic aortic surgery with robotic assistance has been sufficiently demonstrated. Our clinical experience with robot-assisted vascular surgery performed using the da Vinci system is herein described. Methods: Between November 2005 and September 2015, we performed 342 robot-assisted vascular procedures. 245 patients were prospectively evaluated for occlusive diseases, 70 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, five for a splenic artery aneurysm, one for an internal mammary artery aneurysm five for hybrid procedures, three for median arcuate ligament release and nine for endoleak II treatment post EVAR. Results: 327 cases (95.6%) were successfully completed robotically; one patient's surgery (0.3%) was discontinued during laparoscopy due to heavy aortic calcification. In fourteen patients (4%) conversion was necessary. The thirty-day mortality rate was 0.3% and early non-lethal postoperative complications were observed in six patients (1.75%). Conclusions: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures.

Andrea Corbo

University of Camerino, Italy

Title: Heterologous collagen type I as new injectable for skin rejuvenation

Biography:

Andrea Corbo is a Doctor specialized in Dermatology and Professor at the University of Camerino. He has decades of experience in aesthetic medicine and is point of reference for the training of doctors in this area also as Director of the Medical Spa, organization dedicated to clinical and training in the field of aesthetic medicine and dermatology.

Abstract:

Introduction: Heterologous collagen has known over the past years for wound healing and skin regeneration. Here it was micronized and put into sterile vials for injective usage. Through rehydration of the vial, collagen undergoes spontaneous hydrolysis, producing collagenous amino acids and tripeptides. Tripeptides (mainly Pro-Hyp-Gly) are biologically important as growth factor, leading to improve fibroblasts anabolism and cell cycle, and inhibit metalloproteinase of extracellular matrix. Furthermore, amino acids support collagen production according to Michaelis-Menten kinetics. Materials & Methods: Three different amount of equine collagen were previously tested and a 100 mg formulation was chosen for better results and less side effects as patient discomfort and skin irritation. The collagen powder was reconstituting with 5 ml of saline solution and injected intra-dermally at 2cm point-by-point meso technique. Punch biopsies and photography documentation were collected before and after treatment, a self administered questionnaire was recorded by patients. Results: Treatment was effective in skin rejuvenation goals. Biopsies revealed a significant improve of fibroblasts number and dermal matrix proteins, leading in some case to normalize the same matrix framework, also increasing dermal papillae height and skin thickness. Visual and self-evaluation show better features of skin hydration, brightness and texture. Side effects were similar to other injective treatments as transient bruising, redness and heating. Conclusions: This novel product has interesting effects on skin regeneration, consisting mainly in stimulating an increase in the number of fibroblasts. The new and younger fibroblasts produce new collagen, which is expected to be predominantly of type III.

Break: Lunch Break @ Trillium C 13:05-13:50

Martin Gaboury

OroSphere, Canada

Title: Patient Specific Implants (PSI) in orthognathic surgery

Biography:

Martin Gaboury obtained his Doctor of Dental Medicine degree in 2007 at Laval University (Quebec) and then completed his residency in Oral and Maxillofacial Surgery at l’ Hôspital de l’Enfant-Jésus, affiliated with Laval University (Quebec), in 2013. He is board certified in his specialty in Canada (FRCD(C)). He obtained his Master’s degree the same year, with an award-wining thesis project focusing on orthognathic surgery. In 2015, he completed a one year clinical Fellowship in Maxillofacial and Facial Plastic Surgery in Bruges, Belgium. He is a reviewer for the International Journal of Oral and Maxillofacial Surgery and is co-author of three chapters of Prof. Gwen R J Swennen’s new book, “3D Virtual Treatment Planning of Orthognathic Surgery”.

Abstract:

Maxillofacial correction of dentofacial deformities by means of orthognathic surgery is a common procedure nowadays. However, even if maxillary and mandibular osteotomies can greatly enhance facial aesthetic and harmony, some regions of the facial skeleton remain unchanged following conventional orthognathic surgery. Of these areas, the malar prominence and the mandibular angles warrant specific considerations. Indeed, surgical correction of malar and mandibular angles hypoplasia is challenging, and the ideal procedure or material for definitive augmentation is not yet established. With recent CAD-CAM technology advances, patient specific implant (PSI) based on mirroring algorithms have proven themselves to be a precise, safe and reliable option for the management of post-traumatic unilateral defect of the face. Based on that experience, PSI are now introduced in aesthetic augmentation of the facial skeleton. However, bilateral cases are much more demanding for the clinician, from a planning perspective. The complete workflow, form data-acquisition to 3D virtual treatment planning and manufacturing, will be discussed, highlighting the potential pitfalls of this rather new technology.

J Bouguila

La Rabta University Hospital, Tunisia

Title: Post traumatic closed rhinoplasty in North African patients

Biography:

J Bouguila is Assistant Professor at La Rabta University Hospital, Tunis, Tunisia. He completed Medical Doctor (MD) in Tunis-Tunisia in the year 2007; he completed Diploma of specialist in Maxillo-Facial Surgery at Tunis-Tunisia in year 2008, and Oral Implantology & Academic diploma of Microsurgery at Lyon-France during 2008-2009. He is specialized in Formation Attestation in Plastic and Aesthetic surgery (SFA), Diploma of Facial Plastic and aesthetic surgery, Hair transplantation & Orthognathic Surgery at Lyon-France during 2009-2010. He was the French board of plastic reconstructive and aesthetic surgery at Paris-France during 2010-2011.

Abstract:

Background: The application of Rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems in plastic surgery. Objectives: This article presents our experiences in the reconstruction of traumatic nasal deformities using the internal Rhinoplasty approach. Methods: We conducted a retrospective study from January 2001 to December 2013. We included in this study all patients operated for nasal post-traumatic deformity using closed approach. Each patient chart was reviewed with regard to: age and gender, circumstances and date of nasal trauma, timing of the Rhinoplasty as well as for the functional and aesthetic outcomes. Findings: 172 of these patients, including 115 males and 57 females, underwent the internal approach. The patients were, on average, 26 years old at the time of reconstruction and were followed up for an average period of 16 months. The interval from injury to the Rhinoplasty procedure was 4, 5 years, on average. The outcome was assessed by an independent investigator and the patients themselves. The overall aesthetic-improvement rate was 88%, and the patient-satisfaction rate was 95%. There was no complication. Conclusions: Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. The closed Rhinoplasty technique provides great predictability and minimal postoperative discomfort, with no aesthetic damage.

Chair

Dominik L. Feinendegen

Swiss Society for Aesthetic Surgery, Switzerland

Co-Chair

Sahar Ghannam

International Society of Dermatologic Surgery, Canada

Session Introduction

Jose L Covarrubias

Hospital Del Sol, Nogales Sonora, Mexico

Title: Facial vivifiction

Biography:

Jose L Covarrubias has completed his Medical Degree in University Autonoma of Guadalajara and residency in Plastic Surgery in Hospital Dalinde in Mexico City, Master’s in Aesthetic Surgery. He is Medical Director of Hospital Del Sol, Mexico.

Abstract:

This article describes a new technique for facial contouring and support system of the third midface, which uses an innovative technique. This procedure is a minimally invasive technique of facial rejuvenation that has been increasing in the last years. Aging of the face involves alterations in the appearance, the tone of the outer layers of the skin, ptosis of the malar and cheek pads, and the most important is the atrophy of the fat pads of the cheek this leads to the loss of contour in the malar area, nasolabial folds and the marionette lines, this also increase the lower cheeks. Repositioning of the tissue is the key to the rejuvenation. This procedure is ideal for Patients with heavy faces and early aging process, when there is a main issue like ptosis involves, a sub-periostal mid facelift doing it through an intraoral incision (CADWELL LOOK), it’s done, a suture is placed in the temporal area to lift the malar tissue, whit a innovative 18-cm long curved double-beveled needle (COVAS NEEDLE) bearing a tiny sliding carriage to which 2 /0 Non Absorbable suture may be anchored, this create suspension loops, that are anchored to the deep galea in the temporal region and this provide more tissue support, - fat grafts are used to increase volume, Vivification Peel, and Botulism Toxin is the Facial vivification procedure and can be combine with other modalities, like , TCA PEEL 30%, Blepharoplasty, Rhinoplasty, Liposuction of the double chin, Otoplasty, and much more procedures, this is to have a more natural look and the satisfaction of both the doctor and patient. In 6 years 575 patients, we only had 4 complications, 3 tenderness in the temporal area , and one infection of a suture because hair. This procedure can be done at any age.

Sahar Ghannam

International Society of Dermatologic Surgery, Canada

Title: Chemical peels in darker skin types

Biography:

Sahar Ghannam was graduated in 1983 from Alexandria University Egypt with a Master Degree of Dermatology, Venereology & Andrology in 1986. She received a PhD in 1994 with a thesis on chronological aging, photo aging and ionizing radiation effects on the skin in 1995 a board examination was passed to successfully achieve Doctorate Degree of Dermatology Venereology & Andrology. During that time she upscaled in the University positions from a teacher assistant until Associate Professor in Alexandria University. Since that time, she has been interested in aging and anti-aging procedures. She is a Board Member of the International Society of Dermatologic surgery ISDS and the executive director of the International Peeling Society IPS. She is the co- author of the Chemical Peel chapter in the 3rd edition of “Surgery of the Skin” published by Elsevier. He has published over 20 scientific papers. She is the Editorial Advisory Board of the Indian Journal of Dermatology and the Journal of Clinical and Aesthetic Dermatology. She travels a lot lecturing and teaching but also learning.

Abstract:

Although chemical peels with various depths had been performed since long ago, it was in the last two decades that refinement of these peels was mandatory. Refinements were the result of our full knowledge of the skin types and the disease process, and it was essential to guard against side effects. Peels are now customized to suit skin type with the correction desired. Different peels will be discussed with emphasis to the darker skin types.

Break: Networking & Refreshments Break @ Foyer 11:15-11:30

Colin P White

Surrey Memorial Hospital, Canada

Title: The keystone flap – Practical design, use and diverse applications

Biography:

Colin P White has completed his Plastic Surgery Residency from McMaster University and completed separate fellowships in hand, microsurgery, crainofacial and breast reconstruction. He has published more than 25 papers in reputed journals and has been in independent practice for 2 years in British Columbia.

Abstract:

Introduction & Aims: We documented our clinical experience using the keystone flap for various different defects over the body. We review the advantages and disadvantages of the keystone flap as well as technical pearls with regards to raising the flap and some of its modifications. Methods: We show a case series of 16 patients all of whom have had skin cancer resections (sizes 2x2 cm to 6x6 cm, mean=3x3 cm). All of these patients are shown with surgical images to exemplify the diversity of the reconstructions. All of the flaps survived with the most common complication being minor crusting at the suture lines. Results: Based on our clinical experience, the keystone flap avoids tension on a closure. Donor skin graft sites are avoided, and thus there is no donor site care or pain. Keystone flaps avoid extremity splinting and they avoid the need for prolonged dressing care for partially healed wounds. There are better long term surgery site aesthetics compared to skin grafting. The drawbacks include the fact that a larger initial surgical area is needed and that the keystone flap requires more surgical time for suturing. Conclusion: The keystone flap is an excellent reconstruction for full thickness skin defects from skin cancer resection all over the body. We conclude that it can be used reliably on the lower extremity, trunk, hand, calf and scalp

Robert C J Kanhai

Noordwest Ziekenhuisgroep, The Netherlands

Title: Sensate vagina pedicled-spot for male-to-female transsexuals: The experience in the first 50 patient

Biography:

Robert C J Kanhai attended Vrije University Amsterdam, the Netherlands. He became a plastic and reconstructive surgeon in 2005. He has completed his PhD with the thesis, Augmentation Mammaplasty in Male-to-Female Transsexuals. After working in the VuMC and OLVG hospitals in Amsterdam, he went to Noordwest Ziekenhuisgroep in Alkmaar where he performs head and neck reconstructive surgery, breast-reconstruction, gender and aesthetics surgery. He has published several papers in reputed journals and will be serving as an Editorial Board Member for the Clinics in Surgery.

Abstract:

The cosmetic and functional results of vaginoplasty by inversion of penile and scrotal skin in male-to-female transsexuals are, in general, satisfactory. One of the goals of sex reassignment surgery is to create tactile and erogenous sensitivity in the reconstructed genitals. The sexual arousal function of the neo-female genitalia depends mainly on the neo-clitoris, which has been considered state of the art for over forty years. This goal falls short due to the inner neo-vagina’s lack of erogenous sensitivity, having instead only tactile sensitivity of the skin and prostate. This shortcoming persists despite the refinements to the vaginoplasty throughout the years. Due to the lack of a sexual arousal organ within the neo-vagina, patients are denied sexual arousal during penetration of the neo-vagina. This necessitated improvement of sexual innervation within the neo-vagina. In order to improve the sexual functionality, I have innovated a technique that creates a sexual sensate neo-vagina pedicled-spot in the male-to-female transsexuals, which could be compared with the G-spot, in combination with the neo-clitoroplasty. Despite the controversially about existence of the G-Spot, this new technique create a sexual arousal organ in the anterior wall of the neo-vagina by creation of a sensate pedicled-spot, in combination with the neo-clitoroplasty. The conclusion is that a sensate pedicled-spot plasty has proven to be a safe innovative technique which leads to adequate sexual functionality in all patients.

M J Barba

Clinica Dra Barba Martinez, Spain

Title: Labia minora reduction: New reduction labiaplasty cw CO2 laser without stitches to close by Dra Barba, about 150 cases

Biography:

M J Barba completed Bachelor of Medicine and Surgery from the Complutense University of Madrid (Spain) 1986. She has done PhD in Medical Surgical Dermatologia and Venereology Universidad Complutense de Madrid (Spain) and Master in Cosmetic Surgery ReyJuanCarlos by the University of Madrid (Spain). She is a specialist in Senology and Mammary Pathology by Universidad Autonoma de Madrid (Spain) & Specialist Food and Diet Therapy in Children and Adolescents University of Navarra (Spain). She is with surgical activity in Madrid and Zaragoza Chiron Clinics since 1987 (Spain). She works with hospital surgical activities in La Milagrosa Madrid. She is a Medical Director in chief medical clinics in Madrid and Zaragoza since 1987 (Spain). She is a speaker at national and international medical conferences, partner in TV programs, university master courses, and in radio and press.

Abstract:

Research Purpose: To present the results and benefits of reduction labiaplasty labia minora hypertrophy woman with local anesthesia and a fast, simple CO2 laser resection without stitches in the edges of the labia minora vulvar. Methods: We have treated 150 patients with hypertrophy of the labia minora vulvar cw CO2 laser, continuous, and local anesthesia to cut linearly excess labia minora, CO2 laser coagulation and sealing the edges with CO2 laser. Results: During the study period of 1 year, they were treated to a total of 150 patients. The data indicated: better acceptance of surgery by patients, less discomfort, faster return to everyday activity and healing in half the time with surgery and closed with stitches, best result of scars. Conclusions: The thermo-ablative CO2 laser treatment without stitches could be a safe, effective and initial choice option for reducing hypertrophy of the labia minora vulva of women affected by hypertrophy.

Abhay Agrawal

Allure Med Spa & Vardaan Hospital, India

Title: Walk-in walk-out keyhole gynecomastia surgery with VASER

Biography:

Abhay Agrawal is an Indian Board Certified Plastic and Cosmetic Surgeon and Member of Royal College of Surgeons of Edinburg and has completed his Master of Chirurgiae in Plastic Surgery & Reconstructive Surgery from B J Medical College, Ahmedabad, India. He has worked as an Associate Consultant at P D Hinduja National Hospital, Mumbai and is the author of many publications and research work in India. He is currently doing a Fellowship in Advanced Cosmetic Surgery at Allure Med Spa, Mumbai, India. His main interest in Plastic Surgery includes – Reconstructive and Aesthetic Surgery.

Abstract:

Gynecomastia is the most common aesthetic surgery performed in males in India and worldwide. It can be formed by various methods. VASER is an ultrasonic liposuction technology where the fat selectively melts which leads to less blood loss, less pain, better skin tightening, and faster and smooth recovery. VASER assisted liposuction and piecemeal removal of gland is the method employed at our institute under local anesthesia. The gland component is broken down by VASER and then removed piecemeal by a 1 cm keyhole incision. The patient walks-in and walks-out of the hospital directly from the Operation Theater and joins works the same evening. I share our experience of 250 cases of Gynecomastia (including grade 3, without skin excision) by VASER.

Break: Lunch Break @ Trillium C 12:50-13:35

Fatema A Alsubhi

Alsubhi and Lavender Clinic, Saudi Arabia

Title: Arms Laser Assisted Liposculpture (LAL)

Biography:

Fatema A Alsubhi has completed MBBS in the year 1997 from the University of King Saud and Saudi Board of Plastic Surgery. She is a fellow of University of Toronto from 2007-2009. She is a Plastic Surgeon at Prince Sultan Medical Military Hospital. She is Reviewer at the Annals of Saudi medicine.

Abstract:

In arm contouring brachioplasty is the known classical procedure, which is recently recommended only for patients with more skin laxity and less subcutaneous fat. The classic longitudinal visible scar is the most challenging cosmetic concern for surgeons and patients. Traditional liposuction would be indicated in less challenging cases with minimal skin laxity and fatter dystrophy. Nowadays Liposuction is one of the commonest cosmetic procedures. Always there is a limitation in skin retraction with SAL. However, the new evolutions in liposuction have more heat production, this extra heat can add to the benefit of the contouring. Here is a review of 33 patients’ arms with different grades of contour deformity. They were treated with Single laser wavelength ND/YG1444. The selection of patient and the proper indication of the laser assisted liposuction. The clinical detailed advantages and the disadvantages with possible complications and revisions were reviewed. The technical details of the procedure and the postoperative care were discussed as well. Laser enables the purpose skin shrinkage to be achieved and Step forward in body shaping.

Rodolfo Borsaro Bueno Jorge

Federal University of Ceara, Brazil

Title: Important surgical steps in the primary rhinoplasty to prevent deformities of the alar rim

Biography:

Rodolfo Borsaro Bueno Jorge has obtained Medical Residency in Otolaryngology and Facial Surgery Cervico in the Faculty of Medicine of São José do Rio Preto, São Paulo. He is member of the Brazilian Academy of Facial Plastic Surgery (ABCPF), Member of the Brazilian Academy of Skull and Maxillofacial Surgery (ABCCMF) and Member of the Brazilian Academy of Otorhinolaryngology/Neck and Facial Surgery (ABORLCCF). He is preceptor of facial plastic surgery of Otorhinolaryngology discipline of the Federal University of Ceará, Co-ordinator of ENT emergency São Carlos Hospital, President of the Medical Ethics Committee of the São Carlos Hospital (2016-2018). He is developing a Doctorate project in the University of São Paulo (USP Ribeirao Preto, SP). He has also written book chapters related to otoplasty and rhinoplasty and some scientific articles. He is former financial Director of Otolaryngology of Ceará State Cooperative (2008-2012).

Abstract:

The ideal alar rim is oval shaped with a smooth contour, framed by the superior nostril border above and the columellar roll below. It is important a smooth transition between the tip complex and the alar lobule, otherwise, an undesirable shadow that isolates the tip can occur which increases the visual prominence of the tip. Alar rim deformities are one of the most common problems encountered in primary and secondary rhinoplasty patients. Congenital malpositioned lateral crura or from overaggressive surgical manipulation of the lower lateral cartilages and alar rim deformities can have both functional and aesthetic consequences. According to the distance from the long axis of the nostril to either the columella or alar rim, the deformities may be: hanging columella, retracted ala, hanging ala, retracted columella or miscellany. More recently, the extended alar contour graft has been used to prevent notching of the anterior alar rim where the lateral crus begin to diverge from the alar rim as it courses to the piriform aperture. Multiple techniques of varied complexity have been described to treat and to avoid this common and challenging problem. The steps are: (1) Infracartilaginous incision in “ V” (2) Hemitransdomal cephalic suture (3) Minimal resection of lateral crura cephalic margins (4) Improving support of the lateral crura through the “turn in or turn over flap” (5) Horizontal rotation of the lateral crura (6) Different suture of the infracartilaginous incision (7) Rim graft. The objective of this presentation is showing and discussing these important steps to avoid this alar retraction and airway obstruction from collapse of the external nasal valve and preserve the natural contour of the alar rim, thereby improving alar symmetry.