_News_ Letter 03 by niusheng11


									Bishara ATIYEH, MD, FACS, Editor, LSPRAS president - Sami SAAD, MD – Executive Editor, ISAPS National Secretary

Choose a surgeon
you can trust
Plastic surgery
involves many choices.
  The first
and most
important is
selecting a
surgeon you can
C     hoosing an LSPRAS Member Surgeon ensures that you have
      selected a physician who:
      • Has completed at least five years of surgical training with a
minimum of two years in plastic surgery.
• Is trained and experienced in all plastic surgery procedures,
including breast, body, face and reconstruction.
• Adheres to a strict code of ethics.
• Fulfills continuing medical education requirements, including
                                                                                            In this issue
                                                                                                                                                               Designed by Nahleh Group: 01 747 009/10

standards and innovations in patient safety.
                                                                                             Choose a surgeon you can trust................... 1
                                                                                             Reshaping Bodies ............................................ 3

L     SPRAS Member Surgeons are your partners in cosmetic and
      reconstructive plastic surgery.                                                        Body Contouring & Patient Selection........ 4-5
                                                                                             Sequence and combination........................... 6
                                                                                             LSPRAS Executive Committee & Members........ 7

  ‫اجلمعية اللبنانية جلراحة التجميل والرتميم هي املمثل الوحيد للإخت�ضا�ص يف لبنان. مهمة اجلمعية هو املحافظة على م�ضتوى الأع�ضاء‬
  ‫العلمي واملهني والأخلقي. جميع اأع�ضاء اجلمعية هم جمازون من قبل وزارة ال�ضحة العامة ونقابة الأطباء يف لبنان ملزاولة كافة الأعمال‬
                                                                              .‫الطبية واجلراجية املتعلقة بجراحة التجميل والرتميم‬
Vol. 1 No. 3 November 2009
                                                          RESHAPING BODIES

Body Contouring Surgery
after Obesity Surgery and
Massive Weight Loss
 T  he importance of an unsatisfactory body image in causing psychological distress
    in obese patients cannot be overstressed. This psychological distress encompass-
es lack of self-esteem, depression, and tendency to avoid social and sexual relation-
ships. Body contouring following a significant weight loss can re-establish a good
psychosocial functioning because of the perception of improved body image.

Obesity at a Glance                          Obesity Surgery                             and should only be performed by

                                                                                         highly experienced surgeons.
         besity means having excess          BARIATRIC SURGERY                           The decision to have a surgical procedure
         body fat. For adults 35 and                                                     is obviously important and you need to
older, having a Body Mass Index (BMI)        Gastric Band                                consider the available options very care-
greater than 30 is considered obese.         The laparoscopic adjustable gastric
                                             band (LAGB) is a highly effective           fully before you make any commitment
Obesity is not just a cosmetic consid-                                                   to go ahead.
eration. It is a chronic medical disease     and increasingly popular surgical
                                             treatment for weight problems.              Every person’s history is unique so
that can lead to diabetes, high blood                                                    it is not possible to be precise
pressure, heart disease, gallstones,         The Gastric Balloon                         regarding which procedure is most
and other chronic illnesses.                 It is a balloon that is inserted into the   suited to your needs until all factors
 Obesity is difficult to treat and has a     stomach and inflated, thus reducing         have been considered as well as a
high relapse rate. Greater than 95%          stomach capacity and the amount of          careful physical assessment.
of those who lose weight regain the          food a person can comfortably eat.
weight within five years.
Even though medications and diets            Gastric Bypass
can help, the treatment of obesity           Gastric bypass weight loss surgery
cannot be a short-term «fix» but             combines both restriction and
has to be a life-long commitment to          malabsorption to induce and
proper diet habits, increased physical       sustain long-term weight loss.
activity, and regular exercise.              Gastric bypass is a more involved
The goal of treatment should be to achieve   operation than gastric banding
and maintain a «healthier weight», not       and involves dividing both the
necessarily an ideal weight.                 stomach and the bowel.
Even a modest weight loss of 5% to 10%       Biliopancreatic
of initial weight and the long-term main-    Diversion/Duodenal
tenance of that weight loss can bring        Switch
significant health benefits by lowering      Biliopancreatic Diversion (BPD)
blood pressure and lowering the risks of     and Duodenal Switch (DS) – of-
diabetes and heart disease.                  ten just referred to as BPD/
Chances of long-term successful              DS – is the most effective surgi-
weight loss are enhanced if the doc-         cal intervention available for the
tor works with a team of profession-         treatment of obesity. It is also
als including dietitians, psychologists,     the most technically demanding
and exercise professionals.

 M       aintaining your ideal body
         weight is a balancing act be-
tween food consumption and calo-
ries needed by the body for energy.
                                                B     ariatric surgery is one of the fastest growing subspecialties in
                                                      medicine. However, a patient often loses so much weight that
                                               the damaged, stretched-out skin becomes loose and hangs off the
                                               body. This redundant skin poses many problems for the patient, includ-
You are what you eat. The kinds and            ing continued poor self-esteem, inability to fit into clothes, interference
amounts of food you eat affect your            with daily activities, and hygiene issues. Without surgical intervention,
ability to maintain your ideal weight          this skin will never «shrink into» the new body after obesity surgery.
and to lose weight.
Vol. 1 No. 3 November 2009
                Body Contouring & Patient Selection                                                                               Body Contouring & Patient Selection

The final act in restoring                                                                       years. In the years before gastric
                                                                                                                                                                                Patient selection
                                                                                                 reduction procedures, obese indi-

        body image after
                                                                                                 viduals have typically gained and
                                                                                                 lost weight numerous times in
                                                                                                 attempts to lose weight through                                                      P       roper patient selection
                                                                                                                                                                                              is critical for maximizing
                                                                                                                                                                                  the likelihood of a good outcome

substantial weight loss                                                                          dieting or behavioral modifica-
                                                                                                 tion. The prolonged period of skin
                                                                                                 under tension and the frequent
                                                                                                                                                                                   and minimizing complications
                                                                                                                                                                                   following a body lift. Patients
                                                                                                                                                                                    should be at a stable weight for

aesthetic                                                                                        history of «yo-yo» dieting lead
                                                                                                 to poor skin elasticity following
                                                                                                 massive weight loss.
                                                                                                                                                                                    several months and ideally at
                                                                                                                                                                                     their lowest weight following
                                                                                                                                                                                     gastric bypass surgery, this

reconstructive                                                                                    T   he ideal body contouring pro-
                                                                                                      cedure for the patient who has
                                                                                                 lost a massive amount of weight
                                                                                                                                                                                      may range from 1 to 2 years,
                                                                                                                                                                                      depending on prebariatric
                                                                                                                                                                                       weight. For example, follow-

                                                                                                 should effectively address all or                                                      ing gastric bypass, a 200-kg
                                                                                                 as much of the characteristic                                                          man will take longer to stabi-
                                                                                                 stigmata in a safe, efficient, and                                                   lize in weight than will an l00

                                                                                                 consistent manner. The goal of all     followed by Brachioplasty and            kg woman. Weight loss following
            ody Contouring is the name given to a range of surgical pro-                         of these procedures is to reverse or   Thigh Lift. The least common plas-     gastric bypass surgery and other
            cedures which are designed to remove those unwanted ar-                              derotate the inferomedial collapse     tic surgery procedure performed        restrictive and malabsorptive pro-
       eas of fat and unsightly folds of skin. The removal of these will                         of the skin and soft tissues of the    as a result of massive weight loss     cedures, such as biliopancreatic by-
                                                                                                 body.                                  is a facelift.                         pass, tends to be rapid during the
       improve the appearance of your body so that it appears as a ‘reg-                                                                  Circumferential procedures al-       first 8 to 12 postoperative months.
       ular’ shape.
                                                                                                 Body Contouring                          low for the appropriate amount       Weight loss following purely re-
                                                                                                                                                                               strictive bariatric procedures,
                                                                                                 Procedures:                            of tissue to be excised from the

                 E   xcess fat and skin can be
                     found on the stomach, thighs,
                buttocks, neck, face, upper arms,
                                                       along the upper and midback and
                                                       flank. The hip fat deposit produces
                                                       a roll just below the top of the iliac
                                                                                                  .  Abdominoplasty/Apronectomy
                                                                                                 (Tummy Tuck)
                                                                                                                                        areas being addressed. Attempts
                                                                                                                                        to manage the patient who has
                                                                                                                                                                               such as vertical-banded gastro-
                                                                                                                                                                               plasty and gastric banding, tends
                                                                                                                                                                               to be less and slower, with weight
                back etc. The breasts, abdomen,        crest in men and often onto the           . Circumferential Bodylift
                                                                                                                                        undergone bariatric surgery with
                                                                                                                                        abdominoplasty (tummy tuck) and        loss achieved over periods of as
                thighs, and buttocks are often the     proximal lateral thigh in women.          (Abdominoplasty + Backlift)                                                   long as 3 years. The disadvantage
                areas of greatest concern to pa-       The collapse of redundant tissues         . Mastopexy/Breastlift with or
                                                                                                                                        liposuction alone are likely to re-
                                                                                                                                        sult in an unsatisfactory outcome.     of performing body contouring
                tients following massive weight        from the lower abdomen, mons              without implants                                                              procedures on patients with on-
                loss. The typical appearance of        pubis, and buttocks as well as the        . Breast augmentation
                                                                                                                                        Likewise, extending an abdomi-
                                                                                                                                                                               going weight loss is the poten-
                the patient who has lost a massive     redundant tissues from the fat            . Gynecomastia/male breast redution
                                                                                                                                        noplasty to be circumferential
                                                                                                                                                                               tial for early recurrence of tis-
                amount of weight derives from a        deposits of the medial thigh itself       . Thigh lift
                                                                                                                                        without thigh and buttock eleva-
                                                                                                                                                                               sue laxity. We avoid performing
                combination of factors, including a    contribute directly to the excess         . Arm lift
                                                                                                                                        tion and lift usually produces less
                                                                                                                                                                               body lifts on individuals with a
                gender-dependent body morpho-          tissues along the medial thighs.          . Face lift
                                                                                                                                        than optimal results. Many plastic
                                                                                                                                                                               BMI of greater than 35 kg/m2.
                logy and a change in body mass in-     The descent of redundant tissues          . Blepharoplasty (upper and lower
                                                                                                                                        surgeons have been reluctant to
                                                                                                                                        apply skin-tightening procedures       Traction from the waistline in
                dex (EMI), which leads to skin and     from the fat deposits circumferen-        eyelid)                                                                       this population often has only
                soft tissue excess and poor skin       tially along the thighs in women          . Liposuction
                                                                                                                                        to deformities of the thigh and
                                                                                                                                        buttock region because of poor         a minimal effect on skin excess
                tone.                                  creates the potential for skin folds                                             scars, un-reliable scar location,      and cellulite along the lower

                 T   he body contour stigmata of
                     massive weight loss for men
                                                       throughout the thighs, resulting
                                                       in both a vertical and horizontal
                                                       tissue excess. Along with issues
                                                                                                  T   he most common postbariat-
                                                                                                      ric body contouring surgery is
                                                                                                 a tummy tuck or abdominoplasty.
                                                                                                                                        high complication rates, and the
                                                                                                                                        magnitude and difficulty of these
                                                                                                                                        procedures. Plastic surgeons are
                                                                                                                                                                               buttocks and distal thighs.
                                                                                                                                                                               This heavier group of patients
                                                                                                                                                                               who have undergone bariatric
                and women are the consequence          of skin and soft tissue excess, the       The majority of patients undergo       tackling postbariatric body con-       surgeries typically has a large
                of the skin and soft tissues failing   patient who has undergone bariat-         what’s called a circumferential ab-    touring with renewed enthusiasm        pannus present along the lower
                to retract com¬pletely following       ric surgery tends to have deficien-       dominoplasty. This technique in-       and interest. They are approach-       abdomen extending to the hips
                weight loss. The excess skin and       cies in skin tone. Obese individu-        volves removing excess skin from       ing the abdomen, thighs, and but-      and tapering over the buttocks.
                soft tissues descend inferomedial-     als usually have been overweight          around the entire waistline, hips,     tocks as a unit, realizing that each   Difficulty with activities, severe
                ly from the characteristic areas of    since childhood and nearly always         thighs and buttocks. The second        of these areas of the body had to      intertriginous dermatitis, and
                fat deposition. The fat deposits of    since adolescence. The average            most common procedure is Breast        be treated effectively to produce      back discomfort usually are their
                the axilla and flank produce rolls     age for bariatric procedures is 37        Lift or Breast Reduction surgery       the best overall outcome.              biggest complaints.

4                                                                   Vol. 1 No. 3 November 2009   Vol. 1 No. 3 November 2009
                                         Sequence and combinations                                                                                           LSPRAS Executive Committee & Members

Sequence and combinations                                                                                                          ATIYEH Bishara
                                                                                                                                                                FERRAN Fadi
                                                                                                                                                                Vice President
                                                                                                                                                                                         GHANIME Georges
                                                                                                                                                                                                                         ABDEL HAK Elie

                                               of procedures                                                                 KADDOURA Imad
                                                                                                                           ABDEL HAK Elie
                                                                                                                                                       HATEM May
                                                                                                                                                          EID Antoine
                                                                                                                                                                      SADER Nabih
                                                                                                                                                                      Past President
                                                                                                                                                                                         HOJEILY Souheil
                                                                                                                                                                                      HOJEIYLI Souheil
                                                                                                                                                                                                              SAAD Sami
                                                                                                                                                                                                              ISAPS National Representative
                                                                                                                                                                                                                   NASSER Ali
                                                                                                                                                          drantoineeid@hotmail.com                                 alinasser88@hotmail.com
                                                                                                                           C03-716706 O 03-607055         C03-379414 O 01-512228      C 03-893050O 01-447305       C03-202540 O 01-350842
 I ndividuals who have lost massive
   amounts of weight often are candi-
                                               have a significant effect on the upper
                                               body (i.e., breasts, flanks, and back).
                                                                                                                           ABDEL NOUR Edouard
                                                                                                                           C 03-240911 O 01-491331
                                                                                                                                                          El KHOURY Roger
                                                                                                                                                          C03-735344 O 01-894895
                                                                                                                                                                                      HOKAYEM Nabil
                                                                                                                                                                                                                   RISCALLA Paul
dates for, and are eager to have, mul-
tiple procedures.
                                               In men, it may eliminate the need for
                                               upper body-contouring surgery or re-
                                                                                                                                                                                      C 03-344040 O 01-615400      C 03-237112O 01-448651
                                                                                                                           ABI ABBOUD Antoine             FADLALLAH Amir              HUSSAMI Tarek                RUBEIZ Michael
 Initially, younger patients tend to pres-     duce the magnitude of the procedure                                         aatony73@hotmail.com           aafadlallah@gmail.com       thusami@dm.net.lb            trubeiz@hotmail.com
ent with more concerns about their tor-        required.                                                                   C 03-220506 O 03-522468        C03-754479 O 01-741954      C03-376176 O01-362777        C 03-776032O 01-341595
so and breasts, whereas older patients         In women, although the body lift can im-                                    ABI ABDALLAH Ibrahim
often have issue with their face and           pact the back and flanks positively, it also                                abibob@hotmail.com             FEGHALI Ziad                JIZ Fadi                     SAAB Gabriel
                                                                                                                                                          drfeghali@gmail.com         eljiz@hotmail.com            gabrielsaab@hotmail.com
arms. The medial thighs and flanks can         can cause significant downward migration of                                 C03-226989 O04-404407          C03-619321 O01-744122       C 03-618877 O 03-930467      C 03-384997O 09-216171
be of primary concern for both groups. Our     the inframammary fold. Following a body                                     ABI FADEL Makram
preference regarding the torso is to perform   lift, we commonly perform other body-                                       mraflb@yahoo.com               FERRAN Fady                 KADDOURA Imad                SAAD George
                                                                                                                                                          ferran1@inco.com.lb         imadkaddoura@hotmail.com     plastiesaad@hotmail.com
a body lift first, as a single procedure.      contouring procedures, including combi-                                     C03-502525 O01-611617          C03-252511O01-615300        C 03-414140O 01-351800       C03-387531 O 04-418629
The body lift may eliminate the need for       nation brachioplasty and mammoplasty.                                       ABI NAKHOUL Fadi
a formal medial thigh lift in many pa-         thighplasty alone, or thighplasty with                                      drfabinakhoul@hotmail.com      GHANIME Georges             KARAM Bassem                 SAAD Sami
                                                                                                                                                          nghanime@yahoo.com          bfkaram@hotmail.com          info@samisaadmd.com
tients, particularly those younger than        brachio¬plasty, and sometimes an up-                                        C03-216747 O 03-923273         C03-616216 O 04-411999      C 03-333534O 09-545250       C 03-382087 O 01-341080
35 years of age and who have had a BMI         per body tightening may be performed;                                       ABIAD Sawsan
change of less than 20 to 25 kgjm2 be-         in certain individuals we perform a com-                                    s.abiad@ymail.com              GHAYA Souheil               LAHOUD Pascal                SADER Nabih
                                                                                                                                                          sghaya@hotmail.com          drlahoud@yahoo.com           nsadermd@hotmail.com
fore the body lift. The body lift often can    bination of these procedures.                                               C 03-028761O 01-751757         C03-301413 O09-222328       C 03-718386O 09-944506       C03-617670 O 05-454528
                                                                                                                           ABOU MOUSSA Joseph                                         LAWAND Souheila              SAYEGH Boutros
                                                                                                                                                          HAMDAN Ashraf
                                                                                                                           ALI YOUSSEF ABED Ali           drahamdan@hotmail.com       souhailalawand@hotmail.com   docboutros@hotmail.com
                                                                                                                           dr_aliabedali@hotmail.com                                                               C 03-240630O 04-530917
                                                                                                                                                          C03-310800 O 01-751731      C 03-384889 O 01-333703
                                                                                                                           ATIYEH Bishara                 HARB Elie                   MAAMARI Ramzi                SHEHADI Imad
                                                                                                                           aata@terra.net.lb              elieharb@yahoo.com          ramzimaamari@hotmail.com     ieshehadi@gmail.com
                                                                                                                           C 03-340032 O01-746136         C03-275111 O 01-577277      C 03-714124O 01-337420       C 03-307854 O 01-746345
                                                                                                                           AUDI Paul                      HARRANE Nagib               MALAAB Nimr                  SHEHADI Ramzi
                                                                                                                           C 03-339094 O 01-616381
                                                                                                                                                          drharrane@yahoo.com         rosynemer@yahoo.com          C03-362211 O 01-746345
                                                                                                                                                          C03-854618                  C 03-732377 O 05-432422      SHEHADI Sameer
                                                                                                                           AYOUB Salim
                                                                                                                           dr_ayoub@hotmail.com           HASHIM Hussein              MASAAD Georges
                                                                                                                                                                                                                   C03-758326 O 01-746345
                                                                                                                           C 03-680896 O 05-957000        C03-610936 O 01-372593      C 03-740007O 03-740007       SLEILATI Fadi
                                                                                                                           CHAMI Nicolas
                                                                                                                           njchami@bluewin.ch             HATEM May                   MASSOUD Edmond
                                                                                                                                                                                                                   C 03-342636
                                                                                                                                                          mayhatem@cyberia.net.lb                                  SLEIMAN Ziad
                                                                                                                           CHARTOUNI Marc
                                                                                                                           marc.chartouni@gmail.com       C03-211669                  C 03-651651 O 01-640372      ziadsleiman@hotmail.com
                                                                                                                           C 03-270776 O 05-453500        HAYEK Naji                  MELKI Ibrahim
                                                                                                                                                                                                                   C 03-237722
                                                                                                                                                          nhayek@usa.net                                           SMEYRA Mireille
                                                                                                                           CHEHAB Nizar
                                                                                                                           drchehab@hotmail.com           C03-771719                  MOUFARREJ Richard
                                                                                                                           C03-674808 O 01-752575         HAYEK Shady                 C 03-327627                  TOHME Roland
                                                                                                                                                          shadyhayekdr@yahoo.com      NASR Marwan
                                                                                                                           DAOUD Robert                   C03-621179O 01-350000       mwnasr@hotmail.com           C 03-711236O 01-248750
                                                                                                                           C 03-252550 O 01-325241        HAYKAL Sleiman              C 03-545557 O 01-615300      ZAATARI Ahmad
                                                                                                                           DAOUD Youssef                                                                           Zaatari@hammoudhospital.com
                                                                                                                                                          shaykal62@hotmail.com       NASSAR Toni
                                                                                                                           C03-492665                     C03-773777 O 06-666119      tonynassar@tonynassar.com    C03-695757 O 07-732733
                                                                                                                           DARGHAM Imane                  HELOU Sami                  C 03-828229 O 01-803703
                                                                                                                           dargham@inco.com.lb            helsa@inco.com.lb           NASSIF Elie                   www.estheticlebanon.org
                                                                                                                           C 03-772081 O 08-825000        C03-696525 O 01-486120      mwnasr@hotmail.com               www.lspras.com
                                                                                                                                                                                      C03-328077 O 05-950223

6                                                                                             Vol. 1 No. 3 November 2009   Vol.1 No. 3 November 2009

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