ASSOCIATION OF PLASTIC SURGEONS OF INDIA – U.P.CHAPTER
MAY, 2005 VOL 2/05
FACIAL NERVE PALSY ipsilateral unilateral sub-total paralysis. The
characteristic appearance comprises of:
i. Absent forehead wrinkles on the paralyzed side
he seventh cranial nerve or the Facial nerve is
predominantly a motor nerve with sensory taste and excessive wrinkling on the unanalyzed side
fibers from anterior 2/3 of tongue and secreto ii. Drooping of paralyzed eyebrow and excessive
motor fibers to lachrymal and salivary glands. The lifting of unanalyzed eyebrow
nerve innervates the muscles of facial expression. iii. Wide palpebral fissure on paralyzed side
These muscles are in two groups superficial and deep unaffected by facial expressions
and are derived from the 2nd. branchial arch. The iv. Lagophthalmos on paralyzed side – LPS
superficial group comprises of Frontalis, Orbicularis unopposed by paralyzed orbicularis occuli
occuli, Quadratus labii superioris, Zygomaticus major v. Paralyzed lower lid falls away from the globe as
& minor, Quadratus labii inferioris and Orbicularis Orbicularis occuli is paralyzed and a central ear
oris. The deep group has two muscles – Corrugator and lake is formed with epiphora
Buccinator. These muscles of facial expression are vi. Paralytic ectropion results in turning out of the
unique because they move the soft tissue of the face inferior punctum and its stenosis by exposure –
rather than acting to move the underlying bones. epiphora
Aetiology and Site of Lesion: vii. Exposure Keratitis – further lachrymal secretion –
Congenital – Isolated nuclear paralysis or associated further adds to epiphora
with other Cranial nerve palsies e.g. Mobius Syndrome viii. Attempt to close the eye is often incomplete and
Acquired – These are best described as we trace the the eyeball rolls up with a lot of sclaral show –
course of the nerve. They can be Supranuclear, Nuclear Bell’s Sign
and Infranuclear. ix. Paralyzed cheek sags and nasolabial fold gets
1. Beyond the Stylo-mastoid foramen – Parotid erased
cancer, Parotid surgery, Facial laceration x. Plosives are grabled in speech as air pressure is
2. At the Stylo-mastoid foramen – Bell’s Palsy lost because of blowing out of the paralyzed side -
3. Intra-temporal bony canal – Middle ear tumours, buccinator paralysis
inflammations and middle ear surgeries xi. Non paralyzed cheek is hyperactive – an
Proximal to Chorda Tympani Nerve– Taste from objectionable grimace results
anterior 2/3 of tongue absent xii. The nose and philtrum are deviated to the
Proximal to Stapedial Nerve – Hyperaccusis nonparalyzed side
Proximal to Genicular ganglion – Secretomotor xiii. The lip angle sags on the affected side and is
fibers to tear glands –ve hyperactive on the non paralyzed side
4. At internal auditory meatus – VIII nerve is also xiv. Drooling of liquids from the paralyzed angle of
involved – Acoustic Neuroma or Surgery mouth
5. Cerebello-pontine angle - Tumours Treatment: A majority of Bell’s Palsy recovers
6. Nuclear – In the Pons -Stroke, Infantile nuclear spontaneously and requires no surgery. Trypsin
paralysis – VI nerve is also involved Chymotyrpsin (Chymoral Forte) and steroids may be
7. Supranuclear – In the cerebrum - Stroke, helpful along with some facial muscle stimulation by
Meningitis, - only lower face is involved. Electrical stimulus and by massage to prevent wasting
protection of the cornea by Leucoplast eyelid supports.
Eyes need to be protected from exposure keratitis.
Clinical Picture: The infranuclear paralysis of the VII Surgical decompression of the facial canal may also be
nerve is the most common one and it presents as an tried.
Surgical treatment can be categorized into Nerve nuclear and supranuclear palsy however remains
surgeries and Reconstructive procedures. treatment of the aetiology if that is possible.
Nerve Surgeries: Repair of any part of the facial nerve,
severed during facial trauma or parotid surgery should
be done immediately foe best results. Replacement of a
segment of Facial nerve sacrificed during oncological
resection should be ideally done in the same sitting
using Sural nerve graft by microneural anastomosis.
When proximal nerve end is unavailable and peripheral
nerve branches are present nerve cross grafting using
Hypoglossal, Spinal Accessory or Phrenic nerve are ABOUT MAYO CLINIC
tried. The procedures are less desirable because of the
mass movement produced and donor nerve morbidity
that is encountered. This can be eliminated by cross Around the turn of the century, Dr. Charlie and Dr.
facial nerve grafts using Facial nerve twigs of the Will Mayo organized medical professionals in a new
normal opposite side. Nerve surgery is usually way to better care for patients. They created a system
unsuccessful if more than a year has elapsed after the that allowed doctors to take the time to thoroughly
onset of paralysis. investigate patient problems and to quickly and easily
Reconstructive Procedures: There is no one single get help from other specialists. The system was built on
surgery that can correct all the elements of Facial nerve the idea that two heads are better than one and five are
palsy. Forehead, eyebrows, eyelids, eyes, cheeks and even better. It also encouraged a continual search for
lips of both the affected and the normal side need our better ways of diagnosis and treatment. Patients
attention. The procedures that are practiced may be flocked to the Mayos because of their ability to find
divied into 4 categories: answers to their problems. Doctors, too, came to
Static observe and learn at "the Mayo's clinic."
1.Insertion suspension – Fascia lata, tendons or
alloplastic material used to suspend eyelids, cheeks, Mayo Clinic is a charitable, not-for-profit organization
lips from fixed points like orbital rim, zygomatic arch based in Rochester, Minnesota. Its mission is to
or temporalis fascia provide the best care to every patient every day
2. Intrinsic suspension – Use of local tissue like in through integrated clinical practice, education and
Medial and lateral canthoplasty (tarsorraphy) research. A 31-member Board of Trustees composed of
3. Excision suspension – Excision of local tissue – public members and Mayo physicians and
supra-orbital excision to raise eyebrows, face-lift or administrators governs it. Mayo's principal entities
nasolabial fold excision to suspend lips. include: Mayo Clinic, Rochester, Minnesota, a 1,626-
Dynamic physician group practice, Mayo Clinic, Jacksonville,
1.On the paralyzed side Florida, a 325-physician group practice, and Mayo
(i) Muscle transfer – Temporalis, Masseter, Digastric Clinic, Scottsdale, Arizona, a 332-physician group
anterior belly to move lips, eyelids, cheeks practice. Besides this there are Saint Mary’s Hospital,
(ii) Muscle division – Transection of LPS to reduce Rochester, Minnesota, St. Luke's Hospital,
lagophthalmos Jacksonville, Florida, Mayo Clinic Hospital, Phoenix,
(iii) Muscle transplant – Gracilis Muscle Arizona, Charter House, Rochester, Minnesota and
Neurovascular anastomosis to cross facial nerve graft the Mayo Health System, a network of clinics and
(iv) Nerve transfer – Cross facial nerve graft directly hospitals in 64 communities in southern Minnesota,
neurotizing paralyzed muscles northern Iowa, and western Wisconsin.
2. On the normal side
(i) Muscle transplant – Previously denervated There are over 2,700 staff physicians and medical
autogenous muscle graft with muscle belly on normal scientists, around 520 clinical and research associates
side for neurotization and tendons arranged on and fellows, 1,875 residents and students and over
paralyzed side to move forehead, eyelids, cheek and 37,000 administrative and allied health staff working
lips tirelessly to attend a deluge of patients who come to
(ii) Muscle excision – Excision of blocks of facial these premises seeking cure. In the year 2003 the clinic
muscles around the lips to reduce grimacing had 511,000 unique patients, 2,253,513 total outpatient
(iii) Nerve division – Transection of VII nerve visits, 127,300 hospital admissions and 595,300
branches to muscles of forehead and lips to reduce hospital days of patient care.
(iv) Nerve paralysis – Bortulinum toxin or Botox Biomedical research at Mayo Clinic includes strong
– Transient palsy, to be repeated after 6 months. programmes in basic and clinical research. Most Mayo
3.Dissimulative: Surgical creation of wrinkles in medical staff participate in some research activity.
forehead and naso-labial folds With 2,516 research personals and a research grant of
4.Mechanical: Gold weights over upper eyelids 351 million dollars in 2003 there is an ongoing
As is apparent by the plethora of surgical options no research programmes to improve patient care and to
one procedure can deliver all the goods and so usually benefit society.
a combination of options are chosen. Treatment of
Medical education is yet another front in which Mayo If a child had a horrible facial injury or was burned by
Clinic has always been in the forefront. The oldest of thermal or chemical agents or had a facial tumour
Mayo's five schools, the Mayo School of Graduate removed, the distortion and the calamity of such an
Medical Education has trained more than 16,000 occurrence, whether it's from trauma, a burn or a
alumni in virtually all medical specialties since 1915. tumor, are inordinate. One just can't measure it. Dr.
Mayo Graduate School has granted about 425 graduate Levin’s passion is to have this type of technology offer
degrees in seven specialties since 1917. Mayo Medical a solution to such patients.
School has trained and graduated more than 1,000
students since 1972. Established in 1973, Mayo School The technical side of the equation is complete and a
of Health Sciences enrolls approximately 816 students face transplant could be done at Duke right now, but it
each year in 32 allied health science programs. Mayo will still be some time before this sort of surgery is
School of Continuing Medical Education formally performed on a human. The issues are: what immune
became a school in 1996. It offers approximately 275 suppression protocol is the patient going to be on; what
courses and 6,500 hours of continuing medical are the ethical issues; and what are the long-term issues
education each year. for the patient. The surgery has successfully been
performed on rats at The Cleveland Clinic. The surgery
Mayo provides the best care to every patient every day is obviously not for everyone, and so, if the technique
through integrated clinical practice, education and is approved, there will be a seriously scrutinized
research. The needs of the patient come first. Mayo patient selection process.
specializes in virtually everything. Mayo's strength is VOICE LIFT
its comprehensiveness, its ability to provide "one-stop
shopping" for the diagnosis and treatment of virtually
any medical problem. Mayo's expertise includes more The latest luxury for aging baby boomers looking for
than 100 medical and surgical specialties and the fountain of youth is the so-called "voice-lift,"
subspecialties. designed to make patients' voices sound more youthful.
In the past, doctors have mostly performed vocal chord
In 1919, the Mayo brothers dissolved their partnership surgery on people with voice-robbing diseases or
and turned over the clinic's name and assets, including injury. Now cosmetic surgery for the voice — the
the bulk of their life savings, to a private, not-for- voice lift — is becoming more widely known among
profit, charitable foundation. They dictated that any an aging population, dismayed to notice hoarseness
earnings from the practice, beyond those needed to that makes them sound older creeping into their voices.
operate and perpetuate the clinic, should be used for Professionals who use their voices — including
medical education and research. Such has been the case performers, lawyers and telephone operators — are
ever since. All Mayo staff members, including doctors, seeking out the procedure, hoping to shave years off
are paid a salary and there is no profit-sharing. The last the sound of their voice.
family member on the medical staff was Charles W.
Mayo, Dr. Charlie's son, who retired in 1963. Robert There are two general kinds of voice lifts: In some
Walters, a great-grandson of Dr. Will Mayo, is an cases, implants inserted through an incision in the neck
administrator at Mayo Clinic Jacksonville. bring the vocal cords closer together. Doctors also use
injections of fat, collagen or other substances to plump
up the cords and make them more limber, so that the
voice sounds younger.
FACE TRANSPLANTATION But doctors are warning against doing cosmetic
surgery on normal, but aging, vocal cords. There are
risks to the procedures. Dr. Steven Zeitels, an associate
It sounds like science fiction, but it could change the professor at Harvard Medical School and a
face of plastic surgery, literally. Dr. Scott Levin, a laryngologist at the Massachusetts Eye and Ear
Duke University Plastic Surgeon, is helping to advance Infirmary in Boston is of the opinion in an attempt to
research for a revolutionary surgical procedure that actually bring the vocal folds together they may
could offer hope to victims of catastrophic injuries like become over-closed and then the voice can get worse.
burns or gunshot wounds. He is helping researchers at
The Cleveland Clinic study techniques referred to as To produce sound, the vocal cords must meet each
‘face transplantation’. The procedure is a composite other at a rate of between 120 and 220 times a minute,
tissue allo-transplantation and it means it is possible to and that high level of usage takes its toll. Unlike skin,
transplant the face of a donor to the skull of a recipient. the surfaces of vocal cords don’t sag as we age — they
Patients, however, would not look exactly like the get stiffer, which makes them more difficult for them
donor. The brain activates muscles of facial expression to vibrate. Over time, from the use of the voice, they
and the bone structure that is the platform. It's the actually decrease in pliability. Singing, smoking and
facial skeleton, in many ways, that dictates appearance. just day-to-day speaking can make vocal cords less
But is the public ready for that? limber and speech less recognizable. Vocal Changes
are a Red Flag and shouldn't be ignored or written off
as just "old age." Vocal changes can be the first signs of the meeting, and is presented to the health ministry
of polyps, a paralyzed voice chord, or even cancer and plastic surgery society of each member country.
larynx. So watch out!
In this last decade of high tech and the advent of more
sophisticated equipment, our responsibility as surgeons
to evaluate the safety of these new technologies
EQUAM becomes increasingly important. The interaction
between clinicians, scientists and manufacturers prior
to and during the implementation of new technologies
Moris Topaz, MD, Secretary-General, EQUAM – is essential in order to ensure the safe application of
Personal communication with the editor these technologies in clinical use. It is imperative that
EQUAM continue its vigilance and scientific
evaluation of both old and new technologies, devices
The introduction of new technologies to medicine is
and surgical procedures, for the assurance of safety and
essential for its progress, yet imposes unforeseen risks.
enhancement of patient education. EQUAM thus
Past experience with the ultrasonic- assisted
serves to reassure patients, physicians, medical bodies
liposuction (UAL) technique, Trilucent (soybean oil-
and the general public of the commitment to safety and
filled) breast implants, and the silicone gel-filled breast
high standards on the part of the plastic surgery
implant crisis in the U.S.A., have pointed to a need for
basic scientific data supporting their biosafety. There
are new devices constantly being introduced into the
market, some of which apply advanced technologies.
European And International Committee For Quality NEWS
Assurance of Medical Technologies And Devices In
Plastic Surgery (EQUAM) www.ibir.org/equam is an
association with a mission to evaluate the safe use of
medical devices, technologies and procedures in plastic ISCLP&CA 4th.ANNUAL CONGRESS
surgery, and the guarantee of safety and well being of
EQUAM was founded by a group of plastic surgeons The 3rd. Annual Meeting of Indian Society of Cleft Lip
headed by Drs. Marita Eisenmann-Klein of Germany Palate & Cranio-Facial Anomalies was held IN THE
and Jean-Philippe Nicolai of the Netherlands, and now Nizam Institute of Medical Sciences, Hyderabad from
comprises over 40 European, Central and South January 12 to 16, 2005. The highlight of this
American, African, Southeast Asian and Middle- Conference was
Eastern countries. Representatives participating at
meetings are plastic surgeons, scientists, manufacturers NABICON 2005
and representatives from governmental bodies involved
in the development and surveillance of advanced
technologies, devices and techniques in the field of The International Society of Aesthetic Plastic Surgery
plastic surgery. held an instructional course in ‘Technologies in
The previous Consensus Conferences, which are held JOINT CONFERENCE OF PAPS and PSSH
once in two years, have focoused on the
recommendation by the British Medical Devices
Agency (MDA) for the recall of the TrilucentTM The 10th. Annual Conference of the Pakistan
breast implant, and on the European Parliament’s Association of Plastic Surgeons and that of Pakistan
assessment of the continuing use of the silicone gel- Society of Surgery of the Hand was held jointly in the
filled breast implant and their demand to ban its use. beautiful city of Rawalpindi from February 5 to 8,
Other key topics discussed were the growing 2005. The conference started with State of the Art
experience with the use of Botulinum toxin in aesthetic Lectures by Mr. Brian Sommerland, and Mr. Michael
surgery, the implementation of an international breast J. Early from U.K. and Prof. Grace Warren from
implant registry (IBIR), the use of silicone gel-filled Australia. Mr. Sommerland talked about the evoluation
breast implants, and last updates regarding safety of his technique of Cleft Palate Surgery and Mr. Early
issues of ultrasound-assisted lipoplasty (UAL). Various dwelled on the role of Cranio-facial surgery in
resorbable and non-resorbable injectable materials for congenital anomalies, trauma and Head & Neck
soft tissue augmentation are available at present. tumour management. Prof. Grace Warren had a video
Substantial biochemical and biophysical differences presentation on intrinsic replacement using Paul
exist. Not all of the non-resorbable materials have Brand’s many tail sublimis transfer. This was followed
withstood the test of time, and some should still be by a very interactive operative session in which Mr.
considered experimental. Sommerland operated a Cleft Palate, Mr. Early
At the close of EQUAM meetings, a Consensus operated on an unilateral Tessier IV cleft using
Declaration is drawn up summarizing the conclusions calvarial bone grafts to form the missing orbital floor
and correct the malar hypoplasia and Prof. Tehseen A.
Cheema demonstrate a classical Buck Gramco results while deliberating on the finer details of hair
pollicisation of index finger. transplant surgery. The International Laser Hair
A very lively Head & Neck symposium was the Transplant Surgery Centre is a professionally managed
highlight of this conference. Dr. Tahir Ahmed, a center with overseas affiliation and branches in Lahore,
surgical oncologist from C.M.H. Rawalpindi Islamabad and Karachi and a very informative website
deliberated on the approaches and extent of surgical www.ilht.com/pk. A few papers on Rhinoplasty and
resection and Dr. S. Bhattacharya of Lucknow talked Non-surgical facial rejuvenation using Botox were also
about recent modifications in soft tissue reconstruction presented.
and discussed at length about the reconstruction of the
symphyseal segment of mandible. Dr. Tariq Nadeem The last day of the conference was dedicated to Hand.
Ansari, oncologist of C.M.H. Rawalpindi discussed the A symposium on Hand trauma with panelists Prof.
role of adjuvant therapy in Head & Neck Cancers. Dr. Tahseen A.Cheema, Mr. Michael J.Early and Dr. S.
Mamoon Rashid from the host unit showed some Bhattacharya discussed a few problem cases with the
outstanding reconstructive options using microvascular audience. Dr. Haluk Duman looked after the problem
technique. Dr. Shahab Ghani of Karachi then presented of soft tissue coverage; Dr. Shahab Ghani discussed the
50 free flaps used in Head & Neck cancer surgery. This fingertip injuries, Dr. Mabroor Bhatti of Karachi
was followed by an interactive session in which the deliberated on tendon injuries and Dr. Mamoon Rashid
host unit presented a few problem Head & Neck cancer from the host Unit talked about replantations. Dr.
cases and both the audience and the panelists Bhattacharya presented an overview of the injured
deliberated on them. hand and Dr. M. Amin Cheema presented his
experience of thumb restoration. Dr. Aun Mohammed
Chaired by Prof. Abdul Hameed, President of P.A.P.S. and Dr. Sohail Hafeez of the host unit presented some
the next session on Trunk and Perineum had Dr. Haluk excellent free papers on limb salvage surgery in
Duman from Turkey deliberating on immediate and Ewing’s Sarcoma. Prof. Grace Warren’s lecture on
delayed breast reconstruction using TRAM flap, Dr. ‘Severe motor deficits in forearm – have we exhausted
Obaidullah of Peshawar sharing his enormous all options for tendon transfer?’ was most informative
experience of Hypospedias surgery, Dr. Sultan an eye opener.
Muzaffar discussing correction of congenital chest wall
defects and Dr. S. Bhattacharya of Lucknow The Pakistan Association of Plastic Surgeons is a small
demonstrating a wide range of reconstructions society, much like we were 15 years ago. Everyone
performed in the perineal region. There were quite a knows each other by his / her first name and the
few brief communications. atmosphere is very homely. Academics are of the
Mr. Earley’s academic lecture on Nasal Reconstruction highest quality and professionalism, particularly
and Prof Grace Warren’s lecture on Temporalis amongst the younger surgeons is worth emulating. Col.
transfer for Facial palsy were highly appreciated. Mr. Mamoon Rashid and his team had organized a hugely
John P. Gowar of the U.K. delivered an outstanding successful conference in C.M.H. Rawalpindi, which
presentation on ‘The vicissitudes faced by the the delegates will remember for a very long time.
Birmingham Burns Unit over two decades’ and it left
everybody with a lot of food for thought.
Other interesting papers which caught ones UP-APSICON2005
imagination were Dr. A.H.Babar’s effort of controlled
tissue expansion in post burn scars, Dr. Saad ur The Annual Conference of the U.P. Chapter of
Rehman’s work on mandibular distraction, Dr. Association of Plastic Surgeons of India was held at
Mughese Amin’s paper on ‘Honour Amputation of Pushpanjali Hospital in ancient Mogul city of Agra on
Nose’ Dr. Md. Zia ul Islam’s work on healing wounds March 5 and 6, 2005. The Conference comprised of
using the modified and much economical VAC system two workshops – one on aesthetic facial surgery and
and Dr. Tehseen A. Cheema’s experience with Sural one on Hypospadias. Inaugurating the conference, Prof
flaps. Rajive Ahuja, the President of APSI, praised the efforts
The highlight of the Cleft session was a very and ongoing activities of the Chapter, which makes it
informative lecture by Mr. Sommerland ‘Cleft Palate the most vibrant Chapter of our Association.
closure and Maxillary Growth, does it always have to The first day was dedicated to Aesthetic facial surgery
be a compromise?’ Units from Peshawar, Karachi and with Dr, Kulwant Bhangoo from the U.S.A. as the
Faislabad presented some very good work on Cleft Lip guest operator. He performed a traditional Face-lift
and Palate surgery. Dr. Ashraf Ganatra lamented on the with Blepharoplasty in a 45 years old lady, a Septo-
quality of surgery conducted in some Cleft camps by rhinoplasty in a patient with bulbous nasal tip with
foreign surgeons and showed how he has countered deviated nasal dorsum and septum and a bilateral upper
this menace by conducting better camps under the and lower lid Blepharoplasty in a patient with baggy
banner of P.A.P.S. with better follow up treatment. eyelids. There was a very lively discussion between the
operator and the audience, who watched every step on
Mostly surgeons performing hair restoration in Lahore, a giant screen in the comfort of the conference room.
Islamabad, Karachi and Multan occupied the cosmetic The second day was for Hypospadias surgery and Prof.
section. Dr. Humayun Mohammud, Dr. Sajjad Khan, H.S. Asopa of Agra single handedly carried the day.
Dr. A. Taroor and Dr. M. Amin showed some excellent The viewers were first given an idea about the
evolution of Hypospadias surgery in the last 5 decades Don't like that sticky-out belly button?
in a brilliant presentation and later 7 cases were Umbilicoplasty turns that "outy" inwards.
operated to demonstrate a different technique each time Men can have their "man breasts" reduced -
for a different problem. Thus he started with MAGPI and those who dream of a gym-fit body can
operation for glanular and coronal Hypospadias, and opt for silicone pectoral implants.
the continued with Snodgrass operation for distal Stiletto-wearers can have their feet padded
penile Hypospadias with wide urethral plate and and toes shortened to make those Manolos
Snodgrass with buccal mucosa flap for distal penile more comfortable.
Hypospadias with narrow urethral plate. Later he For improvements of a particularly intimate
showed an urethroplasty with a prepucial patch in a nature, surgery can offer practically any kind
mid penile Hypospadias with minimal chordae and of increase or decrease in size or alteration to
another urethroplasty with a prepucial tube in yet shape.
another patient in whom the continuity of urethral plate
could not be maintained during chordae correction.
One part of the body where cosmetic surgery is still in
Lastly in a Hypospadias cripple with multiple fistulae
its infancy is the feet, but not for long perhaps. Dr
and remnant chordae and ventral curvature, after
Suzanne Levine has made a name for herself among
correction of the entire chordae when the penile shaft
the style conscious women of Manhattan, who turn to
could still not be straightened he demonstrated the
her when they can't fit into designer high heels. "It's up
dorsal plication technique, and resurfaced the ventral
to patients to be able to enjoy their lifestyle," says Dr
surface of the penis with prepucial shin flap for an
Levine, who performs a range of operations such as toe
urethroplasty at a later date. An Epispadias case was
shortening at her Institute Beauté clinic. So-called claw
also operated and the reconstruction of the urethra and
toes stick out beyond the big toe. They are
its ventral transposition was very beautifully
incompatible with pointy shoes and can be shortened
with bone removal. Other foot options include
The organizers had not only arranged an excellent
narrowing and collagen injections.
academic feast but also had the foresight of presenting
each of the delegates with three CDs of procedures
shown in this Workshop but performed earlier by the It has echoes of the ancient Chinese practice of foot
operators. Prof. Asopa also presented a coloured atlas binding, yet her patients are anything but enslaved.
of Hypospadias surgery to each of the delegates, which Many are "baby-boomer" career women in their 50s,
itself is a collector’s item. whose feet have weathered a lifetime of discomfort in
The Organizing Secretary, Prof. Rahul Sahai and his what the doctor calls "limousine shoes" - precipitously
team of Surgeons managed an outstanding academic high with virtually no structure.
event, which can challenge any National Conference.
The bar has been raised a few notches and the Dr Levine resets the bones in the foot, and, with lasers,
subsequent organizers will find it difficult to improve returns a healthy glow to the skin. Dr Magdi Greiss, a
upon his mark. leading foot surgeon in the UK, frowns on such
procedures. "A 16-year-old girl asked me to remove
the inherited bunions on her foot because her boyfriend
didn't like them," says Dr Greiss. "Do they hurt, I
ACROSS SEVEN asked. No, she replied. So I told her to get a new
boyfriend." Yet he concedes that cosmetic foot surgery
SEAS is creeping to these shores - already some clinics give
collagen injections in the feet for high-heel wearers.
"Removing a bunion is a serious piece of surgery that
involves slicing through the bone. There's a lot of pain.
FOOT FACELIFTS AND MUCH MUCH MORE So I say, if it's not painful to start with, don't create
No longer is plastic surgery limited to facelifts and
tummy tucks. Today's procedures can remodel those
with cash to burn from head to toe:
A BRA FOR LIFE
Breast implants now come coated in
biocompatible titanium - to reduce the risk of
Feminists may have told women to burn their bras 35
the body rejecting foreign matter. There's no
years ago, but a German-based plastic surgeon has
word on the risk of setting off airport metal
come up with another idea: Implanted push-ups made
detectors. from a material that's been mainly used in space
Surplus fat can be sucked from the upper arms shuttles so far.
and injected into thinning, aging hands. About three dozen women have so far undergone the
Gluteal implants fill out a flat rear - these are 90-minute procedure developed by Ziya Saylan, who
placed just above the sitting area so weight operates in the western German town of
isn't placed on them. Düsseldorf. He uses a mesh made from titanium that's
apparently not harmful to the body and has already The main objection to cosmetic surgery, voiced by
been used for hernia surgery. Brazilian animal welfare groups, is that it might be
Once implanted, the mesh supports the breast from used to conceal genetic defects. Suzanne Blum offers
below. Saylan says that the operation is an option for an example: “A dog may have surgery to correct
women of all breast sizes, although he's told reporters imperfect teeth or a tail. And then it might win a show.
that it works best for "women with small, sagging At that point, it commands huge stud fees—even
breasts." though it has a concealed genetic defect.” The most
While Saylan encourages his patients to keep wearing extreme cases of concealment have involved testicles.
bras for about six months after the operation, he Unscrupulous vets have been known to disguise the
promises them firm forms sans bra in the end. Not too fact that an animal has only one testicle by attaching a
firm, though, as he said in an interview with a beauty suitably shaped prosthesis.
magazine: "A bosom that's too firm can look artificial. Is canine cosmetic surgery illegal? Brazilian law does
We're going for a natural appearance. Nice breasts can not address the controversy directly. A statute of 1943
sag a little, as Leonardo da Vinci already discovered." bans the mutilation of animals, but there is no legal
Some of his colleagues caution that the implant makes consensus on whether cosmetic surgery should be
it impossible for women to check their breasts for classed as “mutilation”. Back at his Sao Paulo clinic Dr
tumors themselves. "There can be some problems with Brito is dismissive of calls for new legislation. “It’s
that," Saylan told DW-WORLD, but said that regular perfectly reasonable to use simple surgery to make a
mammograms or x-rays would still help to detect dog beautiful,” he says. “There’s nothing unethical
cancerous growths at an early stage. about that. “But I agree that vets should not conceal
Still, Saylan's unlikely to convince a huge amount of hereditary defects. It’s not fair on the dog, the judges or
women to abandon their bras. At a price tag of €7,000 the other competitors. “Here at my clinic I would never
($8,450), the operation costs about as much as 150 attach an artificial testicle.”
"bust-holders," as bras are known in German.
COSMETIC SURGERY GOES TO THE DOGS!
As with people, beauty is in the eye of the beholder in
the canine world. “Why shouldn’t a dog be beautiful?”
asks Dr Edgard Brito, who offers wrinkle-reduction, CONFERENCES IN 2005
eyebrow-correction and facelifts for canines. “Beauty
is desirable. We all like talking to someone who looks
good. It’s the same with dogs.”
On the wall is evidence of Dr Edgard’s success. He is April 4 – 9, 2005
pictured with a who’s-who of Brazilian models, actors The 62nd. ACPA Annual Meeting
and television presenters, all of whom have asked the Venue: Myrtle Beach, South Carolina, U.S.A.
Sao Paulo vet to beautify their favourite pooch. Tel: +919-933-9044
“He’s a miracle worker,” says Anita Alt, a dog breeder Fax: +911-933-9604
specialising in miniature schnauzers, visiting the clinic Email: firstname.lastname@example.org
with four-year-old Brutus. We imported Brutus to be a URL: www.acpa-cpf.org
show dog, but then one of his ears started drooping—
the kind of thing that would disqualify him.” April 13 – 15, 2005
Dr Edgard straightened the ear by injecting Restylane. The 48th. Annual Meeting of JSPRS – Japanese
“You only need one application. The ears will stand up Society of Plastic and Reconstructive Surgery
forever.” The ear treatment costs about £40. There is a Contact: Dr. Yoshiaki Osaka, MD. Professor, Showa
detailed price-list of other procedures including Botox University, Tokyo, JAPAN.
injections to correct facial wrinkling. Email: (703) 820-7400
Since undergoing surgery, Brutus has become one of Fax: (703) 931-4520
Brazil’s most successful competition dogs. “He’s been URL: email@example.com
a pan-American champion,” says Anita, “and he’s won
the best-in-show category a few times. But many June 10 & 11, 2005
Brazilian dog lovers believe it is unethical for a 3rd. Workshop on Rapid Free Flap Harvest and
surgically enhanced animal to win a top show. “You Transfer
really hope people won’t bring you dogs like that,” Host: Department of Plastic Surgery, Nizam Institute
says Suzanne Blum, who has been judging of Medical Sciences, Hyderabad, INDIA
competitions for more than a decade. It’s reasonable to Contact: Prof. Mukunda Reddy
use simple surgery to make a dog beautiful. There’s Tel: 098480-50093, 098480-98804
nothing unethical about that “At a crowded show the Email: firstname.lastname@example.org
judges get only three minutes with each animal. email@example.com
“That’s not long enough to tell whether a dog has had
June 16 –18, 2005
ISAPS Nordic Light Course
Venue: The Grand Hotel, Stockholm, SWEDEN
September 25 - 29, 2005
10th. International Congress on Cleft Palate and
Related Craniofacial Anomalies ICC
Venue: Durban, SOUTH AFRICA
Contact: Inter Action Conferencing, University of
Natal, Graduate School of Business Building, Francois
Road, Durban 4041, South Africa.
August 30, 2005 – September 3, 2005.
10th. Congress ESPRAS 2005
European Society of Plastic, Reconstructive and
Aesthetic Surgery, European section of IPRAS
Venue: Medical University of Vienna, Vienna General
Hospital, A-1090 Vienna, Austria
Contact: Hedwig Schulz, Vienna Medical Academy,
Alser Strasse 4, A-1090 Vienna, AUSTRIA
Tel: +43-1-405 13 83-10
Fax: +43-1-407 82 74
November 6 - 10, 2005
Venue: India Habitat Centre, New Delhi, INDIA
Contact: Dr. Arun Goel, Department of Burns and
Plastic Surgery, Lok Nayak Hospital, Jawahar Lal
Nehru Marg, New Delhi 110 002, INDIA
Tel: +91-11-23231871, 22057186
Department of Plastic & Reconstr. Surgery
Institute of Medical Sciences, B.H.U.
Dr. Surajit Bhattacharya
Capital Diagnostics, Mini Plaza, M2 Gole Market
Mahanagar, LUCKNOW 226006, INDIA
Tel: 91 522 2384881 / +94150 81668
Fax: 91 522 2380550
URL: www up-apsi.com