Day 3 :
MEDART Clinics, Saudi Arabia
Time : 10:20-10:45
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.
Background: Aesthetic nasal dorsal reconstruction is associated with difficulty of long-term control of the graft contour andrnalignment. Fascia-wrapped cartilage has been shown to be histologically superior to Surgicel-wrapped cartilage. The aim ofrnthis study was to present a technique involving use of a diced-cartilage graft engulfed in a sleeve of pre-mastoid fascia forrnaesthetic nasal dorsal reconstruction.rnMethods: A retrospective review of 25 patients’ medical charts was performed from April 2014 to September 2015. All patientsrnhad undergone nasal dorsal reconstruction using a diced-cartilage graft for various aesthetic indications.rnResults: The reconstruction technique described herein resulted in good surgical outcomes in all patients. One case of infectionrnoccurred, but no patients developed resorption.rnConclusions: Use of diced cartilage with pre-mastoid fascia provides good clinical outcomes of dorsal nasal reconstruction,rnand avoids morbidity at other sites.
King Saud University, Saudi Arabia
Time : 10:10 -10:35
Sameer Bafaqeeh is Professor and Consultant at the Department of Otolaryngology, and Chairman of Facial Plastic Division. He is the Director of King Saud Facial Plastic Fellowship program & Chairman of Annual International Riyadh Rhinoplasty & Otoplasty Course, at King Saud University.
The ill-defined, droopy tip & high dorsum is one of the most frequent common nasal deformities among our patients which required a careful history and comprehensive nasal analysis to have successful intervention for correcting different degree of nasal ptosis. Considering the tripod theory principles & the assessment of both degree of tip rotation and projection were important in selecting the exact type of surgical techniques. In a retrospective study of 10-years droopy patients who underwent primary Rhinoplasty by one senior consultant (between 2005-2015), their pre & postoperative Photographs and operative records (when applicable) were reviewed to assess the degree of each droopy tip deformity & to evaluate the role of different selected techniques in corrected such deformity. The exact etiology & patient Specific nasal characteristics component found to be excellent gaudiness for selecting surgical techniques & modification to give predictable and reliable outcomes. The external Rhinoplasty approach was performed in all patients because the exposure permits alar cartilage modifications to be performed precisely under direct vision. Our goal in correcting the droopy nasal tip is to eliminate the forces that inferiorly displace the alar cartilages before adopting any alar cartilage modifying technique, and finally increase the tip support mechanisms. A multitude of surgical maneuvers are often necessary to address all the features of the droopy nose and to produce the desired aesthetic long term result. Strong nasal tip columellar strut is very important in all cases to increase the strength & stability of the alar cartilage complex, which essential to a have a good long term result & adjusting optimal nasal tip projection on the operating table.
- Facial Rejuvenation
Rhinoplasty and Otoplasty
Location: Trillium A
Dominik L. Feinendegen
Swiss Society for Aesthetic Surgery, Switzerland
International Society of Dermatologic Surgery, Canada
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.
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 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.
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.
Surrey Memorial Hospital, Canada
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.
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
Noordwest Ziekenhuisgroep, The Netherlands
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.
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.
Clinica Dra Barba Martinez, Spain
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.
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.
Allure Med Spa & Vardaan Hospital, India
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.
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.
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.
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.
Federal University of Ceara, Brazil
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).
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.