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									            NEWSLETTER
                ASSOCIATION OF PLASTIC SURGEONS OF INDIA – U.P.CHAPTER
                JANUARY, 2005                                  VOL 1/05


EDITORIAL
                                                             of loss of normal support of developing teeth and
FIBROUS DYSPLASIA                                            endocrinal disturbances affecting the timing of eruption
                                                             of the teeth. Fibrous dysplasia in other regions present



F
                                                             with:
        ibrous dysplasia of the bone is a lesion of                Bowing and thickening of long bones, often
        unknown aetiology, uncertain pathology, diverse
                                                                       unilateral distribution
        histology, which although is not strictly a
                                                                   Aching and recurrent bone pains
neoplasm but behaves like one. It is a developmental
derangement of bones caused by an aberrant activity of             May involve pelvis, long bones, metacarpals,
bone forming mesenchymal tissue resulting in                           metatarsals
abnormal proliferation of undifferentiated                         Spontaneous fractures and resultant
mesenchymal bone forming cells. The bony lesion                        invalidism
exhibits general histologic features of fibrosis with              Skin lesions – café-au-lait spots
varying degree of simultaneous resorption and repair.        Radiological features: These are variable there being
Since the original term Fibrous dysplasia was                three basic patterns:
introduced by Liechtenstein in 1938, many attempts                1. small lesions with unilocular radiolucency, or
have been made to classify this disease. The disease is                somewhat larger lesions with multilocular
either Monostotic or Polyostotic. The latter is further                radiolucency, both with well circumscribed
classified into:                                                       borders and containing a network of fine bony
     1. Fibrous dysplasia involving variable number                    trabaculae
          of bones although most of the skeleton is               2. similar pattern except that increased
          normal and accompanied by pigmented                          trabaculations render the lesion more opaque,
          lesions or café-au-lait spots – Jaffe type                   and typically mottled in appearance
     2. A more severe disease involving nearly all he             3. more opaque with many delicate trabaculae
          bones of the skeleton, accompanied by                        giving it a ‗ground glass‘ appearance.
          pigmented skin lesions and endocrine               In all the types generally the cortical bone becomes
          disturbances of various types – Albright‘s         thinner because of expansile nature of the lesion, but
          syndrome                                           seldom is the bone plate perforated or the periosteal
Monostotic fibrous dysplasia is a totally different          proliferation obvious. In cranio-facial fibrous dysplasia
disease altogether and will not march on to become           there is a characteristic mottled or pagetoid thickening
polyostotic type. It also does not manifest extra-           and calcification of the base of skull.
skeletal lesions as seen in the polyostotic variety.         There are however advantages of using multiple
Polyostotic Fibrous Dysplasia                                imaging modalities in the evaluation of these disorders.
Clinical features: A third of all cases involve the          C.T. scan can show the diagnostic findings of Fibrous
cranio-facial skeleton The clinical features of cranio-      dysplasia and the extent of bony involvement, which is
facial fibrous dysplasia are facial asymmetry, diplopia,     extremely important in planning treatment in cranio-
proptosis, sinus infection, deafness, loss of vision, oro-   facial lesions in particular. MRI can show the extent
nasal obstruction, malocclusion, cranial nerve               and vascularity of the intra-diploeic fibrous mass, and
involvement, raised intra-cranial and intra-orbital          also best demonstrates the distortion of underlying
pressure. Oral manifestations are related to the severe      cerebral or orbital structures. Tc99 HM-PAO brain
disturbance in the bony tissue of the cranio-facial          scintigraphy is employed to demonstrate the adequacy
skeleton. The commonest lesions are in the mandible          of ipsilateral cerebral perfusion, thereby excluding any
and the peri-orbital bones. Expansion and deformity of       significant cerebral ‗steal‘.
the jaw, disturbed eruption pattern of teeth are because     Histological features: There is considerable variation
                                                             in the microscopic appearance. The lesion is essentially
a fibrous one, made up of proliferating fibroblasts in a                 Tipping or displacement of teeth due to
compact stroma of interlacing collagen fibers; irregular                  progressive expansile lesion
trabaculae of bone are scattered throughout the lesion                Tenderness is\a late feature
with no definite pattern or arrangement.                              Mucosa is almost invariably intact over the
Characteristically C shaped or Chinese characters                         lesion.
shaped trabaculae, which are usually coarse woven               Fibrous dysplasia of maxilla has marked predilection
bone, are seen instead of well-organized lamellar bone.         for children. It is impossible to eradicate without a
Large lesions may show histological variations from             radical surgery, which is mutilating. These are not well
area to area, sometimes presenting greater bony                 circumscribed and commonly extend locally to involve
reaction around the periphery than in the central core          maxillary sinus, zygomatic process orbital floor and
of the lesion.                                                  skull base resulting in severe malocclusion and marked
Treatment: Surgery has very little role in severe forms         facial asymmetry. They do not remain truly monostotic
of polyostotic fibrous dysplasia, as it tends to be a           and are best described as craniofacial fibrous dysplasia.
progressive disease. Surgery in cranio-facial fibrous           Mandibular lesions have been excised and replaced by
dysplasia is usually elective and involves contouring of        vascularized bone grafts.
facial bones. Excision and replacement with
recontoured bone, autogenous bone graft, autoclaved             Cherubism:
bone and implants- titanium, polyrane and methyl                Familial fibrous dysplasia of the jaw or disseminated
methacrylate have all been tried. Chen and Noordhoff            juvenile fibrous dysplasia is more commonly called
in 1970 surgical treatment should be based on zones of          Cherubism because of the typical chubby facial
involvement – total excision of dysplastic bones of             deformity with which these patients present. It is an
fronto-orbital, zygoma and upper maxillary regions and          autosomal dominant gene with variable expressivity.
primary bony reconstruction (Zone 1); conservative              Seen in early childhood 3-4 years, there is a
excision of hair bearing skull (Zone 2), central cranial        progressive painless, symmetric swelling of the jaws,
base (Zone 3), and tooth bearing bones (Zone 4). No             mandible or maxilla, producing a typical chubby face,
recurrence or invasion of fibrous dysplasia into grafted        suggestive of a cherub. Majority of cases involve only
bone is usually observed. Cosmetic recontouring, and            the mandible, which is firm to hard on palpation and
orthognathic surgery for malocclusion are also                  may be accompanied by regional lymphadenopathy.
reported. Rarely emergency surgery is required to               The deciduous dentition may spontaneously shed
prevent deterioration of vision or raised intra-cranial         prematurely, beginning as early as 3 years of age.
pressure. Thus orbital decompression, cranial                   Permanent dentition may often be defective – absence
decompression and oro-nasal decompression is at times           of numerous teeth, displacement and lack of eruption.
required in cranio-facial lesions.                              Oral mucosa is invariably intact and there are no
Radiotherapy has been tried with some success but the           associated systemic manifestations.
hazards of subsequent development of radiation-                 Although progressing rapidly during early childhood, it
induced sarcoma have been reported.                             tends to become static and may even show regression
Usually an uncomplicated fibrous dysplasia is                   as the patient approaches puberty. Surgical
compatible with life but deaths as a result of fibrous          recontouring of the jaw is sometimes advised and
dysplasia have also been reported. Malignant                    radiation therapy is definitely contraindicated.
transformation into osteogenic sarcoma has been
reported I both monostotic and polyostotic variety.

Monostotic Fibrous Dysplasia:
This is a less serious disease and usually involves the
cranio-facial skeleton. Nearly every bone in this region
                                                                VIEWS
can get involved individually but it is seen usually in
the jaw. They have to be differentiated from giant cell
lesions of the jaw namely ameloblastoma,
osteoclastoma, cherubism, histiocytosis X, Brown                ABOUT MAYO CLINIC
tumour of hyper-parathyroidism and aneurismal bone
cysts. Monostotic fibrous dysplasia has often been
labeled as ossifying fibroma or non-osteogenic fibroma          Around the turn of the century, Dr. Charlie and Dr.
or Leontiasis Ossea.                                            Will Mayo organized medical professionals in a new
It is an entity of considerable clinical and histologic         way to better care for patients. They created a system
variation, probably depending upon the stage and phase          that allowed doctors to take the time to thoroughly
of disease:                                                     investigate patient problems and to quickly and easily
       Painless swelling or bulge in the jaw, usually          get help from other specialists. The system was built on
          involving labial or buccal side, and seldom the       the idea that two heads are better than one and five are
          lingual plate                                         even better. It also encouraged a continual search for
       Protuberant excrescences of the inferior                better ways of diagnosis and treatment. Patients
          border of mandible                                    flocked to the Mayos because of their ability to find
       Malallignment of teeth                                  answers to their problems. Doctors, too, came to
                                                                observe and learn at "the Mayo's clinic."

                                                            2
Mayo Clinic is a charitable, not-for-profit organization       In 1919, the Mayo brothers dissolved their partnership
based in Rochester, Minnesota. Its mission is to               and turned over the clinic's name and assets, including
provide the best care to every patient every day               the bulk of their life savings, to a private, not-for-
through integrated clinical practice, education and            profit, charitable foundation. They dictated that any
research. A 31-member Board of Trustees composed of            earnings from the practice, beyond those needed to
public members and Mayo physicians and                         operate and perpetuate the clinic, should be used for
administrators governs it. Mayo's principal entities           medical education and research. Such has been the case
include: Mayo Clinic, Rochester, Minnesota, a 1,626-           ever since. All Mayo staff members, including doctors,
physician group practice, Mayo Clinic, Jacksonville,           are paid a salary and there is no profit-sharing. The last
Florida, a 325-physician group practice, and Mayo              family member on the medical staff was Charles W.
Clinic, Scottsdale, Arizona, a 332-physician group             Mayo, Dr. Charlie's son, who retired in 1963. Robert
practice. Besides this there are Saint Mary’s Hospital,        Walters, a great-grandson of Dr. Will Mayo, is an
Rochester, Minnesota, St. Luke's Hospital,                     administrator at Mayo Clinic Jacksonville.
Jacksonville, Florida, Mayo Clinic Hospital, Phoenix,
Arizona, Charter House, Rochester, Minnesota and
the Mayo Health System, a network of clinics and
hospitals in 64 communities in southern Minnesota,
northern Iowa, and western Wisconsin.                          F ACE TRANSPLANTATION

There are over 2,700 staff physicians and medical
scientists, around 520 clinical and research associates        It sounds like science fiction, but it could change the
and fellows, 1,875 residents and students and over             face of plastic surgery, literally. Dr. Scott Levin, a
37,000 administrative and allied health staff working          Duke University Plastic Surgeon, is helping to advance
tirelessly to attend a deluge of patients who come to          research for a revolutionary surgical procedure that
these premises seeking cure. In the year 2003 the clinic       could offer hope to victims of catastrophic injuries like
had 511,000 unique patients, 2,253,513 total outpatient        burns or gunshot wounds. He is helping researchers at
visits, 127,300 hospital admissions and 595,300                The Cleveland Clinic study techniques referred to as
hospital days of patient care.                                 ‗face transplantation‘. The procedure is a composite
                                                               tissue allo-transplantation and it means it is possible to
Biomedical research at Mayo Clinic includes strong             transplant the face of a donor to the skull of a recipient.
programmes in basic and clinical research. Most Mayo           Patients, however, would not look exactly like the
medical staff participate in some research activity.           donor. The brain activates muscles of facial expression
With 2,516 research personals and a research grant of          and the bone structure that is the platform. It's the
351 million dollars in 2003 there is an ongoing                facial skeleton, in many ways, that dictates appearance.
research programmes to improve patient care and to             But is the public ready for that?
benefit society.
                                                               If a child had a horrible facial injury or was burned by
Medical education is yet another front in which Mayo           thermal or chemical agents or had a facial tumour
Clinic has always been in the forefront. The oldest of         removed, the distortion and the calamity of such an
Mayo's five schools, the Mayo School of Graduate               occurrence, whether it's from trauma, a burn or a
Medical Education has trained more than 16,000                 tumor, are inordinate. One just can't measure it. Dr.
alumni in virtually all medical specialties since 1915.        Levin‘s passion is to have this type of technology offer
Mayo Graduate School has granted about 425 graduate            a solution to such patients.
degrees in seven specialties since 1917. Mayo Medical
School has trained and graduated more than 1,000               The technical side of the equation is complete and a
students since 1972. Established in 1973, Mayo School          face transplant could be done at Duke right now, but it
of Health Sciences enrolls approximately 816 students          will still be some time before this sort of surgery is
each year in 32 allied health science programs. Mayo           performed on a human. The issues are: what immune
School of Continuing Medical Education formally                suppression protocol is the patient going to be on; what
became a school in 1996. It offers approximately 275           are the ethical issues; and what are the long-term issues
courses and 6,500 hours of continuing medical                  for the patient. The surgery has successfully been
education each year.                                           performed on rats at The Cleveland Clinic. The surgery
                                                               is obviously not for everyone, and so, if the technique
                                                               is approved, there will be a seriously scrutinized
Mayo provides the best care to every patient every day
                                                               patient selection process.
through integrated clinical practice, education and
research. The needs of the patient come first. Mayo            VOICE LIF T
specializes in virtually everything. Mayo's strength is
its comprehensiveness, its ability to provide "one-stop
shopping" for the diagnosis and treatment of virtually         The latest luxury for aging baby boomers looking for
any medical problem. Mayo's expertise includes more            the fountain of youth is the so-called "voice-lift,"
than 100 medical and surgical specialties and                  designed to make patients' voices sound more youthful.
subspecialties.                                                In the past, doctors have mostly performed vocal chord


                                                           3
surgery on people with voice-robbing diseases or                  medical devices, technologies and procedures in plastic
injury. Now cosmetic surgery for the voice — the                  surgery, and the guarantee of safety and well being of
voice lift — is becoming more widely known among                  patients.
an aging population, dismayed to notice hoarseness                EQUAM was founded by a group of plastic surgeons
that makes them sound older creeping into their voices.           headed by Drs. Marita Eisenmann-Klein of Germany
Professionals who use their voices — including                    and Jean-Philippe Nicolai of the Netherlands, and now
performers, lawyers and telephone operators — are                 comprises over 40 European, Central and South
seeking out the procedure, hoping to shave years off              American, African, Southeast Asian and Middle-
the sound of their voice.                                         Eastern countries. Representatives participating at
                                                                  meetings are plastic surgeons, scientists, manufacturers
There are two general kinds of voice lifts: In some               and representatives from governmental bodies involved
cases, implants inserted through an incision in the neck          in the development and surveillance of advanced
bring the vocal cords closer together. Doctors also use           technologies, devices and techniques in the field of
injections of fat, collagen or other substances to plump          plastic surgery.
up the cords and make them more limber, so that the
voice sounds younger.                                             The previous Consensus Conferences, which are held
                                                                  once in two years, have focoused on the
But doctors are warning against doing cosmetic                    recommendation by the British Medical Devices
surgery on normal, but aging, vocal cords. There are              Agency (MDA) for the recall of the TrilucentTM
risks to the procedures. Dr. Steven Zeitels, an associate         breast implant, and on the European Parliament‘s
professor at Harvard Medical School and a                         assessment of the continuing use of the silicone gel-
laryngologist at the Massachusetts Eye and Ear                    filled breast implant and their demand to ban its use.
Infirmary in Boston is of the opinion in an attempt to            Other key topics discussed were the growing
actually bring the vocal folds together they may                  experience with the use of Botulinum toxin in aesthetic
become over-closed and then the voice can get worse.              surgery, the implementation of an international breast
                                                                  implant registry (IBIR), the use of silicone gel-filled
                                                                  breast implants, and last updates regarding safety
To produce sound, the vocal cords must meet each
                                                                  issues of ultrasound-assisted lipoplasty (UAL). Various
other at a rate of between 120 and 220 times a minute,
and that high level of usage takes its toll. Unlike skin,         resorbable and non-resorbable injectable materials for
                                                                  soft tissue augmentation are available at present.
the surfaces of vocal cords don‘t sag as we age — they
                                                                  Substantial biochemical and biophysical differences
get stiffer, which makes them more difficult for them
to vibrate. Over time, from the use of the voice, they            exist. Not all of the non-resorbable materials have
actually decrease in pliability. Singing, smoking and             withstood the test of time, and some should still be
just day-to-day speaking can make vocal cords less                considered experimental.
limber and speech less recognizable. Vocal Changes                At the close of EQUAM meetings, a Consensus
                                                                  Declaration is drawn up summarizing the conclusions
are a Red Flag and shouldn't be ignored or written off
                                                                  of the meeting, and is presented to the health ministry
as just "old age." Vocal changes can be the first signs
                                                                  and plastic surgery society of each member country.
of polyps, a paralyzed voice chord, or even cancer
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
                                                                  becomes increasingly important. The interaction
EQUAM                                                             between clinicians, scientists and manufacturers prior
                                                                  to and during the implementation of new technologies
                                                                  is essential in order to ensure the safe application of
Moris Topaz, MD, Secretary-General, EQUAM –                       these technologies in clinical use. It is imperative that
Personal communication with the editor                            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          community.
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


                                                              4
                                                               services to our speciality. Dr. Harold Kleinert was
                                                               invited to lecture on ― My fifty year experience with
                                                               flexor tendon repair‖ and Dr. Carl Hartrampf on ―My
PLASTIC SURGERY 2004                                           personal Evolution in TRAM Flap Breast
                                                               Reconstruction. Dr. Wayne A Morrison from Australia
                                                               gave PSEF Maliniac Lecture on ―A Fortunate Life‖
Plastic Surgery 2004 was a combine meeting of 60th             which concentrated on tissue engineering and its future
Annual meeting of American Society of Plastic                  clinical application. There were excellent discussion
Surgeon (ASPS), Plastic surgery education foundation           on use of digital cameras, video and computer and it
(PSEF) and American Society of maxillofacial surgeon           application in plastic surgery, mainly for record
(ASMS) held in Philadelphia from 8th to 13th October           keeping and digital presentations. The challenges of
2004. It was held in Pennsylvania Convention Center            wound healing, new skin substitute were discussed
in the city center which is the original home of the           with strong research background. The VAC dressing is
Reading Railroad station.                                      becoming more popular dealing with complex wound.
                                                               The last session on the last day was Special Closing
ASPS was established in Founded in 1931 represents             Session on ―Difficult Nose and Secondary Rhinoplasty:
physicians certified by The American Board of Plastic          Challenges and Solution‖ and the speakers were Bruce
Surgery or The Royal College of Physicians and                 L Cunningham, Mark Constantian, Ronald Gruber,
Surgeons of Canada and has about 5000 members. The             Frederick Menick, Samuel Stal and Bernd Neu. This
education foundation PSEF was established in 1948.             was very exciting session with philosophy and heated
ASMS in established in 1947 and its 500 members                discussion about the views and ways. Well planned
include plastic surgeons that are doing maxillofacial          sophisticated exhibition stalls and many of them had
reconstruction.                                                the procedure and informative video. This itself was
                                                               mini conference for education and latest information!
The conference was preceded by symposium on
―Bony, Alloplastic and Autogenous Restoration of the           We can learn lesson of preserving and promoting our
Mid-face‖, held by ASMS. The topics were from                  speciality by becoming more aggressive in our clinical
cosmetic to cancer reconstruction, and from childhood          and research activities. The association can be spoke
to old age. The programme was studded by the                   person for all the plastic surgeons to create awareness
excellent speakers like Joseph McCarthy, Ken Salyer,           about our speciality. The basic information about
Linton Whitaker, Ronald Zuker, Henry Kawamoto, J               plastic surgery, cosmetic and reconstructive surgery
William Little and many others. The Plastic Surgery            can be given on the web site. The site can also keep
2004 conference began with Master Series Courses,              the names and address of all its members and
which were on Cosmetic Surgery, Craniofacial                   qualification so that patients can verify the
Surgery, Breast Surgery and Microsurgery..                     qualification of person. It is worth visiting the website
                                                               of American Society of Plastic Surgeons
The Keynote Speaker during opening ceremony was                www.plasticsurgery.com.
Mr. Michael Raynor, co-author of 'The innovator’s
Solution', the practical guide to developing and
implementing strategy in today‘s disruptive and hyper-         INDIA ISAPS COURSE 2004
competitive business environment. His observation for
American plastic surgeons was they are going beyond
expectation and capacity of general people in cost and         The International Society of Aesthetic Plastic Surgery
innovation. This leaves vacuum below which is being            held an instructional course in ‗Technologies in
filled by other specialties which are much cheaper and         Aesthetic Surgery, Body Sculpturing and Facial
less flashy! He suggested the weapon of reconstructive         Rejuvenation‘ on November 28 to 30, 2004. Held at
surgery, which most of the American plastic surgeons           the beautiful Rambagh Palace S.M.S. convention
reluctant to do! The amazing feature of this ceremony          centre in Jaipur, it was rich in scientific content,
was Patient of Courage Awards, who brave through               cultural extravaganza and very well attended. Dr. C.
serious disease, deformities and reconstruction.               Troilius, the course coordinator, Dr. Thomas Biggs,
                                                               President of ISAPS and editor of the society‘s journal
The scientific programme was dominated by the                  and Dr. Ashok Gupta, our national representative in the
cosmetic surgery. The trend of cosmetic surgery has            ISAPS were greatly responsible for the outstanding
changed from fat removal to fat filling in middle and          success of the course.
upper third of the face for rejuvenation. The treat of
the conferences were, Converse Lecture was given by            There were four sessions on Facial Rejuvenation in
Dr. David J David with emphasis on the International           which both surgical and non-surgical options were
Craniofacial Society and its role to bring Craniofacial        deliberated upon in great details. Face-lift was
surgery to the patients rather than bringing patients to       discussed threadbare; Dr. Y. Levet of France talked
the surgeon! Other invited presentation was ―History           about the history, the anatomy and discussed his
of Plastic and Reconstructive Surgery‖ by Dr. Robert           personal technique of facelift. Dr. Edgar Biemer
Goldwyn, who has served the longest as an editor of            discussed his 8 years of experience in doing extended
PRS journal. He was given standing oration for his             composite face lift, whereas Dr. P. Tonnard advocated

                                                           5
a short scar face lift and propagated a relatively new            Body Dysmorphophobia by Mr. D. Hodgkinson. Dr.
concept of minimal access cranial suspension to                   Lokesh Kumar talked about the legal scenarios and
achieve this lifting. The course coordinator, Dr. C.              warned about the likely pit falls.
Troilius showed his technique of endoscopic brow lift
without fixation and Dr. M. Scheflan revealed the his             Sessions on lasers and liposculpturing were also very
concepts and gave his technical tips and tricks of what           useful. Dr. A. Troilius‘s lecture on what is possible to
he called ‗No Nonsense Facelift‘. Dr. T. Biggs‘s                  do today with IPL and Lasers was an eye opener as
presentation ‗ What I learnt 45 years ago and would not           was Dr. P. Knotoes‘s experience of Laser
do today was both a walk down the memory lane of a                Blepharoplasty. Dr. L. Toledo‘s outstanding efforts of
veteran traveler as well as a precious sermon and                 syringe liposuction left one spell bound. He talked
words of wisdom of an aging Guru.                                 about refinements in liposculpturing and candidly
                                                                  discussed about the complications and suggested
Dr. Woffles Wu of Singapore championed the cause of               solutions. Dr. J. Poell introduced the concept of
Non Surgical facial rejuvenation. His now famous                  Liposuction in combination with body lifting and Dr.
Facial Rejuvenation with the APTOS and W-PTOS                     A.R. Lari talked about body sculpturing in hugely
and his astute use of soft tissue fillers was the source of       obese individuals.
attraction for many colleagues. Dr. S. Hoefflin made a
very beautiful presentation of ‗The Mathematical                  With courses like this Aesthetic Surgery in India,
Definition, Classification and Creation of Facial                 courtesy Dr. Ashok Gupta and his team, has come of
Beauty‘ and Mr. B. Mendelson from Australia opined                age finally. Our own contributions in such meetings
about the anatomical considerations of changes of                 should now improve both qualitatively and
facial shape with aging. Dr. L. Toledo of Brazil                  quantitatively.
discussed at length about computer imaging and digital
photography and Dr. T. Roberts showed the role of
micro fat grafting in facial rejuvenation and facial
contouring. He later on went to show the role of this
technique for Gluteal enlargement.
                                                                  APSICIN 2004
Mr. Ian T. Jackson came up with his concept of ‗Total
Aesthetic Profile Correction‘ in which he very                    The 39th.Annual Conference of the Association of
judiciously used Orthognathic surgery, Rhinoplasty,               Plastic Surgeons of India was held in the beautiful
implants and fillers in various combinations, as per his          premises of the B.M. Birla auditorium in the pink city
patient‘s needs and discussed both the aesthetic and              of Jaipur from November 23 to 27, 2004. The
economic impact of such procedures. Dr. O. Erol to                conference started with an operative workshop, which
some extent went the same way when he discussed his               was organized in the S.M.S. Hospital and beamed live
autologous volumetric shaping of face using surgical              in three halls of Jaipur Medical Association building.
and non-surgical approaches. Dr. P. Kontoes had his               In one theatre, which was devoted to Rhinoplasty, Mr.
views, on non-surgical and combined approaches on                 Satish Vyas of the U.S.A. demonstrated an Aesthetic
optimal facial rejuvenation, known to all by some                 Rhinoplasty and a cleft lip nose correction. Mr. Ian T.
excellent visuals.                                                Jackson and his team manned the second theatre and
                                                                  they performed a fronto orbital advancement in a child
In breast aesthetic surgery, the vertical approach of             of Craniosynostosis, an alveolar bone grafting with
reduction mammoplasty was the flavor of the course.               cleft lip nasal corrective surgery and also demonstrated
Dr. Ruth Graf of Brazil not only talked passionately              the use of hydroxy - apatite granules in the correction
about her procedure of securing an inferiorly based               of facial asymmetry. The third theatre was for aesthetic
dermo-fat flap under a pectoralis major sling to achieve          surgery exclusively. Here Dr. Edgar Biemer of
fullness under the nipple areola complex after                    Germany demonstrated his Composite Facelift,
reduction mammoplasty, but also demonstrated the                  Endoscopic Frontal Lift and talked about Endoscopic
procedure during a live surgery session. Dr. C. Lassus            Carpel Tunnel Release. There was very good
and DR. J. Poell also advocated the vertical approach             interaction with the faculty in all the halls and the
to mammoplasty.                                                   delegates were left super saturated with new ideas.

Dr. C. Troilius who advocated the trans axillary                  The Charles Pinto C.M.E. on the next day was very
approach and Dr. Ruth Graf, who talked about sub-                 well attended. The highlight of this session was a
fascial breast augmentation, discussed Breast                     debate between Orthognathic Surgery and Distraction
Augmentation. Dr. B. Arnljots presented the technique             Osteogenesis. Mr. Ian T. Jackson of U.S.A. and Prof.
of breast reconstruction using the DIEP flap, and                 Ramesh Sharma of P.G.I. Chandigarh spoke in favour
advocated using the internal mammary vessels as                   of Surgery whereas Dr. Wolfgang Kater of Germany
recipient vessels for better flap orientation.                    and Prof. A.K. Singh of K.G.M.U. Lucknow were in
                                                                  favour of distraction histiogenesis. They however
Some ‗Hot Topics‘ that came up for discussion were                eventually resolved that the two modalities are not in
Advances in Hair restoration by Dr. A. Barrera, and               any competition and if used judiciously, both can be of

                                                              6
much use. Dr. Fredrick Gewalli of Sweden deliberated            of scientific presentations in Indian languages.
on Dynamic Principles in Cranio-Facial Surgery and              Presenters deliberated in Hindi, Tamil, Telegu, Gujrati
Dr. Wolfgang Kater advocated a minimal invasive                 and Malayalam, while presenting two sets of slides,
approach instead of Obwegeser / Dalpoint technique.             one in their regional language and one in English, and
Lectures of Dr. Abdul Reda Lari of Kuwait on new                it was surprising to see how lucidly they could express
concepts in abdominoplasty, in which he showed some             their view point in their own language and yet be
mega fat and integument resections, and of Mr.                  understood by all.
Andrew Burd of Hong Kong on integrative care of
vascular birthmarks were very well appreciated. Mr.             The Conference, which was attended by 20 overseas
David Ward, representing the British Association of             delegates and 29 past presidents, and was dedicated to
Plastic Surgeons discussed the prospects of Plastic             Prof. C. Balakrishnan, was surely hit by the absence of
Surgery Training for overseas trainees in the U.K. and          a team of dedicated organizers and volunteers. This
Dr. Raja Sabhapathy was at his usual best when he               APSICON most of the time, was running on autopilot,
most lucidly enumerated the principles and advances in          with not much useful navigation from organizers.
the reconstruction of neglected limb trauma. There was          There were too many last minute programme changes,
another debate – Non surgical vs. Surgical facial               venue changes and ministerial interruptions and free
rejuvenation, Dr. A.R. Lari and Dr. K.S. Bhangoo                paper sessions continued well beyond the scheduled
speaking in favour of non-surgical and the German pair          time. Prof. Malti Gupta, for almost single handedly
of Dr. Edgar Biemer and Dr. Dimitri Panfilov                    organizing this conference deserves our appreciation.
defending the surgical bastion.                                 .

The best of the C.M.E. however was a presentation by
Dr. A. Lee Dellon of U.S.A. in which he talked about
restoration of sensation, relief of pain and prevention
of ulcers and amputations in diabetic neuropathy. He
convinced the delegates that diabetic neuropathy is             ACROSS SEVEN
very much like a compression syndrome and if the
compression sites like the tarsal tunnel are released in
time, and diabetes kept under control, the neurological
                                                                SEAS
complications can be reversed and avoided in future.
                                                                F OOT F ACELIF TS AND MUCH MUCH MORE
Prof. B. Sadashiva Murthy delivered the Gillies
Memorial Oration on Cranio-Facial clefts. Dr. Edgar
Biemer was our Godrej Visiting Professor and he                 No longer is plastic surgery limited to facelifts and
talked about the development of reconstructive breast           tummy tucks. Today's procedures can remodel those
surgery. Dr. Dimitri Panfilov, while delivering the             with cash to burn from head to toe:
Sushruta Oration, talked about ‗Corporal Integrity
Providing Human Identity – 26 Centuries after the                       Breast implants now come coated in
great Susruta‘. Dr. Narendra Pandya delivered Prof.                      biocompatible titanium - to reduce the risk of
M.M. Mukherjee oration and he talked about his forty                     the body rejecting foreign matter. There's no
years tryst with Rhinoplasty. Yet another Oration, the                   word on the risk of setting off airport metal
C. Balakrishnan Oration was introduced from this                         detectors.
Conference and Dr. Ashok Govila from Abu Dhabi                          Surplus fat can be sucked from the upper arms
was the inaugural orator, his oration being an ode to his                and injected into thinning, aging hands.
Guru, Prof. Balakrishnan.                                               Gluteal implants fill out a flat rear - these are
                                                                         placed just above the sitting area so weight
A very informative Prof. R.N.Sharma Memorial                             isn't placed on them.
Symposium on Lasers in Plastic Surgery and a very                       Don't like that sticky-out belly button?
crisp presentation on Naso-ethmoid Orbital trauma by                     Umbilicoplasty turns that "outy" inwards.
Mr. Ian Jackson were highly appreciated. Early                          Men can have their "man breasts" reduced -
morning Instructional Course Lectures on topics as                       and those who dream of a gym-fit body can
diverse as Orthognathic Surgery, Prosopoplasty –                         opt for silicone pectoral implants.
Aesthetic Surgery of Facial Mosaic, Replantations,                      Stiletto-wearers can have their feet padded
Brachial Plexus reconstructions, Correction of Brow                      and toes shortened to make those Manolos
ptosis, Hair Transplantation, Endoscopic mid-face lift                   more comfortable.
and Facial Palsy formed an integral part of the                         For improvements of a particularly intimate
academic extravaganza. The Peet Prize session and the                    nature, surgery can offer practically any kind
A.P.S.I. best paper session had some very high quality                   of increase or decrease in size or alteration to
presentations. Free paper sessions on all three days                     shape.
were very well attended and had some outstanding
papers. For the first time, we has three presenters from        One part of the body where cosmetic surgery is still in
Pakistan, and their work was appreciated by one and             its infancy is the feet, but not for long perhaps. Dr
all. The USP of this conference however was a session

                                                            7
Suzanne Levine has made a name for herself among                 Some of his colleagues caution that the implant makes
the style conscious women of Manhattan, who turn to              it impossible for women to check their breasts for
her when they can't fit into designer high heels. "It's up       tumors themselves. "There can be some problems with
to patients to be able to enjoy their lifestyle," says Dr        that," Saylan told DW-WORLD, but said that regular
Levine, who performs a range of operations such as toe           mammograms or x-rays would still help to detect
shortening at her Institute Beauté clinic. So-called claw        cancerous growths at an early stage.
toes stick out beyond the big toe. They are                      Still, Saylan's unlikely to convince a huge amount of
incompatible with pointy shoes and can be shortened              women to abandon their bras. At a price tag of €7,000
with bone removal. Other foot options include                    ($8,450), the operation costs about as much as 150
narrowing and collagen injections.                               "bust-holders," as bras are known in German.

It has echoes of the ancient Chinese practice of foot
binding, yet her patients are anything but enslaved.
Many are "baby-boomer" career women in their 50s,
                                                                 COSMETIC SURGERY GOES TO THE DOGS!
whose feet have weathered a lifetime of discomfort in
what the doctor calls "limousine shoes" - precipitously          As with people, beauty is in the eye of the beholder in
high with virtually no structure.                                the canine world. ―Why shouldn‘t a dog be beautiful?‖
                                                                 asks Dr Edgard Brito, who offers wrinkle-reduction,
Dr Levine resets the bones in the foot, and, with lasers,        eyebrow-correction and facelifts for canines. ―Beauty
returns a healthy glow to the skin. Dr Magdi Greiss, a           is desirable. We all like talking to someone who looks
leading foot surgeon in the UK, frowns on such                   good. It‘s the same with dogs.‖
procedures. "A 16-year-old girl asked me to remove               On the wall is evidence of Dr Edgard‘s success. He is
the inherited bunions on her foot because her boyfriend          pictured with a who‘s-who of Brazilian models, actors
didn't like them," says Dr Greiss. "Do they hurt, I              and television presenters, all of whom have asked the
asked. No, she replied. So I told her to get a new               Sao Paulo vet to beautify their favourite pooch.
boyfriend." Yet he concedes that cosmetic foot surgery           ―He‘s a miracle worker,‖ says Anita Alt, a dog breeder
is creeping to these shores - already some clinics give          specialising in miniature schnauzers, visiting the clinic
collagen injections in the feet for high-heel wearers.           with four-year-old Brutus. We imported Brutus to be a
"Removing a bunion is a serious piece of surgery that            show dog, but then one of his ears started drooping—
involves slicing through the bone. There's a lot of pain.        the kind of thing that would disqualify him.‖
So I say, if it's not painful to start with, don't create        Dr Edgard straightened the ear by injecting Restylane.
more pain."                                                      ―You only need one application. The ears will stand up
                                                                 forever.‖ The ear treatment costs about £40. There is a
                                                                 detailed price-list of other procedures including Botox
                                                                 injections to correct facial wrinkling.
                                                                 Since undergoing surgery, Brutus has become one of
A B RA FOR LIF E                                                 Brazil‘s most successful competition dogs. ―He‘s been
                                                                 a pan-American champion,‖ says Anita, ―and he‘s won
                                                                 the best-in-show category a few times. But many
Feminists may have told women to burn their bras 35              Brazilian dog lovers believe it is unethical for a
years ago, but a German-based plastic surgeon has                surgically enhanced animal to win a top show. ―You
come up with another idea: Implanted push-ups made               really hope people won‘t bring you dogs like that,‖
from a material that's been mainly used in space                 says Suzanne Blum, who has been judging
shuttles so far.                                                 competitions for more than a decade. It‘s reasonable to
About three dozen women have so far undergone the                use simple surgery to make a dog beautiful. There‘s
90-minute procedure developed by Ziya Saylan, who                nothing unethical about that ―At a crowded show the
operates in the western German town of                           judges get only three minutes with each animal.
Düsseldorf. He uses a mesh made from titanium that's             ―That‘s not long enough to tell whether a dog has had
apparently not harmful to the body and has already               surgery.‖
been used for hernia surgery.                                    The main objection to cosmetic surgery, voiced by
Once implanted, the mesh supports the breast from                Brazilian animal welfare groups, is that it might be
below. Saylan says that the operation is an option for           used to conceal genetic defects. Suzanne Blum offers
women of all breast sizes, although he's told reporters          an example: ―A dog may have surgery to correct
that it works best for "women with small, sagging                imperfect teeth or a tail. And then it might win a show.
breasts."                                                        At that point, it commands huge stud fees—even
While Saylan encourages his patients to keep wearing             though it has a concealed genetic defect.‖ The most
bras for about six months after the operation, he                extreme cases of concealment have involved testicles.
promises them firm forms sans bra in the end. Not too            Unscrupulous vets have been known to disguise the
firm, though, as he said in an interview with a beauty           fact that an animal has only one testicle by attaching a
magazine: "A bosom that's too firm can look artificial.          suitably shaped prosthesis.
We're going for a natural appearance. Nice breasts can           Is canine cosmetic surgery illegal? Brazilian law does
sag a little, as Leonardo da Vinci already discovered."          not address the controversy directly. A statute of 1943
                                                                 bans the mutilation of animals, but there is no legal

                                                             8
consensus on whether cosmetic surgery should be
classed as ―mutilation‖. Back at his Sao Paulo clinic Dr          February 19 & 20, 2005
Brito is dismissive of calls for new legislation. ―It‘s           Brachial Plexus Surgery Group India, 1st. Biennial
perfectly reasonable to use simple surgery to make a              Conference
dog beautiful,‖ he says. ―There‘s nothing unethical               Host: Sir Ganga Ram Hospital, New Delhi
about that. ―But I agree that vets should not conceal             Venue: Working Women‘s Hostel Auditorium
hereditary defects. It‘s not fair on the dog, the judges or       Contact: Dr. Aditya Agarwal
the other competitors. ―Here at my clinic I would never           Tel: 011-25861463 / 25735205, Extn,1227,1836,
attach an artificial testicle.‖                                   +9810025145
                                                                  Email: aditya_agg@hotmail.com
                                                                  URL: www.brachialplexusgroup.com


FORTHCOMING                                                       March 19 –23, 2005
                                                                  9th Asian Pacific Congress of The International

EVENTS                                                            Confederation of Plastic, Reconstructive and
                                                                  Aesthetic Surgery
                                                                  Venue: Taj Mahal Hotel, Mumbai, INDIA
                                                                  Contact: Dr. Mukund R. Thatte, 9th. Asian Ppacific
CONFERENCES IN 2005                                               Congress Office, Travel Corporation (India) Pvt. Ltd.
                                                                  Chander Mukhi, Nariman Point, Mumbai 400021.
                                                                  Tel: +91-22-22021881
January 14 – 16, 2005                                             Fax: +91-22-22029424
4th. Annual Congress of Indian Society of Cleft Lip,              Email: tciconferences@tci.co.in
Palate and Craniofacial Anomalies                                 URL: www.apc-ipras2005.com
Venue: Hyderabad, India
Contact: Dr. Srinivas Gosla Reddy                                 August 30, 2005 – September 3, 2005.
Tel: +91-40-55764884 / 27428888                                   10th. Congress ESPRAS 2005
Fax: +91-40-27427492                                              European Society of Plastic, Reconstructive and
Email: info@isclpca2005.org                                       Aesthetic Surgery, European section of IPRAS
URL: www.isclpca2005.org                                          Venue: Medical University of Vienna, Vienna General
                                                                  Hospital, A-1090 Vienna, Austria
January 21 – 23, 2005                                             Contact: Hedwig Schulz, Vienna Medical Academy,
21st. Annual Breast Surgery Symposium                             Alser Strasse 4, A-1090 Vienna, AUSTRIA
Contact: Southeastern Society of Plastic &                        Tel: +43-1-405 13 83-10
Reconstructive Surgeons                                           Fax: +43-1-407 82 74
4900 B South 31st. Street,                                        Email: h.schulz@medacad.org
Arlington, VA 22206-1656, U.S.A.                                  URL: www.espras.com
Tel: (703) 820-7400
Fax: (703) 931-4520
URL: www.sesprs.org                                               SECRETARIAT

February 2 – 6, 2005                                              Department of Plastic & Reconstr. Surgery
13th. Annual Conference of National Academy of                    Institute of Medical Sciences, B.H.U.
Burns – India (NABICON 2005)                                      VARANASI, INDIA
Venue: India Habital Centre, Lodhi Colony, New
Delhi.
Contact: Dr. P.S. Bhandari
Tel: +91-11-23231871 / 09810498449                                EDITORIAL OFFICE
Fax: 91-11-23222756
Email: nabicon2005@yahoo.com                                      Dr. Surajit Bhattacharya
                                                                  Capital Diagnostics, Mini Plaza, M2 Gole Market
February 5 – 8, 2005                                              Mahanagar, LUCKNOW 226006, INDIA
Joint Conference of Pakistan Association of Plastic               Tel: 91 522 2384881 / +94150 81668
Surgeons and Pakistan Society for Surgery of the
Hand.
                                                                  Fax: 91 522 2380550
Host: Department of Plastic Surgery, C.M.H.                       Email surajitb@sancharnet.in
Rawalpindi; Armed Forces Post-Graduate Medical                    URL: www up-apsi.com
Institute                                                         www.lucknowplasticsurgery.com
Contact: Lt. Col. Mamoon Rashid
Email: mamoon@isb.comsats.net.pk
        paps2005@hotmail.com
URL: paps-pssh2005.tk


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