Aesthetic Surgery Society’s Congress 1. Central oval of the face rejuvenation aesthetic rationales, video/non endoscopic approach, dissection planes, suspension sutures Constantin Stan, Tiberiu Bratu 2. The importance of ocular position in facial rejuvenation Romulo Guerrero 3. The treatment of Facelift complications Julio Daniel Kirschbaum 4. The Facelift we like T. Bratu, D. Grujic , D. Mihajlovic, Lj. Grujic, Z. Crainiceanu 5. Volumetrics in face-lifting, an alternative to injectables Johannes Bruck, Berlin 6. An alternative fixation technique for the endoscopic brow lift. Andreas Foustanos, 7. Large volume breast reduction with vertical pedicle technique M. Icekson, Ioana Nedelcu, A. Ofek, K. Agam, T. Tzur, R. Newman 8. Refinements of vertical scar mammaplasty: circumvertical skin excision design with limited inferior pole subdermal undermining and liposculpture of the inframammary crease Bishara S. Atiyeh, Michel T. Rubeiz and Shady N. Hayek 9. Breast Size and Shape Enhancement with MATRIX Implant (New Dimensional Sequential System - CAIS Planning System) C. Stan, T. Bratu 10. Mono-RF stan Breast Suction Forceps for Pocket Multiplan Dissection in Breast Augmentation C. Stan 11. What am I doing in these particular cases? (primary, secondary or difficult breast augmentations) C. Stan, T. Bratu 12. A Double Flap Technique - An Alternative Mastopexy Approach. Andreas Foustanos 13. Combined otoplasty technique: Understanding the importance of conchal resection in the correction of the prominent ear Alexander Margulis and Bruce S. Bauer 14. Open versus close rhinoplasty D. Totir , C. Mitache, Ruxandra Sinescu, A. Cinca 15. Secondary rhinoplasty Penelopia Marinescu, B. M. Marinescu 16. Connection between aesthetic and functional surgery in blepharoplasty Ileana Boiangiu, Luminita Banacu, T. Panazan, Oltea Popescu, Cristina Brezeanu, Crenguta Jecan. 17. What we are doing and where are we going in abdomen and lower limbs reshaping surgery Noela Elena Ionescu, I.P. Florescu, S. Marinescu, Carmen Giuglea, E. Turcu, Ioana Apostolescu, Ingrid Marinescu 18. The use of breast balloon dissector in augmentation mammoplasty; Our experience in 150 consecutive cases Ioana Nedelcu, T. Tzur, R. Neuman 19. Mastopexy and breast augmentation for ptotic breast. How to ensure a long term result? N. Antohi, V. Stan, C. Stingu 20. Medial and inferior bipedicle mammaplasty for gigantomasty. Case reports. N. Antohi, V. Stan, C. Stingu 21. The results after reduction mammoplasty and/or breast lift A. Rebosapca, B. Andreescu, I. Marinescu, D. Barzu 22. Aesthetic result in breast augmentation – limits and expectations Carmen Giuglea, Marinescu S, Noela Elena Ionescu, Florescu IP 23. Our experiences concerning augmentation mamoplasty with anatomic coesive gel anatomic profile implant D. Totir, C. Mitache , Ruxandra Sinescu , A. Cinca 24. Breast augmentation revision T. Bratu, D. Grujic, S. Olariu, D. Olariu., D. Mihajlovic, Z. Crainiceanu 25. Mammary asymmetry Ileana Boiangiu, Luminita Banacu, Cristina Brezeanu, Crenguta Jecan 26. Mammary hipotrofy and ptosis T. Bratu, D. Grujic, D. Olariu., D. Mihajlovic, Lj. Grujic, Z. Crainiceanu 27. Hair transplant surgery: state-of-the-art Bessam Farjo 28. The place of mesotherapy in allophatic medicine and in aesthetic medicine Ioan Nedelcu 1. Central oval of the face rejuvenation aesthetic rationales, video/non endoscopic approach, dissection planes, suspension sutures Constantin Stan1 ,Tiberiu Bratu2 1 Medical Service Clinic, Bacau 2 Brol Clinic, Timisoara Back Ground Gradually, over the past six years, from my critical point of view, the results of many former techniques done at that moment were sometimes less than natural and short lasting in terms of natural and full rejuvenation. Many papers, books and workshops about alternative face lift procedures were the inspiration sources of my personal experience in this more demanded aesthetic surgery techniques for face rejuvenation. Working on my personal statistics I tried to realize which are the best and reliable combination of aesthetics units of the face involved in facial aging and consecutively what surgical procedures are best suitable for a good, natural and long lasting result. A retrospective study review was performed on 598 consecutive patients who underwent many face lift techniques between January 2000 and December 2005 in order to correct a perceived descent of deeper facial structures. The early face lift techniques that manipulate the superficial muscles aponeurotic system (SMAS) or extended supra aponeurotic skin under mining with skin tightening can result in insufficient volume restoration in the central oval of the face. OBJECTIVE We describe a face rejuvenation concept that combines vertical “en bloc” subperiosteal mobile vertical middle third suspension with a more natural volume restoration and lower lateral cervicofacial lifting with a more postero-superior vector and conservative skin Redraping. METHODS My first ideas and way of working was based on face surgical aesthetic units divided in three horizontal segments (upper, middle and lower thirds). Accordingly to this concept the surgicals approach was oriented more to the upper third ( brow elevation and upper eyelid rejuvenation) middle third (lower eyelid) and the lower third, the key of the entire “old” face rejuvenation as a multilayer dissection with SMAS or not manipulation and a postero-superior vector with skin tightening and enough long, visible scars incisions. The anatomical multilayer undermining in my former typical face lift was not useful and with good results for only a few months, but soon dissipated and lost of the desired fixation effects. Other problem was the lack of solutions for the mid face rejuvenation. Thus, in the last three years I choose to leave the layers of the soft tissue intact and to create a subperiosteal surgical dissection with “en bloc” suspension and desirable permanent adherences. My surgical concept of face correction now has evolved from a few key points elements: 1. Gravity is one of the main factors for tissue dropping of the face in the aging process. 2. Considering the aging process, the face is now divided in three vertical aesthetic unit, the most important is the medial one with anatomic and age related movements. Muscular and adipose part, extended from the temporal area down to the jowl, free from almost any retaining structures, this mobile facial tissues drop vertically. The challenge is to move, after only deep subperiosteal detachment, all the face tissues “en bloc”, where they where before. This allows an efficient, natural, 3Dimensional harmonious re-mounting of the restructured cheek mass. The central oval facial surgery involves a non-endoscopic initially and later endoscopic deep subperiosteal face dissection with multistage reverse fall fixations (cheek malar orbicularis and temporal tissues to the deep temporal area. When is indicated, the aging process of the lateral lower face including the jaw line and the neck, must be treated in the same manner. The neck surgery is performed with short-scar incision and limited flap dissection in subcutaneons plane preserving the fixed areas and as much as possible the skin attachments to the platysma muscle. Plication and strong vertical suspension of the platysma is performed on its muscular part on the crossing zone at mandibular angle to a very strong and firm structures behind the tragus, called Lorre fascia. The temporo eye brow repositioning and the lower eyelid skin excision are the two final adjustments. RESULTS A retrospective review of 598 consecutive patients revealed high patient and surgeon satisfaction and a more natural and long lasting results. CONCLUSIONS One of the most satisfying aspect of this late combination of surgical techniques is a dramatic facial rejuvenation, with a preservation of the patient’s facial identity. The patient face has recovered more luminous and harmonious appearance with preservation of youthful face and either static and dynamic mode. To restore the aging face to its youthful shape (reestablish a youthful malar contour, shorten the lower eyelid, improve the nasolabial crease) the goals of the surgery is to elevate the medical face in a vertical vector with serial suspension suteres. This will achieve a natural looking result that avoids the lateral sweep of more conventional facial lifts that rely on lateral vector of tissue repositioning. The described latest procedures represents a personal evolution to a simpler an effective technique that produced a natural youthful appearance with minimal morbidity and downtime. Primary considerations about the described procedure is simpler and more effective technique that evolved over the course of the study on 5 years. Secondary considerations include a natural, youthful appearance, with minimal morbidity and downtime and satisfied patient. 2.The importance of ocular position in facial rejuvenation Romulo Guerrero In the process of facial aging there exists a loss of the tensile efficacy of the bland tissue and a loss of volume of adipose tissue and of craniofacial structure. Furthermore there exists a descent of the eyeball, given by the loss of efficacy of bland tissues and by the action of gravity. The eye changes position inside the orbit and descends, this descent, modifies the relations that the eye has with respect to the roof and floor of the orbit. When the eye descends it reduces the eye-floor space of the orbit and pressures the adipose bags, which herniate through the orbital septum. Moreover the space between the eye and the roof becomes larger. This produces an elongation and weakening of the orbital septum by which the adipose bags are removed and there is a deepening of the superior palpebral pleat. These are the signs of a senile orbit. Based on the relation of volume and eye-orbit position, the eye must be repositioned in its original location in order to recover the lost space between eye-floor and orbit thus relocating the adipose tissue in its place and not allowing it to dry out because this accelerates the process of descent of the eyeball. Normally with aging the relation between continent and content - that is between eye and orbit - change. Combined with the loss of adipose tissue, this produces notorious enophthalmy in the process of aging. This technique serves to lift the eye, recover the eye-floor space of the orbit, relocate the adipose tissue and prevent senile enophthalmos. In this manner the eye recovers its position and is situated in a more superior location closer to the roof of the orbit; the “adipose bags” disappear and the eye appears larger. An important sign of youth is the position of the eyeball. The proposed technique recovers this position and solves one of the most important problems of facial aging. 3. The treatment of Facelift complications Julio Daniel Kirschbaum San Borja Lima We show our experience treating Facelift complications. We had all kinds of Hematoma, from severe expanding to small organized collections. The treatment varies according to each case. Emergency evacuation was often needed. Postoperative infection is rare: Cellulite was treated with antibiotics, Absesses were always drained. We do not debrided clean dry scars but remove any necrotic region exhibiting secondary infection. In selected patients with injury to a motor branch of the facial nerve, Botulin Toxin was very effective to paralyse the healthy side. This gives dynamic simetry to the muscles of both sides. 4. The Facelift we like T. Bratu, D. Grujic , D. Mihajlovic, Lj. Grujic, Z. Crainiceanu Brol Medical Center Timisoara There are described a lot of techniques for facelifting. In the beginning were less invasive, followed by a period in which they became more elaborated, the skin undermining larger , associated with SMAS excizions , but , also, with higher risks . The final idea is to obtain a better result, anatomic one, without risks and large undermining. In the last four years we prefer the cervicofacial lift with vertical suspension and anchoring of the platissma ongle, followed by fixation and plicature of the SMAS. So we reconstruct the natural curves of the young cheek.The advantage of this technique is a smaller undermining, a good suspension of the SMAS, better scars and a long term result with smaller risks. 5. Volumetrics in face-lifting, an alternative to injectables Johannes Bruck, Berlin Modern Aesthetic surgery of the face relies on the evolution in the knowledge of the process of ageing. Ageing all the structures of the face – bone and soft tissues - change their volume and elasticity. This, together with the effect of gravity results in a displacement of soft tissue structures of the face readily associated with the impression of an ageing face. Pulling on the skin will smooth wrinkles but also reduce mimics and result in a stiff and adynamic complexion of the face. The goal of modern aesthetic surgery however is an alleviation of the results of ageing but still to preserve the dynamic properties of the mimics to conserve and restore a youthful and dynamic complexion. So realignment and reconstruction of displaced or lost volume are the technical manoeuvres to restore a triangular shape of the face in contrast to the rectangular form of ageing cheeks. Liposculpturing with fat injection is one of the procedures of modelling ageing faces. In our experience predictability of volume, reliability and long time effect apparent to the patient are very dependent on the donor site, recipient area in the face, the amount and extend of ancillary procedures and the patients individual rate of resorption. Realigning vascularized fat flaps is our primary choice wherever they are available in the medial infraorbital rim and the lateral zygomatic arch. In the area of the infraorbital rims, paranasion, lateral cheeks and the lips, fat injections alone may not supply the desired amount and homogeneity of volume. Here dermal fat grafts, muscle tissue, facial fat, easily harvested during the surgical procedure, and acellular dermis grafts are an useful alternative to fat injections. Dermis fat grafts can be harvested from the suprapubic area trimmed and moulded to exactly fit any shape and defect. They have proven their reliability to such an extent that they can also be used to cover the stigmata of HIV patients lipodystrophy in the cheeks, inherent their therapy Fat grafts are usually a remnant of trimming the neck during a face lift procedure, while muscle grafts can be harvested from the resected surplus of blepharoplasties and the SMAS. In our own experience fat grafts with intact fat cells from the neck show more reliable results especially in the sensitive periorbital region, where granulomas and irregularities are very well detected and more volume is needed. Acellular dermis is industrially available, safe, easy and predictable in it’s long term volume. The main indications are the paranasion, the lips and the bridge of the nose in secondary rhinoplasties. In summary the biological predictability of volume and homogenity and easy of preparation of grafts consisting of vital or preserved structures like acellular dermis render satisfying aesthetic and reconstructiv results in facial aesthetic surgery and makes them a useful alternative to fatinjection to face. 6. An alternative fixation technique for the endoscopic brow lift. Andreas Foustanos, Greece Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, since only 3 hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal bowpexy. One of the controversial points is the fixation of the flap in the elevated position. Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zigomaxilla. In a 6-year period from September 1999, 300 patients underwent endoscopic brow lift using our fixation approach, which was accomplished with an absorbable suture subperiosteally. Satisfactory forehead rejuvenation was obtained in all patients, with correct eyebrow movement. Long-term results of 6 years confirm the strength and durability of this fixation approach. We consider this approach to be a simple, secure, and reliable forehead fixation method, an alternative to other fixation methods, that allows satisfactory and long-lasting cosmetic results. 7. Large volume breast reduction with vertical pedicle technique M. Icekson, Ioana Nedelcu, A. Ofek, K. Agam, T. Tzur, R. Newman Department of Plastic Surgery Hadassah Medical Center and Hebrew University, Jerusalem, Israel Hereby we present a series of 18 consecutive patients who underwent large volume breast reduction (more than 600gr) in our medical center, in the past 5 years. The breast reduction was performed according to the vertical Hall – Fiendly technique and the mean weight of breast tissue reduced was 730gr per breast. The follow up period was between 1 and 5 years. The out shows that the advantages of the Hall – Fiendly technique (good shape, less scars, reduced blood loss, shortening of the operating time) can be maintained with large volume breast reduction. Our results bring together aesthetic standards and minor rate of complications. This experience enables us to consider the vertical pedicle reduction technique as a good choice for large volume reductions. 8. Refinements of vertical scar mammaplasty: circumvertical skin excision design with limited inferior pole subdermal undermining and liposculpture of the inframammary crease Bishara S. Atiyeh, Michel T. Rubeiz and Shady N. Hayek Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon Vertical scar mammaplasty, first described by Lötsch in 1923 and Dartigues in 1924 for mastopexy, was extended later to breast reduction by Arié in 1957. It was otherwise lost to surgical history until Lassus began experimenting with it in 1964. It then was extended by Marchac and de Olarte, finally to be popularized by Lejour. Despite initial skepticism, vertical reduction mammaplasty is becoming increasingly popular in recent years because it best incorporates the two concepts of minimal scarring and a satisfactory breast shape. At the moment, vertical scar techniques seem to be more popular in Europe than in the United States. A recent survey, however, has demonstrated that even in the United States, it has surpassed the rate of inverted T-scar breast reductions. The technique, however, is not without major drawbacks, such as long vertical scars extending below the inframammary crease and excessive skin gathering and “dog-ear” at the lower end of the scar that may require long periods for resolution, causing extreme distress to patients and surgeons alike. Efforts are being made to minimize these complications and make the procedure more user-friendly either by modifying it or by replacing it with an alternative that retains the same advantages. Although conceptually opposed to the standard vertical design, the circumvertical modification probably is the most important maneuver for shortening vertical scars. Residual dog-ears often are excised, resulting in a short transverse scar (inverted T- or L- scar). The authors describe limited subdermal undermining of the skin at the inferior edge of the vertical incisions with liposculpture of the inframammary crease, avoiding scar extension altogether. Simplified circumvertical drawing that uses the familiar Wise pattern also is described. 9. Breast Size and Shape Enhancement with MATRIX Implant (New Dimensional Sequential System - CAIS Planning System) Constantin Stan1 ,Tiberiu Bratu2 1 Medical Service Clinic, Bacau 2 Brol Clinic, Timisoara Context: The selection of the appropriate breast implant correlated with the implantation of this implant at its proper position on the thorax in respect to patient characteristics is the key to a successful breast augmentation. However, choosing the appropriate implant out of the available 240 shapes of the INAMED-Allergan 410 and 510 families of implants, communicating this selection to the patient and choosing an appropriate operating plan is not an easy task. Objective: To present the audience with a new way to approach implant selection as well as a new way to involve the patient more in the shared responsibility for the outcome of the breast augmentation intervention through the use of CAIS software. Also the presentation will demonstrate the use of software in the selection of the operating plan. Design: The presentation will demonstrate the use of CAIS throughout the various steps of the selection process as well as its assistance in the operating plan: - tissue evaluation - tissue limitations - selection of the width - selection of the height - selection of the projection - simulation of the prospective result - adjustments of the selection to handle special case - operating plan o implant position o needed envelope (lower ventral contour length) o incision length Conclusions: In our experience of more than 900 patients, in the last three years, we have discovered that the selection of an appropriate implant is much simpler through the use of the computer and together with a proper operating plan and the use of proper tools it yields better results. Patient involvement in the implant selection process increases the postoperative satisfaction. Better results, together with more satisfied patients, create more patients because a satisfied patient is a walking commercial. 10. Mono-RF stan Breast Suction Forceps for Pocket Multiplan Dissection in Breast Augmentation Constantin Stan Medical Service Clinic, Bacau One of the more important steps in performing a successful breast implant is creating the pocket for the implant. Traditionally, the pocket is created using a sharp instrument (scalpel or scissors) to cut and dissect the tissue. The main problem creating the pocket with a sharp instrument is the bleeding which obscures the surgical site and can reduce the surgeon’s accuracy. Bleeding is messy and time consuming to control but if time is not taken to control the bleeding, accuracy is compromised. Another traditional method used to create the pocket is blunt dissection. Blunt dissection however can tear rather than precisely and cleanly cut the tissue. Tearing and separating tissue with blunt dissection is a blind method and while it is fast it is very traumatic and causes an abundance of bleeding. The two traditional methods are easier and faster to learn and can be immediately added to a surgeon’s arsenal of surgical treatments, but the sharp or blunt dissection techniques cause more bleeding, more tissue injury, can tear tissue and result in a longer recovery time. An alternative to the two traditional methods is using the state-of-the-art radiosurgery dissection technique with the Ellman Mono RF Stan Breast Suction Forceps, which cleanly and precisely cuts tissue and coagulates bleeding vessels at the same time. A dry pocket means more accuracy and better vision for the surgeon. Utilizing radiosurgery results in a dramatically shorter recovery time in more the 95% of augmentation patients. Even in sub-muscular pocket dissection the majority of the patients can return to normal life in less than two – three days. Precise 4.0 MHz high frequency/low temperature dissection, using the special monopolar plume suction forceps to cut and coagulate bleeding vessels under direct vision can produce a very precise pocket in short time (less than 20 – 30 min.). The radiofrequency method dramatically reduces the risk of complications (bleeding, infection, asymmetry, etc). Additionally there is no pain. Consider the difference between a classic two-week recovery period with sharp or blunt dissection and potentially a two to three day recovery period using radiosurgery. Patients treated using radiosurgery can resume normal activities faster, lie on breast sooner, have less “down time”, a much easier recovery and with less risk of developing capsular contracture. A dramatically shorter recovery time means a better experience for the patient and a more satisfied customer. There is a drastic difference between doing things easier and better. Sharp or blunt dissection is easy and seems logical if a surgeon is unaware of RF Dual Surgery with mono RF Stan Breast Suction. The RF Dual Surgery with mono RF Stan Breast Suction technique is somewhat more difficult to master but the results are worth the time spent learning the technique. Nothing is easy in surgery and everything is difficult until you learn. Sharp or blunt dissection is faster to learn but knowing RF Surgery in breast augmentation exists and learning the technique is better. A physician must and can only do the best using “The Breast Enlargement Ellman RF Stan Sets”. 1. “Breast enlargement Ellman RF Stan sets (inframammary approach)” - Mono RF Stan Breast Suction Forceps - Empire microincision needle Electrode TEE 307 - Empire microincision needle Electrode TEE 313 - Fine Insulated coated needles – D6C.009.Regular wire 2. “Breast enlargement Ellman RF Stan sets (periareolar approach)” - Mono RF Stan breast suction forceps - Empire microincision needle Electrode TEE 305 - Empire microincision needle Electrode TEE 312 - Fine Insulated coated needles – D6C.009. Regular wire (for skin incision) 11. What am I doing in these particular cases? (primary, secondary or difficult breast augmentations) C. Stan1 , T. Bratu2 1 Medical Service Clinic, Bacau 2 Brol Clinic, Timisoara Panel discussion with different cases presented by panelists in interactive discussion with the participants. Every panelist in PowerPoint multimedia presentation will show patient photos for breast augmentation with different characteristics , tissue limitations and surgical problems in particularly breasts: primary difficult breasts with ptosis, soft tissues and thorax asymmetries and secondary cases with implant exchange for different aesthetic and specific complications. 12. A Double Flap Technique - An Alternative Mastopexy Approach. Andreas Foustanos Greece Mastopexy surgery has been modified in the past few years, as Plastic Surgeons worked to improve and maintain the breast shape and especially the “bottoming out” of the gland in the late post-operative period. The concept of internal suspension to support the breast is not new, however in our approach the suspension achieves true permanent lifting in the mammary tissues utilizing a combination of superior and inferior breast flap. We create an inferior mobile, chest wall based flap of breast tissue. We transpose this inferior breast tissue flap up and beneath the upper breast and behind the nipple areola complex with sutures anchoring to the pectoralis fascia. We observed minimal breast descent when performing this approach, providing excellent long term aesthetic outcome. Experience with this approach spans a period of 10 years since the first author described and applied this technique and includes 110 patients, indicating the durability of this correction. 13. Combined otoplasty technique: Understanding the importance of conchal resection in the correction of the prominent ear Alexander Margulis 1 and Bruce S. Bauer 2 1 Department of Plastic Surgery, Hadassah Medical Center of Hebrew University, Jerusalem, Israel 2 Division of Plastic Surgery, Children's Memorial Medical Center of Northwestern University, Chicago, Il. Correction of a prominent ear can have profoundly positive effects on an individual’s self image provided that the otoplasty technique chosen is appropriate for the specific deformity and the results fit what we view as “normal” shape and proportion for the ear and face. Minor ear deformities, either before treatment, or post otoplasty can have equally profound negative effects. Certainly the failure to correctly analyze the complex deformity that comprises the prominent ear is the most common cause of the undesired result. The technique described in this presentation has evolved over the past 20 years of practice and represents both a recognition of the vast variation in the ear deformities that we classify as “prominent”, and a realization that too much emphasis has been placed on creation of the antihelical fold and not enough on the recognition of the role of conchal hypertrophy in creating this ear prominence. The goals of otoplasty were outlined by McDowell and remain universal despite the wide variation in prominent ears. These goals include: 1) correction of protrusion; 2) correction of the prominently visible helix and antihelix; 3) to create a smooth antihelical fold; 4) to not disturb the post auricular sulcus; 5) to avoid a plastered down post- operative appearance, and finally 6) to avoid a sharp antihelical fold. Based on these goals, the majority of otoplasty techniques in the literature address correction of the antihelical effacement alone. However, the sheer number of different methods is testament to the difficulty in achieving reproducible results and a satisfied patient. The majority of patients that I have seen for secondary otoplasty have been those whose conchal hypertrophy has been ignored, ineffectively treated or missed entirely in the initial (and on occasion subsequent) analysis. Overemphasis on creation of an antihelical fold has resulted in sharp, irregular, and unsightly antihelical folds, with buried helical rims in many of these cases. Addressing conchal hypertrophy in these patients alone, or in conjunction with other ancillary techniques, has produced consistent and reproducible outcomes. 14. Open versus close rhinoplasty D. Totir1,2 , C. Mitache1 , Ruxandra Sinescu1 , A. Cinca1 1 Plastic Surgery and Reconstructive Microsurgery Clinic Clinical Emergency Hospital Bucharest 2 Dermastyle Clinic Open versus closed rhinoplasty it's a permanent issue debate each one of them having it,s own advantage and desadvantages. We present our experience in this technique with i tehe last two years in order to emphasis the features of the two methods as well as and the possible indications 15. Secondary rhinoplasty Penelopia Marinescu, B. M. Marinescu Central Military Hospital-Bucharest The aesthetic reconstruction in the rhinoplasty sequellas remains the most challenging of all aesthetic procedures ,especially when dismorfic shape is accompanied whith internal disorders,as bad scars,colapsus of allar border,septal perforation,etc.The paper presents our method for restoration ,using the autollogous cartilage graft . 16. Connection between aesthetic and functional surgery in blepharoplasty Ileana Boiangiu, Luminita Banacu, T. Panazan, Oltea Popescu, Cristina Brezeanu, Crenguta Jecan. Clinical Hospital for Plastic Surgery and Burns, Bucharest Blepharoplasty has evolved to a surgical concept of functional surgery that includes an aesthetic component. The paperwork presents the criteria of functional evaluation along with the aesthetic component of the surgical procedure and the surgical results in cases in which the functional component was disregarded. The surgical result is essentially changed by combining aesthetical and functional techniques. 17. What we are doing and where are we going in abdomen and lower limbs reshaping surgery Noela Elena Ionescu, I.P. Florescu, S. Marinescu, Carmen Giuglea, E. Turcu, Ioana Apostolescu, Ingrid Marinescu Plastic Surgery Department Clinical Emergency Hospital „Bagdasar-Arseni” The increasing demand for Plastic Surgery of the abdomen has also increased the number of complications, few of them difficult to approach. Abdominoplasty is an important procedure both as an aesthetic and reconstructive technique. Despite the fact there are practitioners who perform liposuction in the same time with abdominoplasty, we don’t agree the idea. Our presentation emphasizes there are new possibilities of reducing complications (like ischemia, flap necrosis etc) and enhance the body contour. 18. The use of breast balloon dissector in augmentation mammoplasty; Our experience in 150 consecutive cases Ioana Nedelcu, T. Tzur, R. Neuman Department of Plastic Surgery Hadassah Medical Center and Hebrew University Jerusalem, Israel The Snowden Pencer Spacemaker surgical balloon dissector facilitates the creation of the breast implant pocket during breast augmentation surgery. The surgical balloon dissector is placed through the inframammary incision, beneath the gland on the pectoralis muscle, inflates very quickly, completing most of the dissection, making the procedure much quicker and easier. In our experience, as presented in 150 consecutive cases, the device spreads the breast tissue in its natural plane, providing a virtually blood free breast pocket. This may help to decrease the pain of the procedure and minimize the occurrence of capsular contracture : 1% only. The device can be filled with physiological saline, and be used as a sizer. Symmetry can also be assessed prior to breast implant placement when both sides are inflated. 19. Mastopexy and breast augmentation for ptotic breast. How to ensure a long term result? N. Antohi, V. Stan, C. Stingu Clinical Hospital for Plastic Surgery and Burns, Bucharest Medical University “Carol Davila” On associating mastopexy with the implants for ptotic hypotrophic breasts it is important not only to achieve a good shape and projection. The long-term stability of the result is important as well. The aim of this study is to present our experience in performing mastopexy with breast implants using superior dermal flap and lower myofascial flap. The proposed method was used in eight women second degree breast ptosis. In all cases the vertical scar mastopexy was performed, breast implants being placed under the pectoralis major muscle. The superior dermal flap was sutured to the lower myofascial flap based at the inframammary fold over the lower pole of the implant. The lateral and medial pillars were sutured together. The skin edges were sutured without tension. Good final results were obtained in all cases at one year. No bottoming out occurred. In conclusion, we can consider this technique as a good method to ensure a long term stability of the result of mastopexy associated with breast implants. 20. Medial and inferior bipedicle mammaplasty for gigantomasty. Case reports. N. Antohi, V. Stan, C. Stingu Clinical Hospital for Plastic Surgery and Burns, Bucharest Medical University “Carol Davila” The most frequently used method to reduce the breast volume in gigantomasty is breast reduction with free nipple graft. This method is less appropriate for young women who want to preserve sensibility and natural appearance of the nipple-areola complex (NAC). This aim could be achieved by transposition of the NAC on the different pedicles (superior; inferior, medial, lateral, horizontal bipedicle, vertical bipedicle etc…). But in severe gigantomasty even the most reliable technique could not ensure the viability of the NAC. To prevent necrosis of the NAC we have proposed the transposition of the nipple- areola complex on the medial and inferior pedicles. This method was used in the 22-years old woman with bilateral gigantomasty. The distance from the new position of the areola to the inframammary fold along the breast meridian exceeds 40cm. The medial and inferior breast reduction has been performed. We removed 1820 g from the left side and 1950g from the right site. The postoperative course was uneventful. The sensibility of the nipple was present after the surgery. In conclusion, medial and inferior bipedicle breast reduction could be considered a good alternative to free nipple graft breast reduction for gigantomasty. The method ensure and preserve good vascularity and sensibility of the NAC. It’s easier and more safety to rotate NAC based on the medial pedicle then on the superior vertical pedicle 21. The results after reduction mammoplasty and/or breast lift A. Rebosapca, B. Andreescu, I. Marinescu, D. Barzu Clinical Emergency Hospital Colentina Bucharest Results can be evaluated by the shape and volume of the post-surgical breast, as well as by the quality of the scars. In both of types of mammoplasty – reduction and/or breast lift – we tried to obtain not only the ideal position but also the projection the patient asked for. Most of the incisions were in shape of inverted T and periareolar. The resections of mammary tissue were usually performed in the lower half of the breast. The vascularization of the nipple and areola was provided for by a bipedicle flap, so as to avoid ischemic complications, while the lower pedicle was useful for the suspension of the prepectoral fascia. 22. Aesthetic result in breast augmentation – limits and expectations Carmen Giuglea, Marinescu S, Noela Elena Ionescu, Florescu IP Plastic Surgery Department Clinical Emergency Hospital „Bagdasar-Arseni” Aesthetic result in breast hipotrophy surgery with minimal ptosis is frequently an excellent one after implants insertion, with high level of immediately satisfaction and also reliable long term results. The paper propose our approach in borderline cases (between augmentation and mastopexy), when an important role have the scar quality and aspect and also long-term result on breast shape and position. The right surgical indication is the success key; so the practitioner should establish the correct surgical option: implants insertion for augmentation; implants and mastopexy (various techniques: circumferential periareolar excision, etc). Also, we emphasized the role of implant placement (retroglandular or under the pectoralis major muscle). Obtaining a medium size breast doesn’t matter surgical options lead to the best possible long-term and reliable result. 23. Our experiences concerning augmentation mamoplasty with anatomic coesive gel anatomic profile implant D. Totir1,2 , C. Mitache1 , Ruxandra Sinescu1 , A. Cinca1 1 Plastic Surgery and Reconstructive Microsurgery Clinic Clinical Emergency Hospital Bucharest 2 Dermastyle Clinic We present our experience within the last two years in augmentation mamoplasty with anatomic coesive gel implant and the complications incidence through out this period. 24. Breast augmentation revision T. Bratu, D. Grujic, S. Olariu, D. Olariu., D. Mihajlovic, Z. Crainiceanu Brol Medical Center Timisoara Department of Plastic and Reconstructive Surgery, Casa Austria Considering 10 years of experience, breast augmentation revision requires good preparation from the material and mental point of view. The cases that reffered to us with this problem fortunately were not revendicative cases. They understood that the result can not persist for ever. We conclude that the revision was neccesary in patients that have under gland implants, those who gave birth and nourished babyes and those who refused suplimmentary scars for resolving the ptosis. 25. Mammary asymmetry Ileana Boiangiu, Luminita Banacu, Cristina Brezeanu, Crenguta Jecan Clinical Hospital for Plastic Surgery and Burns, Bucharest We present the criteria to select two different implants (volume, shape and dimensions) in order to correct common mammary asymmetry. We also present cases in which a mammaplasty technique was required in order to correct the mammary asymmetry. 26. Mammary hipotrofy and ptosis T. Bratu, D. Grujic, D. Olariu., D. Mihajlovic, Lj. Grujic, Z. Crainiceanu Brol Medical Center Timisoara Department of Plastic and Reconstructive Surgery, Casa Austria Over the past few years there has been an increase in the discussion of one stage augmentation and mastopexy throughout the literature focused mainly on proper patient selection, technical surgical steps and potential pitfalls and complications. During a period of 2 years we had 31 patients with hypotrophy and IInd and IIIrd degree ptosis, for whom we performed mammopexy and mammary implant in the same surgical time (26 patients with II nd degree ptosis and 5 patients with III rd degree ptosis). The immediate and late postoperative results are more than satisfactory both for surgeon and patient. Some surgeons prefers to do first mammopexy and after 6-9 months the augmentation, others prefer to do first the augmentation and after 3-6 months the mamopexy . When is a severe ptosis or we have to remove a lot of skin with no elasticity, it is preferable to perform a superior pedicle technique combined with complete retromusculofascial implant. Our goal is to maintain the shape long time after surgery. 27. Hair transplant surgery: state-of-the-art Bessam Farjo England It’s nearly 50 years since the first U.S. published hair transplant procedure. Although slow to evolve at the beginning, the last 10 years or so have seen a dramatic transformation of this surgical procedure into a true art form. The latest techniques, ideas and scientific advances will be presented including Follicular Unit Transplantation, Follicular Unit Extraction, Old Surgery Refining, Medications as well as current research. 28. The place of mesotherapy in allophatic medicine and in aesthetic medicine Ioan Nedelcu “Fizioderma” Diagnosis and Treatment Center, Bucharest Mesotherapy is a new and simple therapeutic concept which leads to obtaining a great proximity between the place where the therapy is applied and the pathologic area, aiming to achieve increased efficiency. Mesotherapeutc techniques use very small quantities of drugs that must be injected intradermal in a number of points within the treated area. The origin o the word “mesotherapy” comes from the embryologic concept of “meso- mesoderm”, the embryologic layer situated between the endoderm and the ectoderm and from which the muscles, the blood, the skeleton and the connective tissue will be formed. The word “mesotherapy” connected with “mesoderm” suggests that this new therapeutic technique will be active especially upon the tissues formed from the mesoderm. The birth of mesotherapy is linked to the year 1958 when L. Pistor used this word for the first time in a medical article. The effects of the active substances injected using the techniques of mesotherapy are achieved by: a) The direct and specific action of the drug used and injected in microdoses intradermal b) Reflexotherapy c) The simultaneous stimulation of some of the acupuncture points. In the allopathic medicine mesotherapy is a complementary technique that can be used as monotherapy or in association with: a) Allopathic treatments applied systemically b) Active reologic treatments, infrared, hydrotherapy, massage c) Treatments that modify the functional status of muscular cells (ultrasound, ultrashort, talasotherapy, lasertherapy, polarized light, electrotherapy, electrostimulation) and of fat cells (ultrasound, massage therapy, infrared) d) Treatments applied on the nervous system (acupuncture, reflexotherapy) e) Treatments for the mechanic osteoarticular disorders (presotherapy) f) Phlebotrophic treatments In the allopathic medicine mesotherapy is efficient on: a) Muscular pathology b) Osteoarticular pathology c) The pathology of the spine and the modifications produced by arthrosis d) Vascular pathology In the aesthetic medicine mesotherapy confirmed its spectacular effects in: a) Revitalizing, energizing, calming and rejuvenating the complexion b) The treatment of wrinkles c) Mesolifting (mesobotox) d) The therapy of lipodystrophic changes: cellulites, abnormal fat deposits, lipoma, postliposuction side effects, xantelasma e) The treatment of overweight f) Reshaping the body and face contour (lipotomia) g) The therapy of aging and flaccid skin During the first 30-40 years of mesotherapy the scientific basis of its mechanisms has been established and especially its possibilities and limits in allopathic medicine have been very clearly lined, as shown above. During the past 10-15 years mesotherapy’s use in the aesthetic medicine has undergone a spectacular growth because of the progress achieved in perfecting the techniques and the devices used and also because of the new products with outstanding effects. The place, the indications and the effects of the aesthetic mesotherapy in the treatment of cellulites, aberrant fat deposits, reshaping the contour of the body and face (lipotomia) are discussed, as shown in the personal experience.
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