Docstoc

RESUMENES - ABSTRACTS

Document Sample
RESUMENES - ABSTRACTS Powered By Docstoc
					                                Dr. Michael Nagy

   1. VASER Applications in Breast Reduction Surgery- Expanding VASER
      use to the breast will be discussed. Utilizing aspiration only, or aspiration
      combined with excision of skin and breast tissue. Using the VASER has
      resulted in ‘downsizing’ of the operation with less scarring. Also
      decreased blood loss, less post operative pain as well as making the
      surgery easier for the surgeon.
   2. VASER Assisted Rhytidectomy- VASER use to safely dissect the skin
      flaps as well as aggressively treat the neck will be discussed. We have
      noted excellent skin retraction, reducing the need to perform a direct skin
      excision in the submental area. VASER use has shown to be safe and
      decreases operative time.
   3. Advanced VASER Use in Body Contouring – VASER use in primary
      liposuction procedures of the upper arms and thighs results in excellent
      skin retraction and patient satisfaction. Combining VASER assisted
      lipoplasty and excisional surgery of the extremities results in consistently
      superior results compared to excisional surgery alone.. I will also discuss
      my personal experience with the VASER contralateral study which is
      designed to evaluate effect of VASER on skin retraction, post operative
      pain and bruising, and blood loss.


                              DR. GERMÀN ROJAS


              LIPOIMPLANTE FACIAL TECNICA SIMPLIFICADA

El envejecimiento, comienza en el momento del nacimiento, y sigue un curso
predecible, y sin pausa durante el resto de nuestra vida.
La herencia, los hábitos personales, la fuerza de gravedad y la exposición al
sol, son los factores que contribuyen para que esto nos suceda, pero el
verdadero proceso responsable del envejecimiento es la degeneración y
relajación de las fibras elasticas, de la piel y el soporte de las mismas y el tejido
conectivo.
Uno de los procedimientos quirurgicos, para el tratamiento de las líneas de
expresión facial, pómulos, labios, menton y mejillas, es el Lipoimplante Facial.
El objetivo es presentar una técnica sencilla, con la utilización del mínimo
instrumental, de bajo riesgo y de fácil aplicación, realizada en un periodo de 10
años (1995-2005)



    ELEVACION DE LA COLA DE LA CEJA CON MÍNIMAS INCISIONES

El envejecimiento, los cambios tisulares asociados y los efectos de la
gravedad, dan como resultado un descenso gradual de las cejas y la frente, se
han descrito por los científicos un sin número de técnicas encaminadas a la
reubicación de las cejas, con el fin de mejorar la apariencia del tercio superior
de la cara.
El objetivo es mostrar, un estudio de cinco años (2000-2005) de la técnica que
estamos realizando, la cual se ha venido perfeccionado y estandarizando, a
través de los años y la experiencia.


                  MAMOPLASTIA 15 AÑOS DE XPERIENCIA

Las mamas son sin duda, uno de los elementos más importantes de la belleza
femenina, su anatomía y su desarrollo constituyen una de las características
más destacadas de la mujer, la mama femenina ha sido un constante motivo de
atracción a través de la historia, el arte y la sensualidad, emblema de la
maternidad y zona erógena por excelencia.
El objetivo es mostrar, lo que se ha venido realizando, la evolución y la
casuística utilizada y empleada en 15 años (1983/2008), de arduo trabajo,
sacrificio y dedicación a la ciencia arte de la cirugía estética de la mama.
No existe una mama normal, si no gran numero de mamas normales, sin
importar, los gustos o estándares de belleza, lo ideal y aceptado es que sea
atractiva y armoniosa para a la mayoría de las personas.

                LIPOESCULTURA 15 AÑOS DE EXPERIENCIA

La delgadez y la buena figura es una adquisición reciente de nuestra
civilización y del mundo moderno, atrás quedo la gordura como canon de
belleza de otras épocas. La silueta corporal es debida en parte a la talla, en
parte a la musculatura, pero más que nada a la grasa que la envuelve y es por
eso que la Lipoescultura, es la cirugía que más se realiza en el mundo como
procedimiento estético primario.
El objetivo es mostrar, lo que se ha venido realizando, la evolución de la
técnica y la casuística de 15 años (1983/2008) en el perfeccionamiento de este
procedimiento quirúrgico.


                             Dong-Sung Moon, MD

Dual Plane Tumescent Infiltration for Bloodless Liposuction


Vice-president, Korean Academy of Cosmetic Surgery (KACS)

(ABSTRACT)
To achieve bloodless liposuction it is necessary to infiltrate tumescent solution
evenly throughout all fat layers. But there was no definite written methodology
to make completely even distribution of infiltrated tumescent solution but to
depend on long term experience. The authors propose new concept of
tumescent infiltration technique for bloodless liposuction. It is "Dual Plane
Tumescent Infiltration."
Dual Plane Tumescent Infiltration is consisted of two steps. First step is deep
layer tumescent infiltration - loose space just above the fascia of muscle.
Second step is superficial layer tumescent infiltration - tight space just below
the dermis of skin. At the two spaces, just above fascia of muscle and just
below the dermis of skin, blood vessels are thick and abundant. So dual plane
tumescent infiltration brings on aqua dissection effect of muscle and skin from
the fat layer. As a consequence it results in scanty bleeding. The authors say
deep layer tumescent infiltration as "bloating"(bloating up to fat layer), and
superficial layer tumescent infiltration as "raining"(raining down to fat layer).
To reveal the theory, we checked MRI scan of abdominal wall after performing
dual plane tumescent infiltration. MRI showed definite image of bloating and
raining concept. It means completely even distribution of infiltrated tumescent
solution. For long time with more than 1000 cases of clinical trial, those results
were quite excellent and repeatable. So we think dual plane tumescent
technique might be future standard technique of tumescent infiltration for
bloodless liposuction.


                               Man-Tack Ro, MD

Easy suture ligation method using new instrument in eyelid surgery

Auditor, Korean Academy of Cosmetic Surgery (KACS)

(ABSTRACT)
Eyelid surgery of young person is very common in Asian cosmetic field.
The number of suture ligation method operation is growing up in eyelid surgery.
There are many kinds of suture ligation method exist. Suture ligation method is
easy, but some problem will be occurred after operation. Asymmetry, fading of
crease are common after suture ligation method. We invented new instrument
for making eyelid crease easy and correct. With new instrument we obtained
satisfying results



                            Young Sil Kim, MD PhD

Fat Grafting (I): All-Layer Fat Grafting: fat grafting into fat, muscle and
periosteum layer

President, Korean Academy of Cosmetic Surgery (KACS)

(ABSTRACT)
As human ages, the face becomes wrinkles and droops due to decrease in
volume of the soft and hard tissue in fat, muscle and bone. To overcome this
senility, restoration of the decreased volume of soft tissue and hard tissue is
suggested for the solution.
The author suggested that "All Layer Fat Grafting" will be a proper answer for
that. All layer fat grafting is fat injection technique into periosteum-layer,
muscle-layer and fat layer.
In short-term, this technique minimizes the bleeding, bruise and edema with
short recovery period. In long-term, grafted fat tissue has higher survival rate
due to the abundant blood supply to muscle and periosteum. The author
assured that this technique can change contours of human face safely and
easily.
The author developed the this technique and the proper equipment, and
announced at the congress in November 2004, for the first time. Through more
than 1000 of successful cases for 4 years, now I assured that this technique will
be a standard technique of fat grafting in the near future.

Fat Grafting (II): Homologous Fat grafting: Fat Grafting from other person

(ABSTRACT)
Autologous fat grafting is one of the most rapid developing cosmetic surgery
technique. Through this technique human face contour can be changed and
skin look more younger. But this technique has limitation that the patient should
have abundant fat in the body. So those who has extremely lean body fat can
not be applied by autologous fat grafting.
To overcome this limitation, the author developed 'Homologous Fat Grafting'
with subject of 5 patients who want fat grafting, from the fat tissue of other
person, since 2005 until this time. This procedure was done after '3 Step Tissue
Compatibility Test' which was developed by the author.
On 30th November 2005, 'Tissue Compatibility Test' of first case was done. On
14th February 2006, the world first 'Homologous Fat Grafting' was done in my
clinic, Korea. For 2 years and 4 months follow up, since the first case until this
time, any side effect has not been seen, and the result was fully satisfied. And
after 4 more cases, there has not been any side effect also, and they all was
fully satisfied too.
The author think that homologous fat grafting is very epochal method for
extremly lean person who is unable to do autologous fat grafting and does not
want fat harvesting. Now the author reports this epoch-making satisfactory
results as a literature.

Fat Grafting (III): Stem Cell Fat Grafting: Fat Grafting with Adipocyte
derived Stem Cell

(ABSTRACT)
There are several research results showing the evidences that fat tissue
contains plenty of stem cells. Comparing to bone marrow and cord blood, the
fat is the best provision to gain stem cells easily. And the efforts to use these
stem cells in cosmetic area is remarked.
By the way, fat-grafting has some disadvantage of decreasing in volume of
transplanted fat tissue as the time pass. So one time procedure is not apt to
provide satisfactory survival rate.
To overcome this problem, the author applied a technique to extract high
concentrated adipocyte derived stem cell(ADSC). ADSC was isolated and
extracted with the series of process from the fat tissues of the patients.
ADSC was mixed with purified fat for transplantation. Then the author injected
the 'stem-cell-mixed-fat' into the face and body via 'all layer fat grafting'
technique which was developed by the author.
The result illustrated that the survival rate of transplanted fat was maximized.
Besides maximized survival rate of fat tissue, the restoration of the wrinkle,
inhenced neo-vascularization, skin-rejuvenation, and improved elasticity of the
skin were observed due to the adipocyte derived stem cell(ADSC) effects.


        Suad Helena Quessep, MD and Priscila M. M. Belitardo, MD

Adipocavitacíon Extracorpórea Focalizada

Extracorporeal Focalized Adipocavitation

Background En la era de la tecnología médica y los tratamientos minimamente
invasivos surge el ultrasonido focalizado como un método efectivo para la
reducción de la grasa localizada y el modelamiento corporal.

Methods Realizamos un estudio descriptivo retrospectivo, involucrando a los
pacientes que consultaron nuestro centro en búsqueda de un tratamiento para
la eliminación de grasa localizada en distintas zonas del cuerpo, en el lapso de
tiempo comprendido entre mayo de 2007 y mayo de 2008. De este universo,
156 pacientes eran aptos para este tratamiento, de los cuales 109 pacientes se
sometieron a adipocavitacíon. Todos los pacientes firmaron un consentimiento
informado, recibieron orientación nutricional para llevar una dieta baja en grasa
y se les realizo un examen antropométrico, que consiste en peso corporal y
medida de las circunferencias de las zonas tratadas a una altura
predeterminada, además de un registro fotográfico en posiciones
estandarizadas. Los controles se hacían cada 4 semanas.

Results Nuestra experiencia de más 100 pacientes tratados con el ultrasonido
focalizado extracorpóreo demostró una reducción promedio de la circunferencia
de la zona tratada de 3,2 cm, por sesión, con una variación en el peso corporal
de 221 gramos en promedio, sin ninguna complicación observada. El número
de sesiones realizadas en promedio fue de 2,6 por paciente, con un total de
reducción en promedio de 8,32 cm en circunferencia, al final del tratamiento,
con un índice de satisfacción de 92%. La superficie de la zona tratada
disminuyo en forma homogéneo sin presentar ondulaciones ni fibrosis en un
100% de los casos. Todos los pacientes tratados se incorporaron
inmediatamente a sus actividades cotidianas. Los resultados fueron sostenibles
durante los 6 meses de seguimiento.
Conclusions La Adipocavitacíon Extracorpórea es un método efectivo, seguro
y no incapacitante constituyéndose en una excelente alternativa para el
tratamiento para la grasa localizada e el modelado corporal.




     DR. GUSTAVO LEIBASCHOFF Specialist in ObGyn, Cosmetic
 Surgeon,President of the International Union of Lipoplasty, President of
   ICAM International Consultants in Aesthetic Medicine, Dallas,USA

3818 Cedar Springs #101-347
Dallas Texas 75219
Ph. 469 878 8611
Fax 214 520 3684


   A double-blind, prospective, clinical, surgical, histopathological and
 ultrasound study comparing the effectiveness and safety of liposuction
   performed using Laserlipolysis and Internal Ultrasound Lipoplasty
            method, and assessing the evolution in patients.


Collaborators


DR. HECTOR PIQUE Specialist in Plastic Surgeon, Professor in the
Catholic University of Argentina
DR. ALEJANDRO DIZ Specialist in Internal Medicine and
Ultrasuonography, Buenos Aires, Argentina

DR. ROBERTO SCHROH Chief of Dermatopathology at the Ramos Mejia
Hospital
(Buenos Aires-Argentina) Professor of Pathology in the School of
Medicine, University of Buenos Aires, Argentina
DRA. MARIA CELESTE SLUGA Specialist in ObGyn, Italian Hospital,
Buenos Aires, Argentina

SUMMARY:

A clinical and instrumental study was carried out to determine the effects
of laserlipolysis as compared to the Internal Ultrasonic Liposuction
procedure. The study was aimed at determining the performance of these
devices in patients with lipodistrophy in the saddle bags.
The study had a prospective, longitudinal, and double-blind design.
A group of female patients with lipodistrophy in the saddle bags was
investigated.
Liposuction was performed in all patients: laserlipolysis was applied on
one side, and the internal ultrasound procedure was applied on the other
side.
Pictures were taken from all patients before the procedure, and 1, 6, and
21 days after the procedure.
All patients were clinically evaluated before the liposuction procedure,
and then 1, 6, and 21 days after the procedure.
Histopathological studies were performed in all patients; bilateral fat
biopsy specimens were collected before and after the procedure.
A bilateral ultrasound study (7.5-10 Mhz variable frecuency) was
conducted in all patients before the liposuction, and 30 days after the
procedure.
As this was a double-blind study, neither the team performing the
ultrasound nor the team performing the histopathological studies nor the
patients, knew what device the surgical team had used on each side.
 The study was conducted in patients with lipodistrophy. The surgical
team applied laserlipolysis on one side and treated the remaining side
with internal ultrasound. In every case, the laserlipolysis and the internal
ultrasound procedures were applied for the same length of time. The
surgical team made a bilateral aspiration with a syringe and a 2mm-
microcannula, with a maximum of 200cc of emulsion in both sides.
Prior to liposuction and after superwet-tumescent anesthesia, fat tissue
samples were collected from both sides (left and right). Then, after
performing liposuction, samples were collected again from both sides.
From a clinical point of view results showed, to physician and patients, an
improvement in signs (localized obesity) in both sides, however, the side
treated with laserlipolysis showed fewer side effects (no pain, small
bruising, and little edema) than the other side.
The ultrasound studies showed similar fat tissue results bilaterally.
The histopathological study showed a better effect on the adipose tissue
in the laser treated side.
From a surgical point of view, the laserlipolysis technique is easier to
perform, and scars are smaller as compared to those caused by internal
ultrasound.

Dr. Gustavo Leibaschoff
President of ICAM USA Inc
International Consultant in Aesthetic Medicine
President of the International Union of Lipoplasty -IUL-
Chairman International Academy in Aesthetic Medicine and Pathology-IAAMP-
Member of the American Academy of Cosmetic Surgery AACS
Director of the International School of Mesotherapy ISM
Common lies and misconceptions about the treatment of Cellulite II

Cellulite and Instrumental diagnosis

Dr. Gustavo Leibaschoff
President of ICAM USA-International Consultants in Aesthetic Medicine

Cellulite, has a physiopathology, with modification of the connective tissue, a
decrease in the microcirculatory and lymphatic systems and in the end an
hyperplasia and hypertrophy of the fat tissue. It is not helpful to treat cellulite
with a lipolitic or lipoclastic treatment at first. In the beginning of a treatment you
have to use different procedure to produce stimulation on the microcirculatory
and lymphatic system and to correct the damage in the matrix, and afterwards
you can work over the fat tissue.
Every technique or device that we use should demonstrate their therapeutic
effect on treatment of Cellulite.
In order to achieve this we should know more of the procedure or device we are
going to use, if there is research about the product, what kind of action/effect it
has, and which is the mechanism that produces that action/effect.
Diagnosis should be as accurate as possible in order to identify the pathology
that causes the unaesthetic feature in relation to the observed histopathological
and morphological alterations.
Clinic examination and instrumental test like
Ultrasound (7.5 Mhz-10 Mhz-35 Mhz) –
1) Allow look the characteristics of subcutaneous cellular tissue

2) Measurement of the distance between skin and muscular fascia

3) Presence of lipoedema


Photoplestimography:
Study of permeability and valve function of deep and superficial venous system
and of perforans in order to verify or rule out associations between EFP and
superficial and deep chronic venous failure.

Videocapillaroscopy: allow us look
A- Capillary density (number of vertical capillaries per mm2).
B- Capillary area (vertical capillary area samples measured through randomized
images).
C- Capillary perimeter (vertical capillary perimeter samples measured through
randomized images).
D- Capillary diameter (vertical capillary diameter samples measured through
randomized images).

It is also important to improve the results of Cellulite treatments to combine
different techniques. This allows us to take advantage of different
actions/effects from them; the combined treatments should be like parts of a
puzzle where the action/effect of each procedure will work on different ways on
the physiopathology of the disease


                              Dr. Zoran Zgaljardic

Personal experience in facial rejuvenation with surgical and non-surgical
procedures
Todays philosophy to stay young and not to get old made people who ask for
rejuvenation techniques much younger. It is certain that the condition of the skin
and its tension isn't the same in all people so due to that fact we can't apply the
same surgical or non-surgical procedures.

In the rejuvenation process we use classic surgical techniques of face lift with
minimal incision approach when ever it is possible and in the preoperative
period we use radiofrequent lasers as well as in the postoperative period in
order to preserve surgically accomplished condition.
With face lift and blepharoplasty we also use erbium laser combined with TCA
pilling to improve small wrinkles around eyes and mouth.
IPL combined with radiofrequency we use to solve dischromic changes of the
skin.
Using surgical face lift we tighten SMAS, we restore the fat tissue and we
remove the skin excess also changing the vectors towards vertical during the
skins tightening. As a consequence of a surgical manipulation and correction
we have minimal swelling of the face which goes away within one month. After
the swelling is gone, weather we want it or not, the tension of the face minimally
eases up. Then is the time to apply collagen stimulating non.-invasive lasers
which whom we can extend persistence of the surgically achieved face lift, and
our client is also in our further control and treatment.
In many cases the refreshment of the face accomplished with laser is the first
step towards cosmetic-surgical procedure.

Personal experience with Nd: YAG 1064nm in lipoplasty
The use of laser with low energy in melting fat is a relatively new method and
still doesn't have very large usage in cosmetic surgery although it deserves
that.
Laser interstitial lipolysis with its fotomechanic and fototermic effect melts fat,
disrupts the interstitial and adipose membranes.
Experience, results and complications are based on a 3 year experience and in
the analysis 120 persons where processed, from that 35 persons where treated
with laser lipolysis and 85 of them with laser assisted liposuction.
The advantages of this method over the standard liposuction are: facilitated
aspiration of the emulsificated fat, melting the subcutaneous- superficial fat
equally which is not possible to do with standard and micro cannulas so the
result is smoother skin surface without undulations.
AS the aspiration is much easier, the tissue trauma is smaller so the recovery is
faster.
Stimulation of the collagen makes skin more thightened so we can use it in
cases when the skin is flaccid.
Haemorrhage is smaller as well in the megaliposuctions because the laser
beam does the fotocoalgulation of the small blood vessels.
The entry wound is approximately 1mm so we can apply it on various parts of
the face without scaring.
It is very useful to correct small skin undulation and precise fat dissolving in
secondary liposuction .

12 years personal philosophy in primary rhinoplasty and secondary rhinoplasty

It is well known that secondary rhinoplasty is a consequence of surgical
technique applied in primary rhinoplasty and that tissue reaction on surgical
injuri has minor role in the final aesthetic result .
Overcorrection or undercorrection are mostly main surgical failure in primary
rhinoplasty. Aesthetic preoperative analysis and following conclusion for
operating plan should be result of patient 's desire and surgical possibility to
achieve the best possible cosmetic result.
Primary rhinoplasty should consist of all skills and techniques which should
prevent secondary rhinoplasty and decrease the incidence of it.
Precise external osteotmies with 2mm osteotom, careful hump reduction with
changing frontonasal angle , precise septum reduction with resection of
m.depressor septi-apicis nasi, cartilage grafting whenever is needed to stabilize
columella structure , define the tip of the nose, or camouflage the dorsum is
very useful in primary rhinoplasty, and reduce the incidence of secondary
revision.
I prefer open approach in primary and secondary rhinoplasty including all
procedures described above.


                              Dr. George Felman

                              Male breast ablation

It became very popular today ablation (removing) of male "breast", as this
procedure is performed painlessly using local anaesthetization in out-
patients' clinic.

The statistics says, that men after 30-35 years old become owners of male
"breast".
Growth of male "breast" is usually caused by increased nutrition and reduction
of male hormone. At the same time increase of female hormone by men is
observed.
Even by athletic built men different forms of "breast" increase are observed.

In general, the growth of male "breast" could be classified in two forms:
    1. False increase of mamma. This breast growth is caused by
      accumulation of adipose tissue in breast area.
    2. True increase of mamma itself, which is histological sense is growth of
      fibrous and adipose tissue.
The word "gland" does not conform with our notion of organ, which exudes any
secretion, for example, prostate by men or female mamma, which exudes milk
for child breast-feeding usually till 1 year old.

All these functions are totally absent by male mamma.
Since this "false breast" is located in breast area, it is called mamma.

But in many cases this formation causes a lot of troubles to its owners in
aesthetical sense. Very often men and guys feel shy to undress on the beach,
avoid swimming pools and do not wear tight-fitting stockinet shirt and T-shirts.

All this problems force men to get assistance by cosmetic surgeon hoping get
rid from this aesthetic defect.
In psychological sense all men think that presence of pseudo mamma deprives
them of manhood and decreases self-confidence.

How a man could be helped in this situation?

The most effective method not long time ago was considered surgical removal
of mamma by men.
To our regret, this method leaves visible scars, which are impossible to hide.
These scars in the middle of breast are showing that man was undertaken
surgery and some aesthetical defect was removed. All this influents in very
negative way on the results of surgery! The men are not satisfied! And it is right!
Who needs instead of hiding defects show them to others?

And here the era of lipoplastics has come! This method significantly improved
the results, but only in cases, when only fat should have been removed. But the
mamma itself is was impossible to remove because of its density and very small
size of instrument called "cannula". It forced to cut skin and to remove mamma
by means of the old method.

1996 the New Lipoplastic Transparent Cannula, called "Millennium Cannula"
was invented, which gives possibility through a small opening to remove not
female, but male mamma not leaving any visible scars.
The results are guaranteed!

The removal of mamma by men are performed in many cases by out-patients'
conditions using local anaesthetization But even having big experience it is
hard to be sure in advance, which kind of anaesthetization will be applied in any
specific case.

Ability to work will be partially decreased from some days to one week, which is
connected with the kind of job a patient busy in.

                       New Lipoplastics Method.
   10 Years Experience of NTLC (New Transparent Lipoplastic Cannula)
                               Utilizing.
                           Disposable NTLC.
                                Abstract
Comparative evaluation of NTLC with a metallic cannula. A theoretic rationale of
New Lipoplastics Method. Techniques and results. Advantages of a new
disposable cannula for Abdomiplasty. Gynecomastia and Fat Transplantation.

If your blunt metallic cannula with lateral hole will break, get a look into its
lumen. And what I saw, when a metallic cannula broke by me? A grease of
black color completely covered internal surface of the metallic cannula, although
outside cannula's surface glanced like a new coin! I tried to clean through, but
all by efforts failed. That was a day of New Transparent Lipoplastic Cannula
(NTLC) birthday!

Near the head of the bed of a new-born cannula stood two idols. One of them
was a respected by everybody microcannula–needle and the second was the
whole army of vibrators in which the best engineering thoughts and lots of
money were invested. The first was a master of needle and microcannula and
the second was a technological progress paving the way for success of this
hard work – lipoplastic.

Certainly nobody of the new-born cannula tutors, neither microcannula-needle
nor the army of vibrators were particularly enthusiastic about the new cannula
birth. There is nothing new about this: 'people are losing their lives for metal!' –
Guette “Faust”.

A brief historical review

A first cannula (a hollow tube) for adipose tissue removal without using of
operating knife was subjected to criticism for the bad results and a cutting and
shredding effect. For tens of years a cannula has undergone different changes,
but strange, as it may seem, a cutting effect of the cannula remained the same.
Judge by yourself: what happens in a moment when you are moving in adipose
tissue a cannula made of metal with different lateral openings and closed on the
one end? Nothing! An adipose tissue stares at the cannula, but doesn't want to
enter into it. However not a long time the adipose tissue laughed, the vacuum
machine was connected with metallic cannula, and fat cut out by anterior and
back orifices along the metallic walls of the cannula was sucked into the
syringe or lipovac space.

So the blunt metallic cannula of small or large diameter with lateral orifices is a
cannula which shreds and cuts fat and fibrous tissue and small blood vessels.

Dr. Pierre F. Fournier wrote in his book “Liposuculpture the Syringe Techinique”
in section “Why the syringe and not the suction machine?” on page 23: “We
prefer to use small cannulae with only one blunt hole because the cannulae with
three holes, while performing a good Liposculpturing, often have one or two
holes blocked by pieces of fibrous tissue, that block the passage of adipose
tissue”. That blunt metallic cannula with hole is a cutting cannula and a fat
removed after such Liposuction is an emulsion containing destroyed adipose
cells, fibrous tissue and blood that blocks up all the cannula openings. In order
to understand a difference of NTLC from any metallic cannula with closed end
and lateral hole, we need to remember two physical laws.
Now let’s discuss some physical laws:
  1. Newton Third Law – Force and Counterforce
  2. Why this lipoplastics method is called hydraulic?

Newton Third Law - Force and Counterforce


To every action force there is an equal, but opposite, reaction force. Whenever
a particle A exerts a force on another particle B, B simultaneously exerts a force
on A with the same magnitude in the opposite direction. The strong form of the
law further postulates that these two forces act along the same line.

Force and Counter-Force

       In nature forces and counter-forces are acting, and this applies also for
human.
Our tissues have different counter-force systems. So it is no secret for anyone
that skin, facets, blood vessels have higher resistibility against outside force, no
matter which one is it.

       Muscular as well as adipose tissues have much less counter-force
against any other physical forces. One of these forces is a force of vacuum,
which performs fat removal from a metallic with lateral openings cannula closed
on the end.

       A metallic cannula cuts and because of this a lot of blood and fibrous
parts are in the removed fat. The vacuum machine sucks into the cannula
everything: fibrous tissue together with small blood vessels. The adipose tissue
composition is an emulsion, that contains fat and fibrous tissue.

        By using NTLC fat enters into the cannula opening without sucking force
of vacuum machine, as it has a small resistibility. Fibrous parts have a stronger
resistibility and are not sucked into the cannula. NTLC does not traumatize
adipose tissue, and any blood absence in fat is a best proof of it.

Why this Lipoplastics Method is called a Hydraulic one?

Communicating Vessels

Liquids rise to the same height in all the vessels of an inter-connected system.
If we add water to any vessel, there is a movement of water (a flow of matter)
until the water has levelled out. There is also a flow of potential energy until
each milligram of water on the surface has the same potential energy as any
milligram on the surface of another tube. An increase or decrease of water in
any tube affects the water in all other tubes according to well-known laws of
physics.
One of the main conditions for the success of this Method is a higher
tissue pressure obtained by means of higher fat infiltration– Normal Saline.
If Lipoplastics is performed by means of general anaesthetization, than Saline
doesn’t contain Lidocain, but contains 1cc Adrenalin per 1L Norm Saline.
Therefore, the toxic Lidocain influence is absent.


Description of NTLC

When we are talking about New Transparent Lipoplastic Cannula (NTLC), that
means that an old cannula was existing and is existing.
This is cannula called Karman that is used for abortions with an closed end and
two lateral openings on the opposite side made of semi transparent plastics.
Karman cannula differs from a metallic cannula in that it is made of plastics and
that is all! Karman cannula is registered in FDA and has CE, patent No.
3.747.812 – “Liposculpture the Syringe Technique”, Pierre F. Fournier, page 50.


NTLC

This is a transparent plastic cannula with a angle open end with a universal
plastic handle, suitable for 60cc syringe and suction machine, i.e. an universal
cannula for deep and surface lipoplastics. It is enough to move the cannula with
an opening down – this is a deep lipoplastics, with an opening up – this is a
surface lipoplastics.


NTLC sizes: length without handle is 26cm, inner diameter is 0.3cm, 0.5cm or
0.8cm.

Attention! Sterilization: by gas or by special antiseptical sterilizing solution.
The usage of spirit solution or autoclave is prohibited!
NTLC is a flexible cannula.


Lipoplastics Techniques

Anesthesia Techniques
In cases of small lipoplastics areas, I use local anesthesia of Liter solution of
Lidocain 0.2% + 1ml of Adrenalin.
The adipose tissue infiltration is performed by means of a long needle with
closed end and lateral openings. I begin anesthesia without any needle
movement, that means, I wait for appearance of “wooden” tissue and only then I
move needle into another area that enables to increase pressure in adipose
mass itself.

The needle should be in the middle of fat layer neither higher no lower of
(superfition fascia) surface – Fascia Thompson, which divides fat into
superfition and deep fat.

In 10-15 minutes NTLC is inserted and adipose tissue removal of deeper fat
layers is performed, and only later on from the upper fat layers.
When desired, it is possible to carry lipoplastics without using syringe or
vacuum machine. It is enough to elevate the place, where the NTLC is located
in order to create the sufficient fat outflow by moving the cannula from the
incision place to the end of the area marked before the surgery. The cannula
movement should be rectilinear without bending of the tunnel in which the
cannula is inserted.

Attention: It is important not to “dance” from side to side. This kind of
movements can be 10 or more. Everything depends on fat amount. It is also
important at the end of fat removal process to elevate skin by means of cannula
and remained fat in order to define all roughness and unevenness of adipose
tissue. Afterwards by turning cannula’s cut end to skin, visible roughness and
relief are removed. Thus, this process continues till the surgery end.
Certainly, NTLC connection with suction machine or syringe accelerates the
surgery. Thus, from my experience follows that in order to remove 4 liters of fat
from the upper abdomen layer, you need 24 minutes.

In general, adipose tissue removal is carried without blood, without eximosys
and without removal of fibrosis crosspieces.
It is desirable to inject a solution into an adipose tissue using ….machine. For
abdominal lipoplastics should be used 3-4 Liters of liquid till thickness sense
and lipoplastics should be started immediately, as this “woodness” state
indicates on increased inner tissue pressure.

If a lipoplastics area seems to a surgeon too big, I would recommend to perform
lipoplastics only on half of abdomen, hips and etc. area, and after finishing start
with lipoplastics of rest parts.

Then after checking and concluding that all the skin surface is plain and smooth
without any “mounds” or “dents”, it is necessary to put 1-2 innerskin stitches.
The plastic surgery is finished by putting elastic cross Tensoplast bandage or
an appropriate corset on a patient.

                                                    Results and Conclusion:
                          During 10 years 3638 surgeries have been performed.
                                                            428 surgeries for men
3210 surgeries for women
                    Major                Medium               Small
                    Lipodistrophy        Lipodistrophy        Lipodistrophy
Men 428             210                  140                  58
Women 3210          2100                 470                  880
Results             Good                 Very good            Satisfactory
                    2054                 1561                 23

Fatebolizm – 0
Dead – 0
Seroma – 57
Repeated Lipoplastics - 18

When a surgeon inserts NTLC into different places, fat outflow through
communicating vessels is created, and if vacuum pressure is added to this
process, the best conditions for bloodless fat removal are attained. The rest
depends on skills and experience of a plastic surgeon.

The main characteristics of this cannula are as follows:
   1. It is transparent and gives immediately an information about what we are
       removing.
   2. NTLC is absolutely not traumatic and removes adipose tissue by
       penetrating it and not by cutting it. This fact will be demonstrated in this
       presentation.
   3. NTLC gives a possibility to perform superficial and deep liposuction.
   4. NTLC enables to remove adipose tissue without using special vacuum
       machines or a syringe. Fat removal is possible thanks to NTLC design
       and the Hydraulics Laws.
   5. Lack of cutting characteristics in NTLC prevents tissue traumatism and
       does not cause bleeding. A removed fat does not contain fibrous
       crosspieces and destroyed adipose cells. There is no necessity to
       infiltrate and clean again an adipose tissue for its transplantation.
   6. NTLC enables to remove true henicomastia without any additional
       incision.
   7. NTLC reduces significantly the time of lipoplastics.
   8. NTLC does not require any strong physical efforts for a surgeon during
       lipoplastics.
   9. NTLC penetrates easily an adipose tissue and slides ensuring full control
       a visual one as well as by fingers.
   10. NTLC instantly detects and removes roughness in a subcutaneous
       adipose layer achieving a maximal aesthetical effect.
   11. NTLC cleaning is performed under visual control.
   12. The handle of NTLC is universal and suitable with every vacuum
       machine or syringe of 60cc.
   13. Please pay attention!
   NTLC is sterilized only by means of gas or an antiseptic solution.
    Hydraulic Lipoplastic Surgery Using New Transparent Lipoplastic
                                Cannula.
                            10 years experience

George Felman M.D.


Metallic Cannula                         New Transparent Lipoplastic
                                         Cannula (NTLC)
1. Metallic cannula with closed end      1. Plastic transparent cannula with
and lateral openings                     open end
2. Cutting cannula                       2. Fat penetration by means of NTLC
3. Works only with vacuum machine or     3. Removes fat without using vacuum
syringe                                  machine.
4. Different diameters and sizes of      4. Different diameters and sizes of
cannulas                                 cannulas
5. A removed adipose tissue contains     5. A removed adipose tissue does not
destroyed adipose cells and blood.       contain destroyed adipose cells and
                                         blood. There is not necessity to clean
                                         removed       adipose     tissue    for
                                         transplantation.
6. Hemorrhage                            6. No.
7. Hematoma, seroma                      7. Seroma
8. Perforation of abdomen                8. No.
9. Fat embolism                          9. No.
10. Roughness                            10. No.
11. There is no possibility to clean a   11. Cleaning under visual control.
cannula inside
12. There is not possibility by means 12. Gives a possibility to remove
of metallic cannula to remove true    gynecomastia without any additional
gynecomastia without incision.        incision.
13. A theoretical explanation of      13. A theoretical explanation of
cannula performance is force of       cannula performance of NTLC is:
vacuum.                                   A. Force and Counter-Force Law
                                          B. Hydraulic Law
14. A metallic cannula is a traumatic 14. NTLC – an absolutely no traumatic
one.                                  cannula!
   Should you need any additional information please do not hesitate to contact
                                                                         me at:
                                                       Tel/Fax: 9723 5274242
E-mail: glfelman@zahav.net.il
Website: www.glfelman.com

George Felman, M.D.
General Surgeon
Plastic Surgeon
Cosmetic Surgery
Golda Medical Center, Doctor House
18 Raynes St.
Tel Aviv, Israel

                             George Felman, M.D.

Plastic Surgeon
Cosmetic Surgeon
Board Certified International Academy of Cosmetic Surgery

                                  Abstract
           20 Year Experience of Face Beautification by means of
            Lipoplastics/Lipoaspiraition and Fat Transplantation

20 years ago at the initial period of liposuction method formation that was
invented by George Fisher and developed by Dr. Gerar Iluiz and Dr. Pierre
Furne was born an idea to use an adipose tissue as biological plastic tissue for
correction of different face and body congenial and acquired defects as a result
of trauma or surgery.

Simultaneously without any agreement between themselves Dr. Julius
Newman, Pierre Furne and your most humble servent – George Felman,
presented in 1986 on the Congress of American Cosmetic Surgery Academy
some articles reporting on a new liposuction method using adipose tissue for
transplantation.

Since this moment the method of using adipose tissue for transplantation in
cosmetic surgery became very popular and was used by many surgeons of
different basic qualification. There are certainly some negative references of the
above method, but they are outnumbered.

In the present abstract are highlighted the indications for facial lipoaspiration,
anesthesia, techniques, results and complications. You also can find in abstract
a 10 year experience in using of new disposable transparent lipoplastic cannula
for adipose tissue extraction, the advantages and theoretical grounds for its
usage.

The two revolutionary procedures of liposuction and fat reinjection, each on
their own and in combination, make it possible to achive the best results
possible in correction of facial and body defects!
George Felman, M.D.
Plastic Surgeon
Cosmetic Surgeon
Board Certified International Academy of Cosmetic Surgery

         5 Year Experience of Transumbilical Breast Augmentation
                         350 successful surgeries

                                     Abstract

Cosmetic breast surgery – without scars
Breast enhancement or augmentation is one of the most frequently performed
cosmetic procedures in the United States and all over the world for today. It can
drastically improve the appearance of a woman’s breasts. The enhancement
procedure is used to enlarge small breasts, underdeveloped breasts, or breasts
that have decreased in size after a woman has had children.
Recent studies have supported the safety of saline breast implant. Should a
saline implant leak, the salt water is safely reabsorbed by the body as the
implant deflates. Most of the implant companies provide replacement warranty.

The procedure
Transumbilical breast augmentation is performed on an outpatient basis using
general or local anesthesia. This popular way of performing breast
augmentation is through an incision in the navel. Utilizing this technique, no
incisions are made on the breast or into the breast tissue.
A small incision is made in your belly button. Through this incision, a slender
instrument passes under the skin to a location behind the breast tissue. Next, a
tissue expander is inserted and placed under the breast. With this expander, a
space is developed to create a pocket for the implant size you’ve requested.
The position and size of this pocket is verified. Then, an empty saline implant is
placed in the pocket and filled with sterile saline. The surgeon can adjust the
amount of saline injected into your implant based on the size you have selected
and help correct asymmetry of your breasts. The incision in your navel is closed
with a few absorbable stitches.

The technique advantages
An advantage of this technique compared with other techniques is that no
incision is made on the breast or into the breast tissue.

90 percents of complications following cosmetic breast surgery using regular
technique are caused by incision in breast area. If there is an incision – there is
a scar. This scar can be of dark color, swelled, wide, in any case enough
remarkable in order to cause significant inconveniences, understandable to all
women or men.

No incision in breast area will save a woman from such complications as:
infection, wide scars, bleeding, a temporary or permanent loss of feeling in
nipples or breast.
No incision in breast area absolutely excludes all kinds of complications during
pregnancy or breastfeeding following after surgery trauma.
No silicone gel utilizing in the breast area excludes risks of immune system
injury and cancer of breasts.

All the complications mentioned above do not appear when utilizing the
transumbilical technique.

Transumbilical breast augmentation this is a technique with evident advantages.
More and more surgeons are getting masters of this technique, and more and
more patients prefer Transumbilical breast augmentation technique without
scars in the breasts.

For over 30 years thousands of cosmetic breast surgeries have been performed
in our clinic using an old technique with an incision underneath the breast along
the fold or an incision within the armpit. During 2002-2003 the specialists of our
clinic completely turned to the transumbilical breast surgeries that do not leave
any scars using the latest achievements of medical equipment and leading
cosmetic surgery clinics experience.

While our clinic visiting you will receive a full explanation, you will be shown
several before and after treatment photographs of patients having similar
breasts, will contact the other women passed the transumbilical breast
surgeries. You will be granted written recommendations and a replacement
warranty letter from the implant company, which implants will be presented to
you.

George Felman, M.D.
Specialist Surgeon / Plastic Surgeon
Cosmetic Surgery
Chief Department of Plastic and Aesthetics Surgery

My E-mail: glfelman@zahav.net.il
My website: http://www.glfelman.com


                             Dr. Guillermo Castillo


TOPIC #1

Out-patient Abdominoplasty “Making It Safe”

Abdominoplasty performed in a private clinic as an outpatient procedure under
conscious sedation is now more feasible with advances in anesthesia and
improved management of nausea and pain. Local anesthesia and intravenous
sedation greatly reduce the risk of deep venous thrombosis and the rate of
complications. This presentation further describes the process of patient
selection, intra-operative management with preservation of perforators, a plane
of dissection that preserves lymphatic vessels, and post-anesthesia guidelines
of out-patient abdominoplasty performed under local anesthesia plus IV
sedation



TOPIC #2

Overview- Surgical Site Infections

Surgical Site Infections are a significant problem when they occur in cosmetic
surgery. The factors that influence surgical wound healing and the risk of
infection in surgery are to be presented. Identifying patients at higher risk for
infection, adherence to proper protocols and algorithms, will greatly reduce the
rate of infection. This presentation also describes the algorithms on
management of SSI’s after cosmetic surgery.


   Contaminated periprosthetic pocket management with intermittent lavage
                ( Thomas Haffner M.D. Germany, Cologne )


Summary:

The usual procedure in the management of the contaminated periprosthetic
pocket include giving antibiotics, cold packs and the remove of the implant by
worsening.
The ultrasound guide aspiration of pocket fluids is available only in special
centers such by the BASPI WORKGROUPS of John. B. Tebbets. Aspirating
the pocket howewer needs experience and has special risks as follows:
iatrogenic contamination of the pocket, spreading the infection by means of the
needle itself, implant injury, pneumothorax.
The author shows his technique not only for the diagnostic and aspiration of
some fluids but for the effectively, minimal invasively management of pocket
infections including severe infections of the breast tissue itself.
For the lavage a fresh mixture of ozon saline solution to be prepared in each
time.
Though there are only few patients, who had been treated with this method,
there are amazing healing results included complete healing of the infection, of
the necrotic wound, of the visible and opened infencted pocket with the
conservation of the implant.
The conclusion is, that the dogma of the implant removing can be no longer
hold in any case of pocket infection.
There is a real chance to cure the tissue and pocket inflammation too, to clean
the pocket´s fluid, than conserve the implant even it is visible at the bottom of a
necrotic wound.

3 dimensional breast augmentation with axial symmetry
Thomas Haffner M.D. Germany, Cologne
52-nd World Congress of the International Academy of Cosmetic Surgery
Summary:

The terms "biodimensional system" and "dimensional breast augmentation" are
well known from the work of JB Tebetts (Dallas) and Per Hedén (Stockholm).
The measurement of existing breast base, the desired breast base, the
thickness of the tissue with the pinch test are the basic elemets to be made
before a breats enlargement according to these studies. The calculation of the
implant width and height according the data got before ist than the next step of
planning. Howewer the präparation the breast pocket and the method of
augmentation itself vary depending on the existing form of the breast ( firm or
ptotic) on the patient´s bodyform (slim or fatty) on the implant´s form (
anatomical or round, flat or height, long or short) on the type of the
augmentation ( subglandular or submuscular or dual-plane)
The resulting several possibilities of the operation can be carried out therefore
not always with the optimal symmetry in all the three dimensions.
The problems arising mostly from the difficult preaparation of the breast pocket
or the inframammary fold, from the not proper placement of the implant and
many times from an existing breast ptosis. Stretch deformities (implant
bottoming or displacement ) malposition, inferior displacement of the
inframammary fold occur because of a pocket- or envelope problems during the
operation, because of failure of the proper building of the new inframammary
fold or because of lacking the proper postoperative fixation. The author believe,
that the key for these problems is to note the axis of the breast itself for the first
and to match it to the axis of the implant for the second. All the steps of the
operation should be directed to fulfill this criteria.
Various type of axis problems disturbing the symmetry and their management
are presented.
Spezial steps of the surgery are presented to realize the 3D symmetry
considered the axis of the breast and implant.


Mastopexia de aumento con prótesis en una sesión. Nuestro punto de
vista

                             P. Hernández / J. Terrén

La mastoplastia de aumento es una de las intervenciones quirúrgicas más
habituales en el campo de la cirugía estética, pero no siempre conlleva un
resultado aceptable sobre todo en aquellos casos en los que, debido a una
involución glandular postgravídica, nos encontramos con un descenso
glandular y pérdida tisular o bien un descenso del complejo areola-pezón que
nos obliga a realizar una mastopexia.
 También nos encontramos en la práctica diaria con pacientes que no solo
desean corregir el descenso de las mamas sino que al mismo tiempo solicitan
un aumento de volumen generalmente de gran tamaño.
Tradicionalmente los objetivos de la mastopexia y del aumento mamario con
prótesis son contrapuestos. Mientras que con la mastopexia vamos a conseguir
una elevación tisular, el peso de las prótesis, sobre todo si éstas son de gran
tamaño, va a provocar un descenso de las mismas a largo o a veces a corto
plazo.
Es muy discutido si las mastopexias aumentativas con prótesis se deberían de
realizar en una sesión o bien si primero debería efectuarse la mastopexia y en
una segunda sesión el aumento con la inclusión de prótesis, entre otras cosas
por el aumento exponencial de riesgos que conlleva cuando se realizan las dos
intervenciones en el mismo tiempo quirúrgico. En las estadísticas europeas la
incidencia de reoperaciones tras mastopexia con prótesis es del 28,5 %; sin
embargo en nuestra experiencia no hemos encontrado una diferencia
significativa entre la incidencia de complicaciones si la intervención se realiza
en una o dos sesiones, además las pacientes que solicitan este tipo de
intervención regularmente requieren la intervención en una sola sesión por lo
que consideramos que salvo en casos de ptosis muy severas realizamos este
tipo de intervenciones en una sola vez.
Los autores aportan su casuística comparando la incidencia de
reintervenciones y complicaciones en casos de mastopexia aumentativa con
prótesis con aquellas intervenciones en las que solo se efectuó en una sesión
la mastopexia y la inclusión de prótesis fue realizada un tiempo después.


Ventajas e inconvenientes de la mastoplastia de aumento biplanar

                           P. Hernández / J. Terrén

Las intervenciones de inclusión de prótesis es una de las operaciones
mayormente realizada actualmente en Europa. La inclusión en un bolsillo
subglandular o submuscular es aún actualmente muy discutido, y mientras la
tendencia de los últimos años es la inclusión en un bolsillo subpectoral o
totalmente submuscular, con los inconvenientes que esta técnica conlleva, tras
las publicaciones de Tebbets favoreciendo un bolsillo biplanar o dual plane
éstos parece que son corregidos. Sin embargo esta técnica en nuestras manos
presenta también una serie de inconvenientes que juegan un papel importante
a la hora de decidir que tipo de bolsillo se debe realizar para la colocación de
implantes; así hemos observado que además del dolor postoperatorio que
según nuestra opinión es mucho mayor en la colocación biplanar, también
observamos otra serie de desventajas sobre todo cuando la cubierta tisular
sobre el implante en la zona medial o lateral es insuficiente o que debido a un
desplazamiento caudal de las prótesis estas abandonan la parte del bolsillo
subpectoral situándose en una situación subglandular caudal.
Los autores presentan su casuística de intervenciones con colocación de
implantes en un bolsillo biplanar y describen las complicaciones o desventajas
observadas con esta técnica.


          52 Meeting and Word Congress – Cartagena – Colombia
                              ABSTRACT

  TRATO MÉDICO REGENERATIVO Y REPARATIVO DEL CUTIS DEL
ROSTRO Maurizio Ceccarelli * Director Ae. Phy. Med. Centre - Roma (Italia)

La regeneración es un proceso fisiológico a la base de la continua
reconstrucción de algunos tejidos, cuales aquel cutáneo.
Para mantener funcionales tejidos y aparatos nuestro organismo actúa
una continua regeneración basada sobre una disolución del tejido
preexistente y sobre la reconstrucción del mismo.
En el cutis tenemos particulares enzimas metalloproteinasa capaces de
solubilizar a través de procesos de hidrólisis las macromoléculas que
componen la dermis. Los metalloproteinasa se distinguen con números
progresivos convocas diferente molécula sobre la que efectúan su
acción: MMP1 collagenasi, MMP3 stromelinasi, MMP9 gelatinasi, etc. Las
metalloproteinasa están presentes en la dermis en forma inactiva con el
sitio activo parado por un resto de cistina; la hidrólisis de este
aminoácido libera el sitio contenedor el cinc y permite la acción de la
enzima.
Como en la mayor parte de los sistemas biológicos también la disolución
de la matriz es regulada por activadores e inhibidores de las MMP. El
justo equilibrio entre los dos aparatos permite el mantenimiento de una
matriz dérmica sana y funcional.
La reconstrucción de los tejidos gastados ocurre por estímulo de la
síntesis proteica fibroblastica activada genéricamente por el Growth
Hormon en la fase no-REM del sueño.
Particulares receptores sobre la pared celular del fibroblasto son
activados o de los factores de crecimiento o de los componentes
fragmentatos de la dermis e inducen el sintetization de nuevas moléculas.
Los receptores del tirosin-kinasi, que son activados por los factores de
crecimiento, fibroblast growth factor, y los CD 44 (claster of
differentiation) que son activados por los fragmentos de ácido jaluronico
lisato, determinan la hidrólisis de los polifosfoinositolos de membrana
con liberación del 1-3 difosfoinositolo; éste alcanza el retículo
endoplasmatico liso dónde, atándose a un receptor específico, induce la
entrada de iónes calcio; los iónes calcio activan la proteinKinasi C con
estímulo de los genios a inducción precoz Jun y Fos y siguiente inicio de
la síntesis proteica.
Se tiene así la neoformación de los miembros de la matriz dérmica y en
                                                                   )
particular de glicosaminglicanos, de colágeno reticular (tipo III° y de
elastina.
La reparación es un proceso biológico útil a compensar la pérdida de
parte de un tejido consiguiente a un daño. Esta pérdida es balanceada
con la neoformación de un tejido connectival dicho tejido cicatrizial. Este
tejido es representado ricamente por colágeno de tipo I°.
La célula delegada a la formación del tejido cicatrizial siempre es el
fibroblasto. Obviamente debemos, en este caso, tener estímulos
diferentes de los precedentes para inducir la construcción de este nuevo
tejido y no de los tejidos originarios.
Si primera fueron los fragmentos liberados por la hidrólisis de los
normales miembros de la dermis a activar la regeneración del cutis, ahora
son los miembros endocelulares, liberados por el daño biológico y los
mediadores de la inflamación, consiguientes al daño biológico, a inducir
la activación del proceso riparativo.
En particular tenemos la activación de los CD 39 de parte de los
fragmentos de ácido nucleico liberados por el núcleo de la célula dañada
y la activación de los CD 40 de parte de los mediadores de la inflamación,
interleukina 4, a estimular la formación de tejido fibrotico rico en colágeno
de I° tipo.
De cuanta exposición nos parece importante una precisación: ¿es
suficiente hablar genéricamente, en el rejuvenecimiento facial, de
activación fibroblastica o tenemos que precisar cuáles receptores
activamos?
Es fundamental contestar a este según pregunta porque la respuesta al
estímulo de receptores diferentes puede inducir mejoría biológica o
mejoría estética. Mejoría biológica útil en cada tipo de cutis; mejoría
estética útil sólo en los cutis viejos.
Luego si hablamos de bioestimulation fibroblastica de efectuar sobre una
paciente joven, tenemos que ser siertos que los receptores estimulados
sólo sean los CD 44. Mientras en el estímulo fibroblastico de un cutis
anciano, también el estímulo de los CD 39 y de los CD 40, incluso
induciendo un daño biológico, puede ser aceptado por su mejoría
estética.
De eso, para estimular los CD 44 tenemos que recordar que:
    • Las proteínas derivadas del daño de la matriz extracellulare,
        estimulan la síntesis de los miembros de éste.
    • El CD-44, receptor celular de activación de la síntesis de ácido
        jaluronico, presenta la máxima actividad en presencia de complejos
        de 20-38 monómeros de ácido jaluronico.
Mientras:
    • Los nucleotides (PDRN) extracelulares estimulan los receptores
        purinergicos de tipo 2
    • El adenosina, base purinica, regla la inflamación y la reparación de
        los tejidos
    • Los receptores adenosinicos desempeñan un papel activo en la
        patogénesis de la fibrosis dérmica
    • Los nucleotidos extracelualares ha sido implicado como
        mediadores inflamatorios en muchas situaciones patológicas
    • El estímulo de los receptores Purinergicos 2 de los CD 39 es
        asociado con una respuesta inflamatoria crónica
    • Estimulas flogogenos seleccionan poblaciones de fibroblastos con
        un papel importante en la formación de la fibrosis
    • El interleuchina IL-4 se ata al CD 40 de los fibroblastos con efecto
        profibrotico y reducción del efecto antifibrotico de la IFN-gama
    • El estímulo de los CD 44 determina una mejoría biológica que se
        evidencia también con una mejoría estética, mientras el estímulo de
        los CD 39 y de los CD 40 determina una mejoría sola estética
        consiguiente a una fibrosis de la dermis y por lo tanto a un daño
        biológico.


     EMPLEO DE LA TOXINA BOTULINICA EN EL TRATO DEL ACNÉ
     Maurizio Ceccarelli * Director Ae. Phy. Med. Centre - Roma (Italia)

Las glándulas sebáceas son acinosas ramificadas a secreción olocrina
(transformación del citoplasma de las células glandulares en sebo) y son
constituidas por una porción acinosa secernente situada en la dermis, de
un canal excretor revestido por un epitelio estratificado que desemboca
en el infundibolo del folículo pilífero.
La producción del sebo de parte de la glándula está bajo un control
hormonal. Los andrógenos (Testosterona, Delta-4-Androstenedione,
DHEA) circulantes alcanzan la glándula y aquí, por acción del 5-alfa-
reduttasa se transforman en diidrotestosterona que estimula la función
glandular produciendo sebo.
Con el término acné se refiere a una enfermedad de la piel caracterizada
por un proceso inflamatorio de las unidades folículo-sebáceas, es decir
del folículo pilífero y de la glándula sebácea anexa, que se manifiesta
clínicamente con aspectos polimórficos: del simple comedón a pápulas,
pústulas hasta también a nódulos y a resultados cicatricial.
El acné es identificable de la presencia, más o menos evidente, de los
comedones. El comedón, la lesión elemental del acné, es una dilatación
del orificio folicular conteniente un material blanquecino o pardusco
constituido por lípidos, queratina, pigmentos melanicos, pelos y
bacterias.
Distinguimos:
    • La fase inicial. Es caracterizada por los asillamados puntos negros
       o comedones,; éstos son reales "tapones" de células u otras
       sustancias que obstruyen la salida de una glándula sebácea. El
       resultado es un relieve cutáneo dado por la hinchazón, debido a la
       secreción sebácea que ya no tiene posibilidad de descargarse al
       exterior. Este atasco, como ya dice, ocurre por la iperproducion de
       sebo de parte de la glándula bajo los influjos hormonales.
    • La segunda fase. Es inflamatoria, o bubosa, es decir se crea una
       inflamación local conspicua. Está describiendo aquí el clásico
       "granujo", sin embargo en el acné hay una multiplicación
       cuantitativa del proceso. En esta fase, pues, el cutis se llena de
       foruncolos amarillos o sea pústulas, determinados por colonias de
       bacterias de la piel que infectan las partes ocluidas de los canal
       excretorios sebáceos.
    • La tercera fase. La que la terapia aspira a evitar, es llamada
       nodulocistica. Se pueden formar precisamente nódulos, es decir
       expansiones muy duras de las pústulas que dejarán inevitables
       cicatrices. En mayor edad, sobre todo en quien es entregado al
       humo y a alcohol, y a veces al principio de la menopausia, puede
       presentarse el acné asillamada "rosácea". La diferencia con el acné
       juvenil está en la manifestación inicial, es decir el rostro presenta
       manchas rojas con dilatación de las macetas sanguíneas
       superficiales. Sucesivamente también ella puede manifestarse con
       la fase bubosa y aquel nodulocistica.
Como dice la fase inicial del acné es inducida de la formación del tapón
córneo y de la excesiva producción de sebo, este lleva a la formación del
comedón y al siguiente sovrainfecion de Propionibacterium y
Staphylococcus epidermis.
¿De cuanta exposición, como el bloque colinergico puede ayudarnos en
reducir estas manifestaciones?
    1. podemos reducir el crecimiento epidérmico responsable de la
       formación del tapón córneo. (Acetylcholine ACh,……. muscarinic
      receptors activate a metalloproteinase, which liberates surface-
      associated heparin-binding epidermal growth factor (HB-EGF) and
      causes transactivation of epidermal growth factor receptors
      (EGFRs).)
   2. podemos reducir la producción de sebo. (…….. role for
      Acetylcholine (ACh) en sebum production and as a promoter of
      sebocyte differentiation,)
   3. podemos reducir la vascularización y por lo tanto sea la aportación
      de hormonas andrógenos, sea la vasodilatación, rosácea.
      (Adrenergic neurons release noradrenaline and ATP to
      sobreviviente cutaneous blood flow while cholinergic neurons
      release acetylcholine and a co-transmitter to dilate skin blood
      vessels.)


  HIDROLIPOCLASIA OSMÓTICO-EMULSIVA Y ULTRASONICA POR EL
                                  TRATO
                DE LAS ADIPOSIDADES LOCALIZADAS
     Maurizio Ceccarelli * Director Ae. Phy. Med. Centre - Roma (Italia)

Recientemente se ha vuelto a hablar del empleo de los ultrasonidos en
Medicina Cosmética para el tratamiento de las adiposidades localizadas.
Y se ofrecen nuevas propuestas metodológicas y nuevas
instrumentaciones para este empleo. Habiendo estudiado desde hace
tiempo el efecto biológico de las ondas ultrasónicas y habiendo puesto a
punto una técnica para el tratamiento de los lipomas y de las
adiposidades localizadas en los primeros años 90, creo necesario realizar
unas precisiones científicas sobre este asunto
En 1988 se habla por primera vez del efecto “clásico” (daño biológico y
rotura celular) (versus “lítico”) de los ultrasonidos, de sus indicaciones y
contraindicaciones, y de los principios del daño biológico de cavitación
En 1991, en el Congreso Mundial de Medicina Estética de Rio de Janeiro
(Brasil), propuse oficialmente la hidrolipoclasia ultrasónica (HILCUS)
como metodología médica “clásica” para el tratamiento de las
adiposidades localizadas.
Hemos de intuir que la aplicación de los ultrasonidos sobre un material
biológico embebido en agua determina un notable daño, no por cavitación
directa del material biológico (grasa) sino por el estallido de los
microbolas producidas por la cavitación del agua. Asi pues, la infiltración
de agua en los tejidos y la inmediata aplicación de los ultrasonidos sobre
los mismos determina cavitación del agua, formación de microbolas,
estallido de éstas y rotura del material biológico circundante.
Asimismo podemos afimar que las estructuras más delicadas, como las
células endoteliales y las células adiposas, serán más fácilmente dañadas
que las estructuras más resistentes: tejidos conectivos, hueso, etc. La
HILCUS se emplea para producir una reducción volumétrica de los tejidos
constituidos por estructuras fácilmente sensibles al daño mecánico
producido por el estallido de las microbolas de cavitación.
Nuestra propuesta actual es una revisión de la técnica “clásica” (HILCUS)
potenciándola.
Proponemos:
   • Infiltración del tejido adiposo con una solución con efecto “clásico”
       sobre las células
   • Aplicación de ultrasonidos de alta potencia
   • Limpieza de los triglicéridos y del material biológico producido por
       la destrucción celular
Se proponen dos soluciones con efecto “clásico” celular:
   • Las soluciones hipotónicas
   • Las soluciones a base de fosfatidilcolina y deoxicolato
Las soluciones hipotónicas se utilizan atendiendo al principio del daño
osmolar.
La osmolaridad es una unidad de medida de la concentración de las
soluciones, usada en química.
La osmolaridad equivale al número de osmoles por litro de solución,
dónde osmoles = partículas que contribuyen a la presión osmótica de la
solución.
La presión osmótica es una propiedad coligativa asociada a las
soluciones.
Es una de las principales características que deben tenerse en cuenta en
las relaciones de los líquidos intersticiales e intravasculares que
constituyen el medio interno.
Cuando dos soluciones con el mismo solvente, pero a concentraciones
diferentes, son separadas por una membrana semipermeable, las
moléculas de solvente se desplazan de la solución menos concentrada a
la más concentrada para igualar la concentración de las dos soluciones.
La presión que hace falta aplicar a la disolución para que el paso del
solvente no ocurra es la "presión osmótica".
Para el cálculo de los osmoles, y por lo tanto de la osmolaridad, hace falta
considerar el grado de disociación (coeficiente de Van’t Hoff) que el
soluto presenta. Por ejemplo, 1 mole (peso molecular expresado en
gramos) de glucosa en solución acuosa corresponde a 1 osmole, puesto
que la glucosa no presenta disociación en agua (i=1), mientras que 1 mole
de cloruro sódico corresponde a 2 osmoles, puesto que el cloruro sódico
presenta disociación (i=2), liberando un ión cloro y un ión sodio.
El valor normal de la osmolaridad de los líquidos biológicos (incluido el
plasma) es 300 mOsm/l.
Según la fórmula, son isotónicas (300 mOsm/l) soluciones de ClNa al 0.9%
y de Glucosa al 5%.
Las soluciones hipotónicas (200 mOsm/l) en contacto con los tejidos
determinan hinchazón celular. Las soluciones hipertónicas (360 mOsm/l)
en contacto con los tejidos determinan arrugamiento celular. Pero en el
caso de los adipocitos el pretendido daño osmolar tiene una respuesta
relativa. Sea por la variación de la concentración molecular de la solución
hipotónica introducida al mezclarse con los líquidos biológicos; sea por
la capacidad de resistencia del adipocito a las variaciones de volumen.
Pues un aumento de casi cien veces el volumen inicial no produce rotura
del adipocito. Además esta variación, en condiciones fisiológicas
(engorde), no es brusca sino gradual, y da tiempo a la membrana celular
para adaptarse a la variación. Duplicar o más el contenido adiposo normal
del tejido graso (aprox. 20% del peso corporal), significaría un aumento
de 12-15 kg de peso o más.
Suponemos que un tal incremento ponderal se produciría en al menos un
año. Y eso es tiempo suficiente para la adaptación celular. Pero esta
adaptación celular no ocurriría con un aumento rápido de volumen, es
decir con aquel que ocurrirá con el contacto de una solución hipotónica.
Conforme a los trabajos de la doctora Rittes sobre el empleo de
Lipostabil, publicados en Brasil en abril de 2001, a las soluciones que
contienen fosfatidilcolina y deoxicolato sódico se las atribuye una acción
de daño adipocitario.
Lipostabil contiene fosfatidilcolina 5% y deoxicolato sódico 4,2%.
La acción clásica de la fosfatidilcolina la encontramos en la literatura. El
ácido fosfatídico (DAG) liberado por la fosfatidilcolina actúa como
mensajero celular activando la proteinkinasa C y la fosfolipasa: la primera
determina inactivación receptorial por fosforilación y la segunda un
estado inflamatorio por activación de la cascada de los eicosanoides. En
ambos casos va a producirse un daño celular.
Pero, indudablemente, el daño principal lo produce el deoxicolato de
sodio, sal biliar con acción tensioactiva que emulsiona los lípidos de
membrana con rotura celular. La capacidad de daño de este fármaco es
muy alta, e induce liberación de quininas vasoactivas por rotura de los
lisosomas intracelulares. Esto sumado a la activación de la cascada de
los eicosanoides por parte del ácido fosfatídico liberado por la
fosfatidilcolina, determina una intensa reacción inflamatoria local y, a
veces, incluso general.
Nuestra experiencia nos ha llevado al empleo de este producto en
dilución. La dilución que mantiene buenos resultados “clásicos” con
ausencia de efectos colaterales es la que resulta de añadir 1 ampolla del
medicamento (5 ml) a 250 ml de agua destilada. Añadimos además un
anestésico local para reducir la sensibilidad de la zona.
Así que nosotros proponemos una solución hipotónica, concretamente
agua destilada (estéril e inyectable), a la que añadiremos fosfatidilcolina y
deoxicolato sódico para sumar al daño osmótico el daño químico.
Obviamente corresponde ahora probar que el daño osmótico persiste a
pesar de la composición de la solución propuesta.
Nosotros proponemos la dilución en 500 ml de agua destilada de:
    • 4 ampollas de Lipostabil de 5 ml que contiene 250 mg de
        fosfatidilcolina (5%) y 45 mg de deoxicolato sódico (4,2%)
    • Una ampolla de lidocaína 1% de 10 ml, que contiene 0,1 g de
        clorhidrato de lidocaina
    • Una ampolla de bicarbonato sódico de 10 ml, que contiene 1
        mOsmoles/ml (= 10 mOsmoles)
Resultando que la concentración molecular final es de 0,058 nmoles, que
equivale a 107 mOsmoles
Es decir, una solución francamente hipotónica.
La cantidad (volumen) de solución que debemos inyectar debe permitir el
mantenimiento de una hipotonía periadipocitaria. Por ello, proponemos
inyectar 3 ml de la solución por cada 1 ml de tejido adiposo que queremos
tratar. (1 ml 300 mOsm + 3 ml 107 mOsm = 4 ml 407 mOsm) Solución final
= 102 mOsm
Enfriamos la zona a tratar para inducir vasoconstricción y reducir los
cambios microcirculatorios.
(por término medio, se intercambian 14 ml/minuto).
Infiltrada la zona, se procede a provocar la cavitación on aplicación de
ultrasonidos de alta potencia.
El daño mecánico importante inducido por la cavitación, asociado al daño
químico del deoxicolato sódico y al de la hipotonía, puede producir una
notable destrucción de tejido adiposo que, si por una parte es beneficiosa
por los resultados clínicos y estéticos, por el otro es peligrosa por la
cantidad de triglicéridos que se liberan localmente, y que pueden producir
embolias grasas o simplemente flogosis oxidativa por esteatonecrosis.
Por esta razón, después del tratamiento con los ultrasonidos, podemos
realizar una “limpieza” de la zona mediante un sistema de drenaje.
Utilizamos para ello un simple sistema de drenaje desechable con fuelle y
una aguja (ó cánula) 13 G.


                             ABSTRACT & TITLE


Abstract title: "Facial Aesthetic Surgery & Skin Rejuvenation: Finesse,
Balance, & Beauty."

Authors: David M. Morrow, MD, FAACS; Harry Marshak, MD, FACS; Allan
Y. Wu, MD.. FACOG

Institution: The Morrow Institute, A Multi-Specialty Aesthetic Surgery
Group; Rancho Mirage, California, USA

Abstract Text:

1. Facial aesthetic surgery in the new millennium should reach for the next
   highest level of development: Finesse, Balance, and Beauty. As we move
   forward in the 21st century we stand on the shoulders of all of those cosmetic
   surgeons since the early nineteen hundreds who came before us. They
   were the pioneers in technique, each pushing the envelope of the status
   quo. We have made great strides in the technical aspects of aesthetic
   surgery, now we must require that our techniques become slaves to our
   artistry. For indeed, artistry is what aesthetic surgery is all about. We may
   have done the most technically proficient surgical procedures, however, if
   they were either not done with artistry, or were not the best procedures to
   achieve the most artistic result possible, we have done our patient a
   disservice.

Our goal is to have a refreshed, natural looking face created by outstanding
technical surgery performed with superior artistry.

Submitted by: David M. Morrow, MD, FAAD, FAACS

May 11 08
                 The Ultimate Skin Rejuvenation Procedure:

Abstract: “The Ultimate Skin Rejuvenation Procedure” involves a combination
of chemical skin peeling with IPL (intense pulsed light), and fixed wave length
lasers. This combination of therapies, judiciously and thoughtfully applied treats
virtually every layer of the skin for a complete rejuvenation of the skin.

BACKGROUND: Dr. Morrow has been doing skin rejuvenation since 1978. In
that time he has treated tens of thousands of patients and performed over
25,000 skin rejuvenation procedures. Over the years Dr. Morrow developed
and trademarked his concept of the Designed Skin Peel® performed with his
own proprietary solutions and proprietary cosmeceuticals. Later Dr. Morrow
added to this his expertise in the use of intense pulsed light (ipl) and fixed wave
length lasers for what he now refers to as “The Ultimate Skin Rejuvenation
Procedure.”



                NOVEDADES EN RINOPLASTÍAS CON HILOS
                           Dra Vilma Padín
                        Buenos Aires- Argentina


Nuestra experiencia en la colocación de hilos de autosustentación y de anclaje
a nivel facial data desde el año 2000.
Hemos recibido entrenamiento en los centros más importntes del mundo, lo
que nos ha permitido manejar las técnicas con soltura y poder obtener una
casuística importante.

Luego de la experiencia facial continuamos con la aplicación de hilos glúteos,
siguiendo la técnica de Serdev, modificada por Ferreira para la paciente latina.
También aplicamos hilos en otras zonas corporales como los muslos internos,
muslos externos, brazos, abdomen, etc. con técnicas personales y utilizando
hilos espiculados convergentes y/o de multifijación de polipropileno, con
resultados buenos y muy buenos, combinándolos muchas veces con hilos de
oro, ayudando de este modo a la bioestimulación.
Fue por esto que luego de ver las técnicas de rinoplastías con suturas, de
Barba y de Hernández Pérez, decidimos incursionar en este terreno,
complementándolas en un principio con la bioplastía de Nácul.
Hoy nuestros casos de Rinoplastías se basan fundamentalmente en las
técnicas descriptas, pero en la mayoría de los casos las combinamos con
intervenciones quirúrgicas mínimamente invasivas como COLLUMELA
SLIDING y TIP ROTATION de Serdev, como también técnicas de afinamiento
nasal del mismo autor. Son los casos que se muestran y se describen en esta
presentación.
Para ello utilizamos aguja e hilo de policaproamida de origen búlgaro ( Serdev).
Como corolario podemos expresar nuestra gran satisfacción con estas técnicas
sencillas, de fácil realización con anestesia local, con poco sangrado y sin
taponamientos ni yesos que como todos sabemos molestan al paciente y
complican sus actividades.
Como otorrinolaringóloga estoy ampliamente satisfecha con estos métodos ya
que no he tenido complicaciones a nivel de la mucosa, por lo tanto la
funcionalidad respiratoria estuvo conservada en todos los casos.
Los procedimientos mínimamente invasivos son un gran aliado de la Cirugía
Cosmética y la Medicina Estética ya que nos ayudan a optimizar los resultados
aumentando el confort de nuestros pacientes.


                             Dr. Fernando Sancho

                        Rinoplastia en la nariz mestiza

                                    Resumen


Las características raciales de mis pacientes, mayoritariamente son de origen
mestizo, y en 17 años de practicar Rinoplastias, he podido desarrollar un
concepto claro de las necesidades de ellos.
De narices pequeñas con puntas poco proyectadas y pseudo gibas osteo-
cartilaginosas, la estructura de nuestras narices se caracteriza por cartílagos
débiles, tejido fibroconectivo abundante, hipoplasia del tercio medio facial con
protrución de las arcadas dentarias y retrognatismo mandibular.
La técnica que empleo busca corregir estos defectos, brindando a la nariz el
soporte estructural necesario, con el uso de injertos cartilaginosos que pueden
obstenerse del septum o cartílago auricular, así como la corrección de la
hipoplasia del tercio medio facial y retrognatismo mandibular, con protesis de
Silastic o rellenos grasos, siendo estos últimos poco precisos al momento de
buscar una correcta definición.
Expondré de forma audio-visual la técnica que irá sustentada con algunos
casos demostrativos.

                                    Summary

The racial characteristics of my patients are in the mostly from “mestizo” origin.
In 17 years of rhinoplasty practice I could develop a clear concept of their
needs.

From small noses with little projected tips and pseudo osteo-cartilaginous
humps, the structure of our noses are characterized by weak cartilage,
abundant fibroconnective tissue, hypoplasia of the facial middle third with dental
arches protrusion and retrognatic jaw.
The technique that I apply seeks to correct these defects, providing the nose
the necessary structural support, with the use of cartilaginous grafts that can be
obtained from the auricular septum or cartilage, as well as the hypoplasia
correction of the facial middle third and the retrognatic jaw, with Silastic
prosthesis or fat fillings, being the last ones inaccurate at the time to seek a
proper definition.
I will present the technique in an audio visual form that will be supported with
demonstrative cases.

                       Rinoplastia en la nariz envejecida

                                    Resumen

En la tercera edad, los cambios naturales del tono muscular, la elasticidad de la
piel y en general la laxitud de los tejidos que brindan soporte a la punta nasal,
provocan un descenso de la proyección de la misma y cambios importantes en
los flujos áereos nasales, que ocasionan muchas veces trastornos funcionales
manifestados como obstrucción nasal, rinitis, etc. Estos síntomas motivan las
consultas de estos pacientes por lo que debemos estar atentos para identificar
estos signos, con la maniobra de Cottle para apertura de la válvula podemos
determinar el grado de afectación a este nivel, así como al levantar la punta
nasal podemos comprobar la mejoría subjetiva del flujo áereo nasal.
La técnica que usamos para resolver estos casos busca mejorar la proyección
de la punta nasal, acortar la nariz que esta elongada, manteniendo levantada
con injertos en la columela y en caso de colapso valvular el uso de injertos
dilatadores, para compensar la laxitud de tejidos blandos resecamos
segmentos de piel a nivel vestibular y un segmento en hoja de laurel a nivel del
nasion ocultando la cicatriz en los pliegues naturales del ángulo nasofrontal que
se han formado en esta edad, por último usamos suturas permanentes de
Prolene 4-0 para suspender los cartilagos alares en un punto septo-columelar
invertido, y otro punto de soporte nasion-punta que se fija a periostio del
nasion.
Presentaremos los resultados de nuestro trabajo en los últimos 10 años

                                    Summary

In older people, natural changes in the muscle tone, the elasticity of the skin,
and generally the laxity of tissues that offer support to the nasal tip, causes a
decline in the projection of the it and significant changes in the nasal aerial
flows. Which they often cause showed functional upheavals like nasal
obstruction, rhinitis, etc. These symptoms motivate the consultations of these
patients we must be alert to identify these signs, with Cottle maneuver for
opening the valve we can determine the degree of involvement at this level, like
to raising the nose tip we can prove the improvement of the nasal air flow.

The technique we use to resolve these cases seeks to improve the projection of
the nasal tip, shorten the nose that this elongated, keeping up with graft in the
columella and in case of collapse valve grafts using dilators, to offset the soft
tissue laxity resected segments of skin at the vestibular and a segment in bay
leaf at nasion level hiding the scar in the folds of natural frontal-nose angle that
have been formed at this age, finally we use permanent 4-0 Prolene sutures to
suspend the alar cartilages at an invested septo-columelar point, and another
nasion-tip bracket point that is fixed to the nasion periosteum.
We will show the results of our work over the past 10 years.
                              Lipoescultura Facial

                                    Resumen

En los últimos años y siguiendo una corriente de pensamiento alrededor del
manejo volumétrico del rostro, vengo practicando tratamientos con tejido graso
obstenido de la región abdominal o caderas, usando cánulas apropiadas de
3mm y con mínimas maniobras de manipulación, distribuyo en el rostro
inyectandolas con las cánulas de Cóleman, en diferentes planos para conseguir
un aumento de volumen principalmente del tercio medio facial, o definiendo los
ángulos faciales, mentón, mandíbula, cejas, etc. esta técnica a servido para
corregir deformidades propias de mi raza mestiza así como los primeros
cambios de envejecimiento facial e incluso como un tratamiento
complementario en casos de ritidoplastias.
Presentaré la técnica que empleo con imágenes de audiovisuales.

                                    Summary

In recent years, and following a stream of thought about the volumetric handling
of the face, I've been practicing treatments with fatty tissue of the abdominal
region or hips, using appropriate 3mm cannulas and with minimal handling
maneuvers, distributed in the face injected with the Coleman cannulas at
different levels to achieve an increase in volume mainly from the facial middle
third or defining facial angles, chin, jaw, eyebrows, etc. This technique has been
useful to correct deformities in my own race “mestizo” as well as the first
changes in facial aging and even as a complementary treatment in cases of
Ritidoplasty.
I shall present the technique i used with audio-visual images.


Rejuvenation of Bad hair Transplant Surgeries
DR MUHAMMAD AHMAD
Plastic, Reconstructive and Hair Restorative Surgeon
Aesthetic Plastic Surgery
Rawalpindi, Pakistan
plasticsurgeon999@yahoo.com

Objective:
To share the experience of corrective surgeries in patients not satisfied by their
hair transplant surgeries performed by other canters.
Patients & Methods:
All the male patients having unsatisfactory results after hair transplant surgeries
included (None of the surgery was done by the author). The patients were
divided in 3 categories, i.e., patients having problems with front hairline were
included in group A. Patients having problems in mid-scalp were placed in
group B, whereas patients with problems in donor area were placed in group C.
Group A included the patients having too low hairline, straight front hairline,
unnatural hair angles or multiple hair plugs in front hairline. Group B included
patients having poor distribution of hair, unnatural hair angles, multiple hair
plugs or sprouted grassy looks. Group C included the patients having wide scar
in the donor area (>3 – 4 mm), a well demarcated line with in-dipping (step
deformity), or low-lying scars. In all the patients, the corrective procedures were
performed under local anaesthesia, with a single dose of sedative and first
generation cephalosporin. The donor area was infiltrated with a mixture of
normal saline, lidocaine and epinephrine. The donor area was closed with
single 3-0 non-absorbable running suture. In some cases, undermining of the
wound margins was performed to avoid the stretch on the suture line. Slits were
made according to the preoperative plan. Large hair plugs were
removed/excised. Large hair plugs were also removed in cases of very low hair
line. Only single follicular unit grafts were used to reconstruct the anterior
hairline. The remaining follicular unit grafts were distributed according to the
preoperative plan. Transplanted areas were left open without any dressing. The
first wash was started after 48 hours. The donor area stitches were removed on
10-13 days.
Results:
A total of 19 patients were included who had previous surgeries at other centres
and were not satisfied with the results. Majority of the patients belonged to
younger age group 21 – 35 years (75%). 83.3% patient complained of a
prominent unnatural hairline and 33.3% of these patient had multiple hair plugs
in the anterior hairline. 75% patients had unnatural angles of the hair. Donor
scar problems were also seen including wide scar (33.3%) and poor positioning
in 25% patients.
Conclusion:
Although the hair transplant surgeries are performed very frequently, proper
training under good supervision is must to obtain good results.


PATIENT SATISFACTION IN HAIR TRANSPLANT SURGERY

DR MUHAMMAD AHMAD
Plastic, Reconstructive and Hair restorative Surgeon
Aesthetic Plastic Surgery
Rawalpindi, Pakistan
plasticsurgeon999@yahoo.com

Objective:
To evaluate the patients satisfaction after hair transplantation.
Materials and Methods:
The study was carried out on 100 consecutive patients undergoing hair
transplant surgery. All the patients were given a detailed preoperative
consultation. Hair transplants were performed using local anaesthesia using
adrenaline alongwith a mild oral sedative. The procedure was performed using
clean conditions, sterile and disposable instruments and magnification. The
donor strip was harvested with patient in prone position. The closure of donor
area was done using a non-absorbable suture. Postoperatively, no bandages
were applied and patients began shampooing after 48 hours. The stitches were
removed after 10-12 days. To assess patient satisfaction, a questionnaire was
filled about the important factors pertaining to the patient experience during and
after hair transplantation.
Results:
98% of the patients rated the consultation as ‘excellent to good’, 2% as
‘satisfactory’, and none as ‘unsatisfactory’. 60% of the patients were ‘anxious’
during strip harvesting and 24% felt ‘normal’. 74% remained ‘normal’ on 1st
postoperative night. 28% patients rated the overall experience as ‘excellent’,
38% as ‘good’.
Conclusion:
Every surgeon performing hair transplantation should publish his patients
satisfaction data from time to time, so that factors should be identified which can
help improve the patients satisfaction.

EXPERIENCE OF COSMETIC RHINOPLASTY
DR MUHAMMAD AHMAD
Plastic, Reconstructive and Hair restorative Surgeon
Aesthetic Plastic Surgery
Rawalpindi, Pakistan
plasticsurgeon999@yahoo.com

Objective:

The purpose of this surgery was to introduce our experience of open-tip
rhinoplasty to obtain greater satisfaction in aesthetic rhinoplasty in Asians.
MATERIALS AND METHODS:
20 consecutive patients who underwent open-tip rhinoplasty between July 2005
to June 2007 were included in this study. The majority of the patients were
females with male to female ratio of 1: 4. 19 patients had primary rhinoplasty
whereas only one patient had secondary rhinoplasty. Postoperative results were
evaluated at three months after the procedure. All the procedures were
performed with the patient under general anaesthesia with local anaesthetic
infiltration (1% lidocaine with 1: 100,000 epinephrine). A stair step
transcolumellar incision was made at the narrowest part of the columella. The
soft tissue envelope was sharply elevated in a submusculoaponeurotic plane up
to the bony pyramid. The periosteum was sharply incised and elevated in a
subperiosteal plane to the radix area. Dorsal hump was managed according to
the size. Small to medium size hump (5 mm) were managed by simple rasping.
Large humps (> 5mm) were managed by sharp resection with a guarded
osteotome. Dorsal onlay grafts/spreader grafts were also used where indicated.
In most of the cases, septal cartilage grafts were harvested, and in a few cases
rib cartilage and ear cartilages were also used. Through irrigation was done at
the completion. The soft tissue envelope was closed using absorbable 4-0
suture in infracartilagenous incision and 6-0 non-absorbable suture in
transcolumellar incision. Intranasal splints coated with antisthaphylococcal
ointment were placed and fixed. A dorsal nasal splint was also placed. The
nasal packs were removed after 3-4 days and the stitches were removed on 5th
post-operative day. After 7-9 days, dorsal nasal splint was also removed. The
patients were examined after 3 weeks and at 6 month interval.
RESULTS:
Total of 20 patients were operated. The mean age of the patients was 25.7
years. Majority of the patients were unmarried. All the patients showed
improvement in nasal height, tip projection and nostril shape. Majority of the
patients (80%) were satisfied with their nasal shape. Two patients not satisfied
wanted a more prominence in the nasal tip height. One patient had had
complaint of nostril scar contracture which required further observation and
conservative treatment. Two patients had mild degree of nostril asymmetry but
it was not clinically significant. There was no case of graft extrusion,
displacement or infection. In addition, there were no cases of respiratory
complaints and no revision procedure was performed. Only one patient
experienced excessive sneezing in early postoperative period which resulted in
slight persistence of nasal swelling which became normal after 4 months.
Conclusion:
The patients undergoing cosmetic rhinoplasty should be evaluated properly and
open technique should be preferred as it gives the exposure to all the nasal
structures.

52nd Meeting and World Congress of the International Academy of
Cosmetic Surgery

Steven B. Hopping, MD, FACS
President, The American Academy of Cosmetic Surgery
2440 M Street, NW
Suite 205
Washington, DC
20037
email. hoppingmd@msn.com

Cosmetic Facial Surgery in Ethnic Groups (Fitzpatrick IV – VI)

Subjective. Cosmetic facial surgery in patients with darker skin (Fitzpatrick
      types IV-VI) requires special considerations. In general , this patient
      population can age differently than their Fitzpatrick types I-III
      counterparts. A careful history regarding keloid tendencies and healing
      abnormalities is important. Often other modalites including minimal
      incision surgery with less risk of scarring should be considered first.
      Fortunately, surgical rejunvenation of the eyes and nose rarely exhibit
      adverse scarring.
Objective. The indications and options for ethnic patients (Fitzpatrick IV-VI)
      seeking facial rejunvenation and improvement is discussed.
      Techniques of rhinoplasty , blepharoplasty and rhytidectomy with special
      considerations given darker skin patients are discussed. Outcomes
      information and results are reviewed.
Accessment. Patients with darker skin (Fitzpatrick IV –VI) are candidates for
      facial cosmetic surgical procedures. Keloid formation especially on the
      face may be a contraindication to facelift surgery. These patients can
      still be considered candidates for rhinoplasty and blepharoplasty
      because of the protective nature of the midface against keloid formation
      and adverse scarring.
Plan. At the completion of this presentation, participants should understand
      the indications and contraindications of facial cosmetic surgery in darker
      skin patients(Fitzpatrick IV – VI). They should also understand the
      limitations, complications and outcomes of such procedures.
52nd Meeting and World Congress of the International Academy of
Cosmetic Surgery


Steven B. Hopping, MD, FACS
President, The American Academy of Cosmetic Surgery
Director, The Center for Cosmetic Surgery
2440 M Street, NW Suite 205
Washington, DC 20037
Email. www.hoppingmd@msn.com

Revision Rhinoplasty, Philosophy and Techniques

Subjective. Revision rhinoplasty can be very challenging to the aesthetic
surgeon. Patients require additional consultation time, surgery is often difficult,
complications can be higher, and post operative care is more involved.
Revision rhinoplasty requires much experience on the part of the operative
surgeon. Previous operative records and photographs should be carefully
reviewed if available. Computer imaging can be helpful in operative planning.
Intraoperatively, experience and careful, exacting technique is essential.
Objective. A retrospective review of 50 consecutive revision rhinoplasties
performed at The Center for Cosmetic Surgery is undertaken. The problems
encountered are catalogued and the techniques most commonly utilized in
correcting these problems are tabulated. The majority of cases required
autologous cartilage grafting for either projection or augmentation problems
resulting from previous surgery. Details of these techniques are reviewed.
Accesment. Rhinoplastic surgeons must be adept in use of autologous
cartilage grafts to achieve successful results in revision rhinoplasty. This review
discusses ways to prevent untoward results in primary rhinoplasty as well as
techniques to correct such unwanted sequelae.

Steven B. Hopping, MD, FACS
President, The American Academy of Cosmetic Surgery
Clinical Professor of Surgery, George Washington University
Director, The Center for Cosmetic Surgery
Washington, DC.
Address:
2440 M Street, NW
Suite 205
Washington, DC 20037
Email www.hoppingmd@msn.com

Abstract Submission.    52nd Meeting and World Congress of the IACS

Video and Power Point Presentation (15minutes)

Title: Minimal Incision Rejuvenation of the Upper Face. Video Presentation
and Power Point Presentation
Introduction. Many patients young and old request rejuvenation of the upper
face including the brows, forehead and eyes. Many cosmetic surgeons have
criticized minimal incision approaches to forehead surgery as less effective than
more traditional open techniques.

Objective. This study reviews the effectiveness, complications, and satisfaction
of current techniques of minimal incision browlift surgery.

Methods. A retrospective review of 50 consecutive patients undergoing upper
face rejuvenation with minimal incision browlift was undertaken. This
represented 42women and 8 men. Long term aesthetic results, complications
and patient satisfaction at six months was reviewed.

Discussion/Results. Minimal incision browlift was judged effective or very
effective in 82% of the cases reviewed at 6 month. Long term complications
were 5% and primarily involved localized alopecia, wound infections and
asymmetries. Patients judged their results as satisfied or very satisfied in 85%
of those surveyed.

Conclusion. Minimal incision browlift can provide long term clinical
effectiveness with an acceptably low complication rate and high patient
satisfaction.

Steven B. Hopping, MD, FACS
President, The American Academy of Cosmetic Surgery
Clinical Professor of Surgery, George Washington University
Director, The Center for Cosmetic Surgery
Washington, DC.
Address:
2440 M Street, NW
Suite 205
Washington, DC 20037
Email www.hoppingmd@msn.com

Abstract Submission.     52nd Meeting and World Congress of the IACS

Title: Safe Blepharoplasty 2008. Avoiding Unfavorable Outcomes.

Introduction. Blepharoplasty for rejuvenation of the eyes is frequently
requested by young and aging patients. The results can provide long term
satisfaction or dissatisfaction to patients. Unfavorable results can be very
difficult to correct and are best avoided in this elective, aesthetic operation.

Objective. This study reviews the effectiveness, complications, and satisfaction
of current techniques of blepharoplasty surgery designed to minimize
unfavorable outcomes

Methods. A retrospective review of 50 consecutive patients undergoing
cosmetic blepharoplasty was undertaken. This represented 35women and 15
men. Long term aesthetic results, complications and patient satisfaction at six
months was reviewed.

Discussion/Results. Blepharoplasty can provide long term aesthetic
improvement for patients with premature or aging eyes. Conservative skin and
fat removal or repositioning with lower lid suspention techniques provide faster
recovery and fewer unfavorable outcomes. Ancillary procedures such as
browpexy, brow lift, chemical peeling and free fat grafting can enhance
aesthetic results. Long term complication were less than 6% and most often
involved unsatisfactory incisional healing or aesthetic results. Short term
complications are frequent and patients must be informed preoperative of such
expectations. Patient surveys revealed satisfied or very satisfied results in
84%.

Conclusion. Blepharoplasty is a commonly requested procedure to improve
premature and aging eyes. Current blepharoplasty techniques including
conservative skin excision, fat preservation, lower lid horizontal suspension
along with ancillary techniques can give satisfactory clinical results and minimal
unfavorable outcomes.

52nd Meeting and World Congress of the ISCS
Abstract.

Julia S. Hopping
Director, The Center for Cosmetic Surgery

The 2008 Cosmetic Surgery Practice.      Office Challenges and Solutions.

30 minutes.

Cosmetic Surgery is becoming more competitive and sophisticated. Patients
are better educated and often have specific goals and expectations. To be
successful, cosmetic practices must provide seamless, high value service from
the initial phone call to the final post operative visit. There must be a common
theme of value, integrity, and state of the art service in all aspects of the
patient’s experience. Issues including staffing, aesthetician, patient selection,
office based surgery, malpractice, marketing, medical spas, and improving
office efficiency and productivity will be discussed.


                         Dr. Roberto Blumm Andrade

HIDROLIPOCLASIA CAVITATIVA Y SU INDICACION ADIPOSIDADES
LOCALIZADAS ( TÉCNICA PERSONAL)
Está técnica nos permite destruir el tejido adiposo como su nombre lo indica a
partir de sus destrucción de moléculas de grasa localizadas en diferentes
partes de nuestro cuerpo con la aplicación agua y la aplicación de ondas
capacitivas.
Viene de hidro: agua lipo: grasa clasia: destrucción cavitativa:
radiofrecuencia no ablativo.
Es una técnica que nos permite trabajar con la capacidad física de la
Radiofrecuencia no ablativo capacitivo para inducir termogénesis o calor de tipo
controlado para no producir quemadura o sobrecalentamiento de los tejidos,
este al entrar en contacto con la solución en este caso lactato ringer genera un
efecto inductor por medio de la generación de ondas sonoras , que rompen las
moléculas de grasa y permiten reducir esas adiposidades de intensidad
mediana a grande localizadas en el cuerpo, donde van a ser eliminadas las
toxinas a través de la orina y heces con una reducción zonificada de 5-6 cm por
sesión, se realiza como mínimo 3 sesiones con una frecuencia de 15 días no
menos de este tiempo.

BLEFAROPLASTIA NO QUIRURGICA Y SU APLICACIÓN CIRUGIA
COSMÉTICA
Este método nos permite disolver la grasa orbitaria del párpado inferior de
manera minimamente invasiva no quirúrgica, en cuestión de 5 minutos
valorando al paciente de manera clínica la cual nos permita establecer si no
hay problema de hipertrofia del músculo orbicular con el signo slow o scleral
show porque en ese caso sería quirúrgico, de no ser así se aplica un producto
como es la fosfatidilcolina con mezcla de soluciones especiales para el parpado
inferior , con punto a nivel bolsa externa, medial, e interna con una aguja 30 g
mesoterapia largo de 4mm la cual nos permnita no tocar más alla que su bolsa
grasa , con un número sesiones de 4 , con un período de 15 días entre una y
otra , puede presentar un ligero edema de 24 a 48 horas

CARBOXITERAPIA REJUVENECIMIENTO FACIAL
La carboxiterapia es una técnica antigua que consiste en la aplicación de
dióxido de carbono (CO2) suministrado con fines terapéuticos por vía
subcutánea , percutánea y a nivel de rejuvenecimiento facial mejorando la
textura, rostro y las arrugas producidas por el fotoenvejecimiento de la piel,
además mejoramiento de la flacidez.
Está indicado en todo tipo de rostro con fotoenvejecimiento incipiente de
comienzo o antiguo con su técnica propia de aplicación muy diferente a la
corporal como complemento de todas las alternativas terapeuticas del rostro,
su dosificación es menor a la corporal ya que se usa mínima dosis de acuerdo
a la región anatómica e incluso se puede actualmente aplicar en ojeras , al ser
menor dosis nos hace un efecto de retracción.



                         RESUMEN LIFTING FACIAL

             RITIDOPLASTIA CERRADA (FACE UP FILAMENT)
                           TECNICA LUNA


                        CONDICIONES GENERALES
  El mundo actual nos exige cada vez mas y mejores resultados con mínimas
 cicatrices, menos riesgos, menor incapacidad social y laboral y por supuesto
             que perduren lo máximo posible a través de el tiempo.
   En base a esto comencé a idear una técnica Quirúrgica sencilla, segura y
 efectiva que se acomodara a la constante y vertiginosa evolución de nuestro
                                  universo .
                 (Dr. SAUL LUNA CONDE CIR. PLASTICO).


Del análisis comparativo de las diferentes técnicas en hilos (suturas) para
elevación de la cara podemos deducir que existen de sede el primer método
que salió al mundo médico “Hilos de Oro” y luego “Hilos Aptos” mal llamados
hilos rusos; una serie de variantes con la misma sutura polipropileno y con el
mismo principio las espicas (o salientes del cuerpo de la sutura) cada vez
mejorado, unos mas largos otros sobrepuestos al Polipropileno con diferentes
direcciones con orificios        y placas para suspender, podemos decir
enfáticamente que la técnica de los Hilos Aptos ya es pasado, y queda para la
historia del principio de la, -en mi muy particular concepto hoy obsoleta- “Era
de los Hilos” gracias al doctor Zulamanitze que saca estos hilos que el mundo
medico conoció una nueva forma diferente a la cirugía convencional, menos
invasiva pero que no llega a solucionar el problema de la flacidez cutánea
primer signo de envejecimiento facial. Hubo y continua una avalancha a nivel
mundial de nuevos métodos con modificaciones hasta del color del
polipropileno, vale decir que la F.D.A (aprobó el polipropileno de color blanco )
con otra marca de hilos pero no así los hilos Aptos. El esperar que unos trozos
de sutura de polipropileno produzcan una fibrosis después de ocho, diez o mas
incisiones en la cara, en la cual quedan sueltos con muchas complicaciones
como dolor y tendencia a su salida para solucionar el 25% solamente de la
flacidez en un corto tiempo hacen esta técnica no confiable.
 En conclusión esta Técnica NO cumple con los objetivos trazados.

En un principio la sutura que es fabricada por Tolsov ( Sofia) fue utilizada y
presentada en los trabajos del doctor Nicolay Serdev ( Sofia-Bulgaria) como
sutura “no absorbible”; los trabajo de Inglaterra publicados en el Journal de
cirugía plástica desvirtúa lo no absorbible de la sutura de Serdev. Ya en el
ultimo reporte Serdev rectifica y saca su sutura como absorbible ( Internacional
Journal Of Cosmetic Surgery, title “Serdev Suture” page 408-503) con los
mismos problemas originales del antibiótico usado en el cuerpo de la sutura y
se deshilacha fácilmente al contacto con el agua y los líquidos internos esto
dificulta el enhebrar las agujas, esta sutura pierde fuerza de tracción en el
tiempo por no ser coherente en el cuerpo.
Hoy en dia hemos creado una Tecnica, sencilla, efectiva y segura, para
levantamiento facial y es lo que he denominado FACE UP FILAMENT (Tecnica
LUNA). Estos trabajos se remontan desde 1.996, cuando comence esta labor
junto con el Dr. Felipe Coiffman y el Dr. Juan C. Fernandez, compañeros
Cirujanos Plasticos en la Ciudad de Cucuta (Col.). Pensaba entonces como
ahora que para este tipo de “hilos” o suturas funcionaran deberian tener un
“anclaje” efectivo y firme y no dejarlos a la deriva como se venia haciendo
hasta ahora con ese tipo de tecnicas similares.
 Posteriormente continue con lo estudios en la Ciudad de Caracas (venezuela)
con el Dr. B. Ferreira y Dr. A. Marquez, buscando siempre el mismo objetivo:
Sustentación firme y tensión y fijación permanente.

La sutura poliamida, que usamos en nuestra técnica es un
Pseudomonofilamento no absorbible; hemos sacado algunas suturas con en
contadas oportunidades después de treinta y dos meses de haber sido
colocadas y el cuerpo de la sutura y el nudo quirúrgico han permanecido en
perfectas condiciones a simple vista y al microscopio (10x, 20x9). Los
fabricantes en
 EEUU, garantizan lo no absorbible de esta sutura, que además esta aprobada
por la F.D.A. Las características de semi-elástica es aplicable en ambos (
serdev, hilo Unico), estas suturas además no “resbalan” al realizarse los nudos
quirúrgicos.
Hasta donde hemos revisado y trabajado con suturas creemos que la técnica
nuestra la sutura        POLIAMIDA      Pseudo-monofilamento es la mas
recomendable.

                                    Material


   •   Sutura de POLIAMIDA de 2/0 o 1/0 de 45 cm para utilizar en FACE UP
       FILAMENT (T. LUNA).
   •   1 tijera – 3 pinzas mosquito- 2 pinza hemostática – 1 mango bisturí #4 -
       1 Hoja de bisturí # 11 – 2 pinzas de campo -1 porta aguja mediano, 1
       disector, 1 pinza de Adson sin dientes, 1 pinza de Adson con dientes.
   •    Tipos de agujas Quirurgicas especiales.
   •   Esterilización de material en autoclave y utilización de Gerdex, povidine,
       etc.
   •    Campos operatorios- gasas y guantes estériles, etc.
   •   Micro-cánulas NACUL.
   •   Ambiente Quirurgico.

                                     Anestesia

       •   Anestesia local y solucion tumescente (klein modificada x Luna, SIN
           ADRENALINA)
       •   Anestesia -Lidocaina- local (puntual), en el sitio de la demarcación.
           (1 c.c.)
           ( en los puntos de entrada y salida de la Aguja ).
       •   Tumescencia: 5 a 15 ml de solución de Klein modificada (cuadro 1).
       •   La tumescencia permite:
                     1. Una mejor difusión del anestésico
                     2. Un menor uso de anestésico
                     3. Paso de la Aguja (F-M), sin dolor ni molestias, por el
                        túnel de la solución tumescente.
                     4. Los nervios, vasos y otros tejidos son respetados por el
                        efecto del túnel hídrico.
                     5. El equipo quirúrgico debe adquirir o tener experiencia en
                        anestesia tumescente.
No son necesarios narcóticos ni sedantes previos o durante la operación pues
esta tiene una duración total no mayor de 30 a 45 minutos y es Ambulatoria.

Otras de las ventajas de la anestesia local utilizada serían:

        1- Evita los riesgos de la anestesia general.
        2- Recuperacion Inmediata.

El regreso de el Paciente a sus actividades cotidianas puede ser inmediato o
en un lapso no mayor de 48 horas.

El perfil de seguridad en la colocación de los hilos resulta excelente con esta
técnica que fue introducida por el Dr. Saúl Luna Conde (2004).
Recordar que buena parte de las (los) pacientes vienen manejando vehículos
a motor y un porcentaje importante de ellas (ellos), pudieran venir de ciudades
del interior.

                    Solución de anestesia tumescente local

                                   Componentes

Solución de cloruro de sodio al 0.9%                    500ml.
Solución de Cirfarcaina o Lidocaina al 2%               10ml.
Solución de epinefrina 1mg/ml                            1ml. (Opcional)
Solucion de bicarbonato de sodio 8.4%                     5ml. (Opcional)

NOTA: Se debe guardar estrictamente las normas de Asepsia y Antisepsia de
cualquier procedimiento Quirurgico.

PROCEDIMENTO QUIRURGICO QUE SOLO DEBE SER REALIZADO POR
PROFESIONALES  DE   LA   SALUD  (MEDICOS)   DEBIDAMENTE
ENTRENADOS.

    •  No hay ninguna técnica (2003) publicada de hilos con tensión, tracción
       y fijación sin incisiones solamente hasta ahora la técnica de los hilos
       Unicos. (T. Luna).
    • Procedimiento quirúrgico de exclusivo uso medico.
    Este resultado de logra después de aproximadamente 45 minutos de
    procedimiento:
                         DR. JOSE SAUL LUNA CONDE
                             CIRUJANO PLASTICO

PRESIDENTE S.P.A.C.M.E.C. (Sociedad Panamericana de Cirugía, Medicina
estética y Cosmetología)
PRESIDENTE A.S.P.A.C. (Asociación Panamericana de CARBOXITERAPIA)
DIRECTOR CIENTIFICO MEDICAL SPA CENTER.
DIRECTOR MEDICO DERMOCELL TECHNOLOGIES INTERNATIONAL
CIRUJANO PLASTICO PREPARADOR MISS VENEZUELA – MISS
UNIVERSO.


PROF AHMED ADEL NORELDIN, M D
prof plastic surgery Cairo University, Egypt
sec gen of IPRAS, pan African section

1- FACE LIFTING BY THE CURL THREADS , MY OWN EXPERIENCE

  In this 12 minutes presentation the curl threads for face lifting will be illustrated
in details with video clips showing the technique and results after doing more
than 50 case. A special emphasis will be thrown on the expectations and
limitations of the procedure. The results will show how good the results if
candidates are properly selected.


2- SALVAGE OF ARTIFICIAL HAIR IMPLANTATION VICTIMS BY
FOLLICULAR UNITS NATURAL HAIR TRANSPLANTATION , THE
EGYPTIAN EXPERIENCE

 In some counteries it is still allowed to treat male pattern baldness by artificial
hair implantations to mimic the lost hair in the scalp. The consequences of this
procedure include a lot of problems like the foreign body reaction to the
implanted hairs which causes chronic inflammation in the scalp with consequent
fibrosis. Another problem is the intolerence of the implanted hairs with an
average loss of about 25 percent yearly. Tha auther had the chance to see and
innovate a protocol for managing these patients by follicular unit natural hair
transplantation, The experince of 20 cases will be shown through an interesting
funny cartoon which will take about 10 minutes.


3- CELLULITE MANAGEMENT, IT IS NO MORE A PROBLEM

The multifactorial eatiology of the disease of the modern age, cellulite, makes it
a rather dificult problem to manage. The auther being a certified trainer in the
network lipolysis group, founded in Germany in 2003, uses the
phosphatidylcolin/deoxcholate injection in a new protocol for managing cellulit
for the last three years. the ppc/dc injections proved to have a good role among
other steps in dramatically improving the cellulite in most cases. the tehnique ,
results, precautions and expectations will be shown in this 20 minutes
presentation with cartoon video clips.
                         DR. BERAMENDI’S
          BARBED-CONVERGING POLYPROPYLENE SUTURE THREAD
                       VOLUMETRIC FACELIFT



Based on Subcutaneous Upper-SMAS Implantation Technique of POLYPROPYLENE
BARBED-CONVERGING THREADS, according to Facial Traction Vectors, Dr. Beramendi’s
Volumetric Facelift methodology hallmark is a FAT VOLUMETRIC REPOSITIONING LIFTING
PROCEDURE that restores the original facial youth shaping as it lifts all flabby soft
tissues (fat and skin); creates new facial ligaments to sustain the tissues in their
original place; re-elevates ptotic facial angles; repositions the youthful fatty pad
highlights; and reduces and/or “erases” the nasolabial groove, the nasolabial jowl and
wrinkles.

Dr. Beramendi’s Volumetric Facelift technique takes in consideration the multiple and
independent anatomical compartments of facial subcutaneous fat and also the skull
involution process upon ageing.

The repositioning of facial fat pads structures in their original sites requires the
association of different barbed-converging designs polypropylene suture threads – all
of them developed by Dr. Beramendi. The traction and suspension forces of each
thread model enables the customized relocation of each sagged fat pad, thus granting
the patient a very natural youth look. The array of seven models of threads comprises
self-sustaining threads and suture carrier plate thread.

This 60 minute-minimally invasive and scarless ambulatory procedure (local
anesthetics) permits either a full facelift or local corrections (brow area – forehead –
midface). It is indicated for (a) patients as of 30 years of age or at facial tissues ptosis
onset; (b) diabetics and smokers; (c) elderly; (d) carriers of cardiopathies and
conditions counter-indicating general anesthetics; (e) white, brunette and black skin
individuals; (f) and to refresh a ritidoplasty.

In over 3.500 cases, this technique for the correction of geometric and volumetric
facial alterations has given the patients and the surgeon a high degree of satisfaction
and a minimal rate of complication to date.



                       S Access Facial Elevation (SAFE)

                          Longin H Zurek, MD. FACCS


Objective: To discuss the evolution of minimal access facelifts and present my
modification termed, S Access Facial Elevation (SAFE).
Methods: This presentation will trace the origins of the concept from Europe in
the early 20th Century to its modern application in current techniques, with
particular emphasis on my own modification.


Results: The principles of S Access Facial Elevation are:
- Performed under local anaesthetic on a true "walk-in, walk-out" basis.
- The incision is hidden in the temporal hair and follows the natural curvature of
the ear.
- Limited undermining facilitating "unit lifting".
- First vertical SMAS plication suture lifts up the neck and lower face.
- Second oblique SMAS plication suture elevates the mid-face.

- Third round SMAS plication suture.
- Only the excess skin is removed.
- The wound is repaired without tension.

Conclusions:
- S Access Facial Elevation is safe, with no incidence of any facial nerve injury
and no other significant complication in over 2000 cases.
- Natural result.
- No stigma of facelift.
- Brief "downtime".
- Longevity of Short Access Facial Elevation is comparable to conventional
facelifts.

                      Overview of Intimate Female Surgery

                          Longin H. Zurek MD. FACCS



   In recent years there has been an increasing interest in cosmetic surgery of
   female genitalia, which is undoubtedly related to growing awareness and
   education generated by the media.

Intimate Female Surgery

1. Anatomical consideration for cosmetic and functional aspect
2. Photo-documentation
3. Preop consultation and informed consent
4. Anesthesia consideration
5. Postop care program
6. Scalpel, Radiosurgery, Diode Laser
7. Specialised training, Gyneacology + Sexology + Cosmetic Surgery

Operative Indication
  • 1. Relaxed Vagina ; Birth trauma, Aging process
  • 2. Labia majora atrophy
  • 3. Labial minora hypertrophy
   • 4. Clitorial phymosis
   • 5. Hymenoplasty


Procedures
   • Vaginoplasty
     - Posterior Colporrhapy
     - Anterior Colporrhapy

   •   Perineoplasty
   •   Reduction Labioplasty
   •   Augmentation Labioplasty; by filler, fat,
   •   Perineoplasty
   •   Clitorial Plasty
       - Hoodectomy
       - Clitoropexy
       - Resection of Excess Clitorial Prepuce

   •   Lipoplasty;
       - Augmentation of Labia majora/minora, Mons pubis, Perineal
Body
        - Reduction lipoplasty of Labia majora, Mons pubis.

   •   Hymenoplasty
   •   G-Spot Augmentation Vaginoplasty
   •   Medical Perineal Skin care
   •   Laser T-line & V-line cleanup



Vaginoplasty

Relaxed Vagina to improve sexual gratification and increase self-esteem.
1.enhance vaginal muscle tone, strength, and control.
2. decrease vaginal diameters
3. build up and strengthen the perineal body




REFERENCES
1. Matlock D, Laser Vaginal Rejuvenation Course 2004
2. Chul W, Gyneco-Plastic Surgery Presentation.
3. Kang G, Hands on Laser Vaginal Rejuvenation Training,
   Seoul Korea, August 2006.
4. Kang G, Rebelo A, Personal Communication, Lisbon, Portugal, 2006.
5. Munhoz A et al., Plast, Reconstr. Surg, vol 118,1237, 2006.
6. Baggish K, Karram M, Atlas of Pelvic Anatomy and Gynecology Surgery, 2nd
Ed, Elsevier Saunders, 2006.
7. Alter G J, GenitalRejuvenation and Reconstruction: Fringe Procedure or a
New Frontier. Plastic Surgery 2007, Baltimore.
8. De Alencar Felicio Y, Labial Surgery. Aesthetic Surg J 2007;27;322-328


                          Dr. Hratch Saghbazarian

CURL-LIFT :

My Experience

      In Cosmetic Surgery there is a trend towards non-incisional
treatments, seeking reduced morbidity and rapid healing time.
The technique of Dr. Rene Guillermain (Paris 1960) has been revamped
by Dr. Maximiliano Florez Mendez (Peru2002) and Dr. Pierre Fournier.
       Curl-Lift is an affective method of revealing the beauty of the
sagging face.It is a suture with polypropylene in the subcutaneous
tissue of the face which is pulled maximum and fixed on the
periostium of temporal bone in order to have long-lasting results.
      The presentation describes my experience with more than 1000
patients. The main focus is on the indications, advantages and
complications of the procedure.
     Each indication is illustrated by cases with their final results,
followed by demonstrations of some complications.
  It is an amazing technique to lift the upper, middle and lower part of
the face.

FACE - LIFT

How to get a natural look?

    Face-Lift is one of the most frequently performed operation in the
field of Cosmetic Surgery.
  Too many techniques have been described by notorious plastic
surgeons worldwide.
  The presentation describes a technique which is combination of
Saylan’s S-Lift ,Serdev’s lower Smas-Lift followed by Curl-Lift.
  We describe the different sequences of operation:
    -local anesthesia
    -incision and subcutaneous undermining
    -Smas suspension
    -skin resection
    -sutures

Finally, we present our results.

Abstract Nr. 3

Curl-lift for treating Ectropion
    Ectropion ,drooping of the lower lid is one of the most common
complications of lower blepharoplasty.
     Ectropion is a bothering complication and causes a big
discomfort esthetically, especially when the eye no longer drains and
tearing occurs.
    Curl-lift offers a great help for those patients.
 By introducing Prolene from the temporal hair lines it reaches the
orbicularis oculi muscle and curls back to initial point and fixed on the
frontal eminence.
    It is a wonderful technique which offers great results,which can
not be reached by other interventions.

Abstract Nr. 4

   Difference between Curl-lift and Aptos (Russian threads )


     Curl-lift, developed in France by Guillerman is a subtle lift using
a special needle to attach a Nylon or Prolene, non absorbable, non
barbed suture thread from the area of the face or neck that is being
“lifted” , to a stationary point on the scalp.This procedure lifts the
desired parts of the face or upper neck.
     Aptos, developed in Russia by Sulamanidze is also prolene thread
which contains cogs which enter the SMAS sometimes and their
future consequences are unknown.
     The presentation describes over 10 major differences between
these 2 threads, including their advantages and disadvantages.



Corrección intraoral del surco naso geniano
Técnica mini invasiva de reposición de los tejidos que forman el surco
naso geniano via intraoral

Dr. Ivan Hernandez P. / Dr. Germán Rossani A.
Centro Camelias de Medicina Estética, Lima Perú, 2006

Resumen:
El surco naso geniano, el cual es visible desde nuestros primeros meses
de vida, ha sido considerado por la sociedad femenina, en su mayoría,
como un “inesteticismo” al momento de pronunciarse, producto de la
ptosis de los tejidos por el cual esta delimitado o por la consistencia del
tejido óseo peri oral, situación que hemos podido observar no
necesariamente en adultos jóvenes si no en pacientes de 14 o 15 años de
edad.
Son innumerables las técnicas descritas para su corrección, las cuales
han sido diseñadas para darle volumen al surco y si bien es cierto
mejoran el ovalo facial de manera temporal, en el grupo etáreo adecuado
como tratamiento independiente o adyuvante de otros procedimientos,
no corrige la periferia o la causa de origen y “ES TEMPORAL”
Nuestra intención es dar una alternativa para aquellas personas en donde
el darle volumen al surco no mejora la expresión peri oral y a pacientes
con deficiencias óseas, dentales o de tejido peri orales en donde el tejido
ptosico es evidente y el surco profundo.
Esta técnica, sumamente anatómica y concebida como una necesidad,
parte del principio de reposicionar los músculos formadores del surco
formando una “auto prótesis “ en el lugar del surco, dando volumen a la
zona y mejorando la expresión peri oral, todo esto mediante una pequeña
insición endoral de 2 o 3 cm a nivel de los carrillos.

Bioestimulación capilar
con PRP

Dr. Ivan Hernandez P./ Dr. Germán Rossani
Centro Camelias de Medicina Estética / Lima - Perú


En casi 5 años de experiencia en el manejo del PRP, hemos tenido una gran
satisfacción al lograr los objetivos deseados, lo que se traduce en nuestros
pacientes satisfechos.
Esto condiciona seguir a estudiando este magnífico producto natural de muy
bajo costo y de seguridad y eficacia demostrada tanto clínica con
anatomopatológicamente.
Han pasado casi 5 años, como mencioné, y no nos deja de sorprender las
múltiples aplicaciones de este producto y es justo por esto que nos hemos
decidido a contarles nuestra última experiencia con PRP que ya tiene casi 2
años de evolución. Por que no la contamos antes? Por que este artículo no
trata de un estudio científico, es mas, dista mucho de serlo probablemente,
pero el valor para los futuros operadores y para nuestros pacientes les aseguro
que es incalculable.
En el presente artículo intentamos mostrar al mundo médico, las bondades del
plasma en el cuero cabelludo, que fue sin duda alguna lo que podemos llamar
un ACCIDENTE en el transcurso de un procedimiento de transplante capilar y
la aplicación de PRP en este, fue de pura curiosidad.


LIPOINJERTO ENRIQUECIDO CON PLASMA RICO EN PLAQUETAS
Venciendo al enemigo del filling, la reabsorción.

Dr. Ivan Hernandez P. / Dr. Germán Rossani A.
Centro Camelias de Medicina Estética, Lima Perú, 2006

Resumen:

En el presente trabajo, los autores intentan dar una nueva alternativa
terapéutica, o mas bien, reinsertar en nuestra consulta el filling de tejido
graso autólogo el cual está enriquecido con plasma rico en plaquetas
para darle mayor soporte autosustentatorio y disminuir de esta manera la
consulta repetida para “ retoques”.
El contenido se ha desarrollado desde marzo del 2005, hasta junio del
2006, habiendo tratado 116 pacientes entre 23 y 70 años de edad siendo el
sexo femenino el preponderante en un 79% en los diferentes tratamientos
de filling facial y corporal.
Este trabajo es de carácter prospectivo, experimental, siendo en algunos
casos de tipo caso control.
Se intervinieron 116 pacientes de los cuales existen 76 en filling facial, 30
en filling corporal en diversas patologías.
De estos casos se controlo el proceso de reabsorción de tejido
trasplantado a los 7, 15 y 30 días, luego a los 3 meses y al los 6 meses de
acuerdo a medidas y proporciones de manera experimental, existiendo 12
casos de biopsias de la zona injertada a los 2, 7 y 10 días.
Se logro comprobar o concluir que el tejido autólogo trasplantado
enriquecido con plasma rico en plaquetas, sufría menor grado de
reabsorción que los descritos con la técnica habitual lo cual podría ser
una luz en el camino de la cirugía moderna a la ves que este resultado
pude responder a diversos factores como se tratara en detalle en este
trabajo.


52nd Meeting and Word Congress of the International Academy
of Cosmetic Surgery (IBCS)
November 5-8, 2008
Cartagena, Colombia


Reinhard W. Gansel
Dermatologist, D.A.L.M.
Diploma in Aesthetic Laser Medicine, Univ. Greifswald
Laser Medizin Zentrum Rhein-Ruhr
Porschekanzel 3-5
D-45127 Essen
Germany
Tel.: +49-(0)201-2 43 77 70
Fax: +49-(0)201-2 43 77 69
E-Mail: info@lmz.de
Internet: www.lmz.de



                                 - Abstract -

  Monopolar radiofrequency (RF) treatment and soft-tissue fillers: a safe
                             combination

The demand for no downtime procedures in the field of facial rejuvenation
creates different strategies to achieve proven results. One option can be found
in a monopolar radiofrequency (RF) treatment such as the Thermage procedure
(Thermage®, ThermaCool TC) in combination with soft-tissue augmentation.
Thermage® uses radiofrequency technology in order to heat defined zones in
the dermis and the underlying tissue. It works beneath the surface skin layer to
stimulate collagen growth and to tighten the underlying skin in order to remove
fine lines, to reduce skin laxity and wrinkles and to renew facial contours.
Medium-term injectable soft-tissue fillers such as Sculptra™ (polylactic acid),
Radiesse® (calcium hydroxylapatite) and Restylane® (hyaluronic acid) are
often used to soften deep facial lines and wrinkles. Together, soft-tissue
augmentation and monopolar RF treatment have the potential to restore tissue
volume and improve facial laxity and contours.
Studies assess the safety of RF treatment over skin areas recently injected with
medium-term injectable soft-tissue augmentation materials.

52nd Meeting and Word Congress of the International Academy
of Cosmetic Surgery (IBCS)
November 5-8, 2008
Cartagena, Colombia


Reinhard W. Gansel
Dermatologist, D.A.L.M.
Diploma in Aesthetic Laser Medicine, Univ. Greifswald
Laser Medizin Zentrum Rhein-Ruhr
Porschekanzel 3-5
D-45127 Essen
Germany
Tel.: +49-(0)201-2 43 77 70
Fax: +49-(0)201-2 43 77 69
E-Mail: info@lmz.de
Internet: www.lmz.de



                                  - Abstract -

                                Hair-Removal

Permanent hair removal is one important sector in the field of dermatological
laser medicine. In 2008 we can generate our knowledge out of over 15 years of
extensive research and experience. Scientifically proven is the loss of 70 – 90
% of hair after six months follow-up.
The following systems can be used for treatment: ruby-laser (694 nm),
alexandrite-laser (755 nm), diode (800-810 nm), nd:YAG-laser (1064 nm) and
several intense pulsed light sources (IPL), which emit a spectrum between 550
and 1200 nm.
Photoepilation has always been regarded as an interaction of different physical
and biological factors that have to be combined in a clever way with the aim to
achieve best results.
On the physical side wavelength, spot-size, pulse duration and pulse energy
can be named as important factors, on the biological side there are hair growth
cycle, colour, depths of follicles and individual genetic factors.
All in all it is a fact that laser treatments with all systems are tolerated well. In
general one can see erythema and perifollicular edema. Side-effects which are
undesired but transitory are crusts, swelling, hypo- and hyperpigmentation. If
skin has been burned severely there is the risk that hypopigmentations and
scars will remain permanently.
There is no difference between laser and IPL-systems concerning success of
treatment and safeness. Due to individual conditions (thickness of hair, hair
colour, area and skin-type) one system may be prefered to another or cannot be
used.
To sum up the actual state of research concerning permanent hair removal and
the general interest in this treatment assure us that even new and better
treatment options will establish in future times.

52nd Meeting and Word Congress of the International Academy
of Cosmetic Surgery (IBCS)
November 5-8, 2008
Cartagena, Colombia


Reinhard W. Gansel
Dermatologist, D.A.L.M.
Diploma in Aesthetic Laser Medicine, Univ. Greifswald
Laser Medizin Zentrum Rhein-Ruhr
Porschekanzel 3-5
D-45127 Essen
Germany
Tel.: +49-(0)201-2 43 77 70
Fax: +49-(0)201-2 43 77 69
E-Mail: info@lmz.de
Internet: www.lmz.de



                                    - Abstract -

            Lasers in Cosmetic Surgery: Analysis of Side-Effects

As with all surgery, there may be associated risks with laser treatments. In
general, the more invasive the surgery, the higher the associated risk.
According to the specific type of treatment, you may experience some
temporary side effects, such as redness, swelling, bleeding and discomfort,
such as pain. Scarring, persistent redness, or permanent pigment changes
(hypo-, hyperpigmentation) are possible with more invasive procedures.
Problems that occur are often due to the inexperience of the surgeon. Typical
mistakes are
    • Wrong indication
    • Wrong type of laser
    • Insufficient training of physician/medical stuff: handling (ablation depths,
        number of passes, demarcation lines, contact cooling)
    • Problematic skin colour.
There exist many strategies to manage such problems which range from simply
prescribing a blood stilling agent, to a dose of local steroids and antibiotics up to
additional laser treatments and, in worst cases, to re-pigmentation by skin
coloured pigments (medical micropigmentation). However, as mistakes always
cause discomfort and even pain for the patient the training of the physician or
medical stuff should be extensive to minimize risks.

52nd Meeting and Word Congress of the International Academy
of Cosmetic Surgery (IBCS)
November 5-8, 2008
Cartagena, Colombia


Reinhard W. Gansel
Dermatologist, D.A.L.M.
Diploma in Aesthetic Laser Medicine, Univ. Greifswald
Laser Medizin Zentrum Rhein-Ruhr
Porschekanzel 3-5
D-45127 Essen
Germany
Tel.: +49-(0)201-2 43 77 70
Fax: +49-(0)201-2 43 77 69
E-Mail: info@lmz.de
Internet: www.lmz.de



                                    - Abstract -

                                 Tattoo-Removal


Since the advent of laser technology it is no more a “big” problem to remove a
tattoo which has become disagreeable to its owner. In contrast to former
methods, such as salabrasion, dermabrasion or excision, it is the advantage of
lasers not to form scars inevitably. However, patients still fear that a scar will
form instead of the tattoo and this fear is not without any reason.
Side-effects may be rare with the established systems (Ruby-, KTP-Nd:YAG-
and Alexandrite-laser), mostly transient and risks can even be minimized if
lasers are operated by trained stuff only. Last but not least it is essential to give
detailed information of the procedure and aftercare to your patient.
Therefore possible risks arise from exogenous factors such as the mixture of
the ink which is different depending on maker and tattooist. Chemical analysis
of various inks show ingredients such as metal salts (mercury, cadmium,
chrome) and the so called azo compounds which were designed primarily for
car varnish and the colouring of plastics. In particular we see allergic reactions,
but, what is worse, in the course of the removal toxic or cancer-causing
substances can be unleashed. Therefore the removal of a tattoo can become a
kind of „Russian roulette“ for the health of your patient - despite the fact that
laser systems are safe and you have got excellent trained stuff. Thus, the
formation of scars is nowadays not the main problem of the procedure.


Dr. Paul MCAndrews

         The Value of Medical Therapies in a Hair Transplant Patient


a. Introduction – Androgenetic alopecia, similar to tooth decay, is a physiologic
process that is progressive with aging. The surgical treatments for androgenetic
alopecia cannot stop the existing genetically prone hair from miniaturizing. Hair
transplant surgeons, similar to a dentist, just fill in a cavity.
b. Objective –

 This session reviews the data of “hair count studies” and “hair weight studies”
of finasteride in relation to the limitation to hair transplantations in order to show
the necessity and value of the medical treatments for androgenetic alopecia.



c. Materials and/or Methods – This session reviews the data of “hair count
studies” and “hair weight studies” of finasteride in relation to follicular unit graft
transplants.

d. Discussion/Results – The medical therapies decrease the amount of
follicular unit grafts a patient experiencing hair loss will need.

e. Conclusion – The surgical therapies for hair loss do not replace the medical
therapies for hair loss, and the combination approach is usually most
appropriate.

Dr. Paul McAndrews

                   The Artistic Design of the Frontal Hairline

a. Introduction – The artistic design of the hairline is critical in determining the
final result a patient will attain. A physician can use the latest advances in
technique and technologies but if design of the hairline is incorrect the final
outcome will be a failure and the hair transplant will be unnatural.

b. Objective –
 The purpose of this lecture is to discuss 4 essential features in the artistic
design of a hairline that help keep a hairline looking natural are:
1)   The placement of the anterior edged of the frontal hairline
2)   The placement of the lateral edged (width) of the frontal hairline
3)   The direction of the hair exiting the scalp
4)   The asymmetry of the frontal hairline
c. Materials and/or Methods – Comparing non-transplanted hairlines to
transplanted hairlines in conjunction with the aging process.

d. Discussion/Results – Following the 4 essential features as seen in nature
helps create transplanted hairlines that look as natural as possible not only
today, but tomorrow.

e. Conclusion – Since no patient wants a detectable hair transplant, physicians
should try to mimic the natural essential features of a hairline framing an aging
face.


                              Dr. Tony Prochazka

1. Amazingel - A Cautionary Tale

Abstract: Between 2002 and 2006, as many as half a million Chinese
people were injected with a polyacrylamide hydrogel filler called
Amazingel. Suddenly in April 2006, Amazingel was banned by the
Chinese government. Where did Amazingel come from and why was it
eventually banned? The story involves KGB spies, messianic surgeons,
and corruption at the highest levels of the Chinese central
administration. It's an amazing tale about a less-than-amazing product.

2. The X-LIFT: a new technique in facial thread lifting

Facial thread lifting was introduced to the West by Dr Marlen
Sulamanidze in 1999 and has rapidly become one of the most popular
cosmetic facial elevation procedures. A bewildering variety of
techniques and materials has now been developed in thread lifting,
but certain problems still occur frequently: skin puckering, thread
extrusion and early loss of elevating effect being the most common.

This paper introduces a new procedure called the X-LIFT. It
synthesises a number of familiar concepts and techniques (none in
themselves revolutionary) to create a flexible approach to minimally-
invasive facial and neck elevation, which does not rely on
proprietary materials, achieves a reliable and sustained lift, and is
associated with a reduced risk of the most common complications.

3. Asian Patients - special considerations

Many patients of Oriental ethnicity will be encountered within
cosmetic practice around the world. It behoves us to be familiar with
the special characteristics of Asian skin, Asian anatomy, and also
Asian culture in order to treat these clients optimally. This lecture
will examine some of the special aspects which must be given
consideration in cosmetic treatment for people of Oriental ethnicity.
4. Treatment of Acne Scarring

Acne scarring is not just a disfiguring condition of facial skin. It
is also a potent and always-visible reminder of a past traumatic
inflammatory illness, having often occurred during the most
vulnerable period of the patient's psychological development.

Treatment of this condition requires a multi-pronged approach
tailored to the individual. The aim is improvement, not cure. Despite
treatment limitations, patients are often extremely grateful for even
minor improvements. This lecture provides a brief overview of
currently available techniques.


                               Dr Alain Tenenbaum

INTRODUCTION – ENDOPEEL ABSTRACT

Endopeel transforms Cinderella into a princess just in half an hour with a
                         half a year duration

Abstract Title: INJECTABLE MUSCULAR PEELING : ENDOPEEL WITH
IMMEDIATE LIFTING AND TIGHTENING EFFECT

Authors: ALAIN TENENBAUM, MD,PhD,DSc, ENT facial plastic surgeon and
doctor in sciences

Country: SWITZERLAND

Text of Abstract: Endopeel is an injectable peeling technic mostly made of
carboxylic acid mixed with fatty acids , which provokes an immediate muscular
mass lifting by the process of intermyofibers vacuolization with a complete
restitution ad integrum after 7 months .

Endopeel is a new weapon for plastic surgeons, dermatologists, ENT facial
plastic surgeons and aesthetic medicine MD . It allows in less than half an hour
to lift up the eyebrow, the cervico facial area ( chemical lifting without scar) and
to provoke in the same time a skin volumetric tightening ( 1/3 medium of the
face) .Endopeel stretches also the skin anywhere where it is applied. Endopeel
is THE treatment for the platysma bands as the sad baggy low jowls with
immediate effect , with better improvement due to the immediate amelioration of
the physical quality of the skin .

Endopeel is also improving the unaesthetic problems due to the hyperfunction
of the muscles of the lower lip . Endopeel is an unique treatment for gluteopexy,
rising up the banana fold after 3 hours , compressing the gluteal muscles and
lifting them up , improving the gluteal skin. Endopeel can also be used as
chemical brachial lift, crural lift as for stretching “peau d’orange” (cellulitis)
skin.
Inventor : Alain Tenenbaum

 Advantages of Endopeel over Surgical Lifting
Endopeel acts as a chemical lifting without scars with immediate results (half an
hour for face & neck and 3 hours for body)
It can be combined with a surgical facelift, especially in areas where the
dissection is dangerous or not possible because of the presence of facial nerve
Endopeel can be used as well as maintenance treatment after a surgical lift to
prolong the durability of the facelift
Endopeel is acting also as a brachioplasty, cruroplasty and gluteopexy with
results which appear just 3 hours after the procedure lasting 6 months if
protocols are followed
Endopeel introduces new lifting indications which are inaccessible right now to
surgery. E.g. anterior and posterior face of the legs, décolleté with skin excess
etc
Endopeel can be performed within 15 to 20 minutes without scars and side
effects
It is less expensive than a surgical lifting, non-invasive, ambulatory and without
any social eviction for the patient


Advantages of Endopeel over Chemical Peelings
Endopeel is a peeling from inside towards outside. It is injected in the muscle or
subcutaneous tissue. It works on the skin as well like a phenol external peeling
but without scars, ambulatory, without need for cardiorespiratory monitoring and
with immediate results
Endopeel doesn’t work on hyperchromies but works on the chemical and
physical qualities of the skin as an external phenol peeling without its
complications and side effects
Endopeel, unlike phenol external peelings, can be used also on the neck,
décolleté, hands, arms, legs, gluteus, abdomen and so on
Endopeel is often considered as a “muscular” peeling
Endopeel and Botulinum Toxin
Endopeel has a complete different mechanism of action and cannot be
compared to Botulinum toxin
Endopeel does not paralyze and patients keep their expressions
Endopeel can give similar clinical effects as Botulinum Toxin in the following
cases only:
To treat the forehead wrinkles without paralyzing the frontal muscle
To treat the hyperfunction of the muscles of the lower lip, where clinical effects
are similar with a duration of 6 months to 2 years
In both cases, Endopeel can be used together with Botulinum Toxin

For the medical practise

The products used for endopeel techniques

(a)are not for the diagnosis, treatment, mitigation, alleviation or prevention of
disease or any symptom thereof;
(b)are not for the diagnosis, treatment, mitigation, alleviation of any abnormal
physical or physiological state or any symptom thereof;
(c) are not for altering, modifying, correcting or restoring any organic function,
in human beings or in animals.
they are just for aesthetic purposes and have just a 6-7 months duration effect
with complete restitutio ad integrum histologically and neurophysiologically


 Penile Triple Augmentation Surgery-Up-To-Date Surgical Technique for
                         Penile Augmentation


             Alexander A. Krakovsky MD, PhD, DrSc, FAAPS.
Vice-President of the American Academy of Phalloplasty Surgeons
General Secretary of the American Academy of Aesthetic Medicine


Penile Cosmetic Surgery Center in San Diego, California:
7946 Ivanhoé Ave., Suite 106
La Jolla, CA 92037
USA
Phone: 858-551-8502
E-mail: akrakovsky@msn.com


Objective:

Technology has rendered nearly all previous definitions of masculinity obsolete.
A man is no longer measured by his physical strength, because machines do
much of his work for him. As a result, muscles have become more symbolic
than useful. Historically, men have considered a larger penis to be a symbol of
greater masculinity. In our time, the erect penis has become the most powerful
of a man’s symbolic “muscles.” However, modern cultural taboos remain. How
often do you hear men speaking about liposuction, plastic surgery, or a face lift,
let alone about enhancement of their andrological part? If they discuss it at all, it
is in private conversations and not in public places. Women feel free to discuss
diet; plastic surgery, such as liposuction or breast enlargement and reduction;
and peeling. There is a great disproportion between acceptance of female body
rejuvenation surgery in our society and acceptance of male rejuvenation
surgery, especially with regard to the andrological parts of the body. Despite
this lack of acceptance by society, many men undergo surgical penile
augmentation (phalloplasty) to enhance the length, girth, and glans of their
penises.


Materials and Methods:

A total of 374 phalloplasty surgeries using AlloDerm® were evaluated. Single
augmentation includes girth enhancement only; combination augmentation
include dual augmentation (lengthening and girth enhancement combine) and
triple augmentation (lengthening, girth enhancement and glanular enhancement
combine.) AlloDerm is a cadaveric acellular tissue regeneration matrix that is
minimally processed to remove epidermal and dermal cells, while preserving
the structure of the dermis. The resulting graft serves as a framework to support
cellular repopulation and vascularization. In phalloplasty surgery, this graft is
used to enhance the girth, and/or glans of the penis in the male genital cosmetic
surgery.

Results:

97.2% of patients successfully went through surgery and postoperative period
without any complications. 3.24% of patients developed surgical complications
that were successfully treated medically and surgically. 4.9% of patients
experienced localized swelling 3-7 days after surgery that resolved
spontaneously and 7.3% of patients reported temporary post surgical retraction
that were successfully treated medically and surgically.


Discussion:

Today’s society requires a man to be a highly motivated and competitive
individual, doing everything to stay ahead of others. He diets, exercises his
body and mind, and seeks plastic/cosmetic surgery to look younger, masculine,
and attractive. Across the country, middle-aged and elderly men alike are
having their penises enlarged, pubic fat and breasts liposuctioned, and scrotal
webs tucked. Most are seeking a more youthful and attractive appearance.
Today, a man can modify the size and shape of his penis using procedures
introduced by cosmetic/plastic surgery. With the use of AlloDerm, these
changes can last for years, and could be considered almost permanent. In the
future, AlloDerm may be replaced by artificial tissue, by engineered material, or
by human penis cells cultured and grown for use as a natural matrix. Permanent
penile enlargement surgery is surgery that does not require maintenance of the
desired size or shape after surgery, through additional grafting. The dermal fat
graft, or DFG (a graft made from the patient’s own skin) and AlloDerm (a graft
created from cadaver skin) are the two types of graft that offer permanent
enlargement of the penis.


Conclusion:

The patient’s satisfaction with the results of Triple Penile Augmentation
Cosmetic Genital Surgery was analyzed using the Penis Image Assessment
Scale Questionnaire. The assessment was based upon questions related to the
size of the penis, satisfaction of sexual experiences and the psychological
perspective of the patient to his penis before and after surgery. The results
showed a high satisfaction rate with a new surgical technique for penile
augmentation (Penile Triple AugmentationTM) developed and used by the
author. All surgical complications were successfully treated medically and
surgically.
Dr. Juan Carlos Prada Rojas
Ginecologia y Obstetricia – Universidad Pontificia Bolivariana – Medellín
Miembro de la Sociedad Col. De Ginecología y Obstetricia
Sociedad Internacional de Cosmetoginecologia
Sociedad Internacional De Uroginecologia
Sociedad Americana de Ginecólogos Laparoscopistas

                  CIRUGIA ESTETICA VAGINAL
    RESUMEN PARA EL CONGRESO MUNDIAL DE CIRUGIA ESTETICA

HISTORIA
Es muy poca la información que existe acerca de la cirugía estética vaginal , y
sus orígenes , desde hace mucho tiempo se ha realizado la cirugía para
reducción de labios menores hipertroficos y la cirugía reconstructiva del piso
pélvico con la cual existe una gran relación. Al parecer los inicios tienen su
origen en Francia, y desde hace 5 años el gran auge dado en EU,
principalmente en los Angeles por el Dr. David Matlock.

Pero existe un gran número de médicos dedicados a la cirugía estética genital
que le han dado un mayor valor científico, con la aplicación de técnicas
quirúrgicas con mejores resultados estéticos y funcionales, como es el caso del
Dr. Gary Alter.


Este nuevo campo de la cirugía estética de la cual ni siquiera hay consenso en
cuanto a que sub-especialidad podría pertenecer, es así como en el último
congreso de la IUGA se presento la propuesta para adoptar este tema en el
campo de la uroginecologia.
Mucho menos hay consenso en cuanto el entrenamiento certificado para la
cirugía estética genital femenina.

Por lo que creemos que es importante que una organización científica adopte
esta nueva sub-especialidad y de esta forma se avance con estudios
científicos, técnicas quirúrgicas, personal entrenado certificado y se termine
con organizaciones unipersonales que limitan el avance.

TERMINOLOGIA
Tampoco hay consenso en cuanto a la terminología, es así como al hablar de
cirugía estética genital femenina, se tiene sinónimos con
CIRUGIA INTIMA
CIRUGIA PLASTICA O ESTETICA GENITAL
MOLDEAMIENTO GENITAL
REJUVENECIMIENTO GENITAL
VAGINOPLASTIA .

El termino CIRUGIA ESTETICA GENITAL FEMENINA, parecer ser el término
más
Apropiado.

ESTADISTICAS
Tabla que muestra el número de procedimientos en cirugía estética genital
1992, 2005 y 2006 y se compara con otros procedimientos como cirugía
estética de mama, liposucción, abdominoplastia.

QUIEN ES LA PERSONA MAS APROPIADA PARA REALIZAR ESTOS
PROCEDIMIENTOS
Muchos han ingresado en el campo de la CIRUGIA ESTETICA GENITAL
FEMENINA, como es el caso de cirujanos plásticos, ginecólogos, cirujanos
generales, cirujanos estéticos, pero creemos que el cirujano capacitado para
realizar este tipo de cirugías debe cumplir los siguientes criterios:
-ANATOMIA Y FISIOLOGIA
- CIRUGIA VAGINAL
- ENTRENAMIENTO EN NUEVAS TECNICAS
- CONOCIMIENTOS EN FUENTES DE ENERGIA QUIRURGICAS: LASER Y
RADIOFRECUENCIA
- CONCIMIENTOS EN SEXUALIDAD
- CIRUGIA ESTETICA : LIPOSUCCION Y TRANSFERENCIA DE GRASA.
- MEDICINA ESTETICA : PEELING QUIMICOS / DEPILACION LASER

PORQUE LASER?
Láser diodo de 980 nm y fibra de 600 nm
Versátil
Menos costoso
Usos varios

Ventajas:
   - Poco efecto carbonización
   - Poco efecto electrolítico
   - Poco efecto neuroexcitante
   - Poca lesión térmica
   - No produce carbonización de los tejidos
Se presentaran bases físicas del láser diodo 980

ALTERNATIVA: RADIOFRECUENCIA

PROCEDIMIENTOS

1. LIPOPLASTIA VULVAR
2. HIMENOPLASTIA
3. LIFT PUBICO
4. CLITOROPLASTIA :
       - Hodectomia
5. LABIOS MAYORES
       - Labioplastia de Reducción
       - Labioplastia de Aumento (Transferencia de grasa)
6. LABIOS MENORES
       - Labioplastia de Reducción
       - Correcciones de desgarros previos
7. VAGINOPLASTIA
8. PERINEOPLASTIA
OTROS PROCEDIMIENTOS
- PUNTO G???
- BLANQUEAMIENTO GENITAL

Se hablará de las técnicas en cada uno de los procedimientos y se mostraran
resultados
Fotos antes y después.


COMPLICACIONES
Se enumeran complicaciones, como evitarlas y su manejo
Se mostraran algunas complicaciones de nuestra pacientes y como afrontamos
estos casos.

HACIA DONDE VA LA CIRUGIA ESTETICA GENITAL
Se hará un análisis del presente y futuro de la cirugía estética genital.

OPINION DEL COLEGIO AMERICANO DE GINECOLOGIA Y OBSTETRICIA
ACERCA DE LA CIRUGIA ESTETICA GENITAL
Se presentara el boletín emitido en Septiembre del 2007 sobre el tema.

CIRUGIA RECONSTRUCTIVA DEL PISO PELVICO
Prolapsos genitales e Incontinencia urinaria
Se hablara brevemente de los últimos avances en este tema.

ASPECTOS LEGALES DE LA CIRUGIA ESTETICA GENITAL
Se mostrara el formato de consentimiento diseñado por nosotros para estas
cirugías

Por ultimo se propone un comité para avanzar en Educación Continuada sobre
el tema y la necesidad de que la Academia Internacional y Colombiana
Cirugía Estética lidere en este campo.


                      Overview of Intimate Female Surgery

                           Longin H. Zurek MD. FACCS

In recent years there has been an increasing interest in cosmetic surgery of
female genitalia, which is undoubtedly related to growing awareness and
education generated by the media.

Intimate Female Surgery

1. Anatomical consideration for cosmetic and functional aspect
2. Photo-documentation
3. Preop consultation and informed consent
4. Anesthesia consideration
5. Postop care program
6. Scalpel, Radiosurgery, Diode Laser
7. Specialised training, Gyneacology + Sexology + Cosmetic Surgery

Operative Indication
  • 1. Relaxed Vagina ; Birth trauma, Aging process
  • 2. Labia majora atrophy
  • 3. Labial minora hypertrophy
  • 4. Clitorial phymosis
  • 5. Hymenoplasty


Procedures
   • Vaginoplasty
     - Posterior Colporrhapy
     - Anterior Colporrhapy

   •   Perineoplasty
   •   Reduction Labioplasty
   •   Augmentation Labioplasty; by filler, fat,
   •   Perineoplasty
   •   Clitorial Plasty
       - Hoodectomy
       - Clitoropexy
       - Resection of Excess Clitorial Prepuce

   •   Lipoplasty;
       - Augmentation of Labia majora/minora, Mons pubis, Perineal
Body
        - Reduction lipoplasty of Labia majora, Mons pubis.

   •   Hymenoplasty
   •   G-Spot Augmentation Vaginoplasty
   •   Medical Perineal Skin care
   •   Laser T-line & V-line cleanup



Vaginoplasty

Relaxed Vagina to improve sexual gratification and increase self-esteem.
1.enhance vaginal muscle tone, strength, and control.
2. decrease vaginal diameters
3. build up and strengthen the perineal body

REFERENCES
1. Matlock D, Laser Vaginal Rejuvenation Course 2004
2. Chul W, Gyneco-Plastic Surgery Presentation.
3. Kang G, Hands on Laser Vaginal Rejuvenation Training,
   Seoul Korea, August 2006.
4. Kang G, Rebelo A, Personal Communication, Lisbon, Portugal, 2006.
5. Munhoz A et al., Plast, Reconstr. Surg, vol 118,1237, 2006.
6. Baggish K, Karram M, Atlas of Pelvic Anatomy and Gynecology Surgery, 2nd
Ed, Elsevier Saunders, 2006.
7. Alter G J, GenitalRejuvenation and Reconstruction: Fringe Procedure or a
New Frontier. Plastic Surgery 2007, Baltimore.
8. De Alencar Felicio Y, Labial Surgery. Aesthetic Surg J 2007;27;322-328

                       S Access Facial Elevation (SAFE)

                         Longin H Zurek, MD. FACCS



Objective: To discuss the evolution of minimal access facelifts and present my
modification termed, S Access Facial Elevation (SAFE).


Methods: This presentation will trace the origins of the concept from Europe in
the early 20th Century to its modern application in current techniques, with
particular emphasis on my own modification.


Results: The principles of S Access Facial Elevation are:
- Performed under local anaesthetic on a true "walk-in, walk-out" basis.
- The incision is hidden in the temporal hair and follows the natural curvature of
the ear.
- Limited undermining facilitating "unit lifting".
- First vertical SMAS plication suture lifts up the neck and lower face.
- Second oblique SMAS plication suture elevates the mid-face.

- Third round SMAS plication suture.
- Only the excess skin is removed.
- The wound is repaired without tension.

Conclusions:
- S Access Facial Elevation is safe, with no incidence of any facial nerve injury
and no other significant complication in over 2000 cases.
- Natural result.
- No stigma of facelift.
- Brief "downtime".
- Longevity of Short Access Facial Elevation is comparable to conventional
facelifts.


                   COSMETICS IN OBSTETRICS DELIVERY

COMPARATIVE STUDY, REJUVENATING LASER ASSISTED VAGINAL
DELIVERY (LAASOG SYSTEM), VS VAGINAL DELIVERY WITH
EPISIOTOMY.
Gabriel E. De Peña, M.D., Maylin Martinez. M.D.

Laser Cosmeto-Gynecology and Obstetrics Institute
Santo Domingo, Dominican Republic

Background and Objectives: Obstetrics, a field in medicine which has
evolved very little in the surgical aspect and has never been considered or
looked upon as an aesthetic or Cosmetic option.

Vaginal Delivery with episiotomy : bloody, painful, coarse, unpolished,
which produces malformations and scaring of the vulva and perineum is
definitely not a cosmetic procedure.

Taking in to consideration that women have always been related to beauty,
delicacy, pureness and always preoccupied for their wellbeing and cosmetic
aspect.

We have merged three concepts in one, Obstetrics and Gynecology, Cosmetic
Surgery and Laser-Radio Frequency Technology.

Study design:      Laasog System`s Rejuvenating Laser Assisted Vaginal
Delivery: out of 50 pacient that delivered through Vaginal Delivery with
Episiotomy we included 48 patients with 38-41 week pregnancy and 18-35
years of age. 25 traditional vaginal deliveries with episiotomies and 23
Rejuvenating Laser Assisted Vaginal Deliveries.        Laasog System uses a
combination of Diode Laser and Radio Frequency Technologies, special
retractors, modified skin incisions, modified muscular plicature. Reduction
Labiaplasty and resection of scars from previous episiotomies.

Results and Conclusion: The combination of Laser and Radio Frequency,
modified incisions, special retractors that produce less aggression and protect
the fetus, suture less closure of the skin are associated with minimal bleeding
during the procedure less tissue damage, less inflammation, less traumatic
surgical instruments, a reduction in 13 post operative complication such as
infection, haemorrhages, embolisms, DVT, Infectious diseases such as HIV,
Hepatitis B and C, Urinary Track infections, Seromas, Haematomas, less post
operative pain, a quicker recovery and excellent aesthetic results. Which
converts a Traditional Vaginal Delivery with episiotomy into a minimally
invasive-cosmetic procedure. Which means substantial health, cost-effective
and aesthetic benefits for the mother.



                         BREAST AUGMENTATION

                    TUMESCENT LOCAL ANESTHESIA
                   COHESIVE GEL SILICONE IMPLANTS

                            Ângelo Rebelo, MD*
                              CLINICA MILÉNIO




Breast implants is always a controversial subject. Because, there are many
approaches and opinions vary.
The Approach Via (areolar, infra-mammary, axillary, endoscopic…)
The Anaesthesia (general, local…)
The Positioning of the Implant (retro-glandular, retro-pectoral)
The Type of Implant (silicone, saline, hydrogel, triglyceride…)
The author prefers and usually uses the following procedure, because of fewer
complications and better results.
THE AREOLAR VIA - First choice (inferior circun-areolar or trans-areolar of
Pitangui) because there is no risk of hypertrophic or keloid scaring and it
doesn’t disturb the normal breast anatomy and physiology. The criteria, the
areola must be at least 3 cm in diameter.
THE RETROGLANDULAR PLACEMENT – first choice and in almost all cases
he prefers this placement because it gives a more natural appearance, there is
no discomfort for the patient as in the retro pectoral position and no problem
with dislocation of the implant.
TUMESCENT LOCAL ANESTHESIA - if there are no counter-indications he
prefers the tumescent local anaesthesia.
He uses the modified Klein’s formula, 1,7-2 mm Klein’s cannulas and the Byron
compressed system.
COHESIVE GEL SILICONE PROTHESIS - The author prefers the cohesive gel
silicone implants because they are very safe and of excellent quality.
SURGICAL TECHNIQUE / PROCEDURE – The incision, approach at
aponeurotical level, undermining to perform a pocket at least 2-3 cm bigger than
the prothesis diameter, careful haemostasis, put the implant in place, close by
layers. No draining unless in special case of uncontrolled bleeding.
All patients have a complete clinical history, pre-op routine examinations plus
mammography and/or mammary ecography.


*Plastic, Reconstructive and Aesthetic Surgery
Clinica Milénio – Rua Manuel Silva Leal, 11-C
1600-166 Lisboa Portugal
Tel: 00.351.21.7277265 / Fax: 00.351.21.7277264
E-MAIL: clinicamilenio@netcabo.pt

                        BREAST REDUCTION
                   AREOLO-VERTICAL TECHNIQUE
                UNDER TUMESCENT LOCAL ANESTHESIA

                             Ângelo Rebelo, MD*

                              CLINICA MILÉNIO
There are several and many techniques to perform breast reduction and all
have the same basic principles:
     • Preserve anatomy and physiology of the breast
     • Avoid nipple necrosis.
     • Maintain sensibility of the nipple.
     • Do not interfere with lactation or the ability to breast-feed.
     • Have a good shape and size.
     • Smaller scars and good final appearance.
The point is that many of these techniques finish with long or small horizontal
scars in inverted “T”, “L”, etc.
The author describes a technique with only an areolo-vertical final scar with
indications in many kinds of breasts. In his experience use this technique in
almost all types of hypertrophic breasts, in ptotic breasts and also in some
gigantomastias. It’s a “versatile” technique with no conventional measurements
or draws. He makes the pre-op marking in the right breast, and one of the
important point being the final position of the nipple and the other where finish
the vertical, 1 to 3 cm above the inframammary fold. All the other draw/markings
are made by the handling of the breast. It’s similar to Lassus and Lejour pre-op
marking. The main difference being an inferior dermal triangular flap that he
uses to give consistency and shape to the breast thus preventing the future
ptosis. This dermal flap he don’t use any more in moderate and big hypertrophic
breasts nore in gigantomastias. After marking the right breast by hand,
measurements are taken and the other breast is marked to achieve a good
symetry. He performs all the cases under local tumescent anaesthesia with oral
or IV sedation. One of the advantages of this technique is less risk of
hypertrophic or colloid scaring with few limitations in dress any type of clothes.
This technique doesn’t interfere with normal breast anatomy and physiology and
it’s less traumatic, less edema, less painful and no bleeding. Patients make a
quicker recovery and can do many things in some few days.

TUMESCENT LOCAL ANESTHESIA - He uses the modified Klein’s formula
and the Byron compressed system in a total amount from 500 to 1000 cc in
both breasts.

SURGICAL TECHNIQUE/ PROCEDURE - De-epitheliazation (Schwarmann’s
maneuver) of the area from the upper part of the areola to the end of the inferior
“triangle”. After this he does the necessary resection in the central and superior
region but if not necessary does only the fixation of the dermal flap to the
aponeurosis of the “major pectoralis”. Closure is made in layers to avoid dead
spaces and tension in the final wound. Jackson-Pratt drain is used routinely and
removed 24-48 hours after.


*Plastic, Reconstructive and Aesthetic Surgeon
Cosmetic Surgeon, IBCS
Clinica Milénio – Rua Manuel Silva Leal, 11-C
1600-166 Lisboa Portugal
Tel: 00.351.21.7277265 / Fax: 00.351.21.7277264
E-MAIL: clinicamilenio@netcabo.pt
                                Dr. Giorgio Fischer

   Liposculpture.3rd decade after it's invention.Evolution and instrumentation
ABSTRACT
Liposculpture-3rd decade after it’s invention-Evolutio and instrumentation
After 30 years of experience in liposuction I feel ready to say that I have lived
through thousands of cases and am able to state what can and must be done in
order to achieve the best results.
Liposculpture is an art, it is not a merely surgical technique. One must always
keep in mind that this form of art, as any other, is a long and delicate trip
towards the research of beauty in all of its perfection.
No sculptor finishes his work in one day. I realize now, in fact, that in most of
the cases the first operation is just the beginning of a journey. Liposculpture is
almost always performed at least two times.
Preoperative evaluation is very important. Along with the marking and the
pictures, it is very important to talk with the patient and decide together what
should be done. Show the patient her asimmetries. Make her stand first on one
leg, keeping the other one relaxed, and show her the muscular structure, the
skin elasticity and false fat deposits.

The new concept is that the body must be seen as a violoncello. Each side of
the violoncello should be treated together. No single areas anymore. If you
leave an untreated area above a treated one you will have a curtain effect.

In the operating theatre there are some steps that cannot be omitted in order to
have good results. Infiltration is a very important step of the operation. I never
overinfiltrate the areas to be treated. I usually infiltrate the same amount I think I
will take out. Too much infiltration gives an excessive distortion of the anatomy
of the body.
The patient is a statue and one should never loose sight of the object. The idea
of sculpting the body had always been my primary objective that became easier
when I invented my orthostatic operating table. Since then, in fact, I could only
imagine my patient standing up, then suddenly, I had the possibility of operating
my patient in the normal everyday position with the orthostatic operating table.
Force of gravity was not an enemy anymore.
Another important thing is to operate one side completely and then the other.
No artist draws half of a leg and half of an arm. We do one side and then
compare it with the other one as to have a more symmetrical result.
I start with a deep liposuction in order to defatten the area as much as possible,
and then I superficialize the depth of the cannula. The cannulas are no longer
big diameter cannulas. We only work with 2, 3 or 4 mm cannulas maximum.
Obviously the technique differs according to the areas to be treated, the
elasticity of the skin and the age of the patient. Age is a very important factor, in
fact each age has its problems. When treating young patients, one must always
keep in mind that it is very easy to cause depressions and uneven surfaces; on
the other hand, in older patients the risk of problems with skin retraction may be
very high if one does not proceed correctly. The choice of the patient and and
the goal of the operation varies widely.Always work on wet skin.
At the end of the operation I use a steel iron tube and massage all of the treated
areas vigorously. This gives me the possibility to distribute the softened fat
evenly and make the areas smoother. I then apply Reston foam and
compressive garments.


Post operative massages are fundamental. They contribute to the smoothness
of the result and fasten the postoperative edema process. I make my patient
start massages in the 4th postoperative day and continue for about two months.

The Fischer’s Institute developed during this year a new cannula. The concept
was to make a cannula that could make our work faster and easier.
These principles are the basis for a good technique, but of course only
experience will assure a good result.