Day 2 :
Keynote Forum
Jamal Jomah
MEDART Clinics, Saudi Arabia
Keynote: 3-dimensional surface modeling (3DSM)
Time : 9:45
Biography:
Jamal Jomah, MD graduated with Honors from King Faisal University, Saudi Arabia. He pursued specialty training in Canada where he completed his residencyrntraining in plastic surgery and sub-specialized in cosmetic surgery, craniofacial rehabilitation and medical education. He is certified by the Royal College ofrnSurgeons of Canada and the Canadian Medical Council. He also obtained an honorary fellowship from the Royal College of Surgeons of Edinburgh. In addition, hernis a diplomat of the American Board in Hair Restoration Surgery and a Board Examiner. He is also a fellow of the American College of Surgeons. He holds the titlernof Consultant Plastic Surgeon in Dubai and also has been newly elected as the General Secretary of the Emirates Plastic Surgery Society.
Abstract:
Three D surface technology is used to demonstrate to the patients the expected changes possible with a particular procedure.rnThis technology has allowed the patient and surgeon to both see the expected result at the same time on the same screen.rnThis will help the surgeon identify the patient’s expectations and be cautious about patients who have unrealistic expectations.rnThe Surgeon can also define the steps of surgery and plan it more accurately. The goal is to improve the patient’s satisfaction withrnthis technology and minimize the revision.The aim of this paper is to describe the author’s experience with 3DSI and 3DSM.rnMethod: The 3D images are normally taken with digital camera with adequate lightning and then stored in a computer andrnimages then manipulated using Software. The image can be captured with a camera or the surface can be scanned with a scannerrnbut the latter would require the subject to be motionless for a longer time. The author used the Vectra H1 camera for the facernand the Vectra XT for the body with the mirror image software for manipulation. A single camera is usually adequate (H1) butrnthe 3D camera system (Vectra XT) is more precise and will acquire better and larger images. Once the images are taken, theyrnare transferred to a computer where software stitches the images together. The problems of this system are the cost, limitedrnavailability and resolving the shiny of transparent areas and imaging hair. With the expansion of 3D printing, the cost hasrnsubstantially decreased and becoming more readily available for personal or central use. This is going to be helpful for patients’rneducation and archiving of pre-operative and post-operative results.The main limitation of the process is the cost associated withrnthe products and with the images capturing.rnResults & Discussions: Currently, 2D photography is used to document, analyze and plan surgical procedures in Plastic Surgery.rnThis tool does not represent 3 dimensional figures accurately. It lacks shaped and topographic depth. 3 D imaging measuresrnXY and its coordinates and uses a triangulation concept. It is better than MRI and CT Scans which do not reflect the surfacesrnand surface topography and also it is less expensive and less invasive to the patient. It overlays multiple images from differentrnplanes, over the same object to create a 3D image. The use of Magnetic Resonance Imaging (MRI) is more accurate and morernscientifically helpful in exact measurements however it uses screening tool that is not practical especially in cosmetic practicernas MRI scans are costly and are not readily accepted by the patients. Therefore, its uses are still not foreseen in the near future.rnConclusion: Three-Dimensional Surface Modeling (3DSM) is a useful tool in: 1. For the surgeon to understand the exactrnconcerns of the patients and to have more precise planning of the procedure. 2. For the patients to see the expected changes. 3.rnIt is important to emphasize that this is only digital morphing which may not reflect the actual outcome.
Keynote Forum
Sahar Ghannam
International Society of Dermatologic Surgery, Canada
Keynote: Long lasting fillers
Time : 9:45
Biography:
Sahar Ghannam was graduated in 1983 from Alexandria University Egypt with a Master Degree of Dermatology, Venereology & Andrology in 1986. She receivedrna 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 successfullyrnachieve Doctorate Degree of Dermatology Venereology & Andrology. During that time she upscaled in the University positions from a teacher assistant until AssociaternProfessor in Alexandria University. Since that time, she has been interested in aging and anti-aging procedures. She is a Board Member of the International Societyrnof Dermatologic Surgery (ISDS) and the Executive Director of the International Peeling Society (IPS). She is the co-author of the Chemical Peel chapter in thern3rd 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 ofrnDermatology and the Journal of Clinical and Aesthetic Dermatology. She travels a lot lecturing and teaching but also learning.
Abstract:
The field of facial aesthetic surgery is experiencing explosive growth in non invasive and minimally invasive procedures.rnBiosynthetic fillers such as Ca hydroxy apatite, Polycaprolactone and poly L Lactic acid are biodegradable fillers andrnconsidered to be long lasting fillers. Poly L lactic acid was the first one to be used in aesthetic surgery it is a polymer that providesrnsoft tissues augmentation through stimulation of an inflammatory tissue response with subsequent collagen deposition. Carnhydroxy apatite and Polycaprolactone each consists of a gel carrier and the Ca hydroxy apatite spheres and Polycaprolactonernspheres respectively , that once injected in the subcutaneous space, the gel is slowly absorbed, what remains is a matrix ofrnmaterial which will take the characteristics of the cell that repopulate. When injected into the tissues space, fibroblast producesrncollagen. The author’s clinical experience with these three long lasting fillers will be presented.
- Facial Rejuvenation
Non-Surgical Aesthetic Procedures
Oral-Maxillofacial Surgery and Cosmetic Dentistry
Plastic Surgery
Rhinoplasty and Otoplasty
Location: Trillium A
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.
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.
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.
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.