congress - ISAPS CONGRESS 2016

Transcription

INTERNATIONAL SOCIETY OF
AESTHETIC PLASTIC SURGERY
22
nd
Congress
September 19-22, 2014
Rio de Janeiro, Brazil
www.isapscongress.org
FREE PAPERS
1
NOTES
2
ABSTRACTS
ABSTRACTS
3
Free Paper Session 1 - Rhinoplasty
1943 1
COLUMELLAR INCISION IN RHINOPLASTY:
METHODOLOGY USED IN THE SERVICE OF PLASTIC
SURGERY HFSE
Presenter:
PedroCarvalho,MD
Affiliation:
HospitalFederaldosServidoresdoEstado
Country:
Brazil
Authors:
CarvalhoP,NetoAJ,PaolaDQ,LeiteEP,
CameloRS,CasagrandeFA,SffairRA,
CardosoCG
1825 2
COMPARISON OF RHINOMANOMETRY FINDINGS
BETWEEN SPREADER GRAFT AND SPREADER
FLAP TECHNIQUES AFTER PRIMARY REDUCTIVE
RHINOPLASTY
Presenter:
MehdiRasti,MD
Affiliation:
IsfahanUniversityofMedicalSciences
Country:
Iran
Authors:
AttaeiAL,RastiMJ
Background: Nasal valve collapse and especially internal
nasalvalveinsufficiencyisacommoncauseofnasalairway
obstruction after rhinoplasty specially reductive rhinoplasty
that commonly used in middle east region. This study
compares the effects of spreader graft and spreader flap
techniqueonrhinoplastybyrhinomanometry.
Introduction:Transcolumellarincision,firstdescribedin1934
byRhetiforsurgicalcorrectionofnasaldeformities,hasbeen
usedinrhinoplastyinitsoriginaldesignandadaptationsby
different authors. Our Service adopts the methodology to
dissect the columellar skin, through the marginal incisions
inordertoinsertametalpriortomedialcrusthelowerlateral
cartilages(MCLLC)screen,facilitatingtheachievementofthe
skinincision.
Methods:Thisstudyisadoubleblindedrandomizedclinical
trial that was performed on forty eight patients in plastic
department of aesthetic and plastic surgery of Isfahan
university of medical sciences in first half of 2013. The
inclusioncriteriawerenohistoryoftraumaornasalsurgery
and also the need to reduction of dorsum in all cases. The
patientswererandomlydividedintotwogroups.Onegroup
was spreader graft (SG) and another group was spreader
flap (SF), other steps of operation were completely similar
for all patients. Objective assessment was performed by
rhinomanometrybeforeandafterrhinoplasty.Themethods,
anddevicesofrhinomanometrywerecompletelysimilarfor
allpatientsbeforeandafteroperation.Allofoperationwere
done by one surgeon (senior surgeon). Not only patient but
alsoeachofusdidntknowwhichpatientbelongedtowhich
group.Thepvalue>0.5wassignificant.
Methods: Open rhinoplasty patients underwent 211 from
January2012toOctober2013,these33malesand178females.
Theagerangedfrom18to61years.
Results: According to clinical assessments 6 months after
surgery,weobservedexcellentcosmeticresultofthescar.With
thismethodtherewasgreaterflexibilityintheimplementation
ofaccessthenasalcolumellabyResidentDoctor,aswellasthe
absence of injury MCLLC and absence of maceration of the
skinincision.
Results: Nasal obstruction had no significant difference
before and after rhinoplasty and no significant difference
was observed between surgical techniques. Right left and
total nasal flow and resistance were different before and
afterrhinoplastybutwerenotsignificant.Ourstudyshowed
that both spreader graft and spreader flap techniques were
beneficial in rhinoplsty and both of them could provide
enoughinternalnasalvalvesupport.Thespreaderflapwasan
appropriatesurgicaltechniqueforinternalnasalvalvepatency
incomparisontospreadergraftwithequaleffect.
Conclusion: Although reductive rhinoplasty has a negative
effect on manometry parameters,but these changes weren’t
significant.Thespreaderflaptechniquehasequalefficacyas
spreadergraftforinternalnasalvalvesupport.
4
1869 3
A NEW CONTRIBUTION TO CORRRECT A BROAD
NASAL TIP: THE DOUBLE MEDIAL CRUS GRAFT
Presenter:
YvesJallut,MD
Affiliation:
Dr.JallutandDr.BartolinOffice
Country:
France
Author:
JallutY
1991 4
EXTERNAL NASAL VALVE INSUFFICIENCY: PLANNING
AND PERFORMING
Presenter:
EduardoSilva,MD
Affiliation:
UniversidadeEstadualdePontaGrossa
Country:
Brazil
Author:
SilvaE
The numerous parameters explain that the nasal tip
correction is the most difficult challenge in nose surgery.
the main difficulty for the surgeon is to select an adequate
technique, achieving the purpose of perfect and permanent
results.Thegoalofthisstudyistoplanstepbystep,using
a simple original technique based on structural concept
in order to correct a broad nose. The modification of the
nasal tip includes resection techniques, the cartilaginous
reshapingwithsuturesoronlaygraftsandmorerecentlythe
reinforcement structures approach by inlay graft. Basically,
there are 3 important stages in the performing of a new
nose tip: projection and rotation control of the tip, nasal
base stability and reshaping of the tip. The author reports
an original technique for the control of the tip projection
and reshaping the middle crus with 2 cartilaginous grafts
disposed on the external side of the medial crus. These 2
graftspermitbothimprovingnaturallythesupportofthetip
and stabilizing the columella, avoiding the classical median
columellar strut. After ten year experience with 203 cases,
everypatientresultwasanalyzedandcriticized.Allthecases
werereviewedafter2yearsatleast,andtheunwantedeffects
were noted. 19 patients have had a secondary rhinoplasty
(11%),4forarevisiontipsurgery(2%).Thereisnorespiratory
dysfunction and more than 90% of patients are satisfied
with their aesthetic result. The main problems like skin or
mucosa retraction after resection techniques, unpredictable
long-term effect on the tip, unknown future of the grafts,
specially onlay grafts responsible sometimes for unpleasant
irregularities, could be minimized with this procedure. The
morethenasaltipisstabilized,themoretheresultsarebetter
andlongerlasting.Thesurgeryofthenosetipisfocusednot
only with shaping procedures of the middle or lateral crus.
The reported technique is simple and safe for the nasal tip
surgery through modification and/or reinforcement of the
initial structure, maximizing the contact between skin and
anatomicalcomponentandeconomizingtheinterpositionof
acartilagegraftasfaraspossible.Itisanewconceptincluding
respectofanatomyandstabilitywicharethebestgaranteefor
adurableresult.
Background:Thereductivenosesurgeryisanunpredictable
technique with catastrophic consequences on the nasal
tip: alar retraction, tip asymmetry, septal angle exposure,
external nasal valve insufficiency, among others. Many of
thesesequelaearemorerelatedtotheunpredictabilityofscar
contractionthanontheinabilityofthesurgeon.
Materials and Methods: 72 patients underwent surgery
betweenDecember2010andMarch2014.Thetechniqueof
choicewasstructuredfunctionalrhinoplasty.Allpatientsin
thepreoperativeperiodhadtheirexternalnasalvalvecarefully
examinated.Specialattentionwasgiventotheresistanceof
thelowerlateralcartilagescollapseindeepinspiration,vector
ofthelowerlateralcartilage,alarbase,tipprojection,nostril
retraction, nasal clamping, tip asymmetry and septal angle
exposure.
Thecasescouldbedividedintogroupswiththeirrespective
treatment:
a) external nasal valve insufficiency with appropriate lower
lateralcartilagevector:lateralcruralstrutgraft,turn-inflap,
turn-overflapandalarBattengraft.
b)weakalarcartilagewithappropriatelowerlateralcartilage
vectorandbulboustip:turn-inflap,turn-overflapandcephalic
hingedflapofthelateralcrura.
c)alarcartilagewithinadequatelowerlateralcartilagevector:
lateralcruralstrutgraft.
Results:The72patientswerefollowedfrom6to18months.
There was surgical revision in 2 cases by tip non-definition
due to intense scar contraction. Six postoperative cases will
bepresented.
Discussion: An ideal anatomical configuration is related
to aesthetic ideal characteristics. An important concept in
modern rhinoplasty was introduced by Sheen and reviewed
indetailbyGunter,whoclassifiesthelowerlateralcartilage
vector, enabling its repositioning and/or strengthening.
Attentionincasesofnarrownostrilbase,whichyoucanuse
themattresssuturedescribedbyGruber.
Conclusion: In primary rhinoplasty an anatomical and
functional adequate study of the lower lateral cartilages is
essential for a good result because the anatomical variants
aredifferentandeachcasehasitsparticularity.Insecondary
rhinoplastysurgeonsmusthavesolidtraininginrhinoplasty
andbepreparedformanydifferentsituations.
5
1991 4
EXTERNAL NASAL VALVE INSUFFICIENCY: PLANNING
AND PERFORMING
1719 5
COMPOUNDED ALLOGRAFTING FOR NASAL
RECONSTRUCCION IN COCAINE NOSES
Presenter:
ManuelTafallaNavarro,BS
Affiliation:
Dr.Tafalla’sClinic
Country:
Spain
Author:
TafallaNavarroM
Thenumberofcocaineusers,especiallywomen,hasincreased
significantly in recent years. The consequences of such
consumptionvianasalisnecrosisofthetissuessurrounding
the place of inspiration. That’s what leads to perforation of
thenasalseptumandcolumella,thenasalwingcollapseand,
ultimately, a more than obvious aesthetic deformity. Many
reconstrucciontechniquesexistbuttheauthorwantstoshow
thatafter14yearsofexperienceandhundredofreconstructed
nosesisyougetamoresatisfactoryresult.
Rhinoplasty is a surgery where the precise error margins
aremeasuredinmillimeters,itisforthereasonthatsurgery
shouldbeperformedthroughexhaustiveknowledgeofnasal
anatomy and its variations inherent. The nose is divided
into three components: frame, support and external cover.
Acordingtothegreaterolesserdegreeofnasaldeformityand
collapseandopenorclosedrhinoplastywillbeplanned.
After meticulous dissection and measurement of defects
proccedtoobtainvariousautologouscostalandearcartilage
grafts. Since the nasal support requires a robust prefer the
costal cartilage graft for their more stable characteristics. If
you need only one columellar rod can be gathered from a
floatingrib,butifindicatedadorsalgraftedprefertousethe
fifthorsixthribthroughanincisioninthebreastfoldmedially
located. The spinal onlay graft stabilization is increased by
preparingtherecipientbedinthebacktobeflatandsmooth
asmuchaspossible.
The designs of the nasal tip graft should be similar to the
anatomical nasal tip grafts. Therefore, the author prefers to
reconstructthetipSheengrafting,primaryprocessincreases
the frontal area of the medial crura and Peck graft for
increasing the dome to upper most portion of the nose tip.
Thus,copyingthecurrentsurfaceanatomyofanormalnose,
theamountofguessworkisminimizedinsizeandshape.
Topreventmovementofthetipgraftssuturedwithvycril5/0.
External with a monofilament 5/0 to retire at 7 days. One
weektoputaplastersplintandsetistrip15days.
6
1902 7
LONG TIME RESULT OF GRATED (DICED) CARTILAGE
GRAFT IN SECONDARY NASAL RECONSTRUCTION
Presenter:
AliManafi,MD
Affiliation:
IranUniversityofMedicalSciences
Country:
Iran
Authors:
ManafiA,DezhamF,ManafiF
1864 6
REVISITING THE ROLE OF COLUMELLAR STRUT
GRAFT IN PRIMARY OPEN APPROACH RHINOPLASTY
Presenter:
OzanBitik,MD
Affiliation:
HacettepeUniversityFacultyofMedicine
Country:
Turkey
Authors:
BitikO,UzunH,KamburogluHO,CalisM,
ZinsJE
Background: The effect of a columellar strut graft on final
nasaltippositionhasbeenasubjectofongoingdebate.The
purposeofthisstudywastoretrospectivelyanalyzeaseriesof
100consecutiveprimaryrhinoplastycasesperformedwithout
theuseofcolumellarstrutgrafts,withaspecificfocusdirected
towardscomparingpre-operative,morphed,andactualpostoperativechangesinnasaltipposition.
Methods:Datawascollectedfrompatientchartsanddigital
imagesof100consecutiveprimaryopenrhinoplastypatients.
Preoperative, morphed and actual postoperative digital
imageswerequantitativelyanalyzedusingimageprocessing
software to compare various anatomical features including
nasaltipprojection(NTP),thenasolabialangle(NLA)andthe
Goode ratio (GR). Patient satisfaction regarding long-term
postoperativeresultswasalsosurveyed.
Results:Primaryrhinoplastydidnotdemonstrateauniversal
trend towards either an increase or a decrease in NTP. The
planned changes in nasal tip projection, nasal tip rotation
andnasalprofileproportionswereobtainedwithstatistically
significantaccuracywithouttheuseofcolumellarstrutgrafts.
Theoverallincidenceofcolumellarcontourirregularitieswas
3%.
Conclusions: The primary role of the columellar strut
in primary open rhinoplasty is to support the shape and
structuralintegrityofthecolumella.Forthispurposeashort
strutisusuallyallthatisrequired.
7
Introduction: Use of autologous cartilage graft is a
fundamentalstepinmodernrhinoplasty.Dicingofcartilage
graftsisanacceptedmethodofpreparationofthegrafts.Ithas
theadvantagesofgoodtake,moldingandshaping.Although
therearesomedisadvantegesregardingthesize ofthepieces
ofdicedcartilagegrafts.
Methods: Grating of cartilages graft as a method of dicing
hasshoweditsvalueinexperimentalrabbitmodels[M.A.et
al. comparson in graft resorption between three techniques
ofdicedcartilageusingsurgicalblade,electricalgrinderand
graterinRabbitworldjournalofplasticsurgery2014;3(1):5263.]. It has showed great take, viability and preserving of
regenerative potential. We have used it in clinical cases,
especially in secondary cases since six years ago. In cases
of rib cartilages it has been showed its simple techniques.
Weusediton820casesofsecondarynasaldeformitiesand
viewedexcelentresults.
Results:Wehaveviewedtheexcelenceandremarkableresults
of this technique and we want to propagate this technique
among the plastic surgeons. Use of grated cartilage with
or without fascia has showed excelent handling, molding,
shapingandtake.Itdoesnthavethedisadvantagesofroutine
diced cartilage grafts. Histologic results of sataining of this
type of graft with H&E, glial fibrillary acidic protein and
Ki67showedremarkablepreservationofchondrocytenuclei
regenerativepotentialandmitoticactivity.
Conclusion:Excelenttake,easeofproductionandhandling,
aswellaslongtimedurableresultsaremainadvantagesof
grated cartilages grafts. In this presentation we will present
thetechnique,applicationandresultsofthisprocedureand
share our knowledge to reach a better view of this kind of
technique.
1696 8
SUTURE INSTEAD OF GRAFT
1696 8
SUTURE INSTEAD OF GRAFT
Presenter:
GennadiyPatlazhan,MD,PhD
Affiliation:
InstituteofPlasticSurgeryVirtus
Country:
Ukraine
Author:
PatlazhanG
Study Objectives:Whileoperatingthetipofthenose
andcaudalseptumitisveryoftennecessarytoseparate
theligamentsthatconnectmedialcruraoflowerlateral
cartilages(LLC)withseptum.Thisprocedureconsiderably
weakensthenasaltipsupportandmaycauseitspostrhinoplastyptosisifotherwisepreventivemeasuresare
undertaken.
Materials and Methods:From2005to2013weperformed
690primaryrhinoplastieswith95%outofthisnumber
wereopenones.Toelevatethenasalprojectionalongwith
rotationorjuststabilizingitssupport,therewasdeveloped
andintroducedintopracticetheconnectivesutureto
connectligamentsbetweenmedialcruraandcaudalseptal
margin.Wecalledit“strut-suture”,becauseitsfunction
equalstothefunctionofthestrut.Thesuturewasusedin
311(47%)ofopenrhinoplastycases.Interruptedprolene
5-0suturewasused.Therateofnasaltipprojectioncanbe
controlledbymeansofincreasedmobilizationofligaments
andsuturewithmoretension.Inthecourseofshiftingthe
suturetotheleftortotherightfromseptummakespossible
tocorrectminornasaltipdeviations.Insomecaseswhenit
isnecessarytodecreaseretractedcolumella,weadditionally
usedastrutgraft.WecancompareitwiththeProjection
controlsuturebyJ.Tebbettsand”tongueingroove”
technique.Theygivemorerigidtipbecauseofthejunction
ofcartilagewithcartilage.“Strut-suture”vibratesandacts
naturallyduetofixationofligamentwithcartilage.
Results:Asaresultofimplementationoftheabove
techniqueweachievedexcellentaestheticresultswithgood
nasalprojectionandrotation.Overthe8-yearperiodof
applicationthistypeofsutureforopenrhinoplastywedidn’t
observednasaltipptosisduringpostoperativeperiod.
Conclusions:Thissutureiseasytoplacewithlotsof
positivefunctionsandwhatsveryimportantinmanycases
replacestheapplicationofcartilagestrut-graft,whichisnot
alwaysavailableorwhenavailableisnotalwaysstraight
andsufficientlylong.Thepracticeofusing“strut-suture”
facilitatesandspeedsupopenrhinoplasty.
8
2061 9
DICED CARTILAGE IN RHINOPLASTY: TECHNICAL
REFINEMENTS AND 6 YEARS EXPERIENCE
Presenter:
PatríciaCordeiroLanaMelgaço,MD
Affiliation:
HospitalFelicioRocho
Country:
Brazil
Authors:
LanaPC,daCostaSM,CostadeSouzaGM,
NascimentoBrandaoPennaWC,AraujoIC
1754 10
SOFT TISSUE REDUCTION AND TIP STRENGTHENING
IN MANAGING RHINOPLASTY CASES WITH THICK
SKIN
Presenter:
AmirS.Elbarbary,MD
Affiliation:
AinShamsUniversity
Country:
Egypt
Author:
ElbarbaryAS
Manytechniqueshavebeendevelopedtosculptthestructure
of the nose, relying on the maintenance of this support,
essentialnasalaestheticsandphysiology.Thedicedcartilage
graft was first described by Young and subsequently was
developedbyPeers,inthe1940s.Afterthesepublishments,
Erol and colleagues and Daniel had developed further
techniques using temporal fascia and had confirmed its
feasibility, reviving the interest in diced cartilage by plastic
surgeons. The great potential of diced autogenous cartilage
inrelationtograftorsculptedcartilage,isonversatilityand
efficiencyinfinishingthenasalcontourandfillirregularities.
This paper presents the technique and the results of 402
patientssubmitedtorhinoplastiesperformedbetween2008
and2014attheHospitalFelicioRocho(BeloHorizonte,MG).
Our technique is based on the use of injectable cartilage
withoutwrapitinanykindofmembrane.Theindicationsfor
theuseofdicedcartilageweredeficiencyofthenasaldorsum,
ofvariousethiologies,astheracialnose,traumasequelae,or
after reductive rhinoplasty. The technique also modifies the
nasal contour and the proportions between the tip, dorsum
and columella. As donor sites, we used as first choice
the septum cartilage, followed by the auricular and costal
cartilages,dependingontheamountofcartilagerequired.We
observedalowerrateofcomplicationssuchasasymmetries,
irregularitiesandabsorptionofgraftsafterwestartedusing
thistechnique.Thedicedcartilagehasshownto beasimple
andsafeoptionandhadmorepredictableresultsthanthose
usedpreviously.Thistechniqueiscomplementarytoachieve
morenaturalresultsinrhinoplasties.
Introduction: Thick/sebaceous skin envelope with excessive
fibrofatty tissues are among the difficult problems
encounteredintheaestheticrhinoplastypatient.Itbecomes
furtherchallengingwhencombinedwithill-definedplunging
nasaltips,andweaklateralcruraerelativetotheskinenvelope.
Objectives: This work aim to emphasize the importance of
incorporating soft tissue reduction & strengthening of the
nasaltipintheoperativestepsofrhinoplastytoovercomethe
difficultproblemofthethickskinenvelope.
Methods: The usual operative sequence included an open
approach with bony, septal, tip, and alar base modifications
as indicated for each of the 75 patients included in this
work.Thetwoconstantsurgicalstepsincludedtheplaneof
dissection&strengtheningofthetip.Insteadofthestandard
subperichondrial plane of dissection, exposure was carried
out subdermally in the fibrofatty layer over the lobule then
converted subperiosteally over the bone. This allows for a
uniform & controlled defatting of the thick skin along with
excisingthesoftthatremainonthealarcartilages.Tipsutures
&graftswereusedforallpatientswithorwithoutcolumellar
struts.
Results: Based on objective & subjective evaluation, 90%
of the patients were satisfied with the significant change in
theirnasalappearance,whichstillmaintainedbalancedfacial
features within an average of 2-year follow-up. There were
no functional complaints. The most common postoperative
sequelwastheprolongededemainthesupratip/tipregion.
Inconclusion,thereisnoroutinestandardtechniquesuitable
foranynose&thesurgeryshouldbehighlyindividualized.
However, the results of this work demonstrate that
incorporating soft tissue reduction & strengthening of the
nasal tip in the operative steps of rhinoplasty are useful to
overcome the difficult problem of the thick skin envelope.
Strengtheningofthelobularcartilageisneededforstructure
&definitionofthetipinordertosupporttheoriginallylarge
heavyskin.Thinningoftheformerlythickskinenvelopewill
allow it to contract around the new rigid tip framework to
achievethedesiredaestheticgoal.
9
10
SOFT TISSUE REDUCTION AND TIP STRENGTHENING
IN MANAGING RHINOPLASTY CASES WITH THICK
SKIN
1722 11
BULBOUS TIP. CORRECTION ALGORITHM
Presenter:
VitalyZholtikov,MD
Affiliation:
AtribeauteClinique
Country:
Russia
Author:
ZholtikovV
Aim:Bulboustiporwidetipisatermthatisusedtodescribe
atipofbigsize.Excessofsofttissuesor,moreoften,increased
size of tip cartilages and deformed or excessively convex
lateralcruracancausesuchphenomenon.Alotofsurgeons
resectcephalicportionsoflateralcrurainordertodecrease
the bulbous tip but beside tip convexity decreasing this
technicbringstoanumberoftipdeformations.Overviewing
suchdeformationswestartedtousecomplexandmaximum
predictablemethodstopreventknowncomplicationsincases
ofpatientswithbulboustipdeformation.
Materials and Methods: The authors made 138 operations
of bulbous tip corrections during three years (2010-2013).
All cases included complex rhynoplasty that affected every
nose section and the tip deformity correction was only a
part.Weused“opened”approach.Afterseparationofmedial
crura, nose septum and dorsum treatment, transplantate
collection, osteotomy and sreader installation along the
septumwereinforcedthenosetipwithextenderseptalgraft
thatlengthenstheseptum,itisinstalledamongthemedial
crura,andsuturedtothenoseseptum.Thelateralcrurawere
separatedfromthetrianglecartilages,atthatwedidn’tmake
the resection of cephalic portions or we made it extremely
limitedandslightlylowerthedomes.Thelateralcrurawere
straightened with X-shaped sutures or with cartilage lateral
crura grafts sewed under the lateral crura, or with both
variants.Theexcessivelengthofmedialand(or)lateralcrura
wasshortenedusingsliding.Thedomesweresuturedusing
intradomalortransdomalsutures.TheShieldgraft,softened
beforehand,wassuturedtothenosetipinmostcasesandalar
rimcartilagegraftswereinstalled.
Results:Weachievedexcellentestheticresultsonallpatients,
thenosetipappearednaturalwithoutanyvisibledeformations.
Conclusions:Itisworthtouseminimallydestructivemethodic
during the correction of bulbous tip deformations, not to
decreasethesupportofatipcartilagestructures,toincrease
thesupportofabaseandanosetip,anditisessentialtobe
guidedbyclearandpredictablecorrectionalgorithm.
10
1761 12
TRIPLE PLANE DISSECTION IN OPEN PRIMARY
RHINOPLASTY IN MIDDLE EASTERN NOSES
Presenter:
AhmedF.Elshahat,MD
Affiliation:
FacultyofMedicineAinShamsUniversity
Country:
Egypt
Author:
ElshahatAF
1671 13
MIDDLE EASTERN NOSE VARIETY OF PHENOTYPES
AND SURGICAL APPROACHES
Presenter:
IgorNiechajev,MD,PhD
Affiliation:
LidingoClinic
Country:
Sweden
Author:
NiechajevI
Objective: Rhinoplasty started as a closed technique
and then the open technique gained popularity. Open
technique gave surgeons the opportunity to visualize and
manipulate the cartilaginous skeleton at the tip of the
nose precisely. The dissection planes in open rhinoplasty
technique may be subcutaneous, submuscular (under the
superficial musculoaponeuroticsystem), or subpericondrial
subperiosteal.Eachplanehasadvantagesanddisadvantages.
The aim of this study was to combine planes to get the
maximalbenefitofeachplane.
TheMiddleEastisavastareabetweentheEastcoastofthe
MediterraneanseeandAfghanistan.Thisareaispopulatedby
manynationsandtribes.Severalphenotypeswithprevalence
intheparticularregionscouldberecognized.
Method: The study was performed on 38 Middle Eastern
patients,amongwhom23werefemalesand15weremales.All
patientspresentedforprimaryrhinoplasty.Theyweredivided
into5groupsonthebasisoftheirskinthickness.Dissection
startedsubcutaneousattheareaofthelowerlateralcartilages
and then shifted subsuperficial musculoaponeurotic system
overtheupperlateralcartilagesandendedsubperiostealover
thebonyskeleton.
Material and Methods:From1985to2014authorhavedone
2314primaryandsecondaryrhinoplastieson2024patients.
Among them were 980 patients of Middle Eastern origin
(48%).TheF/Mratiowasduringthefirstdecade0.9:1,butin
thelastsevenyearschangedto2.8:1.Theagerangewas16-59
(median24)years.Thefollowingsubgroupscouldbedefined
by the retrospective review of computerized medical charts
andphotoarchives:Levantinenose,Turkishnose (anatolian),
oriental Turkish nose (Goktürks of Central Asian origin),
IraqiandKurdishnose,Persiannose,northernandsouthern
Afghan nose. Special, frequently applied techniques were:
vertical elongation of the upper lip, reduction of the nasal
spina,reductionofthemembranaceusseptum,improvement
ofthetipprojectionandimprovementofthenasalairways.
Results:Thistripleplaneofdissectiongaveacceptableresults
without any complication. Subcutaneous dissection allowed
thinning of the thick sebaceous skin at the tip and alar
region,subsuperficialmusculoaponeuroticsystemdissection
alloweddirectexposureoftheupperlateralcartilagewithout
thinning skin at an area where it is thin, and subperiosteal
dissection helped masking any bony irregularities resulted
fromosteotomies.
Results:Thelevantinenosehasaneagleprofile,shortupper
lipandprominentnasalspina.Theturkishnoseismoderately
wide, crooked and has a tip with inadequate projection.
OrientalTurkshavefrequentlynoseswithtent-likeappearance
and not defined alar cartilages. Iraqis and Kurds have large
nosescoveredwiththickandoilyskin.Iraniannosesexhibita
largevariety,butfrequentlydisplaymoderatelylargecrooked
noses.
Conclusion: The triple plane dissection in open primary
rhinoplasty in Middle Eastern patients maximized the
advantages of each plane and minimized the disadvantages
andresultedinsafecosmeticresults.
Conclusion:NosesofthepopulationintheMiddleEastshow
large phenotypic variation. Consequently no typical Middle
Easternnoseexists,butthecommonfeatureistheirlargesize
andthenaso-labialangle=or<90degree,whileothernasal
characteristics vary. Rhinoplasty on the patients originating
fromtheMiddleEastisbothtechnicallyandpsychologically
challenging task for the plastic surgeon. Careful consulting
and examination, followed by the computer imaging for
operation planning, are prere quisite for obtaining good
clinicalresultsandhavinghappypatients.
Fig.1.GeographicdefinitionoftheMiddleEast
Fig.2.25-year-oldKurdfromIranbefore,4yearsafterand
18yearsaftertherhinoplasty.Noteevolutionofthenose
featuresduringtheprocessofageing.
11
13
MIDDLE EASTERN NOSE VARIETY OF PHENOTYPES
AND SURGICAL APPROACHES
1725
14
CONTROL AND STABILITY IN NASAL TIP PROYECTION
USING THE SEPTUM EXTENSION GRAFT (SEG)
Presenter:
AndresFreschi,MD
Affiliation:
SociedadArgentinadeCirugPlastica
Country:
Argentina
Authors:
FreschiA,BlancoE
Background: Risk of loosing projection after rhinoplasty
has been well documented. This means, short nasal bones,
weaklowerlateralcartilages,closednaso-labialangleorsome
degreeofmidfacialretrusion.Achievingcontrolandstabilty
isoneofthebigestchallengeinRhinoplasty.Thecolumelar
strutisprobablythemostpopularandusedgraftinnasaltip
surgerybuthasshownsuboptimalresultswhentalkingabout
sustainability over time. Considering the nasal septum as
mainsupportandaxisofthenose,theauthorsdescribetheir
experienceusingtheSEG.
Methods:Seventeenpatientsbetween25and35yearsoldwith
high risk for loss of projection after surgery were operated.
Allofthemhadanopenapproachwithseptumplastyanda
septumextensiongraftanchoredtocaudalseptum.
Results: All the patients have shown a substancial
improvementandstabilityovertimeinnasaltipproyection
showingadventagesoverthecolumelarstrut.
Conclusion: The septum extension graft is a powerful tool
in mantaining tip position over time as other authors have
described. We believe that its main adventage is the strong
fixationthatworksasastructuralextensionfromtheseptum
toreliablycontrolthetipcomplex.
12
2033 15
COMPARATIVE STUDY BETWEEN OPEN AND CLOSED
RHINOPLASTY ON TIP TREATMENT
Presenter:
JoseE.Lintz,MD
Affiliation:
InstitutoIvoPitanguy
Country:
Brazil
Author:
LintzJE
Introduction: The tip nose is often studied by surgeons
because it is common complaint reason pre-and postoperative.Therefore,thetipshouldbethoroughlyevaluated
todeterminethebesttechniquetobeused.Therearethree
typesofapproachofthenose-theopenrhinoplasty,closed
anddelivery.
Purpose:Comparetheresultsofopenandcloserhinoplasty
inthetreatmentofnasaltip,consideringthetechniqueused,
complications,re-operationsrateandpatients’satisfaction.
Methods:Aretrospectivestudyof82patientswhounderwent
closeopenanddeliveryrhinoplasty,duringtheperiod2002
to2008.
Results: 91 surgeries were performed in 82 patients, 55
open rinoplastys, 33 closed and 3 delivery. Of the patients
who underwent open rhinoplasty, 85.1% showed a high
degree of satisfaction. About the patients who underwent
closedrhinoplasty,just72.1%.Fifhteenpercentoftheclosed
rhinoplasty’s patients were re-operated. While on open
rinoplastystheindexwas5%.
Conclusion:Thepercentageofre-operationwaslowerinthe
open rhinoplasty, and the index of satisfaction was higher
in the same despite not having statistically significance (p
= 0126). Advantages of open rhinoplasty: better anatomy
view, preservation of the nasal mucosa, greater refinement
inthecartilagemodeling,lesspost-operativebleeding,easier
technique.Disadvantagesofopenrhinoplasty-transcolumelar
scarringandpossiblelossofskinincolumelarflap,increased
and longer swelling in the post-operative, contraction
possibility,allthoseseenasuncommonandacceptable.The
openrhinoplastywasquiteversatile,effectiveinthediagnosis
andtreatmentofnasaltip,especiallywhencomparedtothe
closedtechnique.
13
Free Paper Session 2 - Periocular Surgery
1936 17
HISTOLOGIC ANATOMY OF TEAR TROUGH LIGAMENT
AND ORBITAL RETAINING LIGAMENT
Presenter:
JaeBeomPark,MD
Affiliation:
ChungnamNationalUniversityHospital
Country:
Korea
Authors:
ParkJB,KangNH,OhSH,SongSH,
KyungHW
1934 18
TEAR TROUGH ANATOMY RELATED WITH FAT
SLIDING IN LOWER BLEPHAROPLASTY
Presenter:
NakHeonKang,MD,PhD
Affiliation:
ChungnamNationalUniversityHospital
Country:
Korea
Authors:
KangNH,ParkJB,OhSH,SongSH,
KyungHW
Palpebralbag,teartroughandlid-cheekgroovearecommon
problems in aging lower eyelid. Many operative techniques
oflowerblepharoplastyhavebeenintroducedtosolveaging
processlikethoseproblemsinlowereyelid.Thepurposeof
thisstudywastoevaluatehistologicalcharacteristicsoftear
troughligamentandorbitalretainingligament.
Tear trough deformity becomes remarkable with aging. For
correctionofagingprocess,manyoperationtechniquesabout
lower blepharoplasty have been introduced. Especially, fat
slidingisthemostpopularmethodlately.Therearestillno
exactstudyaboutanatomyofdissectionandfixationinlower
blepharoplasty. The aim of this study is to evaluate detail
anatomyofteartroughstructureinoperation.
FromFebruary2013toJanuary2014,5freshcadaverswere
dissected.Weresectedtheinfraorbitalrimwithskinto bone
altogetherbyrectangularshape.Thespecimenswerestained
with Hematoxylin eosin and Masson’s trichrome. And we
measured thickness of tear-trough ligament and orbital
retainingligamentfromthepointofitsoriginandorbitalrim.
Tear trough ligament showed obviously osteocutaneous
attachment from periosteum to reticular dermis, and
consistedofsinglebundlegroupofcollagen.Meanthickness
ofcutaneousteartroughfrominferiororbitalrimwas2.1±0.2
mm.Meandistancebetweeninferiororbitaltobonyinsertion
(origin) of tear trough ligament was 3.2±0.4 mm. Orbital
retainingligamentshowedcoarsebilayerstructure, consisted
oftwogroupsofcollagenbundlereachingtomuscularlayer,
not to dermis. Mean distance between orbital retaining
ligamentorigintoinferiororbitalrimwas7.2±1.2mm.
We evaluated tear trough ligament histologically, and
confirmeditssinglebundlegroup&osteocutaneousstructure.
Therefore,fatgraftabovereticulardermislayercouldbemore
effective than deep injection. In contrast, orbital retaining
ligament showed osteomuscular structure and consisted
of two layers. In lower blepharoplasty, we should dissect to
inferiorlayeroforbitalretainingligamentsufficiently.
From May 2012 to April 2014, 15 patients underwent lower
blepharoplasties to correct tear trough. Mean age was 56.2
years with 3 men and 12 women. Before the operation, we
penetratedtheteartroughskinlinewith26Gsyringeneedle
perpendicularly to check bony point of tear trough level.
Infraorbitalareawasapproachedthroughthepreseptalspace
above and prezygomatic space below. After infraorbital rim
wasexposed,wemeasuredthedistanceofbonyleveloftear
trough line from infraorbital rim. 15 cadaveric hemifaces
were dissected. The approach method was same as above.
Thenwemeasuredthedistanceoflevatorlabiisuperiorisand
infraorbitalnervefrominfraorbitalrim.
Bony penetration point of tear trough line was 2.2 ± 0.2
mm away from orbital rim. Levator labii superioris was 5.4
±0.5mmfarfromorbitalrimandwidthwas25.5±2.4mm.
Infraorbital nerve burst through 2.1 ± 0.1 mm inferior to
levatorlabiisuperiorismuscleorigin.
This study demonstrates stereotactic relationship between
the cutaneous tear trough and infraorbital bony structure.
Andwemadeanattempttoclarifysecurerangeofdissection
and sliding fat fixation. Fat sliding in lower blepharoplasty,
dissectionshouldbemorethan2mmtoreleaseteartrough
deformity and not over 5.5 mm to prevent injury of levator
labii superioris and infraorbital nerve. On the basis of this
study,lowerblepharoplastymoreaccuratelyandprecisely.
14
18
TEAR TROUGH ANATOMY RELATED WITH FAT
SLIDING IN LOWER BLEPHAROPLASTY
1822 19
PERIORBITAL REJUVENATION: THE EGYPTIAN
EXPERIENCE IN MANAGEMENT OF DARK HALOS
Presenter:
HusseinS.Abulhassan,MD
Affiliation:
UniversityofAlexandria
Country:
Egypt
Authors:
AlbulhassaHS,AbulhassanAH
Since the work of Coleman that standardized the lipofat
grafting and the discovery of the adipose derived stem cells
in2001,theapplicationsofinjectingthesecellshasextended
to cover new aspects in plastic surgery. Aging process of
the periorbial region includes cascading of eyebrows, fatty
accumulationinlowereyelids,atrophyofteartroughandskin
discolorationaroundtheeye.Youngpatientswithdarkhalos
seekmanytreatmentplans,butinvain.Weproposetheuseof
adiposederivedstemcellsasderivedbythenanofattechnique
asanewlineoftreatmentfortheseproblems.
Material and Methods:50casesweremanagedforperiorbital
rejuvenationanddarkhalosanddiscolorationproblemswere
managed. Clinical evaluation preoperatively and operative
techniqueofpreparingthefattofollowthesameasTonnard
etalwhoadvocatedtheSNIFtechnique.
Results: We found both these techniques are very suitable
whencombinedtogethertocorrectdeformity,darknessand
fine lines. Postperative results were documented over 3-12
monthsperiodwithverysatisfactoryresults.RE-toucheswere
donein15%withpreservedfatin-20Cfor2weeksandreused
safely.
Conclusion: We conclude the safety, efficacy and rewarding
effectofAdiposedderivedstemcells.
15
1879 20
ANATOMIC STUDY OF THE NASO- LABIAL FOLD AND
MIDFACE TRACTION THROUGH THE LOWER TRANS
CONJUNCTIVAL APPROACH AND FIXATION ON THE
LATERAL ORBITAL PERIOSTEUM
Presenter:
PauloM.Godoy,MD
Affiliation:
ClincaIguatemi44
Country:
Brazil
Authors:
GodoyPM,GarciaRodriguesAC
The facial medium third has become an area of interest in
oculoplastic surgery. This area of the face is defined as an
extensionoftheeyelidcomplexuptothefacialtissuesofthe
zygomaticarea.Thelossofelasticityandtoneassociatedwith
gravitycontributewithearliestsignsofagingofthisarea.We
propose,inthisstudy,atractionmidfacewithminimalscars
andcompareitwiththeexistingtechniquesintheliterature.
Thirtycadaverhemifaceswerestudiedwithuptofourdays
of post mortum, without prior surgery or facial scars. As a
parameter,weestablishedapointformedbytheintersaction
of an imaginary line vertically drawn from the medium
pupilar line to the foramen orbital, and an imaginary line
drawnhorizontallythroughthenasaltip.Webeginwitha4
mmincisiononthelateralmarginoftheorbitontheeyebrow
followed by the dissection in the subcutaneous plane up to
ofthelateralborderofthesuperiororbit.Asecondincision
isperformedinconjunctiveofthelowereyelidfollowedbya
blunt dissection and detachment of the lower border of the
orbicularis muscle from the arcus marginalis. Two stiches
are made with a 3-0 suture: one in the superior orbit, and
oneintheinferiororbit.Weintroducetwovascularcatheter,
18F:oneonthesuperiorpartofthenasolabialfoldandthe
second on the lower part of the fold and they continue, on
thesubcutaneousplane,uptothesuperiorandinferiororbit
respectively.The3-0sutureisintroducedinsideeachcatheter
and, with a loop moviment, the catheter can anchor the
tissuesaroundthenasolabialfold.Withthismanouverthe
tissuesfromthemidfacecanbeeaslyelevatedthroughthe
orbitaldirection
1883 21
USE OF A NOVEL ORBICULARIS OCULI MUSCLE
OVERLAP METHOD FOR THE CORRECTION OF TEAR
TROUGH DEFORMITY
Presenter:
YuzoKomuro,MD
Affiliation:
JuntendoUniversityUrayasuHospital
Country:
Japan
Authors:
KomuroY,KoizumiT,MatsumotoS
Although the fat pad sliding method reported by Loeb and
the“arcusmarginalisreleasewithpreservationoforbitalfat”
methodreportedbyHamraareusefulmethodsforcorrecting
tear trough deformity in the Asian population, including
Japanese patients, there have been occasional cases of tear
troughdeformitypersistingevenaftersurgery.Tosolvethis
problem, we developed a novel orbicularis oculi muscle
overlap method and have obtained good results using this
technique.
Methods: The orbicularis oculi muscle overlap method was
performed on 10 patients suffering from prominent tear
troughdeformity.Itwasusedin9femalecasesand1male
case,andtheaveragepatientagewas52years(range,34to72
years).Theoriginoftheorbicularisoculimusclewaselevated
at its adherence to the maxillary bone, and the innermost
portion of the origin of the orbicularis oculi muscle was
excisedbyawidthof6to7mmtoreducethemuscletension.
This muscle flap was overlapped relative to the orbital fat,
whichwasrepositionedovertheorbitalrim,andtheflapwas
suturedinplace.
Results: Tear trough deformity improved in all cases and
patientswerehighlysatisfiedwiththeirflatlowereyelids.
Conclusion:Theorbicularisoculimuscleoverlapmethodis
effectiveforthineyelidswithprominentteartroughdeformity.
16
1897 22
A NEW CANTHOPEXY SUTURE TECHNIQUE WHICH
PREVENTS CHEMOSIS IS PRESENTED IN TWENTY FIVE
CONSECUTIVE PATIENTS
Presenter:
FarhadRafizadeh,MD
Affiliation:
MorristownMedicalCenter
Country:
USA
Author:
RafizadehF
Goals: Blepharoplasty is a common procedure in facial
rejuvenation and is often combined with lateral canthopexy
to avoid post operative lid retraction. Some authors have
recommendedthelateralcanthopexyasaroutineadjucttothe
lowerblepharoplastyprocedure.Lateralcanthopexycarriesa
riskofchemosiswhichisreportedtobetwototenpercent.
Thepurposeofthispaperistodemonstrateasuturetechinque
intendedtoavoidchemosisincasesoflateralcanthopexy.
Methods: A careful lower blepharoplasty preserving the
pretarsalorbicularisandsavingtheinnervationtothismuscle
wasperformedinallpatients.Anewsuturetechniquewhich
avoidsstrangulationofthelateralcanthaltissuesinthesuture
loopwasperformedbytheauthorintwentyfiveconsecutive
patients and fifty eyes, requiring a lateral canthopexy. The
minimum follow up is six months. There are twenty four
femalesandonemalewiththeagesrangingfromfortythree
toseventysix.
Results: In twenty five consecutive patients, no chemosis
occured during the period of observation ranging from
immediatelyaftersurgerytosixmonthspostoperative.There
wasonesuturefailurewhichwascorrectedintheoffice.
Conclusion:Theauthorbelievesthatavoidingstrangulation
of the lateral canthal tissue by a suture loop during
canthopexy, combined with a careful dissection technique
inlowerblepharoplastycanresultinareducedincidenceof
postoperativechemosis.Itisrecognizedthatthenumbersare
limitedandfurtherinvestigationcouldenhancethecertitude
ofourconclusion.
1812 23
CLOSED GLABELAR MYOTOMY
Presenter:
RogerioS.Gomes,MD
Affiliation:
UniversityHospital
Country:
Brazil
Author:
GomesRS
Background: Glabelar-muscle hyperactivity and consequent
wrinklesarefrequentcomplaintsinplasticsurgery.Treatment
consistsofimpedimentoftherelatedmuscles.Itcanbedone
chemicallywithbotulinumtoxin,withtemporaryeffects,or
surgicallythroughtheclassiccoronalapproach,theendoscopic
way,thesuperciliarapproach,thetransblepharoplastymethod
andlimitednon-endoscopicapproaches.Weproposeaclosed
approachforglabelar-muscletreatment.
Methods: 18 patients were operated on between April 2012
andMarch2013.Muscleswereidentifiedwithmarksunder
forcedexpressionoftheverticalandhorizontalfrownlines.
Supraorbital and suprathrochlear nerve projection in the
skin were also marked. Myotomy is carried out guided by
skinmarksandstartsusingpolyglactinorsteelwirepassing
vertically 4 times in different places and horizontally twice
throughthefrownlinesmarkedjustoverperiosteumplane
and returning through the same needle holes using the
subcutaneousplane.
Results: Goodresultswereachievedinallcaseswithvertical
and horizontal glabellar-muscle impediment during the
evaluatedperiod,withwrinkleandhyperactivityimprovement.
The complications noted were temporary numbness in the
centralfrontalregion(2cases).Noonecaseofrecurrencewas
observed.
Discussion: The long-lasting surgical-treatment options
forglabelarwrinklesaremyotomyormyectomy,doneviaa
coronalapproachwithwell-knowncomplicationsassociated,
video-endoscopy(assistedbymanydevicesandprovingextra
surgically time-consuming), superciliar approach, through
a superior blepharoplasty approach for glabelar muscles
and limited nonendoscopic approaches. The closed glabelar
myotomy avoids some possible complications associated
with these related options, decreases surgical time using
conventionalsurgicalinstrumentsandavoidscars.
Conclusions: The closed glabelar myotomy seems to be a
goodalternativetoothersurgicaloptionsbecauseavoidsscars
andgoodlong-lastingresults.
17
1831
24
A FINDING OF MICRO NEUROVASCULAR BUNDLES
ON UPPER EYELID
Presenter:
SufanWu,MD,PhD
Affiliation:
ZhejiangProvincialPeoplesHospital
Country:
China
Authors:
WuS,PanL,JiY,ZhaoY
2024 25
BLEPHAROPTOSIS AS A CAUSE OF FACIAL AGING
AND HEADACHES
Presenter:
HiroyukiOhjimi,MD,PhD
Affiliation:
FukuokaUniversityHospital
Country:
Japan
Authors:
OhjimiH,TakagiS,KimuraH
Authors have found a fine neurovascular bundle in upper
eyelid during the blepheroplasty operation. In 60 upper
eyelidsof30casesofdoubleeyelidblepheroplasty,themicro
neurovascular bundles were found in almost every upper
eyelid.In48eyelids,eacheyelidhasonebundle,whereasin
10eyelids,eacheyelidhas2or3bundles.Theneurovascular
bundleisabout8-10mmlonginadiameterlessthan1mm,
located between tarsal palate and orbicularis occuli, which
originsfromorbitalseptumendsintheupperpartoftarsus.
These bundles are usually dissected during upper eyelids
blepheroplasty. Histological examination shows the bundles
contain both nerve and blood vessels. The bundle has not
beenreportedinpreviousliteratures,thefunctionofitneeds
furtherresearches.
The upper Asian face is different from that of other races.
Its flat bulky eyelids can lead to blepharoptosis whick,
in turn, results in an elevated blow, a wrinkled forehead,
sunkeneyes,anddroopingeyelids(lateralblepharochalasis).
In addition, its patients will also complain of upper eyelid
heaviness, visual disturbances, stiff necks, and headaches.
Purpose of this study is to compare the eyelid and eyebrow
positions of senile blepahroptosis patients with those of
youngerindividualswithoutthedisease;andtoanalyzepostblepharoplastychangesintheeyelidandeyebrowposition.In
addition,wewillcompareblepharoptosissymptomspre-and
post-operatively.
Materials and Methods: Eyelid and eyebrow analysis:
twenty-four senile blepharoptosis patients (48 eyelids) and
45 normal subjects (90 eyelids) were measured pre and
postoperatively using our newly developed software. Mean
ageofblepahroptosispatientsandthenormalgroupwas65.8
and27.8years,respectively.Blepharoplastyincludesexcision
of redundant skin and aponeurotic advancement. To study
blepharoptosissymptomsofheadacheandstiffneck,wesent
questionnairesusingtheVASscaletopatientsbothpre-and
postoperatively.
Results: Blepharoptosis patients upper eyelid position was
significantly lower and their eyebrow position significantly
higher than those of normal subjects. Blepharoplasty
improvedeyelidandeyebrowposition.Beforesurgery,senile
blepharoptosispatientscomplainedofheadacheandstiffneck
in60%and95%ofcases,respectively.Afterblepharoplasty,
headachesimprovedin92%andstiffneckin84%ofpatients.
Discussion and Conclusion:Becauseoftheimprovementin
forehead wrinkling and upper eyelid shape, blepharoplasty
resultedinfacialrejuvenationofsenileblepharoptosispatients
upperfaces.BlepharoplastyforAsiansnotonlymakesthem
lookyounger,butimprovestheirheadachesandstiffnecks,
and the general malaise which accompanies the condition.
Blepharoplastywillbethefirststepinantiagingtherapyfor
Asianupperfaces.
18
1944 27
BROW LIFT SIMPLIFIED
Presenter:
MeredithL.Harrell
Affiliation:
SouthwestPlasticSurgeryCenter
Country:
USA
Authors:
HarrellML,MolinarVE,MolinarA,AgulloF,
PalladinoH
1874 26
SEPTAL RESET IN LOWER LID BLEPHAROPLASTY
Presenter:
NigelS.Mercer,MD,MCh,FRCS
Affiliation:
BristolPlasticSurgery
Country:
UnitedKingdom
Author:
MercerNS
There are many approaches to lower lid and midface
rejuvenation. The rationale, technique and results of the
‘SeptalReset’Procedureperformedoverthelast15yearsare
presented.
Theprocedureisperformedviaasub-ciliaryincision,raising
askin/muscleflap.Theprocedureprimarilyaddressesthefat
herniation from below the globe by suturing the septum to
theinferiororbitalrimasanteriorlyaspossibleimprovesthe
teartrough.
The procedure is effective and has a low complcation rate.
Only occacional, mild chemosis has been encountered on
occasion and only taping was required temporarily. One
patientdevelopedanectropion12monthsaftertheprocedure,
whenherscarsweremature,requiringasmallfullthickness
graft.Therewerenovisualchangesinanypatientandpatient
satisfactionwasveryhigh.Aconsequetiveseriesofresultsis
bepresented.
Background: Medical means of treating sagging eyebrows,
ptosis,anddermatochalasishavelongbeendescribedinthe
literature. Classical invasive approaches include coronal,
pretricheal,anddirectbrowincisions,whichprovidevarious
locations for brow fixation. A less frequently described
techniqueisthetransblepharoplastybrowlift(TBBL),which
combines the benefits of classical incisions, allowing for
a clear field of vision while operating, while also providing
a minimally invasive technique as seen with endoscopic
approaches. The surgical technique for TBBL is often
accompanied by a fixation device to support the brow. The
devicemostcommonlydescribedintheliteratureisEndotine
(Coaptsystems,Inc.,PaloAlto,CA).Inthisarticle,theauthors
recommend the use of absorbable suture as the preferred
mediumwhenperformingTBBLsuspension,whichhasonly
been described in the literature one time previously to the
authorsknowledge.
Purpose: The authors describe their results for TBBL
techniqueutilizingabsorbablesutureforbrowsuspensionas
analternativetoEndotine.
Methods: A retrospective chart review was conducted on 4
patientswhopresentedwithbrowptosisanddermatochalasisinduced visual impairment, and subsequently underwent
TBBL. Absorbable suture was placed for brow suspension
usingeither5-0Vicrylor5-0PDS.Suspensionwasobtained
byloopingthelateralportionofthebrow,andpassedthrough
thefrontalperiosteumatthepointpreviouslydemarcatedin
thestandingposition.
Results: The average age at the time of procedure was 61.5
years.5-0Vicrylwasusedin50%ofpatients,while5-0PDS
wasusedintheremainingpatients.Skindimplingorpalpation
of the suture material were not appreciated post-operatively
or at the 4-day follow-up. The most common post-operative
findingswerebruisingandswellingoftheperiorbitalarea.No
hematomasoccurredatthesurgicalsite.Incisionhealingand
satisfactionofprocedurewasexcellentinallpatients.
Conclusion: This technique is well tolerated by patients
who desire minimally invasive and cost-effective brow
elevation.Thisreportsuggeststheefficacyandsafetyofusing
absorbablesuturematerialforfixationofthebrowscompared
toEndotinefollowingaTBBL.
19
1863 28
SECONDARY BLEPHAROPLASTY
Presenter:
KamolWattanakrai,MD,FACS
Affiliation:
BhumibolAdulyadejHospital
Country:
Thailand
Author:
WattanakraiK
Upper eye lid blepharoplasty is the most popular aesthetic
proceduresinourorientalpeople.Thetechniquesvaryfrom
non-incision to conventional blepharoplasty. Unsatisfactory
outcomes range from minor to a major one that is difficult
to correct. Secondary blepharoplasty require a thoroughly
understandingoftheanatomyanditsvariationafterprimary
surgery.Unnaturalhighfold,toomuchfatorskinremovaland
ptosisaremajorconsequenceafterimproperblepharoplasty.
Surgical techniques include lowering the lid fold, Levator
aponeurosis advancement and fat graft are key elements in
secondaryblepharoplasty.
20
Free Paper Session 3 - Abdominoplasty & Body Contouring
29
VENOUS THROMBOEMBOLISM IN BODY
CONTOURING: AN ANALYSIS OF 17,774 PATIENTS
FROM THE NATIONAL SURGICAL QUALITY
IMPROVEMENT (NSQIP) DATABASES
1885 29
VENOUS THROMBOEMBOLISM IN BODY
CONTOURING: AN ANALYSIS OF 17,774 PATIENTS
FROM THE NATIONAL SURGICAL QUALITY
IMPROVEMENT (NSQIP) DATABASES
Presenter:
AriM.Wes,BA
Affiliation:
HospitaloftheUniversityofPennsylvania
Country:
USA
Authors:
WesAM,FischerJP,NelsonJA,SerlettiJM,
KovachSJ,WuLC
Purpose: To examine the incidence and predictors of
venousthromboembolism(VTE)followingbodycontouring
procedures.
Methods: We reviewed the American College of Surgeons
National Surgical Quality Improvement Program (ACSNSQIP)databasefrom2005to2012forallidentifiablebody
contouring cases. A bootstrap analysis and multivariable
logistic regression analyses (MVR) were used to determine
independent predictors of VTE. Odds ratios from the MVR
werethenusedtodefineriskmagnitudesforeachsignificant
predictor,andeachpatientsriskscorewastotaled.
Results:Seventeenthousandsevenhundredandseventyfour
patientsunderwentbodycontouringduringthestudyperiod.
Average BMI of patients undergoing body contouring was
31.4kg/m2,while2,137individualsweremorbidlyobese(BMI
?40kg/m2).Themostcommonareasofinterventionwere
thebreastandabdominalregions(N=11,881,66.8%;N=5,501,
30.9% respectively). 16,306 (91.7%) patients underwent an
isolatedcontouringprocedure,while1,293(7.3%)underwent
2 procedures, and 175 (1.0%) underwent 3. VTE occurred
in 99 (0.56%) individuals. Multivariate logistic regression
revealedthatagegreaterthan45years(45-60years:OR1.54,
P=0.1; >60 years: OR 3.1, P<0.001), undergoing abdominal
contouring (OR 3.33, P<0.001), obesity (30?BMI<35: OR
3.30,P<0.001;35?BMI<40:OR4.26,P<0.001;BMI?40:OR
3.09,P=0.001;),andbeingadmittedasaninpatient(OR3.01,
P<0.001)wereassociatedwithanincreasedoddsofVTE.Each
oftheaforementionedvariableswereassignedroundedrisk
scores(Table1),withpatients’totalscoresbeingcategorized
as low (0-4), medium (5-7), or high risk (8-9). The low risk
cohortexhibitedaVTEincidenceof0.15%,whilethemedium
riskcohortexperiencedanincidenceof1.12%,andthehigh
riskgroupaVTEincidenceof3.03%(Figure1).
Conclusion: This study identifies predictors of VTE and
definesasimpleriskscoringmodelusingalarge,prospective
dataset.Thesefindingsshowthatinthepresenceofcertain
riskfactorsincidenceofVTEincreasesdramatically;inthese
casesVTEprophylaxismybewarranted.
21
1878 30
MAXIMIZING SAFETY FOR BODY CONTOURING
AFTER MASSIVE WEIGHT LOSS
Presenter:
LindaG.Phillips,MD
Affiliation:
TheUniversityofTexasMedicalBranch
Country:
USA
Author:
PhillipsLG
Thisonehourcoursediscussespotentialpitfallsinperforming
body contouring on patients after massive weight loss, and
ways to minimize their effects or screen for them prior to
a surgical procedure. Emphasis will be placed on pre-op
evaluation and counseling and medical intervention to give
theoptimalpatientresult.Theaudienceshouldattainbetter
understandingoftheimpactofissuessuchasmalnutrition,
poordiabeticcontrol,post-operativenausea(forexample)can
have on patient compliance, healing and ultimate outcome.
Patient examples will be discussed for case-based learning.
Techniques to maximize the patients pre-op status and
improve post-op care will be learned to allow participants
improvedoutcomes.
2001 31
PREVENTION OF SEROMA AND POST-OPERATIVE
WOUND COMPLICATIONS USING NEGATIVE
PRESSURE WOUND THERAPY DEVICES FOLLOWING
PANNICULECTOMY IN MASSIVE-WEIGHT LOSS
PATIENTS
Presenter:
VictorZhu,MD
Affiliation:
YaleUniversitySchoolofMedicine
Country:
USA
Authors:
WalkerME,WebbML,ZhuVZ,SturrockT,
NgR,ThomsonJG,BroerPN,KweiSL
Goals/Purpose: To compare the immediate application of
continuousnegativepressurewoundtherapy(NPWT)versus
standard,closed-suctiondrains(CS)inpreventionofseroma
inbody-contouringpatients.
Methods/Technique:Inaprospective,randomized-controlled,
single-surgeon study, patients seeking panniculectomy
were randomized to NPWT or CS drains. Patients were
compared on multiple demographic criteria including age,
gender, BMI, incision length, pannus weight, nutritional
status, comorbidities, prior surgery and duration of drain
placement. Abdominal ultrasound was performed 2 weeks
following drain removal to objectively quantify persistent
fluidcollections.StatisticalanalysisusingT-testandlogistic
Regressionwasperformed.
Results/Complications: The NPWT (n=12) and CS (n=10)
groups showed no statistically significant differences in
age (p=0.407), BMI (p=0.151), incision length (p=0.528),
pannusweight(p=0.743),smokingstatus(p=0.594),diabetes
(p=0.293), nutritional status (p>0.05), history of prior
surgeries(p=0.378),ordrainduration(p=0.429).BothBMI
(r=0.679, p=0.001) and pannus weight (r=0.536, p=0.010)
showedstrongpositivecorrelationswithpresenceofseroma.
No significant correlations were identified between age,
incisionlength,anddraindurationandpresenceofseroma
(p>0.05). Following drain removal, the mean fluid volumes
onultrasoundwere44.6cm3(0-166)and11.2cm3(0-45)for
CSandNPWT,respectively.Thereisastatisticallysignificant
difference is seroma presence in CS vs NPWT groups
(p=0.037). Controlling for age, BMI, incision length, and
drain duration, NPWT drain systems confer a 96.7% risk
reduction in seroma presence when compared to standard,
closed-suctiondrainsinpanniculectomypatients.
Conclusion:Negativepressurewoundtherapydrainsystems
may reduce the risk of seroma presence in panniculectomy
patients compared to standard, closed suction bulb drains.
Increases in BMI and increases in pannus weight correlate
withincreasesinpresenceofseromaformation.Continuous
negativepressurewoundtherapyconnecteddirectlytodrains
may impact the post-operative outcomes in massive weight
loss patients undergoing panniculectomy and other bodycontouringprocedures.
22
1752
32
COMPOSITE REDUCTION LABIAPLASTY
Presenter:
StefanGress,MD
Affiliation:
PlasticSurgeryMunich
Country:
Germany
Author:
GressS
Thedemandforsurgerytotreattheexternalfemalegenital
area has increased significantly in the recent years. The
majorityoftheseproceduresareaimedatthereductionofthe
labiaminora.Hyperplasticlabiaminoraoftenareassociated
with functional impairments or psychological distress. So
far no standard techniques have been established for labia
minorareduction.Fundamentallyalltechniquesdescribedin
literatureareallbasedonareductionofthelabiaminorainthe
partbelowtheclitorisandnoneofthesemethodsaddresses
the positional correction of clitoral protrusion. Eight years
ago we have created and advanced a technique that allowes
reduction of the labia over their entire lenght (not only the
partbelowtheclitorisbutalsothepartoftheclitoralhoodand
above)andadditionalcorrectionofclitoralprotrusion.This
techniquecreatesseperatelabialsegments,thecomposition
ofwhichallowesforanoptimalshapingandreductionofthe
labiaminora.Since2006wehavemanaged812casesusing
thistechnique,whichhasbeennamed“compositereduction
labiaplasty”.
All patients received postoperative care and follow-up
assessments during a period of 6 months. Except for a few
cases of wound dehiscence requiring surgical correction,
healing was without complications, and the outcomes were
both aesthetically and functionally with an average score of
9.4outof10possiblepointsverysatifactory.
23
1860 33
PEARLS AND PITFALLS OF CARING FOR THE
POST-BARIATRIC BODY CONTOURING PATIENT: OWN
EXPERIENCE WITH 800 PATIENTS
Presenter:
FrancoBassetto,MD
Affiliation:
UniversityofPadova
Country:
Italy
Authors:
BassettoF,MasettoL,CappellinaC,
VindigniV
Thenumberofpatientsseekingpost-bariatricbodycontouring
surgery has grown in prevalence, showing the exponential
growthofweightlosssurgery.Wehaveoperated800patients
during the last 8 years (39% abdominoplasty, 25% large
volumeliposuction,15%breastreduction,10%brachioplasty,
8%thightlift,2%torsoplasty,1%facelift).Theaimofourwork
istounderlinepearlsandpitfallstooptimizetheenrollment,
surgical treatment and post-operative management of these
groupofpatients.Indeedobesitymaynegativelyaffecthealth
on various of medical fronts, favoring local complications,
such as hematoma, infection, seroma and dehiscence, and
systemic complications such as deep venous thrombosis.
Themainpearlsofpatientmanagementincludepsychiatric
evaluation, understanding of obesity-induced physiological,
cellular, molecular, and chemical changes, detailed preoperative assessment, photographs and surgical project,
intraoperativesafetymeasures,andpostoperativecare.
1782 34
2 YEAR EXPERIENCE OF THE TREATMENT OF
CELLULITE USING AN ND:YAG1440NM PULSED LASER
Presenter:
KennethA.Marshall,MD
Affiliation:
HarvardMedicalSchoolMountAuburnHospital
Country:
USA
Author:
MarshallKA
Cellulite is a gender specific entity afflicting millions of
women.Thisconditionisacorrugationoftheskinanddermis
causedbyperpendicularseptaetetheringthosestructuresto
theunderlyingfasciaallowingfattoherniatebetweenthem.
Theanatomicareasmostcommonlyaffectedarethebuttocks
andthighs,bothanteriorandposterior.
Numerousmodalitieslargelynon-invasivehavebeendesigned
andtriedinattemptstocorrectthisdeformity.Forthemost
part, these techniques have been either very incomplete or
transientintheirresults.
Usingapulsedlaserat1440nmenergylevelwiththecannula
containingasidefiringlaserfiberandintroducedsubdermally,
thefatlobulescanbeshaveddown,theseptaereleased,and
the dermis heated from below to encourage tightening and
regeneration.
Goals & Purpose:Thepurposeofthisreportistoreviewthe
firstsequential40patientstreatedbythisauthorwiththegoal
ofassessingtheresultsandtheefficacyofthismodality.
Methods:Thepatientpopulationof40werealltreatedwith
asingletreatmentusingthe1440nmpulsedlaser.Theside
firing was directed to address each of the three parts of the
pathology. The 40 patients ranged in age from 38-71 years
withameanageof40years.Fivepatientshadbothanterior
and posterior procedures done at intervals of 6 weeks. All
patients were managed with compressive garments for a
minimumof4weeks.
1773
35
BELT LIPECTOMY A SAUDIA ARABIAN EXPERIENCE
Presenter:
AsifZ.Bhatti,MBBS,MD,FCPS,FRCS
Affiliation:
SaadSpecialistHospital
Country:
SaudiArabia
Authors:
BhattiAZ,ShaikhM
Introduction and Aims: Belt lipectomy is one of the most
commonbodycontouringprocedureafterweightlosssurgery.
Truncalobesityandskinsaggingpostweightlossweretreated
withtheobjectivetodecreasecomplicationsandincreasethe
patientsatisfactionintermofaesthetics.
Material and Methods: 36 cases were included in the
retrospective study having belt lipectomy procedure after
massivebodyweightloss.Theanalysisofpatientfactors,result
forsurgery,complicationsandsatisfactionwasrecorded.Also
modificationsproposedbyauthorwereseentoimprovethe
outcome.
Results: Out of 36 cases only 1 case needed re-operation
for major complication. There was only 1 major dehisence
neededonlydailydressingtorecoverand4caseshaveminor
complications.Totaloperativetimewasreducedfrom6hour
in initial cases to 4 hour in later cohort of cases. This was
achievedbyadoptingteamapproach,properselectionofcases
andintraoperativemodifications.
Conclusion(s): Belt Lipectomy is major body contouring
procedureanditshouldbedonewithplanning,teamapproach
andinaccordancewiththeprinciplesofsafesurgerytoget
bestresults.
Results/Complications:Theresultswereassessedbygrading
theappearanceoftheareastreatedat6weeks,3months,and
6months.Thelongestfollow-upwas2years,theshortest6
weeks.Thepatientsweresurveyedfortheirownevaluations
and level of satisfaction. Complications and morbidity were
minimal, including modest swelling, bruising and post-op
pain.Therewerenoinfections.
Conclusions:Theoverallsatisfactionratewashighwithonly
onepatientunsatisfied,withoneabsolutelythrilledandwith,
ingeneral,an80%overallimprovement.
24
1960 36
AUTOAUGMENTATION OF THE BUTTOCK IN
BODYLIFT PROCEDURES
Presenter:
HaraldBeck,MD
Affiliation:
WilhelminenspitalVienna
Country:
Austria
Authors:
BeckH,MatiasekJ,Tamandl-WassermannE,
GrillCH,KollerR
Introduction: In Europe, about 13% of the population are
obese (BMI>=30). In the states, the percentage is at 35%,
meaning more than one third of US population is obese.
Thenumberofbariatricproceduresisincreasingconstantly.
Lower bodylift suergery can restore the demolished body
shape. The skin and possible fatexcess of abdomen, hips,
pubicarea,buttocksandthighsareresectedandtheregions
arerecontoured.Pubisandbuttocksremaintheaesthetically
mostdemandingregions.
Methods:Inthelast2years,45patientsreceivedafulllower
bodylift in our department. One-?stage recontouring of the
abdomen, mons pubis, hips, buttocks and thighs was done
on all patients. All patients obtained an autoaugmentation
ofthebuttockregion.Inthefirst24patientsthiswasdone
by suturing the gluteal SFS (superficial fascia system) for
gluteopexy.Inthesubsequent21patients,amediallybased,
triangled fat flap was raised, pedicled on branches of the
superior gluteal artery. The flap was rotated mediocaudally
andheldinpositionbyamattresssuture.
Results: All patients showed improvement in body contour.
Minor wound healing complications were seen in 28 of
42 patients, 21 of these at the proximal inner thigh. Major
complications were seen in 4 patients, requiring surgical
revisions (2 patients with unstable scars, one infection, one
hematoma). Patients who received the fat flap had stronger
andlonger-?lastingpaincomparedtothosewithpexysutures.
(VAS-?Scoreaverageof4.6vs.2.7oneweekpostoperatively).
In the six months follow up, both groups showed an
improvement of aesthetics of the buttocks. The group of
patientswithpexysuturesshowedanearlyre-?ptosis,while
thegroupwiththefatflapshowedamorestableresultafter
sixmonths.
Discussion: Bodylift surgery allows the restoration of
body contour and thus in many cases the restoration of
the psychological integrity of postbariatric patients. For
the aesthetically demanding buttock region, raising a fat
flap ensures a better buttock projection and a more stable
postoperative result. The autoaugmentation of the buttock
region is obligatory for a better distribution of gluteal skin
excess.Themassiveglutealskinexcesslimitsthepossibilities
ofautologousfattransfer.
25
1784 37
AUTOLOGOUS BUTTOCK AUGMENTATION WITH
AUTOPROTHESIS
Presenter:
LuigiM.Lapalorcia,MD
Affiliation:
L2Clinic
Country:
Italy
Authors:
LapalorciaLM,PoddaS,CovacivichA
Fat injections, liposuction, lipofilling, lipostructure and
implant positioning are well established procedures in
buttockshapingsurgerybuteachhasadvantages andpotential
pitfalls. Buttock contouring represents a surgical challenge,
particularlywhenbothptosisandvolumedeficitarepresent.
Isolatedbuttockliftsmaycauseaflattenedbuttockcontour,
whereasaugmentationwithimplantsorfatinjectionsalone
may not correct the ptosis and are subject to complications
relatedtoimplantplacement.PracticinginItalypatientsare
not keen on having implants positioned in the glutei and
our approach to gluteal augmentation is adapted from belt
dermolipectomy and from described techniques of gluteal
augmentation and pexy using autologous tissue described
byCardenas-Camarena,Mendieta,Serra,CardosodeCastro,
Raposo-Amaral,Hunstad,MejiaandHandschin(1-5)Gluteal
skinisincisedcraniallyalongthebeltlineidentifyingthecranial
border of an inferiorly based skin and subcutaneous tissue
flap.Theflapisdisepidermizedandharvestedasneeded.The
disepidermized,harvestedflapisinferiorlyrotatedandtucked
inasubfascialpockettoprovidevolumeandpaddinginthe
inthesuperiorandintermediateglutealareaabovetheglutei
muscles.Fixationofthenewlypositionedflapisassuredwith
3.0vicrylsutures.Thistechniquewasusedinsixpatientswho
underwentgluteoplastyovera2yearperiod.Allofthepatients
who underwent the procedure were women. The average
bodymassindexwas23(range,19.0to27.8).Therewasno
incidenceofcomplications.Postoperativephotographsofthe
patients at a 6 month follow-up demonstrate that contour,
shape, and projection of the buttocks is improved after the
butterflyflapgluteoplastyprocedure.Buttockimplantsurgery
in Italy is rarely practiced and a simple and safe approach,
feasible in a cosmetic surgery setting is a mandatory ability
thatthecosmeticsurgeonmusthave.Thistechniqueissafe
andeffective,anddeliverspleasingaesthetictopatientsthat
arewillingtoacceptscarsasatradeoffforimprovingbuttock
shape.
1849 38
NEW CONCEPTS IN UMBILICUS POSITIONING AFTER
LIPOABDOMINOPLASTY
Presenter:
AlfredoE.Hoyos,MD
Affiliation:
DharaClinic
Country:
Colombia
Author:
HoyosAE
Background: Lipoabdominoplasty is a complex procedure
regarding cosmetic surgery with such postoperative scar
complaintsthathasbecomethelastoptionforsomewomenfor
fatresectionandbodycontourrefining.Theumbilicusisthe
onlyscarthatcannotbehiddenbyswimorunderwear,hence,
a natural shape and concealed scar in this area is essential.
Traditional umbilical transposition might not be the best
option in some cases (umbilicus hyperpigmentation, lower
thannormalumbilicalpositionandpreviousdeformitieslike
umbilicalherniasoroverstretchednavel).Soanewumbilicus
couldbeanalternativeinthesecases.
Purpose:Describeanewapproachforumbilicalreconstruction
and positioning after full lipoabdominoplasty (EVE 4D)
in order to accomplish more natural and aesthetically
pleasantresults.Thenewumbilicuswillbeperformedwith
4 flaps creating a butterfly shape. These may include other
pathologiesfromthenavel.
Methods: From January 2005 to February 2014, a total of
503 umbilical reconstructions were performed following
a dermolipectomy (EVE 4D lipoabdominoplasty). Delayed
umbilicoplasty was selectively done in most cases (472 -
94%) depending on the flap tension after the lipectomy.
The procedure was performed from 10 to 46 days after the
initialprocedure.Theothers(31)wereperformedinthesame
surgicaltime.
Results: Umbilicoplasty was evaluated separately from
lipoabdominoplasty in order to objectify results. Seven (7)
(1.4%) minor complications were reported consisting in
umbilicus flattening by hypertrophic scarring and 2 (0.4%)
suturedehiscence,whichrequiredanewumbilicoplasty.No
majorcomplicationswerereported.
Conclusion:UmbilicoplastyafterEVE4Dlipoabdoninoplasty
canachieveanaturallyshapedandyouthfulnavel,therefore
givingabetterabdominalappearance.Thetechniqueiseasily
reproducibleandsafetouse.Itmightbeusedforumbilicus
reconstruction after tumor resections, hernia correction,
and other associated procedures over the abdominal wall.
Decision regarding the umbilicus positioning must be
carefullyperformedtoavoidunnaturalresults.
1711
39
EN BLOC RESECTION ABDOMINOPLASTY: TECHNIQUE
DESCRIPTION AND STUDY ABOUT ITS RESULTS AND
COMPLICATIONS
Presenter:
AntonioJ.Trufino,MD
Affiliation:
SociedadeBrasileiradeCirurgiaPlastica
Country:
Brazil
Author:
TrufinoAJ
Introduction: Abdominoplasty is one of the most common
procedures performed by plastic surgeons. The goal of
this study is to evaluate the outcome, the safety and the
occurrenceofcomplicationsinpatientsundergoingEnBloc
Resection Abdominoplasty and to describe the 4 variants of
thistechnique.
Methods:Itwasdoneaprospectivestudyof34femalepatients
whoundergoneAbdominoplastyusingtheEnBlocTechnique
asdescribedbyProf.RonaldoPontesin1964andinhisbook
aboutthistopic.
Results:Thereare4variantsofthistechniqueandtheyare
explainedindetailinthisstudywithspecialattentiontothe
preoperativemarkingsbecauseitisthemostimportantstep
of the procedure. There were some degree of scar widen in
14,7%ofpatients.Onepatienthadsuperficialveinthrombosis
(SVT) of the lower limb with a good outcome. Three cases
(8,82%)ofseromawerediagnosed.Theaestheticresultwas
consideredgoodby94,12%ofallpatients.
Discussion:Thetechnique’sadvantagesare:easierresection,
noneedtoholdalongandheavyflapduringundermining,
better scar symmetry, better control of bleeding, reduces
the time of the anesthesia and of the surgery, stimulates
preoperativeplanningandstudy.Thedisadvantagesare:the
needofpracticeandtrainingtolearnhowtodothemarkings
inasafemanner,theneedtodefinetheamountoftissuethat
willberemovedbeforethesurgery,demandingabetterand
morecautiousmarkingandplanning.
There were only minor complications and its rates were
comparabletothosefromothertechniquesdescribedinthe
literature.Skinnecrosisandoverresectiondidn’thappen.
The 14,7% of scar widening may be due to lack of patient
compliance to the postural orientation. Seroma is a minor
complicationthatdoesn’taffectthefinalresultaslongasit’s
treatedproperly.Only2patientswerenotcompletelysatisfied
with the result and it was related to obesity. The SVT case
alertstotheimportanceofthrombosisprophylaxis.
Conclusion: The En Bloc Resection Abdominoplasty brings
manyadvantages,issafe,easytoperform,hasgoodaesthetical
results and has complications rates comparable to other
techniquesdescribed.Ontheotherhand,requiresacareful
learningbeforeyoustartusing
26
2003 40
GLUTEAL AUGMENTATION IN THE MASSIVE WEIGHT
LOSS PATIENT
Presenter:
HarleyA.Cavalcante,MD
Affiliation:
JuvenesseMedicalClinic&FortalezaGeneral
Hospital
Country:
Brazil
Author:
CavalcanteHA
Background: The excessive amount of skin after a massive
weightlossisasingularconditionthatoccursinmanyareas
of the body with ptosis of several segments. Many of these
patients have deflated buttocks and they can benefit from
an autologous gluteal augmentation (AGA) in combination
withacircumferentialbodylift(CBL).Thisprocedurecould
be done with a posterior de-epithelialized flap, using the
lumbosacraltissueexcess,combiningwithaBaroudi-Pollock
quilting suture over de undermining gluteal pocket and
providinggoodresults.
Methods: AGA was performed in association with CBL in
24 patients over a 7-year period. Patients were included if
they had excessive posterior skin excess and gluteal ptosis
after bariatric surgery, weight stability, good clinical and
psychological conditions. The procedure has made under
generalanesthesia.Beginningwiththeposteriorincision,we
didade-epithelializationoftheskinofthelumbosacralarea,
where the lumbosacral perforators of the gluteal superior
artery promotes a good vascular supply. After a posterior
underminingovertheglutealarea,wedidagreatpocket.It
willreceivetheposteriorflapthatshouldbegentlypushand
positioned it into the pocket in a light oblique orientation.
Next,fixationtheflapintothepocketovertheglutealmuscle
fascia,anddidsomeBaroudi-Pollockquiltingpointstoclose
dead space and bring some tissue to make harmony in the
buttock projection. No drains are used at that time. The
woundisthenclosedandatopicalskinadhesiveisapplied.
Results:Ofthe24patients(22femalesand2males),23rated
their satisfaction with the results as high or very high. One
patientwasslightlybotheredbytheposterior qualityofscar.
Therewere11(45,8%)patientswithsomecomplicationbut
only4(16,6%)hasmajorcomplications(1infection,2major
dehiscence, 1 pulmonary complication and 1 post-operatory
anemia-5casesin4patients).
Conclusion: The Autologous Gluteal augmentation (AGA)
performed in association with Circumferential Body Lift
(CBL)isagoodoptionforimprovingdebuttocksaesthetics
and posterior body contouring in patients after massive
weight loss, with a relative low rate of major complications
andagreatsatisfactionresult.
27
40
GLUTEAL AUGMENTATION IN THE MASSIVE WEIGHT
LOSS PATIENT
1664 42
A COMPARISON PROSPECTIVE STUDY BETWEEN
HIGH SUPERIOR TENSION TECHNIQUE AND
PROGRESSIVE TENSION SUTURES IN POSTBARIATRIC
ABDOMINOPLASTY
Presenter:
AndreaMargara,MD
Affiliation:
StudioDottMargara
Country:
Italy
Authors:
MargaraA,BorianiF,MilaneseA
1964 41
THE BODY-QOL: DEVELOPMENT OF A
MULTIDIMENSIONAL PATIENT REPORTED OUTCOME
MEASURE FOR THE EVALUATION OF QUALITY OF LIFE
BODY FOR CONTOURING SURGERY PATIENTS
Presenter:
StefanDanilla,MD,MSc
Affiliation:
UniversidaddeChile
Country:
Chile
Authors:
DanillaS,AedoS,DominguezC,
CuevasP,CalderonME,RiosMA,TaladrizC,
GonzalezR,JaraR,ErazoC,BenitezS,
AndradesP,EnriquezE,AlHimndaniS,
SepulvedaS
Background: The addition of Progressive Tension Sutures
(PTS)totheabdominoplastytechniqueisadvocatedtoreduce
the risk of several complications. High superior tension
abdominoplasty is another technique aimed at reducing
tensionattheprepubicsuturelineandimprovingcosmesisof
theumbilicalarea.
Background: This study aimed to design a new patientreported outcome (PRO) instrument to measure patient
satisfactionbeforeandafterbody-contouringproceduressuch
as liposculpture, abdominoplasty, lipoabdominoplasty and
body-lift.
Methods: A cohort of postobese patients undergoing
abdominoplasty,treatedwiththeprogressivetensionssutures
(HST)techniqueinassociationwiththehighsuperiortension
technique was followed up and compared to a hostile cohort
of patients who underwent a simple (HST) abdominoplasty.
Severalvariablesincludingrateofcomplicationsandpatients’
satisfactionwereexploredinordertofindanypossiblebenefit
derivingfromthecombinationofPTSandHSTtechniquesin
theabdominoplasty.
Methods: Phase 1a involved an extensive literature review,
16 in-depth patient interviews, and expert focus groups with
5plasticsurgeonstodevelopaconceptualframeworkforthe
outcomesdeemedimportantforbodyimageandpreliminary
PRO instruments. In phase 1b, the preliminary instrument
was tested with a second independent sample of 29 patients
withwhomsimpleinterviewswereadditionallyperformed.In
thesecondsample,scalereliabilitywascalculated.InPhase2,
1131patientscompletedthedevelopedscaleincludingacontrol
population,preoperativepopulation,postoperativepopulation
and before/after cohort. RASCH analysis, Factor analysis,
Principal Components Analysis, mulitvariant statistical
analysisandCrobachsinternalreliabilitywereusedtoreduce
theprimaryscaleandcalculatepsychometricpropietries.
Results: In total 90 patients were included in the study,
of whom 34 in group A and 56 in group B. No statistically
significant difference was found between the two groups in
termsofdurationoftheprocedure,hospitalizationtime,rate
of complications, drained volume and patients or doctors
satisfaction.
Conclusions: No beneficial effect appears to derive from the
PTStechniqueinthemassiveweightlosspatientsundergoing
abdominoplasty,aslongasthehighsuperiortensiontechnique
isperformedasanadjuncttothetraditionalmethod.
Results:Inphase1a,thedomainsidentifiedfortheconceptual
framework included clothing and body image, sexual and
affectivelife,self-imageandself-esteem,socialrelationships,
and physical symptoms. In phase 1b, the scale internal
consistencywas91.5%.Apreliminary5domainsand120item
scalewasdeveloped.The120itemscalewasadministeredto
1131patients.Thescalewasreducedintoa4domains,28item
scale.ThedomainsareI)SelfImageandSelfesteem,II)Sexual
activities,III)SocialrelationshipandIV)Physicalsymptoms.
Scalereliabilitycoefficientis92.0%,being91.3%forcosmetic
patients and 87.9% for massive weight loss patients. By
procedure, the reliability is 98.5% for liposuction, 91.4% for
lipoabdominoplasty, and 88.0% for Body Lift. The Body-QoL
scorewassignificantlyworse(p<0.05),inpostbariatricpatients
woman,increasingageandincreasingBMI.
Conclusions: The Body-QoL accurately and realiabily
measuresbodyrelatedqualityoflife.Itcanbeusedinallbody
contouring procedures and provide a reliable tool for plastic
surgeons,researchers,andpatientstomeasuretheimpactand
effectivenessofbody-contouringproceduresfromthepatient’s
perspective.
28
1996 43
ABDOMINOPLASTY IN MASSIVE WIEGHT LOSS
PATIENTS WITH BODY MASS INDEX GREATER THAN 35.
REPORT OF 25 CASES
Presenter:
MiriamGarciaAlvarez,MD
Affiliation:
InstitutoNacionaldeCienciasMedicasy
NutricionSalvadorZubiran
Country:
Mexico
Authors:
GarciaAlvarezM,IglesiasM,ButronP,
MoranM,CruzA,PinedaF,RamirezM,
CastilloF
Abdominoplasty/Body Lift (BL has been contraindicated in
Massive Weight Loss (MWL) patients with Body Mass Index
(BMI)greaterthan35,olderthan55yearsandserumhemoglobin
less than 15mg/dl. The complication rate has been reported
in these patients up to 49.7%. Most of super-obese patients
(BMI greater than 50) not achieve BMI <35 after bariatric
surgery, and their body deformity and functional restriction
persisted. Under these circumstances the panniculectomy is
the standard treatment. Although the functional results are
good,theaestheticoutcomeispoor.
From2000to2013,25MWLpatientswithBMIgreaterthan
35 underwent body countouring surgery. A retrospective
review of their files was performed. 20 patients underwent
abdominoplasty/BLand5patientsunderwentpanniculectomy.
All the patientes were treated under the following
circumstances: serum albumin 3.5g/dl, and hemoglobin 13.5
g/dl,atleastthreemonthsbeforesurgery,andKlein’sformula
wasinfiltratedintoallanatomicalareatoberesected.
Themedianagewas41yearsInterQuartileRange(IQR)(3350.5),18(72%)femaleand7(28%)malepatients.Themedian
body weight before abdominoplasty was 102 kg IQR (90.7118.7), the median BMI 41.2 IQR (37.75-45.6) the median
loss of weight was 64.85 kg IQR (48.78-83.75). One patient
gained 5.8kg after bariatric surgery. 13 patients underwent
abdominoplastyFleurdeLis,3patientsunderwenttraditional
abdominoplastyand4patientsweretreatedwithBodyLiftplus
abdominoplastyFleurdeLis.
Mediansurgicaltimewas316minutesIQR(240-380),transoperativebleedingmedianwas600mlIQR(4000-1100),the
weight of harvesting flap was 6650g IQR (5550-11350), the
median hospital saty 6.5 IQR (4-10.75). Ten patients (44%)
developed minor complications: wound dehiscence 12%,
hematoma8%,woundinfection8%,seroma8%,hypertrophic
scar4%andpneumopathyrelapse4%.Althoughthisisasmall
series and the outcomes have been compared with reported
seriesofMWLpatientswhounderwentabdominoplastywith
BMI <35. We found the surgical bleeding, hospital saty and
complication rate were similar. That is why, we recommend
abdominoplasty in some MWL with BMI > 35, because the
functionalandaestheticoutcomescanbeachievedwithsimilar
morbidity.
29
Free Paper Session 4 - Patient Safety & Abdominoplasty
1890 44
BODY DYSMORPHIC DISORDER. A VENEZUELAN
VISION
Presenter:
AlexisM.Romero,MD
Affiliation:
IVSS
Country:
Venezuela
Authors:
RomeroAM,BrucesCD
Today,concernoverbodyimageisamatterofunquestionable
relevance.therearemanypeoplewhoarenotsatisfiedwith
your own image and try to improve it by various means.
Bodydysmorphicdisorder(bdd)isapsychiatricdisorderthat
manifests as a preoccupation with an imagined or almost
nonexistent appearance flaw. Have an impact on the world
populationof0.7to2.4%.
Objective: To determine the presence of indicators of body
dysmorphic disorder in patients attending the outpatient
department of plastic and reconstructive surgery in the Dr.
DomingoLucianiHospital,Caracas,Venezuela.
Methodology:Itwasaprospective,singlecenter,withcrosssectional incidence study. Patients who consulted for a
reconstructive procedure were excluded. The sample was
composedof152patients.
Results: Mean age was 36.82 ± 11.23 years, the female sex
wasobservedwith97%.91%ofpatients(p<0,0001)showed
excessive preoccupation with their physical appearance. A
totalof31%(p=0,0001)patientsinthesample,thepresence
ofaperceivedphysicaldefectthatcausedlimitationsinsome
aspectofyourlife.Beingtheabdomenarea(p=0,0001)that
wasperceivedasbeingmoreinvolvedin49%ofpatients.In
turnthesexualsphere(p<0,0001)isthemostcommittedto
thepatientsinoursamplewith28%.
Conclusion:Inourstudy31%(p=0,0001)ofourpopulation
hassignificantelementsthatsuggestapossiblediagnosisof
body dysmorphic disorder. That is why it is necessary that
plasticsurgeonsarealertedtothepresenceofelementsthat
pointtotheexistenceofbodydysmorphicdisorder.
1989 45
AUTHORIZED PERSONNEL ONLY: AN EXPLORATORY
AND DESCRIPTIVE STUDY ON AIR QUALITY RISK
FACTORS AND OPERATING ROOM PRACTICES
Presenter:
MicheleA.Manahan,MD
Affiliation:
JohnsHopkins
Country:
USA
Authors:
ManahanMA,GuajardoI,Al-RammahT,
TeterJ,AbdallahA,RossonG
Background:Understandingfactorsleadingtohighlevelsof
undesirableairborneparticulatesintheoperatingroom(OR)
iscrucialforimprovingpatientsafetyandoptimizingsurgical
practices.Ouraimwastodeterminethemagnitudeofeffect
thatopeningORdoorshasonairborneparticulatecountsand
theimpactofstandardsurgicalpracticesuponthis.
Methods:Datawererecordedduringninesurgicalprocedures
in the same OR to ensure consistency. Airborne particulate
counts were collected every fifteen minutes. The particulate
counter and human observers were located at the center of
a side wall, equidistant to the two OR doors. Base data was
collected in the morning before any activity. Data related to
which OR door was opened (sterile core or outer corridor),
numberofdooropenings,jobtitleoftheopener,andreason
for opening (scrubbing, case preparation, status updates,
socialreasons)wasrecorded.
Results: Airborne particulate count significantly increased
when either door was open (p<0.0001, n=379). Overall
particulate levels were likewise overwhelmingly positively
correlated with the total number of door openings during
thedurationofacase(p<.001,n=9).Finally,thenumberof
outer corridor door openings was positively correlated with
average particulate count (p<.03, n=9). As particulate levels
are negatively correlated with case duration (p=.004, n=9),
thelinkbetweendooropeningsandparticulatelevelsisclear.
Conclusions: Results show that each time an OR door is
opened, the number of airborne particulates increases and
therefore air quality decreases. Shift changes, replacement
of malfunctioning equipment, teaching agendas and
unanticipated circumstances are a fact of life in academic
hospitals. Nonetheless, the results demonstrate the
importance of best practices to maximize patient safety
without compromising the pedagogic mission, supporting
interventionslikeintercoms,monitorsandviewingwindows
to minimize unnecessary door openings. Future work will
identifypracticesthatarepotentiallychangeableandevaluate
the effect of these modifications on airborne particulate
counts, ultimately leading to improved patient safety and
betterpatientcare.
30
2048 47
PATIENT SAFETY IN ESTHETIC SURGERY
Presenter:
SorayaR.TerzakiSr.,MD,PhD
Affiliation:
AlorfHospital
Country:
Kuwait
Author:
TerzakiSR
1978 46
DESMOID TUMORS OF THE BREAST AFTER
AUGMENTATION MAMMOPLASTY
Presenter:
JoséCarlosSantosParreira,MD
Affiliation:
HospitalGarciadeOrta
Country:
Portugal
Authors:
CunhaSG,ParreiraJC
Desmoid tumors of the breast, also known as deep
fibromatoses, are uncommon, comprising less than 0,2%
of all breast tumors. Occurrences in association with breast
implants are extremely rare, with only 23 case reports
published in the english literature. The authors present a
casereportofa28-year-oldfemalewithfamilialadenomatous
polyposiswhounderwentaugmentationmammoplastywith
silicone gel implants and 20 months post op developed
bilateraldesmoidtumors.Thereisnopreviousreportofsuch
a bilateral occurrence. A complete review of the available
literature on the subject is presented. A 28-year-old female
with familial adenomatous polyposis presented with a
palpable right breast mass 20 months following bilateral
augmentation mammoplasty with submuscular silicone gel
implants.Biopsywithspecifichistochemicalstainsrevealed
a desmoid tumor. MRI showed bilateral tumors behind the
breast implants with pleural infiltration of the right tumor.
After multidisciplinary discussion and because there was a
significant chest wall infiltration it was decided to initiate
hormonotherapy with tamoxifen. The patient is currently
undertreatment,andadownsizingofthetumorallowingaless
invasivesurgicalapproachisexpected.Theauthorsdeveloped
asystematicreviewoftheavailableenglishliteratureonthe
subject. Of the published case reports 70% occurred with
silicone implants, and the mean interval between implant
placementandtumorappearancewas3years.Surgicaltrauma
couldbeimplicatedintheetiopathogenesisofthesetumors.
Aggressive fibromatose of the breast is a locally aggressive
tumor with a tendency to recur. It is still largely unknown
and the best treatment options are still a matter of debate.
Presentation of such case reports and systematic reviews
contributestotheconstructionofthecollectiveknowledgeon
thisraredisease.
31
Introduction: Patient safety is the most challenging issue
facedbyhealthcareorganizationintheworld.Implementing
riskmanagement(includinginfectioncontrol)isoneofthe
majorwayforimprovingthepatientsafetyandqualityofcare.
Content: In the year 1847 Ignaz Semmelweis presented
evidenceofthespreadofinfectionthroughthehandsfrom
theHCWtothepatients.Hewastakenasaninsaneanddid
not recognize his theory only after his death. By mid- 2oth
century some surgeons, microbiologists, infectious disease
specialists focused on studying on how to prevent infection
acquiredinhospitalsandinparticularaftersurgery.
Studiesdidnotstopandmoreconcernintheworldleadto
organizinginfectioncontrolcommitteesandorganizationlike
theCDCinthestateandothersinEurope,UnitedKingdom.
Several and multiple recommendations and protocol of
workintendedtoguidephysiciansandsurgeonsinmostof
their activities: Standard and special precautions, Aseptic
techniquesrules,Recommendationstopreventsurgicalsite
infections,recommendationsregulatingantibioticsusageto
combattheresistingorganismsandsoon.
We all know and agree that the first enemy of the esthetic
surgeonistheinfection,inspiteofthatthetheircompliance
regarding using the aseptic techniques and the antibiotic
policy,especiallytheprophylaxisisweak.Westillseeinthe
textbook the recommendation of prescribing postoperative
antibiotics,inmanyreferencesandworkshopforthefillings
andmeso-therapyitisraretoseetheapplicationofhand-rub
andpropergloveusage.
Conclusion: We need campaigns and efforts to convince
ourselvesandprofessionalstoreachourgoalinpatientsafety
inregardofthebigdangerofantibioticsresistingorganisms.
1716 48
THE SWEDISH BREAST REGISTRY (BRIMP)- EARLY
EXPERIENCE
Presenter:
BirgitStark,PhD
Affiliation:
KarolinskaUniversityHospitalStockholm
Country:
Sweden
Authors:
StarkB,SamuelsonU,SahlinP
1690 49
FACIAL SYNKINESIS AFTER AUGOLOGOUS FAT
GRAFT?
Presenter:
HyunGuKang,MD
Affiliation:
AjouUniversityHospital
Country:
Korea
Authors:
KangHG,LimSY,ParkM,ParkDH
Background: Register-based studies documented the
paramount clinical and socio-economic importance for the
developement of joint-replacement surgery in orthopedic
surgery. Similar data for breast-implant based surgery
are lacking. The large scale catastrophy with the French
manufacturedPIPbreastimplantshasactualizedtheissueof
startinganationwidebreastregistryinSweden.
Facial synkinesis is an abnormal involuntary movement of
onesetoffacialmusclesaccompanyingavoluntarymovement
ofadifferentfacialmuscle.Itisnotuncommonforpatients
withlongstandingfacialparalysistopresentwithabnormal,
involuntaryfacialmovementswhichimpairfacialsymmetry
and compromise facial function and expressivity. There are
no previous reports of facial synkinesis after fat graft. We
report a case of facial synkinesis, a rare phenomenon after
fatgraft.A38-year-oldAsianfemalewhosecheekhadbeen
treatedbyautologousfatgraft2yearsagoinaprivateclinic,
complained of a conjoint movement of her left cheek while
blinking her eyes. The malar area of her left cheek moved
inwards when she blinked. However, there was no pain,
sensory changes, or facial muscle weakness. To treat the
synkineticmovementofherleftcheek,15unitsofBotulinum
toxinwasinjectedintheleftzygomaticusminormuscle.At
the6-monthfollow-up,shedidnotexperienceanyabnormal
feeling and synkinetic movement of her left cheek. There
werenocomplicationslikefacialasymmetryandinanimate
movement of facial expressions. Botulinum toxin causes
chemodenervation by inhibiting the release of acetylcholine
at the neuromuscular junction. Nowadays, many women
wanttobetreatedbyautologousfatgrafttoconcealwrinkles
andfoldsontheirface.Surgeonsshouldbeawareofthisfact
and they should carefully inject around the area innervated
by the facial nerve. And even though they experience facial
synkinesisafterfatgraft,injectionofBotulinumtoxincanbe
agoodoptiontotreat.Tothebestofourknowledge,thereare
no previous reports of facial synkinesis after fat graft. This
articledocumentsagoodexampleofthisrarephenomenon
afterfatgraft.
Material & Methods: In January 2013, we carried out a
pilot study at three centres; one university- and two private
hospitals. The following prarmeteres were monitored at
the index surgery: patient civic registration number, type of
implantanditscharacteristics,indicationforsurgery,typeof
incisionandsurgicalpocket,aswellasuseofantiobioticsand
drains.Onasecondquestionnairecomplications,indication
for revisional surgery as well as peroperative findings and
treatment were recorded. A third questionnaire related to
patientsownopinion(PROM)iscurrentlyunderconstruction.
Theprimaryendpointbeinganyrevisionsurgery.
Results:235patientshavebeenincludedintothepilotproject,
216primararyand17revisioncases.
Conclusion:Itisnoteasytogainnationwideacceptancefor
abreastregisterasregistrationofdatatakestimeandthere
aremanylegalaspectstoconsider.Manufacturersmayhave
acriticalvueastheyareinterestedinwhattheadvantageis
forthem.However,despitethesedrawbacks,thebenefitofa
nationwideregisterisobvious.Itwillbepossibletodetermine
the number of patients undergoing breast- implant based
surgery, the type of surgical complications and patients
own opinion on a long-term perspective. Problems with a
specificimplantcanbedetectedatanearlystage.Therefore,
a nationwide register for breast implants is of paramount
importance.
32
1802 50
EFFECTS OF BOTULINUM TOXIN TYPE A INJECTIONS
INTO INJURED PAROTID GLANDS FOR REDUCING
SALIVARY LEAKAGE AFTER FACE LIFTING
Presenter:
InsuckSuh,MD
Affiliation:
KangnamsungshimHospital
Country:
Korea
Authors:
SuhI,LeeBH,AhnDK,JeongHS,JungMS,
KimJH
2009 51
“PLASTIC SURGERY SAFETY CHECK-LIST”: A TOOL TO
ENHANCE SECURITY
Presenter:
EduardoR.SucupiraPinto,MD
Affiliation:
SaintLucasHospitalofthePontificalCatholic
University
Country:
Brazil
Authors:
RamosRFM,SucupiraPintoER,ZukerP,
MattaJ,MattaR
Purpose: Botulinum toxin type A(BTA) is used to treat
the excessive glandular secretion like hyperhidrosis. The
mechanism of decreased glandular secretion is atrophy
of gland and denervation induced by the inhibition of
acetylcholine release. Parotid duct or gland injuries with
sialoceles are uncommon but troublesome complication
of surgical trauma. We tried to inject BTA to three patients
withsialocelesafterfaceliftingortumorsurgerytosubside
salivarysecretion.
Introduction: Complications in elective procedures
in plastic surgery are infrequent, can be fatal and can
compromisepatientsurvival.Creatingaprotocolofstrictand
comprehensivesecurityisapriorityinthecriticalphaseofa
surgicalprocedure,toachievethelowmortality.
Material & Methods: The patients underwent face lifting or
tumor surgery a few weeks ago. But the patients suffered
fromconsistentlyleakedserousfluidandswelledcheek.So
we performed starch iodine test and sialography. According
to sialography, right parotid duct was narrower than that of
left.(fig.1).And,usingaspirationfluid,wegotsalivareaction
withstarchiodinetest.(fig.2).So,weinjectedBTAonparotic
area for reducing salivary secretion. (fig.3). In addition,
compression dressing and minimizing temporomandibular
jointmotionwasdone.
Results:Witheverythirddayfollowup,theleakagevolume
gradually diminished in comparison to at first time. There
wasnoleakagewithintwoweeks.Asaresult,swelledcheek
collapsed completely, neither functional problem nor major
complication was shown such as dry mouth and speech
disorder.(fig.3).
Conclusion: We subside salivary secretion and the patients
could return to their daily life as quickly as possible. If the
patients were diagnosed with saliva leakage earlier after the
surgery,theycouldgetmoresatisfiedresults.Inconclusion,
theinjectionofBTAintoinjuredparotidglandsforreducing
salivary secretion is worth consideration before invasive
treatment.
Methods:Thenewchecklistwasbasedonaliteraturereview,
taking as search parameters: Security in plastic surgery,
plasticsurgerychecklist,securityprotocolinplasticsurgery;
in Pubmed and Medline in the last 10 years. Once the new
PLASTICSURGERYSAFETYCHECK-LISTwasmade,itwas
appliedtoallpatientsundergoingelectivesurgicalprocedures
inthe10thserviceoftheSantaCasadaMisericórdiahospital
ofRiodeJaneirointheperiodApril2012-September2013,on
atotalof300patients
Results:87%female,13%male.48%Generalan.,7%spinal,
39%epidural,6%localmoresedation.16%oneprocedure,
74% two procedures, 10% more than two procedures.
Seroma3%,othercomplicationsnotrelatedtowound1%.No
reportedcasesofhematoma,woundinfectionsorsepsis.This
research reports: A case of acute myocardial infarction one
daypost-surgery(facelift)ona56yearsoldpatientwithan
arterial hypertension history. A dermal sacral compression
injury (liposuction and abdominoplasty) on a 51 years old
patientwhohadaprocedureformore than3hours.Acase
ofpulmonarythromboembolism(abdominoplastyandbreast
augmentation)ona39yearsoldpatientwithoutapathological
history.Finallytheresultsofmortalitywere0%.
Discussion:Thegoalsofthisresearcharetoavoidmistakes
that may happen in cosmetic surgery procedures. Through
the use of the checklist, based on the checklist developed
by the WHO, expanding the variables they used, there has
beendevelopedamorecompleteandorientedlistforplastic
surgery.
Conclusions:Attheendofthisstudy,theproposedobjectives
were achieved, the attitudes of some professionals changes
in accordance with the Manual of Safe Surgery. Thus, the
establishment of the new PLASTIC SURGERY SAFETY
CHECK-LISTinmanysurgicalinstitutionsshouldbeadopted
as a priority in stimulating a collaborative attitude amongst
supervisors’surgery,anesthesiologyandnursing.
Obs:ThereisaFigurewiththenewcheck-listmodel.
33
2009 51
“PLASTIC SURGERY SAFETY CHECK-LIST”: A TOOL TO
ENHANCE SECURITY
1929 52
MANAGEMENT OF COMPLICATIONS AFTER
THREADLIFTING TECHNIQUES PERFORMED FOR
FACE REJUVENATION
Presenter:
VladimirV.SafronovSr.,MD
Affiliation:
IMSechenovFirstMoscowStateMedical
University
Country:
RussianFederation
Authors:
SafronovVV,GulyaevIV
According to the ASAPS statistics for the last decade the
total number of the cosmetic procedures steadily grows
whilstamountofplasticsurgeryproceduresperformedstays
almostsame.Thistendencyisduetothecostlinessandrisks
ofthesurgeryandcontinuousimprovementoflessinvasive
cosmeticmethods.
More and more plastic surgeons are performing cosmetic
procedures in a face rejuvenation today. One of the new
promising approaches in face rejuvenation is a thread
facelifting technique. The thread facelifting techniques is a
groupofmethodspresumesliftingoftheptoticsofttissues
of a face with a different kind of threads with a anchoring
mechanisms and needle-conductors. Those techniques are
growing in populatiry because they are simple to perform,
cheaperthanasurgicalfacelift,theirrehabilitationperiodis
shorterandshort-termresultsaremorebeneficial.
There is not much publications is found about the
complications of such procedures and their effectiveness
in long-term period. We have tested several methods of
the threadlifting for the face rejuvenation and developed a
classification of the complications and transient reactions
after such procedures. We have also treated a lot of the
complications occurring after such procedures including
hematoma, different inflammatory conditions, allergy,
conditionsafterthedamageoffacialnervebranches,arteries,
veins, parotid gland. Correction of unsatisfactory results is
alsoperformedafterthetreatment.
Currently we are using a specific algorithm developed in
our department for diagnosis of such complications which
includes clinical examination, ultrasound, computed
tomographyifnecessaryandspecifictreatment.
Patient safety must be the main goal of any physician that
is why knowledge of complications of any wide-growing
popularity methods should be presented to the professional
society.
34
1685 53
DVT/PE PROPHYLAXIS IN COSMETIC SURGERY: TO
TREAT OR NOT
Presenter:
HerveF.Gentile,MD
Affiliation:
MedicalCollegeofGeorgia&UnofGeorgia
Country:
USA
Author:
GentileHF
1824 54
ONPHALOPLASTY: “INFINITY” TECHNIQUE
Presenter:
IsaacFurtado,MD
Affiliation:
BrasilianSocietyofPlasticSurgery
Country:
Brazil
Authors:
FurtadoI,ConradoR,MaiaD
Methods and Conclusion:DeepVeinThrombosis(DVT)and
PulmonaryEmbolism(PE)areasignificantriskforpatients
undergoing cosmetic surgery. There are several factors
which are reviewed that can increase the patient’s risk for
development of these complications. The author presents
the preoperative steps he undertakes to ensure appropriate
patient selection and safety and his algorithm regarding
recommendationsforperioperativemanagement.
35
Omphaloplasty is considered one of the most stigmas in
abdominoplasty.Giventhis,manytechniquesweredeveloped
in order to achieve more natural and hidden scars. These
techniques were created from the basic principle in a way
that is natural and to prevent scar retraction of the circular
form.Theauthorspresentatechniquethatoffersanoblique
shape,brokenbytwosmallsideflapsinordertoreducescar
retractionobtainedbydrawinginthelongitudinaldirectionof
theinfinitysymbol.Thenavelswereevaluatedforlocation,the
finalform(oblique)andsize.Amongthecomplicationswere
stenosis (2.5%), partial dehiscence (2%) and keloids (1%).
The aesthetic result was satisfactory for patients in 91% of
cases,thepatient’squalityofhealing,keloidorhypertrophic
scars were the major causes of dissatisfaction. The use of
the“infinity”techniquewaseffectiveinthetreatmentofthe
umbilicusincompleteabdominoplasty,offeringmorechoice
andaneasyimplementationforomphaloplasty.
1871
55
ETHICS & QUALITY ASSURANCE, TWO IMPORTANT
KEY POINTS FOR PATIENT SAFETY IN REGULATING
AESTHETIC SURGERY & MEDICINE
Presenter:
BahramShahidi,MD,MBA
Affiliation:
PlasticSurgery
Country:
Switzerland
Author:
ShahidiB
Ethical questions in aesthetic surgery are a current topic of
concern not only to both surgeons and patients but also to
healthauthoritiesinthehighestdegree.
All physicians encounter ethical issues on a daily basis.
Therefore having good knowledge of the legal aspects of
ethical problems is essential for all physicians. This helps
surgeons to avoid any possible ethico-legal miscalculations
withtheirconcomitantseriousconsequences.
Thefinancialconsequencesofmishandlingofethicalissues,
togetherwiththeindividualandpsychosocialaftermath,make
great demands on physicians, the community, and last but
notleast,patinets,especiallythosewhosetreatmentfailed.
A rising number of physicians dealing with aesthetic
procedures,alongwiththeincreasingnumberandvarietyof
these procedures, are just some of the many causes of this
problematicissue.
The need for legistlative amendments to regulate doctors’
responsibilitiesandprotectpatientrightsismoreimportant
thanever.
1862 56
HYALURONIC ACID FOR BUTTOCK ENHANCEMENT
Presenter:
MarceloF.Robles,MD
Affiliation:
ClinicaRobles
Country:
Argentina
Author:
RoblesMF
Hyaluronicacidisbeenusingforalongperiodoftimewith
minimaladverseeffectingeneral.TheuseofHyaluronicin
corporalmayhavesameregardsaboutdurability.Onbreast
it have already been publish and the result there are not
satisfactorytillthisdays.Whenwespeakaboutbuttockarea
fat graft and buttocks implants are the main option but in
same patient do not have enough adipose tissue or do not
wants a painful surgery it could be a great option. Also the
onethatjustwillliketohavesomemorebuttsfor6month
toayear.
Material and Method: Three years ago I started with the
applicationdoHyaluronicacidinthebuttocksareaanumber
of 25 patient were treated all females between 23 to 45
years old a phenotype thin any o a little fat to be remover.
The Hyaluronic use was Estrianon (alllamar international,
Rosario,Argentina.)Itcomesinapackof34syringessterile
of3mlwith30mgofHyaluronicacidwithahighreticulation
tokeepshapeanddurabilityintime.Allpatientsweremade
bytumescentanestisiawithaneurolepticsedationinsurgery
room.Theprocedurewasevaluatedasaminimalprocedure
(cups, sterile glove and surgical field. 10 patient have more
that treatment in this three year so the procedure if easy to
reproduciblewhenvolumegoes.
Result:TwentyfivepatientsweretreatedwithHyaluronicacid
intheupperandmiddlethirdofthebuttocksinsuperficial
anddeepsubcutaneousplanes.GoodresultIobtainforthese
threeyearswithnomajorcomplication.
Conclusion:TheuseofHyaluronicacidwithhighreticulation
is an option for buttock enhancement in a specific patient
fenotype. Futher study of corporal enhancement are been
carryonandalargenumberofpatientwillbeneeded.
36
1764 57
THE DUAL PLANE TUNNEL TECHNIQUE FOR
ABDOMINOPLASTY IS REDUCING PAIN TO ALMOST
ZERO. A PROSPECTIVE STUDY
Presenter:
EvangelosKeramidas,MD
Affiliation:
PrivatePractice&Mdone
Country:
Greece
Authors:
KeramidasE,RodopoulouS,LymberopoulosN
Background: The most widely used techniques for
abdominoplasty require drains, 2- days hospitalization
and extensive painkillers administration. We would like to
introduceasafesurgicaltechniquethatminimizespainand
hospitalizationtofewhoursanddoesnotrequiredrains.
Materials & Methods: From May 2010 to Dec 2013, 111
abdominoplastieswereperformedinCentralClinicofAthens,
Greece.Meanageofpatientswas45years.MeanFollowup
was1.5months.
Surgical Technique:Thedualplane,tunneltechniqueinvolves
2 different planes of dissection: Above the Scarpa Fascia in
the lower lateral abdomen, changing the level to the preaponeurosis of the infraumbilical midline and epigastrium
areas. No dissection was performed at the costal margins.
Theepigastiumareawasdissectedasatunnelof6to8cm
wideuptothexyphoid.In75outof91patientsweperformed
plicationoftherectusfasciawithPDS2/Osuture.20mgof
Ropivacaine7.5mgwasinjectedtothemuscle.Nodrainswere
usedandallpatientsweredischargedinlessthan24hours.
Patientswereaskedtofillupaquestionnairewhichinvolved
thelevelofpainandthenumberofpainkillersusedthefirst
five days postoperatively. The pain was evaluated using the
0-10scale.
Results: The mean postoperative pain was 0.5 the first day
and almost zero the next five days. 72 patients scored 0 to
the pain scale in all five days. 61 patients didnt have any
pain killer after the operation. 107 patients did not use any
painkillerafterthethirdday.Themostcommonused(95%)
pain killer was paracetamol 1000mg. Seroma was observed
in 9 patients, in 1 patient a very small necrosis area and 2
patientsdevelopedkeloids.Allpatientsweresatisfiedbytheir
quickandalmostpainfreerecoveryaswellastheiraesthetic
result.Nodeepvenousthrombosisorpulmonaryembolism
wereobserved.
Conclusion: The dual plane, tunnel technique in
abdominoplasty minimizes dramatically the postoperative
pain.Thepatientscouldmobilizeimmediatelyandsafelybe
dischargedhomethesamedayreducingthechancesfordeep
venousthrombosisandpulmonaryembolism.
37
Free Paper Session 5 - Facial Rejuvenation I
1946 58
CORRECTION OF ECTROPION IN SECONDARY
BLEPHAROPLASTIES TROUGH THE
TRANSCONJUNCTIVAL APPROACH
Presenter:
NelsonA.Letizio,MD
Affiliation:
ClinicaNelsonLetizio
Country:
Brazil
Authors:
LetizioNA,AngerJ,BaroudiR
58
CORRECTION OF ECTROPION IN SECONDARY
BLEPHAROPLASTIES TROUGH THE
TRANSCONJUNCTIVAL APPROACH
Gals: Lower eyelid malposition is the most common longterm complication following transcutaneous lower eyelid
blepharoplasty. The malposition may include rounding
of the lateral canthal angle, lower eyelid retraction with
inferiorscleralshow,orectropion.Theresultiscosmetically
unacceptable and may be associated with tearing, irritation,
and other exposure keratitis symptoms. We present the
transconjunctival approach for secondary lower eyelid
blepharoplasty presenting ectropion in 27 patients based
on the mobilization of the orbicularis oculi muscle and
canthopexy(Fig1).
Results:Fromthe27patients,26achievedanimprovingof
theectropion,scleralshoworlidlaxity,onepatientpresented
unilateralrecurrence20daysafterthesurgery(Fig.2,3)show1
yearfollow-up.Thetransientpostoperativeintercurrencesare
listedintheTable1.Theverticalmarkeddistancesdiminished
inallpatientsasshownanexampleinfig.7.(4.5cmto4,.0
cm),showingtheefficacyofthemuscleflapelevation.
Discussion: The important step of this procedure is the
facility to mobilize the orbicularis oculi muscle and the
possibility to excise, to elevate and to fix it in the superior
orbital area exactly as described by other authors through
the transcutaneous approach. In conclusion, it is possible
to perform blepharoplasty revision including the necessary
muscleprocedureswithsuccessthroughthetransconjunctival
approach.
38
59
CONTINUED EXPERIENCE WITH L’ORÉ’S FASCIA
FIXATION OF THE PLATYSMA AND TOTAL NECK
REJUVENATION
1701 59
CONTINUED EXPERIENCE WITH L’ORÉ’S FASCIA
FIXATION OF THE PLATYSMA AND TOTAL NECK
REJUVENATION
Presenter:
DarrylJ.Hodgkinson,MBBS(Hons),
FRCS(C),FACS,FACCS
Affiliation:
TheDoubleBayDaySurgery
Country:
Australia
Author:
HodgkinsonDJ
After adopting the Fogli technique and modifying it, using
atriplecablesuturetofixthebodyoftheplatysmatoL’oré’s
fasciaandwithselectiveresectionofanteriorplatysmabands,
theadditionofaplastysmal“pantsovervest”flaptocoverthe
permanentsuturefixation,hasaidednotonlytheresultbut
thelesseningofpalpabilityofthepermanentsuture.
Inover400casesoffaceliftingsince2007,usingthisvertical
liftingtechniqueoffixationoftheplatysmatoL’oré’sfascia,
someproblemsarosefromthepalpabilityandtheoccasional
extrusionofthetriplecableofnon-absorbablebraidedsuture.
Overthelast3years,theadditionofafascialflap,consisting
of the auriculo-platysmal ligament as well as portions of
the posterior platysma along the anterior border of the
sternomastoid,hasallowedtheauthortoaugmentthevertical
elevation of the platysma, as well as to “cover” the deeply
placedtriplecable2/0non-absorbablesuture.
The advantage of the rigorous vertical vector, combined
with the horizontal vector of the vertical lift, leads to an
improvementofthecervico-mandibularangleaswellastotal
platysmallift,sothattheanteriorborderofthesternomastoid
becomes more prominent and the décolletage area also
tightens.
Other complications of facelifting such as haematoma and
nervedamageareuncommonsimilartopreviouslypublished
series on facelifting and like all techniques, this technique
continuestoevolvewiththeaimofimprovinginitialandlongtermresultsandreducingtheincidenceofcomplicationsand
sequelaeofnecklifting.
39
2006 60
FACELIFTING STRATEGIES AFTER (SEMI)-PERMANENT
DERMAL FILLER SEQUELAE OR COMPLICATIONS. THE
AMSTERDAM EXPERIENCE IN 103 PATIENTS.
Presenter:
AliPirayesh,MD
Affiliation:
AmsterdamPlasticSurgery
Country:
Netherlands
Author:
PirayeshA
Introduction: The surge in the use of (semi)-permanent
flllers(PF)byvarioustypesofphysiciansandpotentialmajor
complications of PF can pose a challenge in subsequent
treatment.Faceliftingwithadjunctivevolumereplacementby
lipofilling or the use of safe, resorpable fillers alone or as a
touchupmayallbeemployedforfacialrejuvenation.Theaim
istoremovenodulesandinfectionandortoimprovecontour
andageingsequelae.
The SILC concept introduced in our practice is proven an
appropriatetreatmentstrategywithsynergyinuseofSurgery,
Injectables,Lasers&Cosmeceuticals.Individualizedtreatment
plan included up to three seperate surgical procedures. 1)
removalofPFandcapsulewithmicroliposuctionafterwhich
eight weeks recovery with IPL light therapy. 2) face & neck
lift with SMAS plication or midfacelift with canthopexies
3) simultaneous or separate lipofilling or absorbable filler
applicationonlyastouch-up.
Methods: 103 patients requesting faicial rejuvenation at
AmsterdamPlasticSurgerysurgicalcentrewithahistoryofPF
treatmentswereevaluatedbetweenJanuary2011andJanuary
2014. Data, procedures, type of PF removal, complications
andsatisfactionoutcomeswereanalysed.
Results: 69 Midfacelifts and 34 Face & Necklifts were
performed (age 38-81 years). PF removal prior to facelifting
was performed in 34 cases. Lipofilling volume replacement
in27casesandabsorbablefillersaloneorasatouchupin62
cases.5Lipofillingcaseswereenhancedwithadiposederived
regenerative cells. Major complications included: 2 toxic
angioedemaafterPFremoval,4skinsloughsinsmokers,2
hematoma’s with conservative treatment after midfacelift, 3
casesoffatnecrosisafterlipofilling,3scleralshowforwhich
canthoplasty.95patientswereveryhappy(n=81)orsatisfied.
4 patients were unsatisfied but declined further treatment.
3 patients continued to have disturbing ongoing nodule
formationandorinfection.
1737
61
IS THE SMAS FACELIFT SAFE? A RETROSPECTIVE
REVIEW OF SUPERFICIAL MUSCULOAPONEUROTIC
SYSTEM APPROACH VERSUS SUBCUTANEOUS
APPROACH TO COSMETIC RHYTIDECTOMY
Presenter:
CharalambosK.Rammos,MD
Affiliation:
MayoClinic
Country:
USA
Authors:
RammosCK,HarlessCA,MaricevichM,
MaricevichR,JacobsonSR
Goals/Purpose: For treating the aging face, a facelift is the
surgicalstandard.Avarietyoftechniqueshavebeendescribed.
Thepurposeofthecurrentstudyistoevaluatethesafetyof
thesub-SMASfaceliftcomparedtothesubcutaneousfacelift.
Methods/Technique: A retrospective chart review was
conducted on all patients who underwent facelift surgery
between2003and2011attheMayoClinic.Patientsincluded
in the study were seeking elective improvement of facial
appearance.Datacollectedincludedthefollowing:age,gender,
type of facelift performed, follow up and complications. All
chartswerereviewedtoidentifythepresenceofhematoma,
seroma, deep venous thrombosis, skin loss, hypertrophic
scar,woundinfection,ormotorandsensorydeficitfollowing
theoperation.Theprimaryoutcomewasoverallcomplication
rate.
Results/Complications:Atotalof229faceliftswereincluded.
143 patients underwent a subcutaneous facelift and 86
underwent a sub-SMAS facelift. For the subcutaneous
facelifts, 88% of the patients were female with a mean
age of 62 years. For the sub-SMAS dissections, 88% of
the patients were female with a mean age of 59 years. The
average postoperative follow up was 12 months. The overall
complication rate was 29.4% (n=42) for patients who
underwentasubcutaneousfaceliftcomparedto24.4%(n=21)
forpatientswithasub-SMASfacelift(p=0.4123).Analysisof
each individual complication failed to yield any statistically
significantdifferencebetweenthetwogroups.
Conclusion: In the present study, sub-SMAS facelift
complication rates were not statistically different compared
to those of subcutaneous facelift. This data suggests that
sub-SMAS dissection can be performed with similar safety
compared to traditional subcutaneous facelift, with the
potentialadditionaladvantageoftheSMASfacelift.
Discussion:Faceliftingstrategiesinpatientswithpermanent
fillersmayrequireafullrangeofaestheticandreconstructive
plastic surgery expertise. The SILC concept is advocated
as treatment strategy and for patient education. Judicious
use of dermal fillers by suitable practioners cannot be
overemphasized.
40
62
MIMETIC MUSCLES IMMOBILIZED AND RELAXATION
FOREHEAD LIFT (MIR-LIFT) NO SKIN PULLING
PROCEDURE
2015 62
MIMETIC MUSCLES IMMOBILIZED AND RELAXATION
FOREHEAD LIFT (MIR-LIFT) NO SKIN PULLING
PROCEDURE
Presenter:
RyuichiUtsugi,MD
Affiliation:
ClinicUTSUGIryu
Country:
Japan
Authors:
UtsugiR,KonoT,OkumuraH,TakedaA
Background: A forehead lift is an effective rejuvenation
procedure.However,foreheadwrinklesanddroopingtendto
recurearlyaftersurgerybecauseofthenaturalactionofthe
mimeticmuscles,whicharethemainfactorcausingwrinkles
anddrooping.ForeheadliftsarenotpopularinJapanbecause
ofthetypicallook,slantedeyesandunnaturallyraisedbrows
as well as early recurrences. To overcome these limitations,
ourfocusisdirectedtothemimeticmusclesinourprocedure,
TheMimeticMusclesImmobilizingandRelaxationForehead
lift (MIR-lift). It is recognised that patients suffering from
wrinkles,blepharospasm,etc,lookmuchyoungerfollowing
botulinumtoxintreatment.Weperformthismusclerelaxation
usingsurgeryinsteadofbotulinumtoxin.
Method:Toapproachtheorbicularisoculiimuscles(OOM),
depressorsupercilii,corrugatormusclesprocerusmuscle,and
frontalismuscle,aforeheadflapiselevatedthroughacoronal
incision into the supra- or sub-galeal layer. Each muscle
belly is cut in multiple places (3 to 4) make sure to protect
themusclebodiesfrombecomingdivided.Inparticular,the
musclefibersoftheorbitalandtheseptalportionoftheOOM
arecutin2-3placesatarightangle.TheweakenedOOMis
fixedbysuturestotheorbitalrimperiosteum.
Results:OnehundredandtwopatientsunderwenttheMIRlift. All were women from 37 to 70, average age 54. The
averagefollowwasover3years(from1to11years).Allpatients
werepleasedwiththeresultoftherejuvenationbecausetheir
wrinklesdisappearedbutthreepatientswerenotsatisfiedfor
other reasons. There were no major complications. Minor
complicationswerefew:initial26patientsexperiencedamild
temporary/permanentsensorylossinthescalp.Twopatients
requiredhairgraftstocorrectasmallareaofalopeciaonthe
incision.
Conclusion:TheMIR-liftisaproven,lowriskprocedurethat
providesabrighterandnaturalfaciallook.Foreheadwrinkles
anddroopingaresurgicallyimprovedtoamajordegreeand
the result is lasting (in contrast to neurotoxins). A striking
improvementofforeheadskintextureresultsfromthemuscle
relaxation.Becausedirectskintighteningisnotrequiredwith
theMIR-lift,unnaturalforeheadexpressionisavoided.
41
2018 63
GRAVOMUEL, GUARANTEED BETTER RESULTS IN
WRINKLE TREATMENTS
Presenter:
IvarvanHeijningen,MD
Affiliation:
AZZenoandDuinbergenClinic
Country:
Belgium
Author:
vanHeijningenI
Peoplewithfacialwrinkleshavehighexpectationsofplastic
surgeons they visit. Extraordinary results are standard;
miraclesarepossible,intheirmind.Thesocialskillsnecessary
tomanagetheseexpectationsareoftenmoreimportantthan
theactualtechnicalskillsaplasticsurgeonneedstomasterin
ordertohaveahappypatientafteraprocedure.Theseskills
are not systematically taught in training and post-graduate
education. The “Gravomuel” patient information system is
an easy way to communicate with patients seeking wrinkle
treatment.Itexplainsinsimpletermswhattheycanexpect
fromacertainprocedure.Thisinformationsystemisbased
on the four most important aging factors: Gravity, Volume
loss,MuscleactivityandElasticityloss.Withasimplediagram
it can be easily explained why certain procedures produce
moreconsistentgoodresultsthanothers.Italsoclarifieswhy
personal skill in non-surgical treatments is of paramount
importance for all plastic surgeons who wish to focus on
facialwrinkletreatment.
1712
64
SLIDING OSTEOTOMY GENIOPLASTY FOR FACIAL
AESTHETICS BALANCE
Presenter:
JohnF.Hoenig,PhD,MD
Affiliation:
GeorgAugustUniversityandMedicalSchool
Goettingen
Country:
Germany
Author:
HoenigJF
Introduction: The chin is one of the most obvious facial
structures and plays an important role in the perception of
thefaceasaninstrumentofcommunication.Toalterthechin
contourinareliablemannerthehorizontalslidingosteotomy
of the mandibular symhpysis with advancement of the
mobilizedsegmentisthetechniqueofchoiceforcorrection
oftheanteriorposteriordeficiency.
Material and Method:Thisstudydescribessurgicaltechniques
and outcome used in aesthetic and functional surgery of
the chin. Over a ten years period 474 patients underwent
orthognathic surgery to correct their malocclusion. Of
these 474 patients 155 were treated in combination with a
sliding genioplasty (SGP). 37 patients (29 females and 8
males)withanaverageageof32years(range18-47)hadan
isolated sliding genioplasty. In this group 33 patients had
chin advancement and 4 for a chin reduction. Mean chin
advancementwasamodest4.5mm(2-to7-mmrange),and
chin vertical displacement was a mean 3.9 mm (2.5- to 4.1mmrange).Allpatientsinthemandibulardeficiencygroup
hadresidualsagittaldisproportionoftheprogonionrelative
tothesubnasale(-7.6mmmean)andnewlycreatedvertical
disproportion with mean lower face heights of 67.8 mm
comparedwithmeanmidfaceheightsof65.3mm.
Thesurgicaloutcomewasevaluatedaccordingtotheanalysis
ofphotographsobtainedbeforeandaftersurgery,theanalysis
of pre- and postoperative measurement and patients self
judgment.
Results: All patients healed uneventfully without any major
post operative problems. Paraesthesia of the mental nerves
occurs to some degree in almost all patients measured by
SimmonWeinsteindiagnosticdevice.Inthegroupofsingle
sliding chin osteotomy no major branches of the mental
nerveshavebeentransacted;paraesthesiawasonlytransient
(usuallyamatteroffewweeks).Afteratleast1yearfollowing
the operation, normal sensitivity of the lower lip and chin
of both sides was evaluated by almost all of these patients
(93, 1%). All patients having had only a single genioplasty
recoveredtotallyfromaneurosensorydeficit.
Thelevelofsatisfactionwassignificantlyhighinallpatients:
42
2046 66
ENDOSCOPICALLY ASSISTED RHYTIDOPLASTY
OF THE LOWER THIRD OF THE FACE:
VIDEOENDOSCOPIC CORSET
Presenter:
NiandraSartori,MD
Affiliation:
HospitaldaPlastica
Country:
Brazil
Authors:
SartoriN,RighessoR,ChemEM,NettoR,
MartinsAL
1675 65
FACELIFT COMPLICATIONS RELATED TO MEDIAN
AND PEAK BLOOD PRESSURE EVALUATION
Presenter:
MarcoMaricevich,MD
Affiliation:
UniversityofPittsburgh
Country:
USA
Authors:
MaricevichM,MaricevichR,AdairM,
KashyapR,JacobsonS
Background: Hematoma remains the most challenging
complication of facelift and has been associated with male
sex, hypertension, aspirin use, smoking, and high body
mass index. Patients who underwent facelift were studied
to determine rates of hematoma and other complications
and to identify predictive and protective factors, including
meticulousanalysisofperioperativebloodpressure.
Methods: Charts of patients who underwent facelift from
2003to2011atourinstitutionwereretrospectivelyreviewed.
Demographic, clinical, and procedural data were collected.
All postoperative complications were recorded. Data from
continuousbloodpressuremonitoringintheoperatingand
recoveryroomswereobtainedfromaperioperativedatabase
andstratifiedbymedianandpeakvalues.Logisticregression
wasusedfordataanalysis.
Results:Ofthe229patientsincluded,themajority werefemale
(88.2%),meanageatpresentationwas62years,and35.8%
had hypertension. Postoperative complications occurred in
60 patients (26.2%). The most common complication was
unfavorablescar(7.4%),followedbyhematoma(6.5%).Male
sex (P=.02), history of hypertension (P=.04), preoperative
systolicbloodpressure(SBP)morethan160mmHg(P=.04),
andoperatingroompeakSBPmorethan165mmHg(P=.04)
were predictive factors for hematoma. Recovery room peak
SBP more than 150 mmHg (P=.09) was also associated
with hematoma. On multivariate analysis, only male sex
and preoperative SBP more than 160 mmHg remained
independentriskfactorsforhematoma.
Conclusions: This study is unique in that it compares the
rate of hematoma to continuous blood pressure data in the
operatingandrecoveryroomsstratifiedbymedianandpeak
values. Meticulous control of perioperative SBP is essential
for a safe facelift. History of hypertension, increased SBP
at admission, and increased perioperative peak SBP are
predictorsforpostoperativehematoma.
43
ForagoodwhilecontroversyinfacialsurgerywasaboutSMAS
techniques.Todaythefocusisonimprovingcervicalcontour.
Wideundermining,asperformedbysubmentaldissections,
can improve results, however it increases complication
rates including haematoma, becoming that a limitant
factor. In an attemp to surpass this drawbacks the authors
presenttheendoscopeuseasanadjuvantduringFeldmans
cervicoplasties. The modifications required are detailed.
Retrospective study of 16 patients sequentially submitted to
rhytidoplasty in a period of 12 months, according with the
described technique. The results were graded by the senior
author(RR)and3othersindependentplasticsurgeons(EC,
RN,AM),whodidntknowdetailsaboutsurgicalprocedure.
Thephotogramswerecollectedpre-operativeand6months
post-operative and then compared and graded according
to Ellenbogen and Karlins paramethers. A mark from one
to 10 was attributed to each criteria, resulting in a score by
Labbé’sscale.Theaveragegroupscorewas8,29,considered
very good according Labbé’s scale. In 10 cases (62,5%) the
result was very good (8-10 marks), in 5 cases (31,25%) was
good (6-7 marks), and just one case (6,25%) the score was
under 6, graded as average. No hematoma or cutaneous
irregularitieswereverified.Nonerecidiveinplatismalbands
occurredduringthe6monthsfollowup.Theendoscopeuse
as an adjuvant during cervicoplasties seems to achieve very
good results without increasing complications. Additionaly
a smaller submental incision can be performed, and a
magnifiedanddirectviewofallstructuresincervicalregion
isallowedtoeveryteammember.
Keywords:Rhytidoplasty/methods.Face/surgery.
Hematoma/prevention&control.
1776 67
MID-FACE LIFT THROUGH INTRAORAL APPROACH
USING A 20-CM NEEDLE FOR SCAR AVOIDANCE
Presenter:
PedroVidalGarcia-Huidobro,MD
Affiliation:
HospitalClinicoFuerzaAereadeCHile
Country:
Chile
Authors:
VidalGarcia-HuidobroP,BernerJE,WillP,
CastilloP
67
MID-FACE LIFT THROUGH INTRAORAL APPROACH
USING A 20-CM NEEDLE FOR SCAR AVOIDANCE
Background:Fordecades,thecornerstoneforfacialcontouring
andrejuvenationhasbeenthefacelifting.However,thereis
acurrenttendencyamongpatientswhoarenowrequesting
lessaggressiveprocedures.Proofofthisistheincrementof
lesscomplexprocedures.Therepositionofthemalarfatpad
playsacentralroletorestoreaconvexmid-facecontour,and
untilnow,ithasbeenachievedmainlythroughlargeincisions
orendoscopictechniques.
Objective: The authors aim to present a minimum scar
procedure for mid-face contouring that, in less than 1 h of
surgical time, lifts the ptotic malar fat pad along with the
surroundingSMASandbuccalfatpadtorestoreayouthful
lookingfacialcontour.
Methods:A1-cmincisionismadeintheoralmucosaabove
thefirstpremolarfollowingacarefuldissectionbetweenthe
periosteumandtheSMAS.A27-gaugeepidermalneedleis
thenusedtomark1cmbelowthezygomaticprominence.An
absorbablepolyglactin910braidedsuture2-0isusedtohold
astronghorizontalstitchcatchingtheSMAS.Afterwards,the
sutureispassedundertheSMASusingthe20-cmneedleand
tookout4cmabovetheearandbehindthehairline.Suture
tensioncanbeadjustedatwilltoachievethedesiredmid-face
lift.Finally,theoralmucosaincisionisclosedusingthesame
Vicryl2-0andtheskinincisionbehindthehairlinewithnylon
4-0. Twenty-four consecutive patients were addressed using
thistechniquewithconsistentsatisfactoryresultsbetweenthe
years2007and2012bythesamesurgeon.
Results:Patientsweremostlywomen(17),between24and70
yearsofage.Sixpatientshadthisprocedureasasinglesurgery,
therestincombinationwithotheraestheticprocedures.Only
1 patient was dissatisfied with the result and underwent
posteriorsurgicalrevision.Therestweresatisfiedatoneyear
aftertheoperation.Cheekandupperlipswellingarethemost
frequentcomplaintsandalwaysresolvedspontaneouslyafter
thesecondweek.
Conclusions: The authors conclude that this is a reliable
and safe procedure that obtains the desired results in midfacerejuvenationbyrestoringayouthfulcontour.Resultsare
similartootherlargeincisiontechniques,withtheadvantage
ofscaravoidance.
44
1786 68
THE MIDFACE: SURGICAL OR MEDICAL APPROACH
Presenter:
SamiaAounKanoun,MD
Affiliation:
FarabiMedical
Country:
Tunisia
Author:
AounKanounS
1847 69
WRAPPING ROUND FACELIFT
Presenter:
JunghakYang,MD
Affiliation:
JelimPlasticSurgicalClinic
Country:
Korea
Authors:
YangJ,YangDB,KohKS
The aging of the mid face represents one of the first signs
of aging that can start even from thirty. His treatement is
certainlysurgicalandinvolvesrepositionningofthemalarfat
padthathasmigratedtolocateabovethenasolabialfoldsvia
subciliaryincision.Thismid-faceliftnotonlyneedknowledge
ofanatomybutalsoaverygoodtrainingandlargeexperience.
But surgeons are frequently confronted to patients who are
seeking fast, simple and effective procedures. For these
reasonswemustbeabletosuggestthemothersprocedures
likeinjections,certainlylesseffectiveandtransientbutfaster
and more convenient for someones. Our goal being patient
satisfaction,wemustmasterboththesurgicaltechniquethat
themedicalone.
Objective:Recentimprovementsintheunderstandingofthe
anatomyoftheagingfacehavebroughtaboutnewlyrefined
techniques for facial rejuvenation. Although the concept of
skin envelope tightening in facelift operation has been still
valid,manysurgeonsstartedtogiveweighttotheconceptof
volumetricchangeinthefacialrejuvenationsurgerybecause
patientisnolongercontentwithjust“facelifted”appearance
andgottoknowthattheyouthfulfacehastheappearanceof
roundedfullness.
Methods: The principles of our technique include preexcisionoftheexcessiveskinandsubcutaneoustissuebefore
dissection, exposing the bare platysma aponeurosis and
SMAS layer through the supraplatysmal dissection, round
andovalshapeSMASmoldingthroughSMASplication.
Results: Serious complications such as skin necrosis,
permanentnerveinjury,andearlobedeformitywasnotfound.
Resultsarehighlyrejuvenatinganddurable,thenaturaland
oval shape in appearance. The nasolabial folds and midface
areparticularlywelladdressedbyourtechniques.
Discussion: To obtain better contouring for youthful facial
shape and consistently longer lasting results in facelift
operations,volumetricSMASchangethroughourwrappinground technique through even supraplatysmal plane
dissection and roundly tightening SMAS plication is very
useful,wethink.
45
1662 70
THE CLASSIC FACELIFT ENHANCED - THE PEELING
ASSISTED VOLUME ENHANCING (PAVE) LIFT
CONCEPT
Presenter:
PhillippGonser,MD
Affiliation:
OceanClinic
Country:
Germany
Authors:
KayeKO,GonserP
Introduction and Aims: Surgical rhytidectomy techniques
have become an indispensable part of modern concepts of
facial rejuvenation during the last 20 years. Many different
techniques have been described and the tendency over the
lastdecadeshowsacleartrendtowardslessinvasivesurgical
techniques with natural results, where the overall goal is a
rejuvenated not an overstretched face. The rejuvenation or
regenerationoftheskinitselfisanessentialpartofanyfacial
rejuvenation and significantly influences the overall result;
the repositioning of facial volumes and the tightening of
aged skin alone cannot achieve a complete and convincing
rejuvenation of the face. This abstract highlights the
possibilities and limitations of the adjuvant intraoperative
useofpeelingandautologousfatinjectiontechniquesduring
surgical rhytidectomy and outlines the effectiveness and
safety of the peeling-assisted volume enhancing (PAVE) lift
concept.
Material and Methods:ThePAVEconcepthasbeenestablished
in 140 patients since 2008 in our clinic as a standard for
facial rejuvenation combining the simultaneous, single
operativesessionuseofTCA/PhenolPeelingtechniquesand
volumeenhancingautologousfatgraftingwithclassicfacelift
techniques(MACS/OMEGA).
Results: We are able to present aesthetic outcome and long
term results of the PAVE concept within a 5 year period,
provingthetechniquebeingsaveandefficient.
Conclusion(s): The adjuvat use of TCA/phenol peeling
techniques and autologous fat transfer within our PAVE
-Facelift concept enhances the outcome of any classical lift
and defines a more complete rejuvenation concept with
resultssuperiortopuresurgicallifts
1692 71
MODIFIED HIGH SMAS FACELIFT FOR ASIANS
Presenter:
MinHeeRyu,MD
Affiliation:
SaintBaumAestheticHospital
Country:
China
Authors:
RyuMH,HongS
Background: There have been many described methods for
facelift,butlackingfortheAsianface.Therearedifferences
infacialcharacteristicsofAsiansandCaucasians,itisdifficult
AsiantohavesatisfactoryresultratherthanCaucasians.We
wouldliketopresentourexperienceandresultswith‘Modified
HighSMASFacelift’toimprovetheagingAsianface.
Methods:DuringaperiodbetweenApril2011andJune2013,
atotal58patients,6menand52women,allunderwentthis
facelift technique with release of retaining ligaments and
facial spaces dissection in sub-SMAS plane. The mean age
was53.38yearsold(range,35-69yearsold).Theindicationfor
surgerywastypicalsaggingofthefaceassociatedwithaging,
and relative contraindications were a previous facelift and
severefacialatrophy.
Results: Patients were followed post operatively during a
meanperiodof20months(range,10-36months).Allcases
showed improvement of the mid and lower face soft tissue
sagging.Onepatienthadaunilateraltemporalnerveinjury.
Three patients had a hematoma. Two patients had wound
dehiscence.
Conclusions: It is often difficult to get satisfactory result
for Asian in facelift because of their facial characteristics.
‘Modified High SMAS Facelift’ is applied to improve facial
saggingforAsian.Whiletheearlyresultsofthisseriesshow
promising long-term efficacy and a good safety profile, the
small number of patients and limited follow-up period
warrantfurtherstudy.Wehopethisarticlecancontributeto
providemoreinsightintothefaceliftprocedureintheAsian
patient.
46
Free Paper Session 6 - Cosmetic Medicine
1938 72
FACIAL FILLER DEFORMITY
Presenter:
JamalJomah,MD,FRCSC,FRCSEd,ABHRS,
FACS
Affiliation:
MedArtClinics
Country:
SaudiArabia
Author:
JomahJ
Introduction: Since the introduction of facial fillers, various
synthetic permenant fillers were injected in the face. Some
weresafebutotherswereverydisfigurung.Initiallysilicone
resulted in various significant abnormalities and had to
be condemned. Then other fillers followed and currently
polyacrylamideisthemostpopularsyntheticfiller.
Aim:Theaimofthispaperistopresentsomeofthedeformities
seenwithpermenantfillersandtheirmanagement.
1941 73
LARGE MOLECULAR WEIGHT FACIAL FILLERS
Presenter:
MohammadShamekh,MD
Affiliation:
MedArtClinics
Country:
SaudiArabia
Authors:
JomahJ,ShamikhM
Introduction:Hyaluronicacidconstitutesalargespectrum
ofproducts thatextendfromlowviscositylowmolecular
weighttohighviscosityandhighmolecularweightand
mostlyhydrophilicagents.Theuseoflargemolecularface
isoftenofflabelanditisusedwithcautioninthefaceat
variouslocationsandplanedepths.
Aim:Theaimofthispaperistoreviewthecasesofusing
highmolecularweighthyaluronicacidinthefaceand
outlinetheiradvantagesanddisadvantages.
Method: Retrospective study conducted over the past 7
years whereby all polyacrylamide facial fillers patients were
reviewed and their clinical picture was documented. There
were 50 cases presented for correction and the main agent
usedforfillingwaspolyacrylamide.Allthecaseswerereferred
totheauthorandinalmostallofthepatientsnorecordwas
presentastotheamountandlocationandplaneofthefiller
used.Itwasseeninvariouslocationsofthefaceparticularly
inthesub-orbitalandinthemalarandincheekareaswhiles
thesignificantnumberofpatientsdescribedmigrationofthe
product.
Method and Results:Reviewofthepatientswhounderwent
Macrolaneinjectionsover5years.Therewere613patients.
Ofthose,7%malesand93%females.
Somepatientpresentedwithacutecelluliticinfectionwhich
required drainage in the form of aspiration on various
locations. A few patients presented with significant postaspiration deformity resulting in atrophic and depressed
regions in the face and discrepancy between right and left
sides. These patients required surgical intervention in the
form of fat injection and in some cases full facelift was
conducted to remove all the materials and an attempt was
made to correct the abnormality. Case illustrations will be
presentedineachcategory,alongwithatreatmentstrategy.
Theamountsinjectedvariedbetween1ccto4ccperarea.
Thefollowupdurationisalmost3to5yearsandthecharts
werereviewedforpossiblesideeffects.Thefollowingside
effectswerenoted,painuponinjectionisalmost60%of
thecases,followedbymilderythemawhichresolvedin
fewdaysandlastly,plumpnessandclumpsintheregion.
Thematerialwithcautionwasinjectedusingamicro-
cannulaandwasinjecteddeepovertheperiosteumusinga
retrogradethreadingtechnique.
Conclusion: The case review demonstrated the significant
deformity that results from polyacrylamide and the main
problemwithitcausesfromthemigrationoftheproductin
the face and possibly extension in the orbital region which
makes evacuation extremely difficult. A facelift procedure
wouldbethelastresortbutitshouldbemodifiedtoprevent
migrationandpossibleinfection.Intravenous(IV)antibiotics
should be started prior to the procedure and be continued
after that. In addition, fat injection is an essential step in
improvingthecondition.
47
Themainareaofthefacethatwasinjectedonwasas
follows:
Nasolabial39.5%,
Cheeks23%,
Chin8.4%,
Malarprominence7.64%,temporal6%
preparotidhollow3%
Theresultswerenotedandpatientssatisafactionnoted.
onlytwoofthecasesrequiredaspiration,norejectionseen,
andHyaluronidasewasneverrequired.Inaddditiontoits
efficacypatientsnotedlongevityofupto2years
Conclusion:DespiteitsOFFLABELuseitapearsthatHigh
molecularweightHyaluronicAcidcanbeusedintheface
especiallyoverthebonyregionstoprovidemoreskeletal
supportandskeletaldefinition.Thematerialistemporary
butlong-lastingextendingforalmost2years.
1868 74
HYPERHIDROSIS TREATMENT USING THE ND: YAG
1440NM WAVELENGTH LASER WITH TARGETED
ENERGY DELIVERY
Presenter:
DavidL.Cangello,MD,MSc
Affiliation:
ManhattanEyeEarandThroatHospital
Country:
USA
Authors:
CangelloDL,KatzB
2050 75
A NOVEL TREATMENT FOR POST SURGICAL SCARS:
COMBO, AN INTEGRATED DEEP AND SUPERFICIAL
CO2 LASER
Presenter:
FrancescaDeAngelis,MD
Affiliation:
ClinicaMediterraneaNaples
Country:
Italy
Authors:
DeAngelisF,GallottiJ
Background: Primary Focal Axillary Hyperhidrosis is a
chronic disorder of sweating within the axilla that creates
significant impairment of an individuals daily activities and
psychologicalwell-being.
Scarsqualitydoesmakeabigdifferenceintheoutcomeof
asurgicalprocedure,badscarring,forexample,maygive
theperceptionofapoorresulteveninthecaseofaperfectly
performedsurgery.
Severe hyperhidrosis affects 2.8% of the overall population
(7.8 million individuals) and it is estimated that axillary
hyperhidrosis effects over 1.4% of the U.S. population
representing over 4 million individuals, a prevalence
comparabletothatofpsoriasis.
Materials and Methods:Weselectedtwenty-fivepatients,
undergonearecentsurgicalprocedure,witharesultingscar
ofatleast5cmlength.Thescarwassplit,lengthwise,intwo
halves,toobtainacasesideandacontrolateralcontrolside.
Rightatthetimeofstichesremovalonesidewastreated
randomlywithanewCo2fractionallaser.Thisdeviceisable
todeliveralmostsimultaneouslyadeepablationofa0.12
µmspotsizefollowedbysuperficialspiral-shapedablation
of1,3µm.Patientsreceivedthreetreatmentsonamontly
basis;controlsweredoneafter3and6monthsafterthelast
session.
Objective: The purpose of this study is to determine the
efficacyofasingletreatmentutilizinganewfibertodisrupt
thesweatglandslocatedintheaxilla.
Methods: A total of 15 patients with moderate to severe
hyperhidrosis of the axilla (HDSS scores of 3 and 4) were
enrolled in this prospective IRB controlled study. Subjects
were treated in a single session with a 1440nm pulsed
Nd:YAG laser with a new fiber design designed to deliver
targetedenergy.
Results:Wehaveevaluatedthescarresponsewithpunch
biopsiesandhistology,picturesandfiveindependent
observers,thusconfirminganoverallimprovementofthe
treatedsideofthescar.
Efficacywasmeasuredatthreeandsixmonthsthroughboth
subjectiveandobjectivequantitativemeansincludingpatient
andphysicianquestionnaires,HDSSscore,andquantitative
improvements utilizing digital software analysis (Image J
softwarebyN.I.H.)andhistologyresults.
Results:Atotalof15patientsweretreated.Minimaladverse
effects were reported from patient diaries and physician
assessment. High improvement by subject evaluation and
subjective physician evaluation was reported. The average
HDSSscoreimprovedby2points.ImageJsoftwareanalysis
reportedanaverageof84%reductioninsweatareavolume
atthreemonthsand99%atsixmonths.Histologicreports
demonstratedareductioninbotheccrineandapocrineglands.
Conclusion: The 1440 wavelength combined with the
Sidelight 3D fiber delivery system is an effective tool in the
treatmentofseverehyperhidrosis.
48
76
A NOVEL APPROACH FOR THE TREATMENT OF
SPIDER VEINS: “GIVEN NEEDLE”
1801 76
A NOVEL APPROACH FOR THE TREATMENT OF
SPIDER VEINS: “GIVEN NEEDLE”
Presenter:
MirsadM.MujadzicSr.,MD
Affiliation:
GeorgiaRegentUniversity
Country:
USA
Authors:
MujadzicMM,RitterEF,GivenK
Background: Spider veins, or telangiectasia on the lower
limbs,areverycommonandhavebeenreportedtobepresent
in 41% of women over 50. Sclerotherapy as a traditional
treatment for telangiectasia has a low cost, though it is
burdenedwithadversesequelaeincludingulceration,scarring,
hyperpigmentation,thrombosis,andallergicreactions.Lasers
haveshownfewerbutstillsubstantialcomplicationssuchas
hyperpigmentations,scarring,pain,andulceration.Itslower
efficacyrelativetosclerotherapyhaslimitedlaserapplication
forthetreatmentofspiderveins.
Objectives: To present a new alternative in management of
spiderveinsanditsresultswhichinvolveslowvoltagecurrent
deliveredviaaninsulatedmicroneedlewithbeveledtip.
Patients and Method:Thetechniqueutilizesamicroneedle
withaninsulatedshaftandbeveledtipwhichisinsertedinto
a handpiece connected to a mono-polar electrical generator.
The needle is introduced through the skin into or on the
spidervein.Thecurrentisthenappliedwithobliterationof
thevein.Thirtypatientsweretreatedwiththe“Givenneedle”.
Allpatientswerefemalewithanaverageageof43years.Only
onepasswasperformedandpatientfollowupwasanaverage
of6months.
Results: Twenty patients (66%) had more than a 70%
resolution. The most common complication was skin
erythema,whichdevelopedin8patients,followedbybruising
in5patients.Bothofthesecomplicationsresolvedin2-3weeks.
There were no complications as seen with sclerotherapy or
laser, such as vessel thrombosis, serious allergic reactions,
hypopigmentation,ulceration,orscarformation.
Conclusion: A novel approach for the treatment of
telangiectasia has been described. The development of an
insulated micro needle with a beveled tip, utilizing low
current flow, has minimized adjacent tissue damage and
improvedefficacy.Thelowcost,lowlevelofcomplicationsand
comparableresultsofferavaluablealternativetosclerotherapy
andlasertreatment.
49
1772 77
THE AESTHETICS OF NON-SURGICAL FACIAL
CONTOURING FOR EASTERN WOMEN
Presenter:
ShengkangLuo,MD,PhD
Affiliation:
TheSecondPeoplesHospitalofGuangdong
Province
Country:
China
Author:
LuoS
Aestheticfillerinjectionsforfacialsofttissueaugmentation,
including those for anti-aging and facial contouring, are
dramaticallygainingtheirpopularities,andhavebecomean
integral part of many aesthetic surgeons’ practices. In the
West,moreattentionisgiventofillerinjectionsforthepurpose
of anti-aging; however, in the East we are more focused on
usingfillersforfacialcontouring.Whilewehavedonealarge
numberofsuchcasesandaccumulatedextensiveexperiences,
therearemanypotentiallyinterestingareasthatareworthto
explore, so that a set of facial contouring principles can be
developed for oriental females. As we all know, there are
culturalandradicaldifferencesbetweenWesternandEastern
women,whichleadtodifferentaestheticstandardsforfacial
contouring. The Western world appreciates the beauty of
angularcontoursandsharpfeatures,butweingeneralprefer
an“ovalface”withsmoothcontoursandappropriatefeatures.
Furthermore, we give more attention to the proportion and
volumeofthemiddleface.Wepreferafullgeisomaanda“T”like nasal region, which makes the facial features clear and
vivid.Intheareaaround“T”,wepreferan“O”-likesmooth
arch,whichmakesthewholefaceappearsroundandsweet.
Inouropinion,“T”and“O”aretwomajorobjectiveaesthetic
measures, which are grounded on the facial characteristics
of Eastern women. To achieve this outcome, three facial
contouring principles deserve a special focus and attention.
First,weshalladdvolumetotheupperfaceandnarrowthe
lowerface.Thiswillgenerateanoval-likecontourinthewhole
face,whichispreferredbymosteasternwomen.Second,we
shallmakethevolumeandshapeofnasalandchinregions,
appear more delicate and sharp and hence more consistent
withEasternaesthetics.Finally,weshallfillthesunkencheek
and nasolabial fold, to eliminate the unpleasant appearance
of the middle face. In addition to the principles, we believe
it is important to well communicate with the patients, and
understandtheirexactdemands.Thiswillallowustogettheir
trust,andperformbetterineachfacialcosmeticprocedure.
2044 78
NONSURGICAL RHINOPLASTY WITH FILLERS
Presenter:
HenriqueL.ArantesSr.,MD
Affiliation:
BrazilianSocietyofPlasticSurgery
Country:
Brazil
Author:
ArantesHL
Rhinoplastyremiansoneofthemostchallengingoperations
in plastic surgery, with a great variety of techniques
avaliable to successfully navigate these challenges. For
decades, surgical rhinoplasty has been the therapeutic gold
standard for individuals seeking to improve the cosmetic
appearanceoftheirnose.However,surgicalrhinoplastyisan
invasive procedure that has both significant downtime and
complicationsrates rangingfrom5to21%.Perhapsthemost
significantchangeinfacialrejuvenationinthelast10years
hasbeentheintroductionofnonsurgicaltreatmentsforthe
relaxation of facial wrinkles and for the restoration of lost
volume. New fillers have been developed whose safety and
efficacy have been supported by clinical research, specially
hyaluronicacid(HA)fillerswithlonglastingresults.Theuse
offillerstoimprovetheappearanceofthenoseisincreasing,
speciallywiththenewtrendsofstructuredrhinoplasty,where
wemostlyincreaseinsteadofreducethenosesize.
Thesuccessofthetreatmentdependsonpatientselectionand
clearlyexplanationofthelimitsanddurationoftheresults.It
couldbeindicatetoenhacesomefeatureslike:columellaand
nasolabialangle,tipprojetion,dorsumprofileandprevious
surgerydeformities.
This clinical study protocol included 25 patients, been 20
females and 5 males, with age between 25 to 41 years old.
They signed an informed consent form for the study after
havingbeeninformedofallpertinentdetails.Thepreference
forinjectionwasHAgelvolumizers,withlongremanence.A
bifasic,cross-linkedgelwithgoodviscoelasticityandcohesion
wasselected.
TheprocedurewasdonewithlocalanesthesiawithLidocaine
2%andepinephrine1:200.000.Itwasusedflexiblecannulas
of23Gandtheentrypointisinthebaseofcolumella,laterally
tothemidlineandanteriortothemedialcruxofalarcartilages.
Thisaccesspermitthetreatmentofallthecolumellaandtip.
When is necessary to correct deformities from the dorsum
andthenasalprofile,it’susedasecondaryentrypointdirect
inthenasaltip,betweenthealarcartilages.
Thenonsurgicalrhinoplastywithfillersdoesnotreplacethe
rhinoplastybutit’sanexcellenttemporaryalternative.
50
78
NONSURGICAL RHINOPLASTY WITH FILLERS
1830 79
CLASSIFICATION OF GLABELLAR WRINKLES FOR THE
INJECTION OF BOTULINUM TOXIN
Presenter:
SufanWu,MD,PhD
Affiliation:
ZhejiangProvincialPeoplesHospital
Country:
China
Authors:
WuS,WuH,PanL
Glabellar wrinkles are caused by contraction of 3 muscles:
corrugator, depressor supercilii, and procerus. The glabellar
wrinkles are different shape due to individual habit and
musclecontraction.Authorsclassifiedtheseglabellarwrinkles
into4types,shapedas“????”.Shape“?”isthemostcommon
type, which is caused by contraction of corrugators alone.
Shape “?” is frequent type, which is caused by contractions
ofcorrugators,depressorsupercilii,andprocerus.Shape“?”
isuncommon,whichiscausedbycontractionsofcorrugators
and a little frontalis above it. The rare shape is “?”, caused
by contractions of all muscles mentioned above. For the
treatmentofdifferentshapesofglabellarwrinkles,thedesign
ofinjectionpositionsofbotulinumtoxinshouldbeadjusted
tomatchthecontractionmuscles.Theclassificationishelpful
fortheinjectionofbotulinumtoxin.
51
1915
80
THE FRONTIER BETWEEN LASER AND CHEMICAL
PEELINGS
Presenter:
RomuloM.MeneSR.,MD
Affiliation:
Country:
Brazil
Author:
MeneRM
Over the past century, different combined techniques have
beendevelopedtoimprovethedermalandepidermalsigns
of photo or chronological skin aging. Nowadays, modern
plasticsurgeryiscomplementedwithdifferentnon-surgical
proceduressuchaslasersandchemicalpeelings.
Thegoalinuseofnon-invasiveskinproceduresistoachieve
patient satisfaction to give them a more youthful look by
diminishing the signs of aging and the damage caused by
yearsofsunexposureespeciallyontheface,handsandneck/
chest.
Unfortunately,thesetechniquesarestilllimitedtothephoto
types1,2and3(Fitzpatrickclassification).Itisfundamental
that the laser equipment used for resurfacing, be of the
highesttechnologyandtheoperatorbewelltrainedtoavoid
sequels. The best laser equipment to remove the epidermis
andtostimulatethedermis,istheonesthatusethehighest
powerofErbium-YAG(3,000mJ),ithasthesameadvantages
over CO2 lasers, without the side effects typical caused by
CO2 lasers. (Hypochromia, long recovery time of the skin
tissueandlonglastingerythema).
Newlasertechnologyoffersanotheralternativetorejuvenate
theskinwithfewersideeffectsthanearlierlasers.Thelatest
generation is fractional laser resurfacing, it penetrates deep
into the skin, leaving the surrounding skin unaffected and
intact,therebyallowingthehealthyskincellstoassistinthe
healingofthedamagedcells.Ithastheoptiontoworkina
selective and fractional manner in great depth, safely with
extensiveskindamage,toincreasecollagenproduction,reduce
theappearanceofwrinklesandacnescarswithconsiderably
lessdowntimethanotherinvasivelasertechnologies.These
procedures facilitate the interaction with chemical peels. It
isfundamentaltointegratechemicalpeelsformulationthat
combines,AHAwithsalicylicandformulationthatincludes
Retinol,PhyticAcid,AzelaicAcidandSalicylic.TCAChelated,
simultaneously,withlaserskinresurfacingisbeingusedin
theperiorbitalandtheperioralareas.It’simportanttousethe
correctproductsandfollowtheprotocolsinpost-laserorpost
chemicalpeelingperiod.
2011 81
COMPLICATION TREATMENT AFTER NON-SURGICAL
AESTHETIC PROCEDURES FOCUSING ON TREATMENT
FOLLOWING INTRAVASCUKAR INJECTION
Presenter:
ThomasRappl,MD
Affiliation:
MedicalUniversityGraz
Country:
Austria
Authors:
RapplT,MayS
Nonsurgicalaesthetictreatmentisthequickestraisingmarket
in medicine. In the US, annual cosmetic surgery volume
(surgicalandnonsurgical)increasedby725%between1992
and2005,withover$10billionspentin2005(TomLiu,PRS,
June2008-vol.121,issue6).Futuregrowthisexpectedtobe
driven largely by non-surgical procedures. Worldwide, the
treatment of wrinkles with fillers and BoNT/A products are
themostcommonnon-surgicalcosmeticprocedures.Onthe
otherhandthereisaraisingnumberofcosmeticpracticioners
who are treating patients in very different kind of ways.
Therefore theris an increasing demand for complication
treatment. Complications can be mild (transitient like
hematomas,nodules,swelling,redness,etc),moderate(filler
displacement,papules,etc.)orsevere(skinnecrosisfollowing
intravascularinjections,asymmetries,severeinfections,filler
migrations,etc.)ComplicationsfollowingBoNT/Atreatments
aretransitingafterseveralweeks,iftherighttreatmenthas
not been set in time. Also filler complications are more or
less self limiting as far as these are resorbable materials.
Complications with permanent fillers are often ending up
in the operating room. Intravascular injection is the most
concerning complication leading to cutaneous necrosis. A
newprotocoltopreventskinnecrosisfollowingintravascular
injections shows to be the best salvage procedure. As soon
as white spots are obvious after filler injection, a treatment
with Heparine and Ilomedin/Prostavasin has to be started
immediatelytopreventskinnecrosis.Followingthisprotocol
it was possible to prevent skin damage after intravascular
injection.
52
2016 83
FACIAL REJUVENEATION WITHOUT SURGERY WITH
CO2 INFUSION GAS: COMPARTMENTAL DETACHMENT
TECHNIQUE (CDT FACIAL)
Presenter:
PatriciaErazo,MD,PhD
Affiliation:
CLINICACiurgiaPlasticaeRejuvenescimento
Country:
Brazil
Authors:
ErazoP,MunizAM,SilveraLS,LaraPL
1765 82
RHINOPLASTY WITHOUT SURGERY USING DERMAL
FILLERS
Presenter:
SaiedVejdani,MD
Affiliation:
MollasadraAestheticLaser
Country:
Iran
Author:
VejdaniS
Objective: There are so many surgical ways to treat nasal
deformities; Most of the aesthetic patients nowadays want
todononinvasiveprocedureswithnodowntime;oneofthe
nonsurgicalmethodsisusingfillers.Therearemorethan50
differentfillersonthemarketbutIonlyusedhyaluronicacid
forthesetreatments.
Material and Method:187patients(145Femalesand42Males)
weretreatedfrom2008till2013.Theywereinrangeof24to
61yearsoldandtheyhaveafollowupof4to16months.Most
ofthepatientswerecomingfromaRhinoplastysurgeryand
theywerenotsatisfywiththeresultanddoesn’twanttodo
the2ndone.IamalwaysofferingthemthesurgerybeforeI
performanyinjection.Firstsessionwasconsultancysession
andnextappointmentwastheprocedure,andallofthemhad
atleastonesessionforcheckuptheinjectionsitesbetween1
to2weeksaftertreatment.Dependsonthesiteoftreatment
and the dept of the defect I used different models of the
hyaluronicacidwithdifferentviscosityandconcentration.
Result: The pictures of all patients have taken before, 1
weekafter,15daysafter,4monthsafter,and9to15months.
Althoughthedurationoftheeffectsisnottoolongandthe
patientsneedtodotheprocedureevery9to15monthsbut
thepatientsatisfactionisveryhighandtheyprefertoperform
dermalfillerthananormalsurgery.
Conclusion:Thispapershowsthenewconceptofsomeother
aesthetic application for dermal filler which sometimes can
replacethenormalsurgeryfortheselectedpatients.
The Carbon Dioxide gas, it benefits to rejuvenation mainly:
1.- Chemical Characteristic Promotes the collagen, the
enhancement and improvement of the vasculaization
2.-Mechanical Characteristic: Considering the ease of its
penetrationthecarbondioxidegastreatsseverallayersinthe
skintissue(emphysema).
Thetechniquewepresentisintendedtorecoverlostvolume
infacialcontours(reposition):Front,MalarandMandibular.
Therefore the carbon gas benefits mainly by the technical
maneuver of detachment that occurs when the gas comes
quickly and with pressure on the tissue, which is essential
for performing the Compartmental Detachment Technique
(CDT).
Thegoalofourtreatmentaimsfacerestructuration,triangleof
youth(wideangle,lateralorbitalwallanddefinedmandibular
contour). Carbon dioxide produces local vasodilatation with
increasedvascularflowenhancingtheBohreffect,therefore,
a local hyperoxygenation of the tissues. Carboxitherapy, is
how we call the technique of introducing medicinal carbon
gasinskintissue,epidermis,dermisandhypodermis.This
techniqueaimstostimulatethecollagenandtonurturethe
bed,aswellastodetachwithhighflow:softtissuefromsoft
tissue, soft tissue from bone. By introducing the gas into
the skin tissue, we induce a detachment without trauma
whichmeetsthephysiologicalphasesofthehealingprocess
by encouraging the quality and assembling of collagen.
The detachment is performed on the deep-level bone level
(subperiosteal).RegionRetroauricular-mastoidandPlatysma
2) Clavicle 3) Mandibular Angle and submental region 4)
Zygomatic5)Malar6)Frontandsidewalloftheorbit.
All these points are specific for traction in facelift. By
administering the gas we distribute it manually to help the
detachment of the flap that is immediately repositioned by
pullingitandcarryingitupward(vectorsoftraction).
Based on compartmental anatomy, it is possible to handle
smaller segments of the face with minimal incisions and
surgicaltreatment.Thisoftenresultsingettingfaceliftresults
thatinpasttimeswasonlypossiblewithlargedetachments.
Forthisreasonweperformthetechniqueofdetachmentin
various facial compartments with infusion Carbon Dioxide
gas.
53
83
FACIAL REJUVENEATION WITHOUT SURGERY WITH
CO2 INFUSION GAS: COMPARTMENTAL DETACHMENT
TECHNIQUE (CDT FACIAL)
54
Free Paper Session 7 - BCRF Clinical & Research Awards
1916 84
RADIAOFREQUENCY-ASSISTED LIPOSUCTION
TECHNIQUE FOR FACIAL AGING UNDER LOCAL
ANESTHESIA
Presenter:
CuiHaiyan,MD
Affiliation:
ShanghaiJiaotongUniversity&Shanghai
NinthHospital
Country:
China
Authors:
HaiyanC,JinanC
1778 85
MALE MUSCLE DEFINITION WITH VASER ASSISTED
LIPOSCULPTURE AND FAT INJECTION
Presenter:
NaciCelik,MD
Affiliation:
PragoKlinik
Country:
Turkey
Author:
CelikN
Objective: To explore radiaofrequency-assisted liposuction
techniqueusedinfacialagingpatientsunderlocalanesthesia.
Methods: 360 cases patients underwent radiaofrequencyassistedliposuctionprocedure.Thetreatmentwasperformed
usingBody-Titedevice.
Results: 360 cases radiaofrequency-assisted liposuction
procedures were performed, facial contour correction and
tissue tightening and skin retraction were observed almost
immediately in most patients. There was no scarring,
infection,burn,orlessbleedingandbruisingandedema.
Conclusions: This clinical procedure show that the removal
of small volumes of fat with concurrent subdermal tissue
contraction can be performed safely and effectively using
radiaofrequency-assistedliposuction.Especially,canbeagood
solutiontothelooseskinandsofttissueaccumulationlocated
atnasolabialoutsideandaltercationoutside.Radiaofrequencyassisted liposuction technology is a very effective for facial
beautification.
[Keywords]radiaofrequency-assistedliposuction,facialaging,
localanesthesia
Background:VaserLipoSystemisawell-knowntechnology
whichenablesthelipoplastyofsuperficialfatlayersand
fatinjection.Thistechniqueallowstheplasticsurgeonto
enhancethemuscularlookoftheupperandlowerbody,
backandextremities.
Objective:Inthisstudy,improvementofthebodycontour,
self-esteemandphysicalactivityofthepatientsafterVaser
andPowerXassistedlipoplastyandfatinjectionisreported.
Methods:Theareasthatwillbetreatedwereassessedbythe
helpofaprofessionalfitnesstrainerbeforetheoperation.
FollowingdeepandsuperficialinfiltrationwithPowerX
system,firstVaserVmodeforsuperficialemulsification
andlaterVaserCmodefordeepemulsificationwasused.
Aspirationofthedeepemulsifiedfatandthesuperficial
fatandtransitioningforthedefinitionofthesuperficial
anatomywascompletedwithPowerXorventilatedcannulas
andaspiratedfatwascollected.Aclosedfatinjectionsystem
wasusedwithoutcentrifugationorwashingoffoffat.Only
tumescentsolutionandbloodwereremovedfromthe
aspirate.Aftercompletionoftheliposuction,fatinjectionto
thepectoralareaanddeltoidmusclewasperformedwhen
necessary.
Results:Atotalof61patientswereoperated.Allpatients
returnedtotheirroutinein10daysandstartedworkoutsin3weeksaftertheoperation.Musculardefinition,
augmentationofthepectoralanddeltoidarea,andlifehabits
ofthepatientswereevaluated.Satisfactoryresultswere
obtainedin59patients(96.7%)whenthemuscledefinition
andgenerallookofthepatientwereconsidered.Fatinjection
forthemuscleaugmentationwashighlyappreciatedby39of
47patients(82.9%).Allbutone(98.3%)reportedincrease
ofthequantityandthequalityoftheirwork-outs.8of21
smokersstatedthattheyquitsmokingaftertheoperation.
Nomajorcomplicationoccurred.Minorcomplications
included9casesofseroma,2casesofprolongedswelling.
Conclusions:MalemuscledefinitionwithVaserassisted
liposuctionisatimeconsuminganddifficultoperationwith
highlyfavorableresults.Itshouldbeperformedbyhighly
experiencedsurgeonswhodidalotofliposuctionsandfat
injectionspreferablywithVaserLiposystems.
55
1988 86
CIRCUMFERENTIAL DEEP LIPOABDOMINOPLASTY-THE BODY TRANSFORMATION
Presenter:
AugustoS.CamaraValente,MD
Affiliation:
BrazilianSocietyofPlasticSurgery
Country:
Brazil
Author:
CamaraValenteAS
86
CIRCUMFERENTIAL DEEP LIPOABDOMINOPLASTY-THE BODY TRANSFORMATION
Theconceptsofthistechniqueare:Thedeepliposuctionof
the lamellar layer, preserving the areolar layer flap with its
subdermal vascular plexus, nourished by perforators which
should be preserved to the maximum. The flap fixation
(Scarpa’sfascia)intheabdominalaponeurosisisfundamental
for the final success. The post operatory care should be
carefullybecausetheveryaggressivedeepliposuctioncreates
aflapsusceptibletovariousfactorssuchascompressionby
the girdle. Because this, the girdle should be kept open for
7 or more days to prevent the flap ischemia caused by the
compressionoftheperforators.
Somearticlesdemonstratedthattheareolarlayertendstobe
inthesamethicknessofallpartsofthebody.ButtheLamellar
layer presents various thicknesses depending of the region
analyzed. The liposuction of the lamellar layer creates a
strongareolarflap,nourishedbyperforatorswhichshouldbe
preservedtothemaximum.Withoutalteringthearchitecture
ofthislayer,wekeepthesubdermalplexusintact,whichis
responsiblefortheendperfusionoftheflapedge.Alltension
is transferred to the Scarpa’s fascia, the flap base, and this
avoidsthestretchingofthemicrocirculationofthesubdermal
vessels and consequently necrosis. The fixation determines
the wound without tension and for this heals aesthetically
better.Besides,theflapfixationintheabdominalaponeurosis
preventsthesuperiordisplacementofthescar,andthepubis/
vulvar region in the post-operative period. This series of
326 patients, operated by the author, was submitted by this
techniquewiththecomplicationratesimilartoliterature,but
withatrueandverygoodresults.
Cicunferencialdeepliposuctionofthetrunkinthelamellar
fatty layer, associated with abdominoplasty of the areolar
created flap (skin, areolar fatty layer and Scarpa’s fascia)
nourished by perforators, with the flap fixation in the
abdominalaponeurosisleadstoanoverallsatisfactionindex
of97%,withnaturalandtruebodytransformation.
This kind of liposuction of the trunk associated to the
abdominoplastyisanewconceptofbodycontouringsurgery.
56
1955 88
LIPOSUCTION IN THE XXI CENTURY: THE SIMPLE
FACTS
Presenter:
HugoR.Jativa-NaranjoII,MD
Affiliation:
CentralUniversityofEcuador
Country:
Ecuador
Authors:
Jativa-NaranjoHR,NoronaB
1791 87
BI-PLANARLIPO-ABDOMINOPLASTY-INTRODUCING
THES.L.A.S.
Presenter:
YoramWolf,MD
Affiliation:
Dr.YoramWolfLtd&MaccabiSheruteiBeriut
Country:
Israel
Authors:
WolfY,DimaE,SandbankJ
Abdominoplasty is one of the most commonly performed
esthetic procedures, first introduced by Kelly in 1899 as a
dermolipectomyofthelowerabdomen.Inthelate60’sand
early70’sthesecondgenerationabdominoplastycommenced
with the introduction of rectus sheath suture plication.
The third generation came about in the late 80’s and early
90’swiththeadditionofsuctionassistedliposuctiontothe
procedure.
Latelynewconceptshavebeenadvocatedincludingreduced
undermining, lateral subcostal perforator preservation,
progressivetensionsuturesandlymphvesselspreservation.
Theneedforvacuumdrainsinabdominoplastyhasalsobeen
contemplated. Numerous authors have tried to evaluate the
risk for complications in these new techniques, namely of
seromaformationandofvascularcompromise.
AsapaststudentofDr.VladimirMitzofParis,thepathfinder
of biplanar facelift, it was only natural to seek for the same
concept in lipoabdominoplasties. In search for a better
supporttothelowerabdominalwallandbetterutilizationof
theabdominalwalltissues,theauthorhascontemplatedon
theconceptofBiplanarAbdominoplasty.
Thebiplanarabdominoplastyconceptwillbepresented,based
ontheevolutionof285consecutivecasesofabdominoplasties,
MatarassotypesIIIandIV.Avectoranalysisandphysiologically
baseddiscussionof“howitworks”willbeoffered.Emphasis
willbegiventothefascialanatomyoftheabdominalwalland
the layers of dissection and tension in this technique. The
histologiccharacteristicsoftheSubscarpalLipoAponeurotic
System (SLAS) will be presented. Statistical data will be
presentedforthewholeseries,withafocusontheoutcome
andriskswhenthebiplanartechniquewasused.
Theauthorbelievesthatbiplanarabdominoplastyisanother
stepforwardinabdominalwallestheticsurgery.Theuseof
this novel approach enhances better results and patients’
satisfaction.
Introduction:Everynowandthenmedicalsciencedelightfully
surprisesus,andenrichesourknowledgewithbreakthroughs
whichrepresentreal“TechnologicalBooms”.Suchisthecase
with the discovery of Liposuction, by the French surgeon,
Ives-GérardIllouz,almostfourdecadesago.Thecontribution
of this procedure to the practice of plastic surgery, in both
thecosmeticaswellasthereconstructivedomain,hassimply
been formidable. Surgeries which once were impracticable
are now routinely performed all around the world. Truly,
specialized literature can now account for a “pre and postliposuction”era.
Material and Methods: More than 1500 patients, from both
genders,differentagesandethnicities,encompassingabout
4800bodyareas,wereoperatedonbetween1996and2012.
Surgeries were performed solely under local tumescent
anesthesia or complemented with peridural regional
anesthesiaincombinedprocedures.Theexperiencegained,
coupled with reports from world authorities, have enabled
theseniorauthortoidentifyandestablishthefollowingfacts
whichareconsideredofparamountimportanceinthedaily
practiceofthismarvelousprocedure:
1-LiposuctionandLiposculpturearenotsynonymous.
2 - Liposuction is widely acknowledged as the pioneer of
minimalinvasivesurgeries.
3-Itallowsfortreatmentofsmallaswellaslargevolumes
offat.
4-Representsatherapeuticoptionforobesity.
5 - Klein’s tumescent anesthesia is considered as the gold
standardinthissurgery
6-Practicallyallbodyareascanbesuccessfullysculpted.
7 - Liposuction has different connotations depending on
genderandrace
8-Liposuctionrepresentstheidealmeansforharvestingfat
graftsandobtainingstemcells.
9-Liposuctionisasafeprocedure.
10 - Liposuction achieves high grades in all performance
categories.
11-InnovationssuchasUALandLALhavenotlivedupto
theirexpectations.
12-Beliefswhichhavebeencompletelydemystified.
13-Classicalmaximswhichdefytime.
Conclusion: Like any other surgical technique, Liposuction
has udergone evolution, and incorporated innovations.
Although its indications have increased, the fundamental
pillarsremain.
57
1815
89
PREDICTORS OF PAIN INTENSITY AFTER
LIPOSUCTION
Presenter:
SergeyA.Plaksin,MD
Affiliation:
PermStateMedicalAcademy
Country:
Russia
Authors:
PlaksinSA,KhramtsovaNI
Theaimofthisstudywastoinvestigatetheintensityofapain
syndromeaftersuction-assistedlipectomy(SAL)andwater-jet
liposuction(WAL)in30patients.Painintensitywasassessed
ona10-pointscaleduringseveralhoursfollowingaliposuction
procedure.Similarly,thecontentoflipoaspiratewasassessed
forfreefatandthenumberoferythrocytes.Weanalyzedthe
relationship between pain intensity and the composition of
lipoaspirate. The results indicated that the free fat released
from the destroyed adipocytes was significantly higher (p =
0.04) after SAL - from 4 to 78% (median 27%), than after
WAL - from 0.8% to 50% (median 8%). The percentage of
destroyed fat in lipoaspirate positively correlated with the
intensity of pain on the day of liposuction (p=0.05; R=0.6).
Subsequently, the number of erythrocytes in 1 microliter of
lipoaspirate was calculated in the lower part of lipoaspirate
that is free of adipocytes. Lipoaspirate from different parts
of the body was collected into the separate containers.
The number of erythrocytes after SAL averaged 200,000
(median= 214,000; range 15,000 to 400,000) red blood
cells.WeobservedsignificantlyfewererythrocytesafterWAL
(p=0.002)averaging41500(median33,600;range8,600to
125,000).Thelowestbloodlosswasobservedintheabdominal
area (p=0.003): the average number of erythrocytes in that
area was 27,000 per 1 mL versus other areas averaging at
78,000.Theintensityofpainafterliposuctionwaspositively
associatedwiththenumberoferythrocytesinlipoaspirate,but
therelationshipwasnotsignificant(p=0.3;R=0.25).Itfurther
suggests the use of analgesics. Lipoaspirate after WAL and
SALdifferedsignificantlyinitscolor:itwaslessintenselyred
afterWALthanafterSALwhichcouldbedeterminedvisually.
Theintensityofcoloroflipoaspirateisassociatedwithgreater
tissue trauma, indicating the need to administer a higher
dosageofanalgesicsinthepostoperativeperiod.
1931
90
CRITICAL APPRAISAL OF SUPERFICIAL LIPOSUCTION,
POWER ASSISTED LIPOSUCTION AND VASER FOR
REFINEMENT OF BODY CONTOURING OUTCOME. 30
YEARS EXPERIENCE
Presenter:
RiccardoFrati,MD
Affiliation:
UniversityofRome
Country:
Italy
Authors:
FratiR,VadodariaS,GasparottiM
We are subspecilised in the field body contouring and
particularlyliposuctionforaperiodof10to30years.
Superficialliposuctionwaspopularisedbytheseniorauthor
(MG)andhasremainedamajorbreakthroughforachieving
softtissueretractionandskintightening.
Powerassistedliposuctionistimetestedandwellestablished
energy assisted device known to make fat extraction time
effective and allows the surgeon to use thinner cannulas
facilitating superficial liposuction with ease. The second
author(SV)usesPALforthelast10years.
VASER is becoming very popular for selective fat
emulsification allowing smooth superficial liposuction. The
advantage of VASER consisted in achieving a superficial
emulsification of the fat to define the relevant anatomy for
the muscle groups in each treatment area according to the
3Dliposculptureprinciples.Itisalsosuperiortoconventional
methods for liquefaction of the fibrous tissue matrix
particularly in gynecomastia and revision liposuction cases.
AuthorsacknowledgethatVASERistimeconsumingandhas
steeplearningcurve.
Atotalof3484patientsweretreatedoveraperiodof30years
inthreeseparateseries:51byRFusingVASER,1049bySV
using PAL, 2384 by MG using superficial liposuction. We
willpresentourauditedoutcome,complicationsandrevision
rates.
We believe that artistic use of the device is as important as
thedeviceitselftoachieveconsistentlysatisfactoryoutcome
inbodycontouringsurgery
58
91
IN VIVO CONTROL OF STEM CELL LOCATION
FOLLOWING IMPLANTATION USING AN INJECTABLE
MICROBEAD DELIVERY SYSTEM
1985 91
IN VIVO CONTROL OF STEM CELL LOCATION
FOLLOWING IMPLANTATION USING AN INJECTABLE
MICROBEAD DELIVERY SYSTEM
Presenter:
JosephK.Williams,MD
Affiliation:
SpherIngenicsInc
Country:
USA
Authors:
DosierCR,WilliamsJK,CohenDJ,BostLF,
BoyanBD,SchwartzZ
Introduction: Control of cell location after implantation
remains a challenge in cell based tissue engineering
strategies.Wehavedevelopedamicroencapsulationstrategy
toproducealginatemicrobeads200micronsindiameterto
controlretentionofcellsattheinjectionsite.Further,wehave
developedamethodtofacilitatecontrolledreleaseofcells.
Methods: Adipose-derived stem cells isolated from GFP
positive Sprague Dawley rats were labelled with Xenolight
DiR fluorescent dye and microencapsulated at a density of
10millioncells/mLalginate.Alginate-lyasewasincorporated
into the microbead formulations at various concentrations
toallowfordegradationofthemicrobeads.Microbeadswere
injectedintothemuscleofimmunocompromisedmice.Cell
retentionattheimplantsitewasmonitoredover14daysusing
a Maestro 2 imaging system. The inguinal lymph nodes,
lungs, heart and sternum were harvested after 14 days and
imagedforimplantedstemcellstoassesscelldelocalization
followingreleasefromthemicrobeads.
Results:Cellsinjectedinsalinesuspensionhadareductionin
signalof60%at14daysrelativetoday0signallevels(Figure
1).Microbeadslackingalginate-lyasehadanincreaseofsignal
of40%after14daysconfirmingcellretentionattheimplant
site. Lower doses of alginate-lyase displayed similar signal
levels to the microbeads lacking alginate-lyase, suggesting
limited degradation after 14 days. High dose alginate-lyase
resultedina10%increaseinsignalrelativetoday0signal
levels after 24 hours, and had declined to a 20% decrease
in signal level after 14 days due to release of the cells and
migrationfromthesite.Thecellsuspensionandhighdose
alginate-lyase groups resulted in fluorescence in the lymph
nodes following release (Figure 2). Lower doses of alginatelyaseresultedinnosignaldetectioninthelungsafter14days.
Discussion: We demonstrate control of cell retention in the
implantation site via microencapsulation and control of cell
release via alginate-lyase incorporation in a dose dependent
manner. This technology will enhance the effectiveness of
cell based tissue engineering strategies currently limited by
failureofretentionofcellsintheimplantationsite,andmay
improvefatcellgrafting.
59
1854 92
ADIPOSE-DERIVED STROMAL VASCULAR FRACTION
CELLS AND PLATELET-RICH PLASMA: BASIC AND
CLINICAL EVALUATION FOR CELL-BASED THERAPIES
IN PATIENTS WITH SOFT TISSUE DEFECTS OF THE
FACE
Presenter:
PietroGentile,MD,PhD
Affiliation:
UniversityofRomeTorVergata
Country:
Italy
Authors:
GentileP,CervelliV
1995 93
COMPARISON OF CONVENTIONAL FAT GRAFTING
AND CELL-SUPPLEMENTED LIPOTRANSFER IN ATHYMIC RATS
Presenter:
AlexandraConde-Green,MD
Affiliation:
UniversityofMarylandMedicalCenter&
JohnsHopkinsUniversity
Country:
USA
Authors:
Conde-GreenA,WuI,GrahamI,ChaeJ,
SinghDP,HoltonIIIL,SlezakS,ElisseeffJ
Background:Actually,autologousfatgraftshavemanyclinical
applications in breast surgery, facial rejuvenation, buttock
augmentationandRombergSyndromeandasatreatmentfor
liposuctionsequelae.
Purpose:Autologousfatgraftinghasbecomeattractiveforthe
treatmentofsofttissuedefectsinaestheticandreconstructive
procedures. However variations in long term results are
reportedmainlyduetounpredictabledegreesofresorption.
Studieshavebeenconductedtooptimizeeveryparameterof
theprocedurestillthemostcontroversialpartisfatprocessing.
With the growing interest in adipose-derived stem cells
(ADSCs), another approach has been to enrich the fat with
regenerativecellsinordertoimproveangiogenesisandgraft
survival.Thereforeweaimedtocomparecell-supplemented
lipotransfer with conventional fat grafting and evaluate the
outcomes of these grafts to determine which method leads
toahigherpercentageofgraftretentionandabetterquality
graft.
Objective: It is the aim of work to describe the preparation
and isolation procedures for Stromal Vascular Fraction
(SVF),preparationofPlateletRichPlasma(PRP),andclinical
applicationinthetreatmentofthesofttissuedefectsofthe
face.
Methods: 20 patients, affected by Romberg syndrome (n =
5),softtissuedefects(n=5)outcomesofburn(n=6),posttraumatic scars (n = 4) were treated with SVF-enhanced
autologous fat grafts obtained by Celution® System. 20
patients, affected by Romberg syndrome (n = 5), soft tissue
defects (n = 5), outcomes of burn (n = 5), post-traumatic
scars(n=5)weretreatedwithfatgraftingbasedonColeman
techniquemixedwith0.5mlofPRP.Inordertoestablishthe
effectsoftheirtreatment,theauthorscomparedtheirresults
with a control group made up of 10 patients treated with
centrifugedfat.
Methods:Atotalof32subcutaneousinjectionsofprocessed
human lipoaspirates (8 samples decanted, 8 washed with
normal saline, 8 centrifuged at high speed and 8 cellsupplemented) were carried out in eight athymic rats. Each
animalreceived4differentconditions,inarandomfashion
and was followed for 12 weeks. Evaluation included serial
measurementsofvolumeretentionandhistologicalanalysis.
Results:InapatientstreatedwithSVF-enhancedautologous
fat grafts, we observed a 63% maintenance of contour
restoringafter1yearcomparedtoonly39%ofcontrolgroup
(n = 10) treated with fat graft centrifuged (p< 0.0001). In
patients treated with fat grafting and PRP, we observed a
69%maintenanceofcontourrestoringafter1yearcompared
tocontrolgroup(n=10).
Results: All four techniques were able to maintain volume
correction for the duration of the study, however cellsupplemented and centrifuged grafts showed consistent
volume maintenance. Based on histological analysis, cellsupplemented and washed grafts showed higher scores of
viabilityandvascularitywiththelatterpresentingfewercystic
necrosis,minimalinflammationandlesscalcification.
Conclusion:Asreported,theuseofeithere-SVForPRPmixed
withfatgraftingproducedanimprovementinmaintenance
ofvolumeinpatientsaffectedbysofttissuedefectoftheface.
Conclusion:Graftretentionisastrongindicatoroflongterm
survival of fat grafts, so are viability and vascularity. Cellsupplemented lipotransfer had optimal outcomes, while
washingresultedinhighviabilitywithalessintensiveprocess,
andhigh-speedcentrifugationresultedinconsistentvolume
retention but less viability. These approaches offer distinct
advantagesmakingthemidealunderdifferentcircumstances
andcontributetotheversatilityandreliabilityoffatgrafting.
Whenusingfatgraftinginchallengingcases(fibrosis,delayed
woundhealing),viabilityandvascularityplayanevenbigger
roleinthelongtermsurvivalofthesesegrafts.
60
1998 94
MAXIMIZING THE AESTHETIC RESULT OF BODY
CONTOURING WITH LIPOSUCTION, LIPOFILLING
AND LIPOABDOMINOPLASTY
Presenter:
JorgeMarcos,MD
Affiliation:
ClinicaVitalis
Country:
Peru
Authors:
MarcosJ,MarcosH,MarcosF,UriarteM
The cosmetic surgery body contouring with liposuction
circumferential lipoabdominoplastia and lipofilling in the
samesurgicalprocedureisaprocedurewithexcellentresults,
though controversial and rare. Traditionally associated with
anincreasedrisksurgicalofthromboembolismandhealing
complications, however, improvements in the prophylaxis
of thromboembolism, in abdominoplasty techniques with
preservation of perforators and scarpa fascia, and better
understanding of surgical anatomy have reduced this risk,
therefore,itsusehasincreasedinrecentyears.
Methods: We report our experience of five years which
combines liposuction, lipofilling and lipoabdominoplastia
in one surgery, 120 patients were operated female between
24and66yearsofage(mean,39years),weighingbetween
52and116kg(mean,73kg),80%overweight.Theclassical
lipoabdominoplasty was performed in 58% of cases, 22%
minilipoabdominoplasty and 20% inverted T or anchor.
All interventions were performed with epidural anesthesia,
sedationandlocal;liposuctionwasperformedwithsuper-wet
technique,startingwiththeanterior,posteriorandliposuction
flanks. The lipofilling gluteal was performed with patient
supine and hips on her side. The lipoabdominoplastia was
performed using the technique limited dissection saldanha
with respect abdominal flap perforators, Scarpa’s fascia and
plicationoftherectusmusclesconcerned.
Results: Obtained with liposuction between 1200 to 10500
ml of fat (mean, 3900 ml), graft-hip buttocks between 160
to1000ineachside(average360g)andwasremovedfrom
120to800grsintheflapabdominal(mean,540g).In16%
had minor complications included mild wound dehiscence
that resolved with healing, seroma. There were no major
complications.
Conclusion:Thecombinationofcircumferentialliposuction,
lipofillingandlipoabdominoplastyisacombinationthatgives
excellentresultswithminimalcomplications.
61
1744 95
ANTI-AGING TREATMENT OF THE FACIAL SKIN BY
ADIPOSE-DERIVED STEM CELLS
Presenter:
NataleF.Gontijo-de-Amorim,MD
Affiliation:
VeronaUniversity&PontificalUniversity
CatholicofRiodeJaneiro
Country:
Brazil
Authors:
Gontijo-de-AmorimNF,Charles-de-SaL,
TakiyaCM,BorojevicR,BenatiD,BernardiP,
SbarbatiA,RigottiG
Background:CelltherapyusingStemCellsisanewmodality
that arises as a new paradigm. Adipose-derived stem cell
(ADSC)hasgreatregenerativepotentialandiseasytoobtain.
Skinagingisaresultoftheactionofextrinsicandintrinsic
processes(byownage).Theaimofthisstudyistodetermine
whethertheapplicationofADSCsshouldaffecttheskinaging
process demonstrated by histological, histomorphometrical,
andimmunohistochemicalanalysis.
Methods: A prospective, randomized study was conducted
in20healthpatientsofbothgenders,agedbetween45and
65 years, with neck and face flaccidity. Dermal application
of 2 x 106 ADSCs was done in 1 cm2 of left pre-auricular
region (adipose tissue harvested from the lower abdomen
and expanded ex vivo). A biopsy was done, 15 days prior.
After 4 months of the ADSCs application, a second biopsy
was performed for comparative analysis by histological,
histomorphometricalandimmunohistochemicalstudies.
Results:Theadiposetissuefromlowerabdomenprovedtobe
arichsourceofadultstemcells,withanaverageof8.65x106
mesenchymalcellsafterexvivoexpansionfromeach10mLof
lipoaspirate.Theagedskinshoweddifferentdegreesofelastic
fibers network damage: decrease in oxytalanic fibers and a
variedamountofelastosisandelastogenesis.Celltherapyled
toanincreaseoftheoxytalanicandelasticfiberssynthesisin
associationtothedecreaseinelastoticzones.
Conclusion: The adipose tissue is a rich source of ADSCs,
showing a regenerative effect on the skin, through their
mesenchymal stem cells, promoting increased production
ofnewelasticfibersandtheremovalofelastoticareas.The
mechanismsoftheseprocessesarestillunknown.
Free Paper Session 8 - Reconstructive Aesthetic I
2054 96
CERVICOFACIAL FLAP FOR RECONSTRUCTION OF
CHEEK DEFECTS
Presenter:
MarcoRios,MD
Affiliation:
UniversityofSaoPaulo
Country:
Brazil
Authors:
RiosM,BarreiroG,DoiA,BusnardoF,
GemperliR
1668 97
HYPERTELORISM: THE HEMIORBITAL
TRANSPOSITION, A SIMPLE METHOD FOR
CORRECTION AND A TEN YEAR FOLLOW UP
Presenter:
AlaaA.Gheita,MD
Affiliation:
FacultyofMedicineCairoUniversity
Country:
Egypt
Author:
GheitaAA
Largeoncosurgicaldefectsofthecheekpresentachallenging
reconstructive problem and the cervicofacial flap has been
the reconstruction of choice for midface soft tissue defects.
Deep plane dissection and the subcutaneous approach has
been advocated to decrease complication rates and improve
results. This paper describes the experience of the team of
plasticsurgeryattheInstituteofCancerofSaoPaulo(Octavio
FriasdeOliveira)-ICESP,thereconstructionofdefectsofthe
faceusingthecervicofacialflap.
The indication for surgery in hypertelorism congenital
anomaly is primordial for aesthetic reasons. The challenge
ofgoodsurgicalcorrectionoforbitalhypertelorismisgreater
thanforanyothercraniofacialskeletaldeformitiesbecauseof
problemsassociatedwithsofttissuecoaptationtothecorrected
skeleton.Theauthorpresentindetailanewprocedurewitha
longtermfollowup.Hehasappliedthismethodinthepast
10 years. The suggested method has multiple advantages
mainlybeingmoresimpletoperform,shorteroperativetime,
saferandreliable.Itsconceptistheexcisionofexcessivebone
&tissuesinthemidlinefollowedbyverticalsectionofeach
orbit in its middle rather than total mobilization of the two
orbits which is more difficult and necessitate much longer
operativetime.Themedialhalvesofbothsectionedorbitsare
mobilized medially then approximated to each other in the
middle line. The excessive bones removed from the middle
lineorthecenteroftheforeheadaretransposedlaterallyon
thesuperiororbitalrimsoastoblockthemovedmedialparts
from shifting outward later on long term. This procedure
hasmanyadvantagesmainlyashasbeenpointedoutbeing
mucheasiertoperformthusshorteroperativetime,withless
complication and still very satisfactory results on long term
followup
Methods: We present our experience with cervicofacial flap
for reconstructing cheek defects resulting from excision
of primary cutaneous malignancies and metastatic parotid
and/orneckdiseasewithskininvolvement.Twentypatients,
between62and87yearsofage,underwent20cervicofacial
flapsforcheekreconstruction.Alltheflapsweredetermined
by the location of the defect and the need for simultaneous
parotidectomyand/orneckdissection.
Results: The size of the cutaneous defects ranged from 5.3
x4.1to9.2x6.9(mean7.1X5.9)cm.Superficialmarginal
flap necrosis occurred in one patient. Only one developed
ectropion in acute phase, with spontaneous resolution over
aperiodof3.5months.Inonecasetherewasaneedanother
surgery because of hematoma formation in the immediate
postoperative period. There was no facial nerve damage
during reconstruction, although in the 2 buccal branches
wereinjuredduringtumorresection.Ninetyfivepercentof
patients endorsed the quality of the final result, only one is
notsatisfiedwiththeaestheticandfunctionalresult.
Conclusion: The reconstruction with cervicofacial flap is
versatilereconstructivetechniqueinheadandnecksurgery.
Thisunitisreliablewithexcellentvascularityandlowrates of
necrosis,becauseithasanreliableaxialbloodsupply.
62
1947 98
PROPHYLACTIC MASTECTOMIES AND IMMEDIATE
BREAST RECONSTRUCTION WITH PROSTHESES. OUR
WAY TO DO IT, THE P-SCAR
Presenter:
AymanZakaria,MD
Affiliation:
TeresColosseumStavanger
Country:
Norway
Authors:
ZakariaA,NystedA
1808 99
THE USE OF MYO-CUTANEOUS LATISSIMUS DORSI
FLAP WITH A FAT EXTENSION TO FULFILL THE UPPER
POLE
Presenter:
JoaoM.Tavares-Filho,MD,PhD
Affiliation:
FederalUniversityofRiodeJaneiro
Country:
Brazil
Authors:
Tavares-FilhoJM,FrancoD,FrancoT
Immediate reconstructions after prophylactic Mastectomies
aredifficult;themostcomplicatedandmostdifficultofthem
allarethereconstructionswithprostheses.
Theauthorspresentaseriesofcasesofbreastreconstruction
withlatissimusdorsiflapwithafatextension,associatedwith
siliconeprosthesis.
Wewanttoshowyouourtechnique,whythepatternofour
scar,anddiscussthemostcomplicatedaspects,andshowyou
someofourcases.
The idea was to add part of the lombar fat fold to fulfil the
upperpoleofthenewbreast.Thebreastvolumewasgivenby
siliconeprosthesis,whilethelombarfatwasposicionedatthe
infra-clavicularregion.
We do not use the entire dorsal fat, only a segment
correspondingtotheregionwherethereisalackofsamein
theareaofthenewbreast.
The technique is simple and reproducible in most patients
andtheresultswereverysatisfactoryandlong-lasting.
Magnetic resonance imaging tests proved the adipose
segmentmaintenanceinthedesiredarea.
63
100
PRE-EXPANDED CERVICO-ACROMIAL
FASCIOCUTANEOUS FLAP BASED ON THE
SUPRACLAVICULAR ARTERY FOR RESURFACING HEAD
AND NECK DEFECTS
1783 100
PRE-EXPANDED CERVICO-ACROMIAL
FASCIOCUTANEOUS FLAP BASED ON THE
SUPRACLAVICULAR ARTERY FOR RESURFACING HEAD
AND NECK DEFECTS
Presenter:
ZheYang,MD
Affiliation:
HospitalofPekingUnionMedicalCollege
Country:
China
Authors:
YangZ,LiYQ,TangY,HuCM,ZhaoMX,
ChenW,MaN
Objective:Largesofttissuedefectsofheadandneckposea
challengeforplasticandreconstrctivesurgeons.Toimprove
functionalandcosmeticresults,toperformwithminimal
donor sitemorbidity,weusepre-expandedcervico-acromial
fasciocutaneousflapbasedonthesupraclaviculararteryasa
feasiblechoiceforheadandneckreconstruction.
Methods:From2008to2013,theexperienceofsofttissue
defectsintheheadandneckregionof22patients(agerange
between5to42years)with25pre-expandedcervico-aromial
flapswasreported.Inthefirststage,oneortwoexpanders
wereimplantedonthedeepfasciaofthesupraclavicular
toacromionregion,andthena600-800mlofsalinewas
injectedduringa100-120daysperiod.Afterexpansion,in
thesecondstage,alargeamountofskinwasobtainedto
resurfacedefectsofhead(3cases)andneck(19cases).Donor
sitedefectswereclosedprimarilywithouttensionexceptone
casewithfreeskingrafting.
Results:Allthe25flapshealedprimarilywithgoodfunctional
andcosmeticresults.Themaximumsizewas22*16cm,
whereastheminimumwas10*10cm.Clinicalfollow-up
wasperformedbetween3to24monthspostoperatively.A
significantimprovedfunctionwithgoodestheticoutcomewas
achieved.Postoperativecomplicationincludedflapsagging
orepidermolysisin4flapsduringtheearlyperiod,andthe
donor sitesscarswereacceptablewithoutfunctionalmobility.
Conclusions:Pre-expandedcervico-acromialfasciocutaneous
flapbasedonthesupraclaviculararterycanprovidealarge
amountofthintissueofbothgoodcolorandtexture,without
theneedformicrosurgeryanddonorsitemorbidity.Itisan
usefulandreliablereconstructiveoptionforresurfacinglarge
skindefectsoftheheadandneck.
64
1688 101
THE HEALING WITH MINIMALLY VISIBLE SCAR - OUR
EIGHT YEAR EXPERIENCE WITH NEONATES CLEFTLIP-SURGERY
Presenter:
JiriBorsky,MD
Affiliation:
FacultyHospitalKralovskeVinohrady&3rd
FacultyofMedicineCharlesUniversity
Country:
CzechRepublic
Authors:
BorskyJ,JurovcikM,VeleminskaJ,
CaganovaV,KabelkaZ,BiskupovaV,
BartonikovaA,VlkR,JanotaJ,ZachJ,
PeterkaM,PeterkovaR,TkaczykJ,
BrabecR,CernaO,MestakO,CernyM
2030 102
AUGMENTATION RHINOPLASTY USING TIPCOLUMELLA INTEGRATED COSTAL CARTILAGE GRAFT
Presenter:
KztsuyukiTorikai,MD,PhD
Affiliation:
FureaiYokohamaHospital
Country:
Japan
Authors:
TorikaiK,NaganishiH,KijimaT,NagaokaR
Introduction: We present the results of our eight-year
experience with neonates cleft-lip-surgery with newborn
patientsupto8daysold.
Material and Methods:Weoperatedonpatientswithunilateral
andbilateralcleftliporcleftlipandpalateattheageof1to
8 days after birth: 343 neonates with unilateral cleft lip and
75withbilateralcleftlip.Allsurgerieswereperformedfrom
December 2005 to December 2013 by one surgeon. Preoperative care was given by neonatologist in the well baby
nursery and post-operative in the NICU. The first phase is
initiated by ENT specialist who evaluates torus tubarius.
Followsexaminationoftheeardrumandsuckingoutmiddle
earfluidifpresent.Orofacialphysiotherapystartedonthefirst
postoperativeday.Newbornslefthospitalbetween3rdand4th
postoperativeday.Allpatientsworesupportivesiliconnostril
retainersfor2-3months.Inaddition,beforethesurgerywe
performed 3D scans of palate shaped casting using laser
ScannerRolandLPX250andFESAmethodaswellasfacial
scannerVectra3D.
Results:Wehaveexperiencedonly4complicationsresulting
from this surgery. At the time of patients’ discharge the
woundswereusuallyhealed.Wepresumethattheaesthetic
resultsaresuperiortopatientsoperatedin3monthsandlater.
Comparison of 3D scans of palate and face between study
groupandcontrols(patientsoperatedat3months)revealed
nosignificantdifferenceinmaxilaandfacegrowth.
Discussion: Cleft lip is usually operated on at the age of
3 months or later. It puts psychological pressure on their
families, especially due to the visible disfigurement. By
correcting the patients’ cleft lip before they leave hospital,
atleastpartoftheproblemissolvedevenbeforeitcantake
effect and therefore the quality of life of the whole family
significantlyimproves.Intheeventofsuperiorneonatal,safe
proceduresofanesthesiologicalandENTcareareavailable.
Conclusion:Ifperformedunderhighqualityanesthesiological
conditions, neonatal, and ENT care settings, and of course
with experienced hands, the early correction of cleft lip is a
safe and reliable method for neonates and gives very good
aesthetic results. Support by MH CZ-DRO, University
HospitalMotol,Prague,CZ00064203
65
Background: In the treatment of cleft lip and palate, it is
idealtogetthebestresultsafterallthetreatmentshavebeen
completed.Especially,toobtainestheticallysatisfyingresults
of nose is still challenging. We have been performing one
stage repair of cleft lip and palate including primary cleft
rhinoplastyandwemakeitarulenottoperformsecondary
revisionintheirchildhood,asbestwecan.However,itisvery
difficult to acquire symmetrical shape of nose by primary
operationaloneandnotafewcasesrequiresecondaryrepair
ofnoseasafinalsurgery.Weperformsecondaryrhinoplasty
by the use of septal cartilage. But there are some cases
whereenoughbearingpropertycannotbeobtainedbyseptal
cartilage.Weperformaugmentationrhinoplastyusingcostal
cartilage-newlydesignedtip-columellaintegratedtypeofgraft
tosuchcases.Inthispresentation,wearegoingtodiscussthe
operativemethodandthetreatmentresultsofaugmentation
rhinoplastyusingcostalcartilage.
Methods:BetweenApril2009andMarch2013,weperformed
augmentation rhinoplasty using costal cartilage to total 21
cases.WeusedVIorVIIcostalcartilageasadonorcartilage.
If VII costal cartilage was enough in quantity, we used VII
costal cartilage. The straight part of the harvested cartilage
was utilized for the dorsum augmentation and the rest was
usedfor the columellapart. The twopartswere curvedand
integrated by suture into L shape and grafted through the
reverseUincisionofthenoseandfixedwithsuture.
Results: So far, we have had satisfying results in all cases.
Onecasedevelopedlocalinfectionandanothercaserequired
reoperationduetothewarpingofgraftedcartilage.
Discussion: This method enables us to repair the external
nose from the root of the nose to the nasal tip with robust
bearingproperty.Exceptforthecaseinwhichthepatientdoes
not wish a drastic change of nose, we can recommend this
method as one of the esthetic strategies for the secondary
repair of external nose. The worst disadvantage of this
method is the possibility of warping of grafted cartilage. To
avoidwarping,weusenaturalcurveofthedonorsite.
1826 104
THE KLD FLAP; ADRESSING LATERAL CHEST WALL
COSMESIS WITH LATISSIMUS DORSI BREAST
RECONSTRUCTION
Presenter:
JoaoCorreiaAnacleto,MD,FPCS
Affiliation:
ChampalimaudFoundation
Country:
Portugal
Authors:
CorreiaAnacletoJ,ComendaMaviosoC,
MartinsJ,GomesPintoD,GouveiaP,
MagalhaesA,SantosMouraA,CardosoMJ
1982 103
PORCINE VS HUMAN ADM IN IMMEDIATE BREAST
RECONSTRUCTION
Presenter:
JasonR.Taylor,MD
Affiliation:
KaiserPermanente
Country:
USA
Authors:
TaylorJR,KivulsJ
ADMs in immediate breast reconstruction with breast
implantshasbeenwelldocumentedandacceptedforuse.(1)
The purpose of this study is to compare the use of porcine
ADMwithhumanADM.Glassberg(2)andSalzberg(3)have
reportedresultsthatarecomparableforuseofbothproducts.
GlassberghasshownalowerseromaratewithporcineADM.
The Latissimus Dorsi (LD) flap, first described by Tansini
in 1897, is a commonly used tissue transfer for volume
replacement,eitherfortotalorpartialmastectomydefects.In
thiseraofcosmeticawarenessandoncoplasticbreastsurgery,
theconventionaltechniquepresentedtwomainconcerns;the
largeobliquebackscarandthebulkinessonthelateralchest
wall,undertheaxilla.
Weconductedaconsecutivecasereviewovera4yearperiod.
This involved one hospital, 4 general surgeons and 2 plastic
surgeons. All cases of immediate breast reconstruction for
mastectomy using tissue expanders or breast implants with
ADMswereincludedforcalendaryears2010to2013.In2010
and2011wewereusinghumanADMandin2012and2013
porcineADM.
Harvesting has been addressed in several ways, from
shortening of the scar to the endoscopic approach, with less
traumatictissuedissection,enablingpatientstobenefitfrom
reducedpostoperativepain,shorteradmittancesandimproved
cosmesis.
Results: Study includes 153 patients with 234 reconstructed
breasts.ResultsaredividedintohumanADM98andporcine
ADM136.Proportionoflarge,medium,andsmallADMsused
wassimiliar.TheageandBMIwereconsistentthroughoutthe
study.
Lateral chest wall deformities have not been so widely
thought of, although the resulting defect associated with the
conventionaltechnique,evenwhentheproximaltendoniscut,
canbequitedisturbingformanypatients.
MastectomyInitialfillImplantInfectionSkinSeroma
Weightvolumelossloss
Tryingtoimprovelateralchestwallcosmesiswe developedthe
kLD(kiteLatissimusDorsi):thisconsistsinpedicledissection
fromthemuscle,perforatorflapstyle,untiltheexternallimitof
thebreasttobereconstructed,leavingnounnecessarybulkiness
undertheaxilla.Aretrospectivestudywasdone,comparingtwo
patientcohorts,onesubmittedtotheconventionaltechnique
andtheothertothekLDreconstruction.
HumanADM:793grams279ml7(7%)6(6%)4(4%)5(5%)
PorcineADM:622grams343ml4(3%)7(5%)13(10%)24(18%)
Inthelast18monthsnipplesparingmastectomy(NSM)has
beenusedinourgroup.In2013:21/73mastectomieswereNSM.
6/21breastshadskin/nippleloss.Ifthesecasesareexcluded,
the skin loss rate for porcine ADM becomes 5%, which is
similartohumanADM,therestofcomplicationratesremain
unchanged.TheseromarateforporcineADMismuchhigher,
butsuccessfulreconstructionwasachievedwithinfectionand
implant loss rates the same as human ADM. Complications
wereassociatedwithradiationtherapy,smoking,diabetesand
highBMI,butnotpredictive.Expansionprocessandaesthetic
outcomesappearequivalent.
BreastQwasusedtoassesspatientsatisfactionandtheBCCT.
coretoevaluateaestheticoutcome.Procedureswereundertaken
bythesameoncoplasticteam(LevelIIIOncoplasticTraining
Unit).StatisticanalysiswasdoneusingSPSSv21andtheQuisquaretest.ThecosmeticanalysisusingtheBCCT.coresoftware
showednodifferenceswithstatisticalsignificancebetweenthe
twogroups;BreastQquestionaireresultswereonlysatistically
significantregardingthesensationofmuscularcontractionin
thebreast(feelingoflateralpull).
Conclusion: The use of porcine ADM and human ADM in
immediatebreastreconstructionarecomparable,withgreater
seroma rates in porcine ADM. Our outcomes are similar to
otherreports(4)
While the cosmetic evaluation showed no differences using
theBCCT.core,probablyduetotheuseoffrontalviewsonly,
thisnewtechniqueseemstoimprovethefeelingofcontraction
reportedbypatientsinthebreastarea,possiblyrelatedtothe
fixationoftheproximalborberoftheflaptothelateraledgeof
thebreast.
66
1969 106
USING FACTORIAL EPIDERMIC GROWTH (FEG) ON
BURNED PATIENTS
Presenter:
RicardoManzurAyala,MD
Affiliation:
ClinicaReinaCatalina
Country:
Colombia
Authors:
ManzurAyalaR,CarrilloJ,DonadoR
1739 105
THE ‘DOWN SLIDING’ OSTEOTOMY; HIGHLIGHTING
AN UNDER-USED SURGICAL TECHNIQUE TO
RECONSTRUCT THE DEFICIENT MAXILLA
Presenter:
NatashaL.Berridge,BSc(Hons),BDS,BM,
MFDS,MRCS
Affiliation:
NorthwickParkHospital
Country:
UnitedKingdom
Authors:
BerridgeNL,HeliotisM
Vertical‘downgrafting’ofthemaxillaisrutinelyperformed
using orthotopic bone graft or heterotopic donor bone
products.Itiswelldocumentedthatwiththisapproach,bone
graftingdoesnotalwaysresultinafavourablestableoutcome
as relapse commences before complete integration of the
graft.
We wish to highlight the ‘down sliding’ osteotomy, first
described by Reyneke in 1985, which allows anterior and
inferior movement of the maxilla after a ‘z’ shaped Le Fort
1 osteotomy is performed. Bony contact is preserved at the
medialpyriformandlateralmaxillarybuttressesasthemaxilla
displaces down a sloping plane, thereby obviating the need
for bone grafting. We demonstrate how to decide wheteher
a patient is suitable for this technique by utilizing Visual
TreatmentObjectiveSchematicspriortothecommencement
ofpre-surgicalorthodontics.
The ‘down sliding’ osteotomy is a straightforward and
reliabletechnique.Itavoidsthenecessityofadonorsurgical
site, thereby minimizing operating time and hospital stay.
We believe that the ‘down sliding’ osteotomy is a highly
cost-effective yet under-used surgical technique to manage
maxillarydeficiencyandshouldbecontemplatedforsuitable
cases.
67
Epidermal growth factor (EGF) is a polypeptide with 53
amino acids, which it is produced by alive organisms or in
ourcase,weuseEGFobtainedtorecombinantbiomolecular
engineering,expressedinE.coli.Thispolypeptideuseforthe
mitogenactivitythatallowsthecellularregenerationandin
ourspecificcasethewoundhealingofburnedareasinspecial
zones, allows to diminish the surgical procedures and an
earlyrecoveryofthecorporalburntsurface.Wewillpresent
ourexperienceshowingthecasuistryandtheresultsobtained
withthistypeoftreatment.
1706 107
TREATMENT OF GIANT NEVUS WITH LARGE SHEET
OF SCALP IN CHILDREN
Presenter:
XiangboYe,MD
Affiliation:
NavyGeneralHospitalPLA
Country:
China
Authors:
YeX,ShiZ,YuY
107
TREATMENT OF GIANT NEVUS WITH LARGE SHEET
OF SCALP IN CHILDREN
Background: Giant congenital melanocytic nevus could
disturbthechildrensmentalandphysicaldevelopment,and
turn into malignant melanoma at the rate of 4%~12%. The
earlytreatmentofgiantnevusinchildrenisnecessary.
Objective:Toevaluatetheclinicalefficacyofthelargesheetof
scalptransplantationinchildrengiantnevustreatment.
Methods: The treatment procedure included three stages.
Pre-operation stage: 1) scalp measurement to determine
the excision area of giant nevus; 2) blood component
reservation. Operation stage: 1) scalp excision and nevus
excisionconductedatthesametime;2)nevusexcisionarea
partitionedintoseveralparts;3)inflationfluidpreparedwith
phenylephrinetoreducebleeding;4)nevusexcisedseparately
with careful hemostasis. Post-operation stage: 1) circulation
system management; 2) scar inhibition treatment. The
surgicalareasize,skintexture,skincolor,andscarformation
wereobservedaftertreatment.
Results:FromMarchof2008toOctoberof2012,7children(5
malesand2females)receivedpartialexcisionofgiantnevus
andlargescalptransplantationinourdepartment.Themean
age was 6.8 years old. The post-operative follow-up period
rangedfrom8monthsto4years.Theareaofsurgeryranged
from4.33%to9%oftotalbodysurfacearea,5.48%onaverage.
Thesatisfactoryeffectswereobtainedinall7cases.Thecolor
of operative area approached the normal skin, occasionally
withscatteredpigmentationandmildhypertrophicscars.The
hairgrowthwasnormalatthedonorsite.
Discussion: Excision procedure could avoid relapse or
malignanttransformationofgiantnevus.Asfarasthescalp
areainchildren(5-6%oftotalbodysurfacearea)concerned,
singlesurgerywithscalpcouldcovermoregiantnevusareain
childrenthaninadult.However,becauseofspecialcirculation
system in children, this procedure takes serious risks in
preventingcirculatoryfailure.
Conclusion:Thegiantnevusinchildrencouldbetreatedwith
thelargesheetofscalp.Thegraftedskinshowednosignificant
pigmentation,andscarformation.
[Keywords] Giant congenital melanocytic nevus; Scalp; Skin
transplantation
68
1922 108
THE NEW METHOD OF ENLARGEMENT OF THE PENIS
Presenter:
RubenAdamyan,DM
Affiliation:
ClinicK31
Country:
RussianFederation
Authors:
AdamyanR,GulyaevIV,StarcevaOI,
IstranovAL
2056 109
NASAL RECONSTRUCTION USING THE MIDLINE
FOREHEAD FLAP
Presenter:
FredericoSantos,MD
Affiliation:
BrazilanSocietyOfPlasticSurgery
Country:
Brazil
Authors:
SantosF,PazM
To date, all existing methods of thickening of the penis
anywaybasedontheincreaseinthevolumewithautologous
tissues: skin, fat or muscle flap. The spectrum of tissues is
wide enough: rotation flaps (for example, inguinal flaps) to
complex microsurgical reconstruction. All these techniques
are difficult to use, and postoperative care lasts for weeks
and sometimes months of rehabilitation. In addition, these
proceduresaretraumaticenough:thescatsaftersurgerycan
notalwaysbehiddenunderclothing.Regardingtheresultsof
operationsisnotalwayspossibletopredictthefinalthickness
of the penis, because the tissues used for its thickening in
thefirst6monthsaftersurgerycansignificantlydecreasein
volume.Alsoasaresultofunpredictablescarringprocesses
thepossiblecontracture(contraction)ofthepenismayexist,
whichleadstoareductioninitslengthandcurvature.
Brazilisatropicalcountrywherethesunexposureisafeature
of your population. Due to this factor, it is very often the
developmentofskinlesionsrequiringsurgery.Andthenose
is a very committed organ. The objective of this study is to
evaluate the use of mid-frontal flap in nasal reconstruction
after oncological resections. The technique was used in
betweenJuly/2003andDecember/2013admittedinCaruaru
Regional Hospital in Pernambuco. The procedure was
performedinassociationbetweenPlasticSurgeryandHead
and Neck Surgery. We evaluated the amount of nasal tissue
affected,definingstructureswhichrequirerepair,providing
an adequate aesthetic and functional result. There were
no complications during surgery. In most cases there was
involvement of at least three nasal subunits. Not suffering
tissue was observed. When indicated, the use of cartilage
grafts was performed in first repair time. An aesthetic and
satisfactorynasalfunctionwasachieved.Theuseoftheflap
could satisfactorily replace the resected cutaneous tissues,
including mimicking the nasal skin, with good aesthetic
result.Therespiratoryfunctionofthenosewaskept.Inthis
study,thetechniqueprovedtobesafeandagreatalternative
inthecurrentpracticeofnasalreconstruction.
As for injecting methods of thickening of the penis with
nonresorbable fillers, which until recently actively practiced
inaestheticsurgeryofthepenis-thesemethodsposeadirect
threattothehealthofpatientsisthereforeprohibitedtouse.
Augmentationofpeniswithimplants-isasafeprocedurethat
doesnotrequirethelongrehabilitationperiod.Theoperation
takesalittletime,doesnotrequiregeneralanesthesiaandis
performedunderspinalanesthesia.Theprocedurestartswith
twoincisionsatthecoronaoftheglance.Thentwosilicone
implantsareinsertedundertheskinofthepenis.Thusthe
diameterofthepenismaybeincreasedfor10-50%
Twentypatientsweretreatedbythismethodofthickeningof
thepenis.Weachievedagoodcosmeticresultinallcases.
69
Free Paper Session 9 - Facial Rejuvenation II
1799 110
AUTOLOGOUS PLATELET DERIVED FOR
RHYTIDECTOMY
Presenter:
FernandaRibasPereira,MD
Affiliation:
HospitalMoinhosdeVentoandPoliclinica
Miramar
Country:
Brazil
Author:
RibasPereiraF
110
AUTOLOGOUS PLATELET DERIVED FOR
RHYTIDECTOMY
Introduction: The hematoma is the most common
complicationpostrhytidectomy,observedinmostofthetime,
inthefirst24h.Theuseofplatelet-derivedsealants(biological
sealant) are an alternative to improve the adhesion of the
flaps, reduce fluid drainage, the incidence of hematomas,
ecchymosis,edemaandpostoperativepain.Theautologous
fibrinsealant(PlateletPoorPlasma)isrichinfibrinogen,has
haemostaticfunctionsandthePRGF(PlasmaRichinGrowth
Factors) has a higher concentration of platelets that release
proteinsandbiologicalgrowthfactorsnecessarytostartand
accelerate the natural process of repair and regeneration of
tissueactivity,reducinghealingtime,painandedema.
Objective: Patients underwent a rhytidectomy were treated
withtheAutologousFibrinSealantonthedetachedflapsand
the PRGF were applied in the scars and as a mesotherapy.
Weanalyzedtheoccurrenceofhematomas,ecchymosis,fluid
secretions,edemaandscarringinthefirst24hourspost-op
andscarsqualityat12monthsposop.
Methods: The procedures were performed at Miramar
PolyclinicinPalmadeMallorca-SpainandHospitalMoinhos
deVentodePortoAlegre-Brasil,fromJan2010toOct2013,
consistingof105patientsunderwentaCarbonell’stechnique
rhytidectomy, treated with Autologous Fibrin Sealant in
midface and cervical detached flaps and PRGF in the scars
and facial mesotherapy. Were used the Anitua’s protocol as
amethodofobtainingplasmaderivatedandwereevaluated
thepresenceofhematomas,ecchymosis,serouscollections,
edema and quality of healing. Were not used drains or
postoperativeocclusivedressings.
Results:Noexpansivehematomasweredetected,wasobserved
the presence of 18 small serous collections, 21 bruises. The
postoperative edema and pain were minimal and detected
goodhealingintheevolutionof12monthspost-opwithout
epidermolysisand/orskinnecrosis.
Conclusion: Our study corroborates with the literature that
showsthattheuseofplateletderiveddecreasespostoperative
morbidity, decreasing the secretion of fluids, bruising and
ecchymosis, reducing dead space and eliminating the need
forpostoperativedrainage,reducingpainandpostoperative
edemaandimprovingthequalityofhealingandskintexture.
70
1977 112
LASER LIPO-SCULPTING OF NECK AND FACE
Presenter:
SalvatorePagano,MD
Affiliation:
ClinicaGolden
Country:
Spain
Author:
PaganoS
1870 111
LASTING RESULTS WITH ENDOSCOPIC BROWLIFT:
EIGHTEEN YEARS OF EXPERIENCE
Presenter:
EnzoRiveraCitarella,MD
Affiliation:
UniversityofMarylandMedicalCenter&
JohnsHopkinsUniversity
Country:
USA
Authors:
Conde-GreenA,RiveraCitarellaE,BarriosE,
SinderR,PitanguyI
Purpose: Since the advent of endoscopy, there has been an
increasenumberofpatientsseekinglessinvasiveprocedures
and refusing the extensive coronal scar for rejuvenation of
theupperthirdoftheface.Theuseofinjectableshasrisen
dramatically, however the cost is of primary concerns for
repeated applications, and patients are desiring definitive
treatment. We present our technique for the endoscopic
browlift summarizing our 18 years of experience, treating
patients presenting with eyebrow ptosis, asymmetry and
fronto-glabelarlines.
Technique:Thesuperiorthirdofthefaceistreatedfollowing
twovectorsoftraction.Thefirstvectorisvertical,elevatingthe
medialforeheadstructuresaftersubperiostealundermining
up to the glabella. Then undermining is continued in a
supraperiostealplanetotreattheprocerus,corrugatorsand
depressorsuperciliimuscles.Threefixationpointsusingnonabsorbable 2-0 sutures are placed in the scalp to reposition
thisregion.Thesecondvectorissuperior-oblique,elevating
the lateral brow and orbital region after undermining the
temporal region in an interfascial plane up to the superior
temporalline.Thentractionofthesuperiortemporalregion
isperformedbyfixingthesuperficialtemporalfasciatothe
deeptemporalfasciawithnonabsorbablesutures.
Results:BetweenJanuary1995andJanuary2013,946patients
(838women,108men)benefitedfromthistechnique,74%
of which had additional cervico-facial lift. Their age ranged
from23to86yearsoldwithameanfollow-upof8.5years.
Complications included 2.2% cases of temporal hematoma,
3.4% brow asymmetry, 8% temporary paresia of the frontal
nerve. Five percent patients underwent a second procedure
atameanof6.5yearsaftertheirprimaryprocedure.Eightynine percent of patients reported that their appearance was
verygood.
Conclusion: Endoscopic browlift is an effective technique,
providing adjustability, optimal elevation and symmetry of
theeyebrows.Itimprovesthefrontallinesandthewrinkles
on the bridge of the nose. The technique does require a
learningcurve,buthaslowratesofcomplications.Although
somemuscularactivitymayreturn,itseldomreturnstothe
preoperativestateandresultshaveshowntobelonglasting.
71
Background: Demand for minimally invasive procedures is
becoming increasingly popular in facial rejuvenation. Neck
andmid-lowerfaceareregionsthatcanbenefitthelipolytic
andskintighteningeffectofalaserinnerstimulation.
Materials and Methods: 50 patients (45F/5M) with mild to
moderatefatdepositandtissuelaxityofthecervico-facialarea
have been treated with a single inner 1440 nm wavelength
(CellulazeCynosure)treatment.(meanage48y.o.meanBMI
29.5). The sidelaze canula has been introduced through 3
smallincisions(1submentaland2infralobular)underlocal
tumescent anesthesia plus sedation. Laser energy has been
deliveredwithinthedeepsubcutaneousfatuntilreachingfat
melting and in the superficial dermical layer until reaching
46-47C distributed in squares of 5-5cm of skin. Gentle
lipoaspiration has been realized for better contouring. Postoperativelycompressiongarmentshavebeenappliedduring
the first 48h. Evaluation has been assessed by standardized
digitalphotography,physicianGlobalAestheticImprovement
Scale (GAIS), physician Cervicomental Angle Scale (CAS),
Patient satisfaction scale (PSS) and skin surface calculation
byRISCSoftwareat1-3-6monthsand1year.
Results: The total average energy delivered per patient has
been 1100 J in the deep plane and 700J in the superficial
plane per 5x5 cm square. The amount of lipoaspirate has
beenbetween60-250ml(average140ml).Thesurgicaltime
averaged about 1h (range 45-75 min). Adverse events has
been limited to transient swelling and bruising and fibrous
nodulessolvedin2-3weeksbylinfodrenageandultrasound
sessions.Noburnsandnerveinjurieshasbeennoticedthanks
toconstantmonitoringoftheinnertemperature.Allpatients
have experienced an improvement in the cervico-facial
contourespeciallyinthedefinitionofthemandibularlineand
submentalarea.Allexternalphysicianandpacientevaluation
scales have attested this progressive improvement. Digital
skinsurfacecomparinghasshownameanreductionof23%
(18-37%)ofthecervico-facialareaduetothetremendousskin
tightening.
Conclusions:Thelipolyticandtighteningeffectofthe1440
nmwavelengthrepresentaminimallyinvasiveandfastoption
toimproveneckandfacecontour.
112
LASER LIPO-SCULPTING OF NECK AND FACE
1729 113
EYEBROWS ELEVATION - AN AMAZING CHEAP TRICK
Presenter:
DomingosQ.DePaola,MD
Affiliation:
HospitaldosServidoresdoEstado
Country:
Brazil
Authors:
DePaolaDQ,DePaolaNetoDP,
CarvalhoDePaolaDC
Redeeming a technique published in 1967 by Dr. RenÈ
Guillemain, “the Curl lift”, we find a very easy and a long
lasting result procedure to elevate the eyebrows, in a fast
resolutionambulatoryintervention.
The“Curllifting”techniqueforeyebrowselevation,whichwill
bedescribed,consistsinsofttissueselevationusingsmooth
threads tied up in the level of the hairline. The threads are
inserted under the skin, in two different surgical plans in
ordertoavoidthe“underminingeffect”whenthethreadsare
tiedup.
Inallcases,localinfiltrativeanesthesiaisused:athinneedle
isusedtoadminister1%lidocainesolutionintheareaofthe
entry and exit of the modified blunt Reverdin needle, and
along its passage through soft tissues. The pre-operatory
marks are done with the patient in erect position. The first
drawingisaverticallinefromthemostexternalpointofthe
eyebrowuntilthehairline.Thesecondonebegins2cmfrom
thefirstoneandends2,5cmfromtheendofthefirstline,
in the level of the hairline. The third and fourth lines are
horizontalandcompletethesquare.
ThelaststepisabandagewithMicroporeattheforehead,for
threedays,toimmobilizetheregion.Theroutineoperationis
easyandquicktoperform,accompaniedbyminimalinjuriesto
thetissues,withtheintervention’soutcomemanifestingitself
asearlyasontheoperatingtable,ashort-termrehabilitation
period, and complying with elementary recommendations.
Theobtainedoutcomeprovestoremainforalongtime.
We are using the Curl-lifting technique for eyebrows
elevation,abovedescribed,sinceMay2003,inmorethan800
patientsfrom35to82years(averageof58,5years).Wethink
thelonglastingresultdependsmainlyatthechangingplans
done between the vertical and the horizontal lines on the
cornersofthepreliminarilymarkedsquarecontour.Basedin
theresultsweachieve,aftermorethan800casesusingthis
technique,aloneandassociatedwithotherprocedures(facelifting,Aptosthreadsforthefaceelevationandfillingproduct
procedures),wereachtheconclusionthatthistechniquecan
substitutewithadvantagesallotherssurgicaltechniquesfor
eyebrowselevation.
72
113
EYEBROWS ELEVATION - AN AMAZING CHEAP TRICK
1666 114
INTRODUCING THE 1.2.3.DIMENSIONAL CONCEPT
FOR CAUSAL RELATED TREATMENT OF THE
AGEING FACE; 1D: LIFTING STRICTLY VERTICAL, 2D;
SUPERFICIAL MICRO FAT GRAFTING, PRP AND TCAPEELING; 3D: DEEP LIPOFILLING (2D + 3D = ORGANIC
COSMETIC SURGERY®)
Presenter:
HieronymusP.Stevens,MD,PhD
Affiliation:
BergmanClinicsTheHague
Country:
Netherlands
Author:
StevensHP
The 1.2.3.Dimensional Concept and Organic Cosmetic
Surgery® represent a causal related view on the complex
processoftheagingface.Inaclearconcept;vectoranalysis
of aging and different techniques to reverse any undesired
changes are combined with repair on a cellular level
(regenerativesurgery).Incaseofagingbyptosisonly,strictly
vertical lifting is advocated, exactly opposite to the vector of
gravity(alongthesame1Dimensionalverticalline).Preferred
(frequentlymodified)techniquesforforehead,eyelid,tarsus,
midface, face and neck are presented (2200 cases treated
overthelast12years).Whenthecauseofagingisrelatedto
theskin,being2Dimensional,superficialmicrofatgrafting
+ PRP was preferred over non-regenerative techniques. In
a retrospective study (on 82 out of 220 patients randomly
selected) the addition of PRP resulted in a significant drop
in the number of days returning to work/restart of social
activities when added to a lipofilling procedure (from 18.9
daysto13.2days,p=0.019).Thiseffectseemedabsentwhen
MACS-lifting was combined with lipofilling. The aesthetic
outcome of the lipofilling group and MACS-lift + lipofilling
group+PRPweresignificantlybetterthanthegroupswithout
PRP. Adding PRP to facial lipofilling reduces recovery time
andseemstoimprovetheoverallaestheticoutcomeinMACS
lifting.Resultsfrom350casesofsuperficiallipofilling+PRP
are presented, demonstrating improved skin quality by not
only reduced fine wrinkles but also improved skin texture,
color and elasticity (currently a prospectively randomized
clinicaltrialisconducted).ResultsfromaddingTCA-peeling
subsequently are also presented. If loss of volume (3D
support)isinvolved,neitherliftingnorsuperficialinjectables
offertherightanswer.Insteadatechniquewitha3Doutward
vectorshouldbeused.Largervolumesofdeepipofilling(1222ccpersideoftheface)yieldsignificantlybetterresultsthan
liftingalone(peerreviewedpublication,p<0.05).
In conclusion, the 1.2.3.D Concept & Organic Surgery®
provideaclearcausalrelatedapproachtotreattheagingface
with significantly better results & reduced healing time by
combining lifting, superficial and deep micro fat grafting,
PRP&TCA-peels.
73
114
INTRODUCING THE 1.2.3.DIMENSIONAL CONCEPT
FOR CAUSAL RELATED TREATMENT OF THE
AGEING FACE; 1D: LIFTING STRICTLY VERTICAL, 2D;
SUPERFICIAL MICRO FAT GRAFTING, PRP AND TCAPEELING; 3D: DEEP LIPOFILLING (2D + 3D = ORGANIC
COSMETIC SURGERY®)
2064 115
SURFACE-VOLUME RELATIONSHIPS IN
CERVICOPLASTY AND FACIAL REJUVENATION
Presenter:
LucianE.Ion,FRCS(Plast)
Affiliation:
AestheticPlasticSurgery
Country:
UnitedKingdom
Author:
IonLE
Background:Wehaveevaluatedanassessmentprotocolbased
on commercial available 3-D imaging technology, to assist
clinicalpracticeinthedecisionregardingtension-freeversus
tension assisted cervicoplasty and short scar versus normal
scarrhytidectomy.
Materials and Methods: Patient 3-D image captures used
duringcosmeticsurgeryconsultationhavebeenassessedfor
measurementofthesurfaceandvolumebetweentheregional
shape and the desired target. The captured technology was
vectra M3 (Canfield Scientific); the simulation and analysis
usethesoftwareassociatedwithit,SculptorandVectraview
respectively(CanfieldScientific).
The diagnostic and contour analysis protocol involved
characterisationofthestartingshapeandthelevelofcervicofacial shape desired/acceptable to the patient, to allow the
decision regarding surgical technique to be used, and has
beenpartofourroutineclinicalpracticeforfacialandcervical
sculptinginthelast3years.Themeasurementofsurfacein
relationtovolumecorrectionhasbeenamorerecentaddition
to theprotocol.Facialandneckareachangesrelatedtoneck
contouring, facial contouring and volume augmentation
throughfattransferandchinaugmentationareanalysed.
Results: Four main categories of facial and cervical
changes correspond to the common types of cervical-facial
rejuvenation: the neck contour distorted by volume or
platysmabands,deficientfacialvolumeassociatedwithptosis
andexcessivefacialvolumeassociatedwithptosis.Correction
oftheconvexcervicalcontourappearstobeneutralinterms
ofskinsurfaceareachanges,orproducesanincreasedarea.
Correctionofsevereplatysmabandsisassociatedwithskin
surfaceareareductionandthereforeskinexcess.Correction
offacialvolumeexcessisassociatedwithskinavailabilityasa
resultofsurfacedecrease.Correctionofvolumedeficientand
ptoticfacialcontourisassociatedwithincreaseinthefacial
surfaceandthereforenoskinexcess.
Discussion:Wediscusstheimpactofthesefindingsonthe
decision is regarding tension free versus tension assisted
cervicoplasty, and short versus long scar rhytidectomy and
proposeaclassificationtoassistinclinicalpractice.
74
1952 116
APPRAISAL OF CHECK DIMPLE CREATION PRACTICE
IN 208 PATIENTS - 5 YEARS EXPERIENCE
Presenter:
ShaileshVadodaria,MB,BS,MS,MChFRCS
Affiliation:
TheClementineChurchillHospital
Country:
UnitedKingdom
Author:
VadodariaS
1958 117
PERCUTANEOUS FACE-LIFTING: A LESS INVASIVE
LIFTING TECHNIQUE USING DOUBLE SIDED NEEDLES
Presenter:
TuncK.Tiryaki,MD
Affiliation:
CellestPlasticSurgery
Country:
Turkey
Author:
TiryakiTK
Dimples on the cheeks are becoming increasingly popular
eveninthewesternworldparticularlyinUnitedKingdomin
therecenttime.Itisquitelikelytobethe“celebrityeffect”of
CherylColeaswellasKateMiddleton.
Most of the younger patients in plastic surgery expect
significantimprovementofearlysignsofagingyettheydont
wanttoundergoextensivesurgery.Inthelower1/3oftheface
wherethemajorproblemissaggingskin,thiscanbeachieved
by repositioning the aging skin and underlying structures
bytechniqueslikeshort-scarlifts.Ourgoalwastoattempt
to achieve comparable and durable results with minimally
invasive surgery, using punctures instead of incisions. Our
paperdescribesanoveltechnique,achievingtheliftingofall
differentplanesofthefaceatonce,byverticallysuspending
the soft tissues with percutanous loop sutures. The access
to the surgical field is achieved through small punctures
behindtheearsandtheneckstructuresaresuspendedwith
cross - neck sutures anchored to additional percutaneously
placed suture loops around the ears using a double - sided
needle or shuttle needle. Mitigation of gravitational force is
accomplishedbytheloopsuspensions,andskinre-drapingis
achievedthroughtheinherentretractioncapacityoftheskin,
whichisunderminedparticularlyontheneckbyliposuction
cannulas to obtain effective re-draping over the suture -
createdinternalsplint.Thiscombinedtechniquefortheface
wasappliedinselected468patientsbetweenDecember2005
andMay2012withafollow-uprangingfrom8monthsto7
years.Themeanageofthepatientswas42.5years.
Dimplesareconsideredbythemajorityasanattractivefacial
feature.IntraditionalAsianfolklore,thepresenceofadimple
suggests good fortune and fertility, while in the West it is
simplyviewedascuteandunique.
Naturaldimplesoccureitherononeorbothsidesoftheface,
and are generally present only when the face is animated,
oftentoanunnaturallyexaggerateddegree.Theauthorwill
discussthereviewofliteraturedescribingvarioushypotheses
aroundnaturalcheekdimplesandtheirrelationwithvariation
infacialanatomy.
The author has performed cheek dimples in 208 patients
underlocalanestheticsasanofficeprocedureoveraperiod
oflast5years.Hewilldiscussthetechnique,complications,
revision rate and will give some technical tips to avoid
unsatisfactoryoutcome.
In 13 patients the neck suspensions were removed due to
various reasons after the second month, without any loss
of the achieved neck definition, presumably due to the fact
that the remodeling was stable at the time of the removal.
Outcomes were satisfactory in all but 11 cases, of which 6
foundtheresultinadequate.Operationtimewaslessthan60
minutesunderlocalorlocalwithsedationanesthesiaandthe
recoverytimewas5-7days.Theconceptoffacialendo-lifting
iscreatingapercutaneoushammockachievingtheliftingof
alldifferentplanesoftheneckatonce,byputtingstrongand
non-absorbablesuturesonnon-underminedplatsymausing
a double - ended (shuttle) needle and anchoring it to fixed
threadloopsaroundtheears.
Inmostofthecases,thisiscombinedwithamid-facialloop
suspension. The sustainability of the procedure does not
relyonthesuturesonlybutthehealinginthenewposition
similartoorthopedicfracturetreatment.Inselectedpatients,
thissafeandsimplepercutaneousfacialliftingmethodcanbe
quicklyandeasilyperformedunderlocalanesthesiawithlong
term durability, low morbidity and high patient satisfaction
rate.
75
1954 118
FAT GRAFTING AS AN ADDITIONAL SUPPORT IN FACE
LIFT OPERATIONS
Presenter:
SauliusViksraitis,MD
Affiliation:
SVPlasticSurgeryCenter
Country:
Lithuania
Authors:
ViksraitisS,DaunoraviciusD,ZacharevskijE
Study Objectives:Topresentourexperienceofautologousfat
transferperformedduringdeepplanefaceliftoperationsin52
consecutivepatients.
Methods: A retrospective analysis of all facelift operations
performedbyanauthorinSVPlasticSurgeryCenter,Kaunas
during 2009-2013. A total of 52 patients had undergone
faceliftsinthistimeperiod.Thefollow-upperiodforalltreated
patientswas12months.Abdomenandthighswerethetwo
main areas used for the fat harvesting. The fat was washed
andfiltratedusingmanualtechnique,fatcentrifugationwas
not applied. Cannulas of 0.8-1.1 mm diameter were used
for fat injection. All facelift procedures were started from
autologous fat injections to nasolabial and nasojugal folds,
lipsandeyebrows.Additionally,thefatwasusedtoimprove
malarandzygomaticareas.
Results:Attheendoffollow-upperiodasignificantvolumetric
improvementofmalarandzygomaticareaswasobserved.Fat
transfer noticeably corrected nasolabial and nasojugal folds
andhadaconsiderablepositiveeffectonaginglipelongation.
Amarkedoverallskinqualityimprovementwasobservedin
alltreatedareas.
Conclusions: Fat grafting can be successfully used as
an additional support in face lift operations for marked
improvement of aging lips, nasolabial and nasojugal folds,
aswellasforoverallskinquality.Fatinjectiontomalarand
zygomatic areas can significantly correct the suborbital line
deformationandreplacesubperiostealmidfacelift.
1760 119
SKIN RESURFACING AND FACE-LIFT IN THE SAME
SURGICAL PROCEDURE: WHAT ARE THE ISSUES
Presenter:
AristidesArellano-HuacujaSr.,MD,FICS
Affiliation:
ClinicaDermatologicayCirugiaEsteticade
Puebla
Country:
Mexico
Author:
Arellano-HuacujaA
3873 cases have been done with this procedure since 1994,
minimalcomplicationshavebeenobserved.Thefaceliftand
skinresurfacingtechniquesarecarriedoutduringthesame
surgical procedure, in order to save time and improve the
patient recovery. Perioral and orbital wrinkles, photo aging
sings such as pigmentations and changes in skin color are
treatedwiththeskinResurfacingtechnique.Manysurgeons
forneckandcheeksisperformedasusuallyhavementioned
theface-lifttechnique.Byusingthesetwotechniques,afullfacerejuvenationisobtainedwithonlyonesurgicalprocedure.
The patient recovery is quicker and the result obtained is
muchbetter.Westartperformingthefacialrejuvenationwith
surgicalprocedure,SMASplicationandskinresurfacingin
onesurgicalstagein1997.However,itisneededbetween6
to 8weekstorecoveryfromtheskinResurfacingwithCO2
laser.Thisproceduretakesmorerecoverytimeandproduces
moreedema,rednessandpatientdiscomfort.Forthatreason,
westartedin2000toperformthefacialrejuvenationandthe
skinresurfacingwithErbium:YagandCO2Laser.Itisalso
carried out the Blepharoplasty in the upper eyelid and the
tranconjunctival approach in the lower eyelid with the CO2
laserinthecutmode.
Withthiscombinedtechniquetheresultishighlysatisfactory
because a face-lifting procedure is carried out in the areas
wereskinlaxityismoreoftensuchascheeksandneck.The
skin Resurfacing method is used in those places were the
surgerywasnotperformed.
We have seen that performing this procedure, the patient
results are much better. If face lifting is carried out at the
samesurgicaltimewiththeskinresurfacingpatientsrecovery
takeslesstimeanddiscomfort.In20dayspatientskincolor
is in the same tone. The skin looks much younger, smooth
and facial rejuvenation is highly improved. It is possible to
performdifferentfacialtechniquesatthesametimesuchas
fatgraft,chinimplant,endoscopicforehead,etc.
76
1823 120
RHYTIDECTOMY - WHEN MORE IS MORE
Presenter:
RubemBartz,MD
Affiliation:
PlasticaClinicaCirurgicaeEstetica
Country:
Brazil
Author:
BartzR
After29yearsofexperienceinfacialrejuvenationweshow
our routine detailing all the steps from initial appointment
with the mirror, when the patient shows us his priorities,
photos and preparation in the operating room, trichotomy
andinfiltration.
We emphasize the technical part, with drawings and
photographsofmultipleincisions,amplitudeofundermining,
openandclosedliposuction,fatgraftingandlipectomy.
Weunderstandthefacetreatmentshouldactinallsegments:
Upper face, Midface and Neck, as in depth in SMAS and
Platysma,asintheskinandbasedinourexperiencewecan
assurethatasmorestructuresofthefacewetreat,betterare
thetheresults.
In the Temporal and Frontal regions we frequently use
Peninsula and Coronal incisions and classic lifting of the
eyebrowsandtreatmentoffronto-glabellarwrinkles.
Inthemidfacewhereweoperateinthedeepstructures,with
SMAS applications, SMAS Smasectomia or classic SMAS
(detachmentandresection).Wefrequentlyremovethefatpad
ofBichattoimprovethecontourofthemandible.
Intheneckwealwaystreattheplatysmamusclelaterallyin
conjunctwiththeSMASandinselectedcasesweoperatethe
medialPlatysma.
We also present Blepharoplasty, Chin Augmentation,
Mechanical Peelings, and other procedures. We include
severalpatientsinthepre-opandpost-opwherewecansee
theresults.
WeconcludetheRhytidectomytobeeffectiveinalong-term,
promoting a harmonious and natural result that should
includeallsegmentsofthefaceandtreatbothsuperficialand
deepstructures.
77
1679 121
THE SOFT FACE LIFT, HOW TO PERFORM A
MINIMALLY INVASIVE, EFFECTIVE, LONG LASTING
PROCEDURE
Presenter:
AlainG.Bonnefon,MD
Affiliation:
CliniqueBonnefon
Country:
France
Author:
BonnefonAG
Mostpatientsundergoingfaceliftsdesireminimallyinvasive
procedure.Thus,wehereinexplainhowtoperformminimally
invasive,effective,long-lastingfacelift.
First,becausepatientsusuallywishtoavoidapermanentlyset
look,wemustlimittheoperativezonetocomprisetheparotid
area 2 cm lower than the mandibular border and along the
zygomatictiearch.Notissuetraumashouldoccuroutsidethe
parotidzoneandzygomaticarcharea.
Second,becausethemostaggressivepartofthesurgeryisthe
skin undermining, almost sero residual skin undermining
shouldbeleftattheendofsurgery.
Third, we must ensure effectiveness. The superficial
muusculoaponevrotic system (SMAS), an excellent vector
with which to reposition the volumes of the face in their
original positions, must be freely elevated from the parotid
andFurnasligamentsonthezygomaticarch.
Finally,toensurealong-lastingoutcome,alargefixedzone
involving the joining of parotid fascia to fascia and not fat
againstfatisrequired.Thus,afterSMASelevationoverthe
parotidthefasciaisjoinedseveralcentimetershigherwithout
tension.
Byfollowingthisprotocolinover2000procedures,90%of
patientswereabletoretuurntoanormalsociallifewithin4
days.
Theadvantagesoftheherein-describeddeepverticalliftare
asfollows:minimalinvasiveness,rapidity(completedwithin
1.5 hours), high safety margin (no paresis in over 2000
cases),rapidreturntonormallife,nomodificationoftheskin
vascularisation (thus np problem in heavy smokers and no
prematureskinaging),andlonglastingoutcome.
1832 122
AUTOLOGOUS FAT TRANSPLANTATION IN FACIAL
REJUVENATION
Presenter:
GuanhongZhong,MD
Affiliation:
YestarAestheticPlasticSurgeryHospital
Country:
China
Authors:
ZhongG,OuyangF
1814 123
VECTORS OF TRACTION AND IMPORTANT DETAILS IN
RHITIDOPLASTY
Presenter:
BarbaraH.Machado,MD
Affiliation:
IvoPitanguyClinic
Country:
Brazil
Author:
MachadoBH
Object:Themainreasonofagingfaceislossoffacialvolume.
Thepurposeofthisstudyistoachievetherejuvenationbythe
autologousfattransplantation.
Facial rejuvenation procedures have evolved from small
resections to more aggressive dissections. Different
techniquesforcervicofacialrejuvenationhavebeendescribed
and obviously the key for consistent results relies on
surgeon’sjudgmentandabilitytodiagnoseandindividualize
treatmentplanaccordingtotheaestheticneedsofthepatient.
Inthispresentation,weintendtodiscusstheadvantagesand
disadvantages on observing some important detalis such as
incisionpositioning,vectorsoftractionforbothskintraction
and SMAS/platysma plication, planes of undermining,
earlobe repositioning, indications for fat grafting and other
ancillaryproceduresindicatedineachcase.Withthispurpose,
ananalysison9183faceliftsperformedatthisprivateservice
was performed and the statistics considering age, sex, and
complicationswillbeprovided.Weemphasizetheuseofthe
vectoroftractionconnectingthetragustoDarwin’stubercle,
theroundliftingtechnique,tobetteraddressandreposition
the tissues that have suffered the aging process to their
previousandnaturalposition.
Methods: Autologous fat grafts were taken from abdomen
and thigh by liposuction under local or general anesthesia,
which were then transplanted into the receipt positions in
variouslayersofthetissuesaftercentrifugation.
Results:Totalof342positionsin213femalepatientsunderwent
the fat transplantation. Age of patients ranged from 18-60
yearsold,averageofwhichwas33.Thereceiptpositionswere
involvedforehead,temple,teartrough,nasolabialford,cheek,
hollowsaroundeyelids.Injectionvolumesrangedfrom0.8ml
to32ml,andaverageofthemwas6.08ml.Thepatientswere
followedupfrom2monthsto24months.Inalltransplanted
position,110positions(32.12%)gotsatisfiedresultsafterone
operation, whereas 278 positions (81.29%) were satisfied
aftersecondoperation.
Conclusion:Autologousfattransplantationismajorapproach
for the treatment of facial volume deficiency, which usually
needsseveralsessionsoftransplantationduetotheabsorption
offattissues.
Complicationsandtheirtreatmentswillalsobedemonstrated.
78
1951
124
PROGRESSIVE TUNNELIZATIONS IN NECK FACE LIFT
DETACHMENT FAT GRAFTS AS COMPLEMENT
Presenter:
DilsonF.Luz,MD
Affiliation:
SociedadeBrasileiradeCirurgiaPlsticae
ISAPS
Country:
Brazil
Author:
LuzDF
Theauthordescribe12yearsexperincedintheapplicationofa
newandsimplemethodoffacialcutaneousdetachmentusing
speciallydesignedbi-facetedrigidsteelwandscalled“Dilson
Luz Vascular Dilation Wands®”. These wands considerably
reduce the bleeding during face-lift surgery, reducing both
postoperative hematomas as well as the risk of facial nerve
injury.Thistechnique“PROGRESSIVESTUNNEZATIONS”
involvesstretchingthebloodvesselstothepointofruptureby
insertingprogressivelylarger“wands”.Atthepointofrupture,
a spontaneous coagulation within the vascular extremities
occurs. This is due to a significant blood platelet migration
inducedbythestimulationfromtheruptureofthevascular
intima. The wands vary in dimension from 1.5 to 20mm
andthemorelargewereusedforcutaneousfacialcomplete
detachment,andthemorefinetoperformtunnels.Amethod
which we found to result in minimal bleeding across the
detached surface as well as an excellent perfusion of the
over lying skin. With this new technique, we have obtained
improved cutaneous detachment, reduced postoperative
swelling,edemaandecchymosis;prophylaxisoffacialnerve
damageand/orlatepostoperativehematomaformation.The
fatgraftswithactivedplateletsalwaysperformingthefacelift.
79
Free Paper Session 10 - Hair Restoration, Otoplasty & Face
1693 125
RESTORATION OF THE HAIRLINE FOLLOWING A
FACELIFT
Presenter:
HenriqueN.Radwanski,MD
Affiliation:
IvoPitanguyInstitute
Country:
Brazil
Author:
RadwanskiHN
1720 126
THE ALTERNATIVE HAIR RESTORATION: AESTHETIC
AND RECONSTRUCTION HAIR TRANSPLANTATION
Presenter:
SamirIbrahimAbuGhoush,MD
Affiliation:
MandalaBeautyClinic
Country:
Poland
Author:
IbrahimAbuGhoushS
An unsatisfactory result from a facelift can cause great
anxiety to both the patient and the surgeon. Tell-tale signs
ofanaestheticsurgicalprocedureincludedisruptionand/or
dislocation of the hairline. This is a consequence of excess
traction, destruction of hair follicles or pre-pilose incisions
resulting in visible scars. Most plastic surgeons are not
familiar with hair transplantation. However, in most of the
abovecases,ahairtransplantspecialistcanrestoreanatural
hairline, giving the patient the possibility of camouflaging
scarsandusingashorthaircut.Theauthorwillpresenthis
experience in over 15 years of hair transplantation, sharing
hiscaseswithcolleagueseagertolearnthefinerpointsofthis
specialtyofplasticsurgery.
Qualifiedhairrestorationspecialistshouldnotbelimitedto
treatingthetypicalpatternhairlosspatients,Heshouldoffer
alternative hair transplantation that includes reconstruction
HairTransplantation.
Plastic and aesthetic surgeon should have some knowledge
and master some of hair transplantation, or at least should
consider hair transplantation as an alternative treatment in
somecases.
A Candidate for alternative hair transplant can be any with
hairlosscausedby:
-PostBurnscars
-Post-traumaticscars
- After surgical procedures such as face-lift, and cleft lip
repair
-Patientswiththin,scary,orcompletelyLackof;eyebrows,
eyelashes,beards
-Transgenderpatients
-Geneticsoradiseases
In our daily practice as plastic surgeons, we often meet
with cases where hair transplantation seems to be the only
solution,orthetreatmentofchoiceinmanycases,like;
1.Postburnandposttraumaticscars
2.Postcleftliprepairscars
3.Aftersomesurgeriesonthefaceandheadlikeafacelift,
removal of tumors or deferent lesions, and certain birth
defects-ratherthanconductingbigoperationssuchas:tissue
expanders,flapsorskingraftsandsurgicalscarremovals-
hairtransplantscangiveamuchbetterresultsandatlower
costandinlesstime.
Hair transplantation may play an important role in the
aesthetic and psychological transsexual patients who are
grateful for the natural and significant change in the
appearancethathairtransplantscangivethem.
In this presentation I will be showing the use of hair
transplantationinplasticsurgerypractice.
80
126
THE ALTERNATIVE HAIR RESTORATION: AESTHETIC
AND RECONSTRUCTION HAIR TRANSPLANTATION
1837 127
THE EVALUATION INDICATORS OF AESTHETIC
EFFECTS ON HAIR TRANSPLANTATION
Presenter:
ZhiqiHu,MD,PhD
Affiliation:
NanfangHospitalofSouthernMedical
University
Country:
China
Authors:
HuZhiqi,MiaoY
Todate,hairtransplantation(HTS)are210yearsold,which
involvingthetransplantingofhair,beard,eyebrows,eyelashes
andpubichair.Asiswellknown,HTSisarelativelytedious
surgery,involvingtheevaluationanddesignofrecipientsite,
the selection of donor area, the calculation of hair follicles
(HFs) number, the separation and preservation of HFs, the
processofHFsimplantation,andsoon.Eachofthesesteps
iscloselyrelatedtothevisualeffectsofpost-operation.Based
onourexperience,theaestheticresultofHTSreliesmainly
on some indicators to evaluate, including the survival rate,
density,directionandtextureofimplantedHFs.
Survival Rate:ThesurvivalrateofHFsismainlyinfluenced
by both patients and surgeons. For patient, in addition to
atrophicscars,otherlocalsituationdoesnotaffectthesurvival
of transplanted hair; for surgeon, if the surgeon has more
than3years’experienceinHTSandtheharvestedHFscanbe
storedat4degreeofsalineinvitro,thesurvivalrateofHFsis
usuallyupto90%.
Density:ForeastAsians,thedensityofhumanhairisabout
75follicles/cm2.Forscalp,theHFsareusuallyimplanted3540/cm2toachievenormalappearance;however,forothers,
such as the eyebrows and eyelashes, usually required to
achieve the normal density. Factors affecting the density of
HTSalsoincludebothpatientandsurgeon.Forpatient,HTS
can achieve normal hair density using appropriate slitting
technique, except the recipient site with atrophic scars and
subcutaneoussofttissueloss;forsurgeon,onthepremiseof
ensuringthesurvivalofimplantedhair,usingdifferentpunch
tools is the key. Based on our experience, using the slitting
needlewith1mmor0.8mmdiameterusuallycanachievea
betterdensity.
Direction:Surgeonistheonlyfactorinfluencingthegrowth
direction of implanted hair. In order to achieve a natural
appearance, HFs should be implanted according to the
naturaldirectionofhairgrowth.
Texture:Thescalphairusuallybechoseasadonatearea.For
eyelashesandeyebrowsimplantation,weusuallyselecthairs
withtextureclosetotheeyelashesoreyebrowstotransplant,
suchashairlinehairoftheoccipitalorbehindtheears.
81
1898 128
THE ART OF NATURAL LOOKING HAIR TRANSPLANT,
THE TEMPORAL PEAKS AND FRONTO TEMPORAL
ANGLES
Presenter:
HumayunMohmand,FRCS,ABHRS,
FISHRS
Affiliation:
Dr.HumayunsHairTransplantInstitute
Country:
Pakistan
Author:
MohmandH
Objective: Hairrestorationhasmovedon,fromgivingback
hairs on the scalp to a un detectable, naturally looking,
aestheticallypleasinghairrestorationandFramingoftheface.
TheArtofcreationofthisnaturalnesscannotbecompleted
ifweignorethetemporalpeaksandfronto-Temporalangles.
They form an integral part of an aesthetically pleasing hair
restoration. More and more doctors are now contemplating
torestoretemporalpeaks.Thismakesitevermoreimportant
tounderstandwhataretheimportantfactorsthatneedtobe
lookedat,inordertocreatethenaturalnessandundetectability.
Badly done Fronto-temporal angles can easily catch an eye
ofanobserveranddefeattheobjectofmakingnaturalness.
Thisisevenmoreimportantifthepersonisstylingthehair
sideways.Wewillshareourexperienceonmorethan8000
casesofcreatinganundetectablehairrestorationwithspecial
emphasisonbothtemporalpeaksandFronto-temporalangle.
Method: Important factors were kept in mind regarding
thenaturallookinghairline.1):Avoidanceofastraightline.
2): The acute angle of exit from the skin and 3): The angle
of curvature of the hair shaft. In our experience since the
incorporation of these three simple points, the naturalness
of the hair restoration has improved significantly. This is
especially true for the temporal peak and Fronto-temporal
angles. This is especially helpful if the person opts for side
parting.
Result: Almost all the patients were satisfied with the
technique and the naturalness of the surgery. The main
differencewasnoticedinthepatientswhounderwentsecond
orthirdsession.Theycouldreallyappreciatethedifference.
Thistechniquemakesthehairtofallontheforeheadandthat
givesaverysoftnesstothehairtransplant.
Conclusion:Webelievebytakingcareofthesepoints,onecan
bring more naturalness in the already existing techniques.
Weareallinpursuitofmimickingnatureasclosel
1855
129
PREPARING HOLES FOR MICROGRAFTS IN HAIR
TRANSPLANTATION
Presenter:
MilanD.Jovanovic,PhD
Affiliation:
ClinicalCenterofSerbia
Country:
Serbia
Authors:
JovanovicMD,ArafehMA,BayazidTN
Hair transplantation can be accomplished by making holes
for micrografts with 18 gauge needle, 64 blade on round
beaverhandle,15bladeonconventionalscalpelhandle,laser
orChoissingle-hairimplantatnionneedle.
Problems with these methods are bleeding and false
determinationofdirectionforfuturepilegrowth.Wesolved
theseproblemswithneedlespromila1,1mlinsamenumber
asnumberofgraftswhichweareplanningtotransplant.
Material and Methods: After removal donor strip with No.
10 blade from occipital donor area we prepared mini and
micrografts.Recipientareaisinjectedwithpreparedsolution
(160ml Ringer lactate, 1ml Epinephrine and 2ml 40%
Xylocaine).Fifteenminutesafterinjectionandmakingplan
forgraftdistribution,weinjectasmanyneedlesasnumber
of grafts planned, covering whole recipient area. Needles
are administered in pile’s growth direction, starting from
firstrow,thansecondandsoon,untilweplaceallprepared
needles.Weplacethemoneinfrontofanotherwithprecise
locationforfuturefolicle.Whenallneedlesareinplace,we
start with transplantation working backwards, removing
needlesandplacingminiandmicrograftsineveryslit.
Discussion:Injectingdonorandrecipientareaswithprepared
solutionwepreventbleeding.Ifitdoeshappeninsomeslits
itcanbestoppedwithsimplefingerpressurefor1-2minutes.
Using same number of needles as number of grafts, we
can easily determine and control direction for pile growth.
There are no falling out of grafts caused with hematomas
andnopressurecausedwithneedlestitching.Thismethod
is superior to using laser for making holes because CO2
lasercausesmicronecrosisanditismoredifficulttocontrol
bleeding.
Conclusion: With using same number of needles and hair
graftswereduceoperatingtime,wehavebetterdetermination
of direction of pile’s growth, and we can prevent follicle
extractionthatcanbecausedwitheverynewneedleprick.In
thiswaywehavegoodaestheticresultsandreducedoperating
time.
82
1858 130
BLEPHAROPLASTY COMBINED WITH PERIOCULAR
LIPOINJECTION
Presenter:
ZekiCan,MD
Affiliation:
AnkaraUniversitySchoolofMedicine
Country:
Turkey
Authors:
CanZ,AslanE
1979 131
PRECISIONINOTOPLASTY:COMBININGREDUCTION
OTOPLASTYWITHTRADITIONALOTOPLASTY
Presenter:
JessicaBettyChang,BS
Affiliation:
NewYorkUniversity
Country:
USA
Authors:
SinnoS,ChangJ,ThorneCH
Blepharoplastyisawellknownsurgicalprocedureamongall
plasticsurgeons.Howeverdifferencesandvariationsofthis
surgicalprocedurehighlyexists.Asweareusingtoachieve
ayounglookingface;wecannotconsideritasaisolatedpart
from other aesthetic units on our face, like in all aesthetic
unitsinourbody.
Background: Otoplasty for prominent ears is a routine
procedure. A significant percentage of patients requesting
otoplasty,however,havesomedegreeofmacrotiainadditionto
protrudingears.Thisclinicalscenariorequiresearreduction
in addition to traditional otoplasty. There are relatively
few studies in the literature that describe ear reduction,
and those that do describe smaller subsets of patients. The
authorspresentaseriesofotoplastypatientsoverathree-year
periodinwhich36%underwentearreductioninadditionto
traditionalsetbackotoplasty.
Periocular region and midface are containing characteristic
changes which are releated with age, race and gender. For
achievingoptimalresultsweshouldfindcombinedsurgical
solutionstocorrectaestheticproblemsonthatpart.
Inourstudywetriedtoshowourexperiencesaboutupperand
lower lid blepharoplasty patients, combined with periocular
fatinjections.
Asaconsequenceoutcomesofthisstudyresultedasespecially
in older patients, multiple approaches to patient including
autologous fat transfer are providing much better aesthetic
outcomesinacomparisonwithsingleapproachwithupper
orlowerlidblepharoplasty.
Methods:Aretrospectivereviewwasperformedofthesenior
authorsotoplastyproceduresfrom2010to2013.Chartswere
reviewedforpatientdemographics,pre-operativeassessment,
surgicaltechniqueused,complications,andneedforrevision.
Allotoplastyprocedures,primaryorsecondary,wereincluded
intheseries.
Results:Overathree-yearperiod,84totalotoplastyprocedures
were performed. Of these, 30 patients had some degree of
scaphalreductionasacomponentoftheotoplasty.Nineteen
of the patients had an otoplasty previously but were not
completely satisfied. Complications were limited to suture
protrusionbehindtheear.Noneofthepatientsinthisseries
haverequiredre-operation.
Conclusion:Scaphalreductiontomodifythecontourofthe
upperauricleand/ordecreasetheoverallsizeoftheearisa
valuableadjuncttootoplasty.Thistechniquemaybeindicated
inasignificantpercentageofpatientspresentingforotoplasty.
83
1891 132
HEALTH-RELATED QUALITY OF LIFE AND CLINICAL
OUTCOME AFTER OTOPLASTY USING COMBINED
TECHNIQUES
Presenter:
AlexanderPorleyHornos,MD
Affiliation:
PrivatePractice
Country:
Brazil
Author:
PorleyHornosA
Background:Prominentearsarerelativelyfrequentandisthe
most common congenital defect of the ear. Many otoplasty
techniques are described in the literature, including some
whoadvocatetheuseofcombinedtechniques.Theprotruding
ears,besidesprovideconsiderableaestheticdamagetofacial
harmony,isrelatedtopsychologicalandbehavioralproblems.
Theavailablemedicalliteraturelacksdataabouttheeffectof
otoplastyonhealth-relatedqualityoflife.
Objective:Analyzingtheclinicaloutcomeofotoplastiesusing
combined technique and measure the improvement on the
patientqualityoflifeconferredbythesurgicalprocedure.
Methods: Retrospective analysis of the results of otoplasties
performed using combined techniques of “Stenstran”,
“Mustarde” and “Furnas”. We analyzed epidemiological
data, incidence of complications as well as evaluating the
improvement in quality of life by the validated Glasgow
Benefit Inventory questionnaire (GBI). Scores in the GBI
canrangefrom-100(maximaladverseeffect)through0(no
effect)to100(maximalpositiveeffect).
1665 133
AUTOGENOUS GRAFT FROM THE TIBIA FOR
CORRECTION OF NASAL DEFORMITIES
Presenter:
EvandoL.Lucena,MD
Affiliation:
ClinicaLauritzen
Country:
Brazil
Author:
LucenaEL
The objective of this study is to assess the surgical
reconstruction of the nasal dorsum using an autogenous
graftfromthetibialcrest,inahundredseventyfivepatients
with nasal deformities originate of traumas, sequelae of
rinoplastiesandinfectiondiseasewhowereanalyzedclinical
andradiologicalandtomography.
Ages ranging twenty to sixty years old, fifty males and fifty
females. Satisfactory results without complications were
obtained in 168 patientes dislocation of the graft occurred
inthreecases,extrusionintwocasesanddehiscenceintwo
cases.
Thetibialcrestgraftisextremelyusefulforreconstructionof
thenasaldeformitiesbecauseitiseasilyobtainable,integrates
well with a minimun of complications improving both the
functionandtheaestheticappearance.
Results:Fortypatientswereincluded,thusanalyzedasample
of77earsoperated.Themeanagewas24.4yearsand80%
female.Thereweresevencomplicationsinthesample(9%).
TheGlasgowBenefitInventoryquestionnairewasanswered
by 26 patients. We showed an improvement in GBI scores
after intervention. The mean general benefit score was of
62.45points(from30.5to97.2points).
Conclusions:Clinicaloutcomeparametersandcomplications
ratescomparabletotheliteratureconfirmedtheeffectiveness
and safety of an otoplasty using combined techniques. The
otoplasty can also significantly increase patients healthrelatedqualityoflife.
84
1928 134
THE IMPORTANCE OF NASAL PROPORTIONS IN RHINOPLASTY
Presenter:
StefanoBruschi,PhD
Affiliation:
CittadellaSaluteedellaScienzaHospital
UniversityofTurinItaly
Country:
Italy
Author:
BruschiS
2005 135
MODIFIED Z PLASTY TECHNIQUE TO CORRECT
ASYMMETRICAL LEVEL OF ALA IN A CLEFT NASAL
DEFORMITY
Presenter:
MonishaKapoor,MBBS,MS,MCh
Affiliation:
SaketCityHospital
Country:
India
Author:
KapoorM
In aesthetic surgery proportions are synonymous of beauty.
Rhinoplastyisallaboutproportionssoyouhavetomeditate
ontheoptimalproportionsandtrytoimitatethem.
This paper illustrates a new technique of modified Z plasty
to correct Alar level asymmetry in a cleft nasal deformity,
whereintheAlaislowerdownbyincorporatingaflapfrom
belowtheAlaintothelateralnasalwall.Theflapactedasa
splinttokeeptheAlaintothenewpositionascomparedto
the opposite side and long term result was satisfactory and
thepositionwasmaintainedevenafteranyearonfollow-up.
Thismethodisthefirstreportedmethodofcorrectinglevel
asymmetryincleftnasaldeformity.
On my opinion the parameters that have to be taken into
account to get the optimal proportions are the following;
dorsalslope,dorsallengthandtipprojection.
Once we know the parameters we have to know which of
them comes first and where to start. The key point for the
optimalaestheticproportionsisthedorsalslopewhichisthe
visualtransferofthenaso-facialangle.Whenthisangleisset
to32-35∞wecanfocusourattentiontothetipprojectionand
dorsallength.
I began measuring the external proportions and I always
tend to bring them to the optimal; Nasal slope 32-35∞, tip
projection2,7-3,2cm,nasallength(fromtheradixtothetip
defining point) 4,5-5 cm. How to obtain these proportions
intraoperatoryisshown.
Thedorsalslopeisthesummingupoftheseptalheight,from
thenasalspinetotheanteriorseptalangle,plustheheightof
thedomedefiningpointanteriortotheseptalangle.Sothe
septalheightisfixedin19-21mm,weaddthetipprojection
3-6mmfromthedomedefiningpointtotheanteriorseptal
angle. So the fixed point is the septal height. When this is
achieved the projections of the tip can be managed by
increasingordecreasingthetipdefiningpoint.
85
1970 136
REJUVENATION OF THE MIDFACE BY SUBCILIARY
APPROACH
Presenter:
FranciscoM.Carvalho,MD
Affiliation:
InstitutoDrJoseFrota
Country:
Brazil
Authors:
CarvalhoFM,FurtadoIR
Thetreatmentofthemediumthirdofthefacethroughthe
finger assisted malar elevation technique was described by
Aston as a procedure accomplished during the face-lifting,
with the objective of to correct ptosis in that area. We have
been accomplishing the suspension of the malar fat pad
usingthesubciliaryaccess,duringtheblefaroplasty.Afterthe
incisionanddetachmentoftheskin,itismadetheapproach
ofthemalarregionwithasmallincisioninthesuperiorlimit
ofthemalarfatpad;adigitaldetachmentismade,beginning
belowthemalarcrest,goinguntilthenasolabialfold,allowing
theelevationofthemediumthirdofthefaceanditsfixation
intheperiosteumoftheorbit.Theresultissatisfactory,with
thecorrectionoftheptosisandvolumetricreplacementofthe
orbitalarea.
1974 137
FACE VOLUMETRIZATION TECHNIQUES: FILLERS VS
THREADS
Presenter:
EnriqueO.Etxeberria,MD,PHD,FACS
Affiliation:
HospitalQuironBizkaia
Country:
Spain
Authors:
EtxeberriaEO,SesarML,FernandezAF,
CorreaOH
Plastic & Aesthetic Surgeons are very used -all around the
world-,todistinguishbetwen‘minimallyinvasivetechniques’
and‘majorplastic/aestheticsurgeries’.
We want with this paper to add a new value in our preop.
planningsurgeries:
1.-whywedonotaddthesetwoconceptswhenplanningour
surgeries?
2.- does adding these two conceps add value and improve
safetyandresultswhenwescheduleourprocedures?
3.-Inthesecontextwhatcanaddvaluetoourmajorsurgeries
andhow:volumetrizationorvectorizingfacialimplantfillers,
vs. facial contour/lifting threads? How do they affect to our
finalresults?Whytheyimproveoursurgicalresults,shorten
oursurgicalproceduretime,and,definitelyimprovepatient
safety, patient final result and patient satisfaction with our
global planning, making decission and final postoperative
result?
Weputfacetofacetwominimallyinvasiveusualprocedures:
facialvolumetrizationfillersvs.contourthreads/liftthreads,
adeddtooursurgicalfacialaestheticandplasticprocedures.
86
Free Paper Session 11 - Aesthetic Breast I
1795 139
GYNECOMASTIA MANAGEMENT WITH LIPOSUCTION
AND THE SHAVE METHOD
Presenter:
JerzyR.Kolasinski,MD,PhD
Affiliation:
KlinikaKolasinski
Country:
Poland
Author:
KolasinskiJR
1927 138
BREAST ECOLOGY ASSESMENT IN THE STUDY OF
LOCAL MICROFLORA (BR.E.A.ST. M.F.): A STUDY WITH
IMPACT ON THE SAFETY OF AREOLAR APPROACH IN
BREAST AUGMENTATION
Presenter:
DanaM.Jianu,MD,PhD
Affiliation:
ProesteticaMedical
Country:
Romania
Authors:
JianuDM,Streinu-CercelA,FilipescuM,
CobaniO,JianuSA,Streinu-CercelO,
Streinu-CercelA
Background: In breast augmentation areolar approach is
“traditionally” considered a source of contamination due to
“endogenous breast flora” residing in the lactiferous ducts.
TheBREAST-MFstudywasdesignedtocharacterizetheflora
of breast skin and parenchima and to correlate it with the
safetyofthesurgicalapproach,particularlythroughareola.
Material and Method: This is a prospective cohort study
consistinginbacterialidentificationofthebreastskin,nipple
ducts,andparenchyma.Thestudyincluded39adultfemale
patientswhoconsentedtomicrobialsamplingduringbreast
surgery. 845 swabs were collected before and during the
interventionfrom65breasts.
Results:Priortointervention,61.6%ofthe232swabscollected
from the breast skin yielded positive cultures, compared to
only 4.4% positive cultures from the intraoperative steps.
The main species identified on the skin (more than 90%)
werestaphylococcalspecies.Only3(4.7%)ofthe64areolar
incision swabs were culture-positive and in all cases the
microbialspeciesidentifiedappearedtobeidenticaltothose
presentontheskinpriortotheintervention–staphylococcal
species(Shominis,Slugdunensis).
Conclusions: This study shows that nippleareola complex
does’nt represent a major source of intra-operative
contamination.Transversaldisectionofthemammarygland
isn’tassociatedwithahighrateofbacterialculturepositivity,
implyingthatthelactiferousductsandsinusesdon’tconstitute
asignificantbacterialreservoir.Ourfindingssuggestthatin
the areolar region it is more likely to find isolated bacteria,
carried-overfromthe(surrounding)skin,ratherthanawellestablishedresidentflora,asinitiallyconsidered.
Introduction:Gynecomastiaisarelativelycommoncondition
affecting over 5% of the male population. In 2012, 20,723
surgeries for gynecomastia were performed in the US. A
commonsurgicalmethodisexcision,andinextremecases,
reduction of the breast. In recent years minimally invasive
techniqueshavebeenfrequentlyappliedsuchasliposuction
andtheshavemethod.
Aims and Objectives:Theobjectiveofthestudyistoevaluate
the effects of surgical management of gynecomastia using
minimallyinvasivesurgicalmethodssuchasliposuctionand
theshavemethod.
Materials and Methods:Onehundredfifty-sixpatientswere
treatedforgynecomastiaintheperiodbetweenJanuary2006
andApril2014.In153casesitwasbilateral;in3itwas unilateral.
Patientswereaged15to51(28.9mean).Inmanagingthese
patientsinvasivetechniquessuchassurgicalexcision,aswell
asminimallyinvasivetechniquessuchasliposuctionandthe
shave method, were applied. The excised glandular tissue
washistologicallyexaminedtoexcludeneoplasmformation.
Invasivetechniqueswerecomparedwithminimallyinvasive
proceduresfortheirradicalness,safetyandaestheticeffects.
Results: The following methods were used to treat
gynecomastia: simple surgical excision of the gland
combined with skin flaps surgery (6 patients), liposuction
combined with surgical excision of the gland (26 patients),
only liposuction (78 patients), and the shave method (46
patients).Applicationofmini-invasivemethods(liposuction,
theshavemethod)madeitpossibletoobtainverygoodand
goodeffectswithminimalscarring.Histologicalexamination
did not identify any maligancy. Complications included
four cases of postoperative hematoma, and five cases of
nipple and surrounding skin paresthesia. It was found that
liposuctionwasthemosteffectivemethodfortreatingadipose
gynecomastia.Incasesofglandularormixedgynecomastia,
liposuctionsupplementedwithglandremovalwithashaver
gaveaverygoodorgoodaestheticeffect.
Conclusions: Minimally invasive techniques in treating
gynecomastia, such as liposuction and the shave method,
allow patients to obtain very good aesthetic results while
preserving the necessary radicalness of the procedure with
lowincidenceofcomplications.
87
139
GYNECOMASTIA MANAGEMENT WITH LIPOSUCTION
AND THE SHAVE METHOD
1779 140
MASTOPEXY WITH SUBMUSCULAR MAMARY
IMPLANT IN DUAL POCKET
Presenter:
LeandroD.Procopio,MD
Affiliation:
Country:
Brazil
Authors:
ProcopioLD,SilvaDD,RosiqueR
Background:Combinedmastopexyandbreastaugmentation
isanincreasinglypopularprocedure,andmanyvariablesmay
influencethefinalresults.
Methods: We describe a technique that results in greater
coverage and support of the breast implant by placing it
between the pectoralis muscles. The pectoralis major is
divided into two straps, avoiding dissection of the muscle
fibersfromtheribcage.
Results:BetweenNovember2009andNovember2012,atotal
of118patientsaged17to54years(mean,33years)underwent
this procedure. Good long-term results were achieved, with
a low rate of re-intervention despite differences in original
breastshape.
Conclusions:Theversatilityofthisprocedureallowsittobe
usedincombinationwithvariousothersurgicalprocedures,
dependingonindividualpatientsrequirementsandsurgeon
preferences.
88
1828 142
BILATERAL BREAST REDUCTION IN ONE HOUR
Presenter:
JanVermeylen,MD
Affiliation:
AzTurnhout
Country:
Belgium
Author:
VermeylenJ
1695 141
A LOOK INSIDE THE COURTROOM: AN ANALYSIS
OF 292 COSMETIC BREAST SURGERY MEDICAL
MALPRACTICE CASES IN THE USA
Presenter:
AdityaSood,MD,MBA
Affiliation:
RutgersNewJerseyMedicalSchool
Country:
USA
Authors:
SoodA,PaikAM,MadyLJ,EloyJA,LeeES
Background:Malpracticeclaimsaffectthecostandqualityof
healthcare.
Objective:Theauthorsexaminelitigationincosmeticbreast
surgeryandidentifyfactorsinfluencingmalpracticelitigation
outcomesintheUSA.
Methods:TheWestlawdatabasewassearchedforjuryverdict
and settlement reports related to medical malpractice and
cosmetic breast surgeries. Cases included for analysis were
examinedforyear,geographiclocation,patientdemographics,
procedureperformed,allegedinjury,causesofaction,verdict,
andindemnitypayments.
Results: Of 292 cases, the most common injury sustained
wasdisfigurement(53.1%).Negligentmisrepresentationhad
a 98% greater chance of resolution in favor of the plaintiff
(reative risk [RR], 1.98; 95% confidence interval [CI], 1.412.79),andfraudhada92%greaterchanceofdispositionin
favoroftheplaintiff(RR,1.92;95%CI,1.32-2.80).Themost
common causes of action cited were negligence (88.7%)
and lack of informed consent (43.8%). One hundred sixtynine (58.3%) cases resulted in favor of the defendant and
121(41.7%)casesweredisposedinfavoroftheplaintiff;97
(33.4%) cases resulted in damages awarded and 24 (8.3%)
cases resulted in settlement. No significant difference was
foundbetweenthemediansofindemnitypaymentsawarded
toplaintiffs($245000)andsettlements($300000).
Conclusions: Based on this study, negligent or intentional
misrepresentationstronglyfavorsplaintiffsineitherawarded
damages or settlements in cases of cosmetic breast surgery
litigation. This study emphasizes that transparency and
adequate communication are at the crux of the physicianpatientrelationshipandaretoolsbywhichplasticsurgeons
may reduce the frequency of litigations, thereby containing
healthcarecostsataminimum.
Keywords: breast augmentation, breast implant, breast
reduction,cosmeticbreast,mastopexy,medicalmalpractice
89
A simplified vertical scar breastreduction technique
is presented which allows everyone to do a bilateral
breastreductioninapproximately60minutes.Thetechnique
is very easy to learn and is a simplification of existing
techniques.
More then 100 consecutive cases have been done by the
author. Not only is it an interesting teaching technique but
italsohasaveryimportantfinancialadvantageforthoseof
uswhohavetobuyoperatingtime.Probablybecauseofthe
simpleandfasttechniquethecomplicationrateisalsovery
low.
Alldetailsofthetechniquewillbediscussedopenly.
2049 143
A REVIEW OF MAUDE ADVERSE EVENT REPORTING
FOR ALCL IN BREAST IMPLANT PATIENTS
Presenter:
JohnCanady,MS,MD,DSc(hon)
Affiliation:
MentorWorldwide
Country:
USA
Authors:
CanadyJ,VargoJM,WixtromRN
1992 144
GEOMETRIC MULTIPLANAR STRUCTURED
MAMMAPLASTY
Presenter:
OsvaldoJPereiraFilho,MD
Affiliation:
ClinicaJaneHospitalIlha
Country:
Brazil
Authors:
PereiraFilhoOJ,Bins-ElyJ
Purpose: ALCL (anaplastic large cell lymphoma) is a rare
T-cell lymphoma reported to date in approximately 170
womenworldwidewithbreastimplants(IQUAM2014).This
evaluationaimstoelaboratedetailsofreportedcases.
Background:Thepurposeisplantheupperpediclemastopexy
and breast reduction according principles of the divine
proportion, phi, associated with structured multiplanar
assembling of the new breast. The strategy is based on the
constancyofthesubmammaryfold,orientatedoverafigure
of almost “V”-shape triangle with the vertex situated at the
umbilicus and each branch opening in direction of the
clavicular-acromiumarticulation.
Methods: Medicaldevicereportsof“ALCL”inbreastimplant
patientswereidentifiedusingtheFDAManufacturerandUser
FacilityDeviceExperience(MAUDE)databasethroughearly
2014.ThedistributionofALCLreportsacrossmanufacturers
wasevaluatedrelativetobreastimplantsales.Clinical/device
historyfromonemanufacturerscaseswerealsoreviewed.
Results/Discussion: ALCL reports in the MAUDE database
throughearly2014includeatotalof178patientsand188devices
reported by or involving devices from Allergan/Inamed/
McGhan/CUI(166;88%),Mentor(11;6%),Unknown/Blank
(8;4%),Sientra/Silimed(2;1%)andPolytech/Silimed(1;1%).
Todate,only3confirmedcasesofALCLhavebeenreported
amongpatientswhosedevicehistorywasknowntoinclude
only Mentor breast implants. Indeed, in 2 Mentor-related
implantcases,breastreconstructionpatientswereoriginally
implanted for 16 yr with salt-loss textured implants of
anothermanufacturerfollowedby1.5yrwithMentordevices.
Mentor breast implants sold worldwide 1985-2010 account
for about half or more of the FDA-estimated “5-10 million
women who have received breast implants worldwide”.
Despite this widespread use, only 6% of all MAUDE ALCL
reportspotentiallyinvolveMentordevices.Whilelimitations
of MAUDE (eg, incomplete, unverified, and/or duplicative
reporting)mustbeacknowledged,thedistributionofreports
across implant types relative to the distribution (sales) can
providevaluableinsightsintorelativeratesofoccurrenceof
complicationsacrossmanufacturers.
Conclusion: Review of MAUDE reports of ALCL in breast
implantpatients,togetherwithdevicesales,indicatesanonuniformdistributionofcasesacrossreportingmanufacturers,
whose breast implants differ in various characteristics
includingmaterialsandprocessesusedfordevicetexturing.
In addition, individual cases highlight the importance of
taking into account the patients total breast implant and
surgicalhistorywhenevaluatingpossibleassociationofALCL
toanygivenimplanttype.
Method:Thestrategyhasprospectivelybeinginvestigatedin
262patients,comprehendingn=524breasts.Themeanage
was3years,rangingfrom16to72years-old.Thefollow-up
occurredfrom6monthto3years.
Technique: The new breast is planned over a “V”-shaped
triangle with the vertex situated at the umbilicus, point u.
Eachbranchesopensinanangleofalmost60degreeparallel
to themammaryline,closedtotheclavicula-acromiumjoint.
P1,thekeypointofthestrategy,issituatedattheintersection
ofeachbranchoftheVtrianglewiththesub-mammaryfold
line, previously demarched with the patient in orthostatic
position.Theamountofthenewbreastconeleftisplanned
pullingthebreastupwardwithahookatthepointP2.The
same distance between P1-P2 measured in cm demarcates
theinferiorlimitoftheconebasefromP2.Theassembling
ofthenewbreastisperformedusingprogressivemultiplanar
layersinaconvergentfashionrotatingthebreasttissuefrom
lateral and medial in direction to key point P1. The sutures
of the inner layer is performed between the breast tissue
to the pectoral muscle superficial fascia. The main layer is
betweenthemammarytegumentandthesubmammaryfold
superficialfascia,usuallysixtoeightstitchesfromlateralto
P1andtwotothreefrommedialtoP1.
Result: The data were scored as good, according Strassner
grading. Satisfactory upper pole projection, lateral to
medial rotation and reduced axillary laxity was a constant.
The complications were few: minimal scar ulceration in 16
patients,6%,asymmetryin13,5%,andpartialortotalnippleareolarcomplexnecrosisin5,2%.
Conclusion: Balanced breast is satisfactorily obtained
according the proposed approach with minimal rate of
complications.The method adds predictability to the
mastopexyandbreastreduction.
90
144
GEOMETRIC MULTIPLANAR STRUCTURED
MAMMAPLASTY
1859 145
15 YEARS EXPERIENCE WITH ANATOMICAL SHAPED
IMPLANTS FOR BREAST AUGMENTATION
Presenter:
CarlosH.Goes,MD
Affiliation:
InstitutodeCirurgiaPlasticaSantaCruz
Country:
Brazil
Authors:
GoesCH,SalesPM,ArantesHL
Anatomicsiliconegel-filledbreastimplantwasinitiallyused
byCroninandGerowin1962.Thegreatadvantageofthese
teardrop implants is the similarity to the natural shape of
the breast, providing pleasant natural results. However the
implants were smooth and filled with a low cohesivity gel,
wichmostofthemturned.Theroundimplantswerecreated
tosolvethisproblem,neverthelesstheyofferamoreartificial
aspect.
From June 1998 to June 2013, anatomic breast implants
were made available for patients who desired mammary
augmentationwithnaturalresults.
All surgeries were performed by the main author and with
exclusive esthetic purpose. Implants from five different
manufacturers were used: McGhan Style 410 (Allergan),
Vertex (Eurosilicone), Esthea (Perthese), CPG 232 (Mentor)
andBiodesignEnhance(Silimed).
Infifteenyears,522implantswereplacedin261patientsusing
the dual plane technique or in the retromammary position.
Agerangedfrom18to64yearsold.Theimplantwith300cc
was the most used (volumes ranged from 150cc to 635cc).
All surgeries were performed through the inframammary
fold. Implants were placed in the retromammary pocket in
21.4%ofthepatients,whereas78.6%weresetinadualplane
situation.Implantrotationwasobservedin8patients(1,5%)
allone-sided,0,75%ofthepatientswerereoperatedtolimit
theimplantpocket,allwerewithmicrotexturizedimplants.
Therotationswerenoticedinapostoperativeperiodof2to
33months(seven,87,5%werenoticedwithin8monthsfrom
surgery). Capsular contractures occurred in 6 patients, all
in a retro mammary position, 2,29% of all patients, 8,61%
consideringsubglandulartechniqueandwithin7to9years
fromsurgery.
Weconcludethatthedualplanetechniquehelpstoreducethe
incidenceofcapsularcontracture,offersabettercoverforthe
implant,decreasetheincidenceofimplantrotationandthe
rougherthetexturizationoftheimplant,lesschancetorotate.
91
145
15 YEARS EXPERIENCE WITH ANATOMICAL SHAPED
IMPLANTS FOR BREAST AUGMENTATION
1766 146
BREAST AUGMENTATION: MINIMIZING
POSTOPERATIVE NAUSEA AND VOMITING. A
PROSPECTIVE STUDY
Presenter:
StavroulaRodopoulou,MD
Affiliation:
PrivatePractice&Mdone
Country:
Greece
Authors:
KeramidasE,RodopoulouS,PaskovitisA,
ArambatziA
Introduction:Thisstudyevaluatespostoperativenauseaand
vomiting(PONV)afterbilateralbreastaugmentationsurgery.
Theefficacyofaparticularprotocolisevaluated.
Materials and Methods: From Oct 2010 till Oct 2013 were
performed210casesofbilateralbreastaugmentationwitha
specificantiemeticprotocol.
Anaesthetic Protocol Induction with propofol IV. Intra
operative medications: Propofol, Fentanyl, Remifentanyl,
Anti-emetic,Ondansetron,Metoclopramide,Dexamethasone
Specifically for antiemetic protection were administered
Ondansetron8mgrIV(2mgrattheinductionand6mgrslowly
deliveredfor30).Metoclopramide10mgrattheinduction.In
high risk patients (young women, obese, non smoker, with
previous history of nausea and vomiting) we administered
dexamethasone8mgrattheinduction.Sevofloranewasgiven
in heavy smokers and patients with vasoconstriction. Post
operatively Ondansetron 4 mgr IV was delivered 4-6 hours
after the operation. Patients started drinking water in 3-4
hoursafteroperationandweremobilizedafter4hours.The
PONVthefirstfivedaysaftersurgeryandthesurgicaltime
wereevaluated.
Results: 92% of the 210 patients reported no nausea and
vomiting on the day of surgery. The percentage of patients
whoreportednonauseaandvomitingonthenextfivedays
were, a 95%, 99%, 99%, 100% respectively. The mean
surgicaltimewas40minutes.
Conclusions: We believes that the use of Ondansetron,
Metoclopramide, and Dexamethasone are of paramount
importance for preventing POVN. Moreover, the shorter
surgical time results to less need of opioids and can be
beneficialtoo.
92
1877 148
PATHOLOGICAL FINDINGS IN GYNECOMASTIA,
FINDINGS IN 3719 PROCEDURES
Presenter:
OrenLapid,MD,PhD
Affiliation:
AcademicMedicalCenter
Country:
Netherlands
Authors:
LapidO,JolinkF,MeijerSL
1882 147
BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE
T-CELL LYMPHOMA: MD ANDERSON CANCER CENTER
EXPERIENCE AND REVIEW OF THE LITERATURE
Presenter:
MarkW.Clemens,MD
Affiliation:
MDAndersonCancerCenter
Country:
USA
Authors:
ClemensMW,ClarkeC,FanaleMA,HuntK,
MirandaR,MadeirosLJ
Purpose: Breast Implant-Associated Anaplastic Large T-Cell
Lymphoma(ALCL)isararediseasereportedinlimitedcase
reports.Thepurposeofthisstudyistoreportontheclinical
presentation, treatment, and outcomes of ALCL within a
singleinstitutionexperienceaswellastoanalyzethecurrent
researchontheclinicalmanifestationsofthedisease.
Methods:ThePubMedandEMBASEdatabaseswerereviewed
forarticlesonimplantassociatedALCLpublishedfrom1997
through2013.Aretrospectivereviewwasthenperformedof
all ALCL patients who presented and received treatment at
MDAndersonCancerCenterfrom1997to2013.Preoperative
demographics, diagnostic imaging, implant characteristics,
surgicalandadjuncttreatment,complications,andoncologic
outcomeswereassessed.Pathologicandlaboratoryevaluation
were reviewed including immunohistochemistry staining
andscanningelectronmicroscopy.
Results: Eight women were treated during the study period
for breast implant-associated ALCL. Original indication for
implantplacementincludedcosmeticaugmentation(62.5%)
and reconstruction for acquired deformity (37.5%). Seven
(87.5%) of patients had a history of a previous malignancy,
which included breast cancer (62.5%), Basal cell carcinoma
(25%),andHodgkinslymphoma(12.5%).Averagetimefrom
breastimplantationtoALCLsymptomswas123months.
Conclusions: Breast implant associated ALCL is an
uncommon malignancy with a mixed clinical presentation
usually characterized by indolent localized disease but may
rarely be associated with systemic spread. Greater national
awareness and larger multicenter studies are required to
improve diagnosis, identify causal association, and for the
determinationofidealtreatmentalgorithms.
93
Objective: This study aimed to analyze the histopathology
results of surgically excised breast specimens with the
diagnosisofgynecomastia(GM).
Methods: Pathology reports were obtained from the
nationwide network and registry of histopathology and
cytopathology in the Netherlands (PALGA). The reports of
5113breastsfrom3719procedures(2325unilateraland1394
bilateral procedures) were analyzed for the prevalence of
pathologies in different age groups. The average age of the
patientswas35.3±18.3years(range,1-88years)
Results: The most common finding was GM followed by
pseudo-GM. The overall prevalence of invasive carcinomas
was0.11%andofinsitucarcinomaswas0.18%.Theyoungest
patientwithinvasivecancerwas65yearsoldandtheyoungest
patientwithcarcinomainsituwas24yearsold.Theoverall
prevalenceofatypicalductalhyperplasiawas0.4%;inpatients
younger than 20 years, it was 0.23%. The youngest patient
withatypicalductalhyperplasiawas16yearsold.Pathological
findingswerefoundmoreofteninunilateralprocedures.
Conclusions: The prevalence of malignancies in GM
resectionspecimensislow;however,itincreaseswithpatient
age.Unilateralcaseshaveastatisticallynonsignificanthigher
prevalenceofmalignancies.
1780 149
TEN-YEAR RESULTS FROM THE NATRELLE® 410
ANATOMICAL FORM STABLE SILICONE BREAST
IMPLANT CORE STUDY
Presenter:
MarkL.Jewell,MD
Affiliation:
LomaLindaUniversitySchoolofMedicine
Country:
USA
Authors:
MaxwellP,VanNattaBW,BengtsonBP,
MurphyDK
Background:Natrelle®410siliconegelbreastimplantswere
approvedbytheFDAonFebruary20,2013,andthe10-year
study supporting their approval has been completed. This
publicationupdatesthepreviouslyreported6-yearresults.
Methods:Thisprospective,pivotal,multicenterstudyenrolled
941subjects:492augmentation,156revision-augmentation,
225 reconstruction, and 68 revision-reconstruction.
Annual clinic visits collected complications, reoperations,
explantations, and subject satisfaction, and one-third of
subjectsunderwentbiennialMRIrupturescreening.KaplanMeier risk rates were calculated for all local complications,
reoperations,andexplantations.
Results: Capsular contracture rates increased approximately
1%peryearfromthepreviouslyreported6-yearratestothe
final10-yearby-subjectratesof9.2%foraugmentation,11.9%
for revision-augmentation, 14.5% for reconstruction, and
26.8%forrevision-reconstruction(by-implantratesof6.9%,
7.8%,10.3%,20.5%).Theseratesaresignificantlylowerthan
thosefromtheNatrelle®roundgelcorestudy(51%lowerfor
augmentation and 59% lower for revision-augmentation).
TheoverallrupturerateintheMRIcohortforallindications
was 16.4% for subjects and 9.7% for implants. Eleven late
seromas were reported (0.6% of study devices), and there
was 1 occurrence reported of implant-associated ALCL. For
both augmentation and reconstruction subjects the most
common reason for explantation was subject request for
size/style change. Satisfaction rates remained high through
10 years, with the percentage of subjects saying they were
somewhatordefinitelysatisfiedwiththeirimplantsat96.2%
for augmentation, 87.5% for revision-augmentation, 93.3%
forreconstruction,and90.0%forrevision-reconstruction.
Conclusion: Natrelle® 410 anatomical form stable implants
have demonstrated long-term safety and effectiveness, with
lowcomplicationratesandhighsatisfactionrates.
1972 150
EFFECTS OF ANTILEUKOTRIENE AGENTS ON
CAPSULAR CONTRACTURE: AN ANALYSIS IN 520
PATIENTS FOR LONG TERM
Presenter:
RuthM.Graf,PhD
Affiliation:
FederalUniversityofParana
Country:
Brazil
Authors:
GrafRM,BalbinotP,KurogiAS,MarcanteR,
MontenegroML,PedrosoCA,DalNegro
JuniorE,daSilvaFreitasR
Capsular contracture is one of the most common local
response in both aesthetic breast augmentation and
reconstructive breast surgery involving the use of silicone
implants.Eventhoughthedesignoftheprosthesis andthe
surgical techniques have improved, the reported incidence
of clinically significant capsular contracture is still between
4.6-25% (1) and is one of the main causes of reoperation
(2). The purpose of the present study is to analyse the
influence of a leukotriene antagonist drug (zafirlukast and
montelukast) used as a preventive approach to capsular
contractioninpatientsthathaveundergoneaestheticbreast
augmentation surgery. According to the physiopathology of
thecapsularcontractionandthedescribedLTA’seffect,itis
hypothesisedthatthosedrugswoulddecreasepost-operatory
capsular contraction incidence, when compared to previous
results described in the literature. A retrospective study
was performed, including 520 female patients that had
undergonebreastaugmentationormastopexyaugmentation
surgery. All patients received antileukotrine therapy for 90
daysandwerefollowedwithclinicalexamination.Thestudy
includedpatientsthatwereoperatedsince2005until2012,
fromthePietaMedicalCenter,aprivateplasticsurgeryclinic
in southest of Brazil. They were 520 female patients that
undergone augmentation mammoplasty since 2005. 329
(63,2%)patientshadamammaplastyaugmentationsurgery,
while 191 (36,8%) patients had undergone a mastopexy
augmentation. The incidence of capsular contracture on all
thepatientswas2.3%(Graphic6).Takingintoconsideration
the type of surgery, mastopexy augmentation was the one
related with higher contracture (3,7%), almost double
percentage of augmentation mammoplasty (3,7%) (breast
augmentationhadlesscapsularcontracturethenmastopexy
breast augmentation) but with no statistical significance (p:
0,126).Inconclusion,wehavenotedastatisticallysignificant
decreaseonthecapsularcontracturerateaftertheintroduction
ofLRAstoourpractice.Furthermore,montelukasthasbeen
demonstrated to be a safe drug and be a good option as a
preventivetherapyforcapsularcontractureonpost-operatory
ofaestheticbreastaugmentationsurgery.
94
1747 151
IMMEDIATE MEGA VOLUME FAT GRAFTING TO THE
BREAST FOLLOWING REMOVAL OF BREAST IMPLANTS
Presenter:
SaadADibo,MD
Affiliation:
MAClinic
Country:
Belgium
Authors:
DiboSA,AbboudMH
1852 152
PEDICLED TRAM IN THE ERA OF MICROSURGICAL
BREAST RECONSTRUCTION - IS THERE STILL A ROLE?
Presenter:
SamuelShih,MD,MPH
Affiliation:
EmoryUniversity
Country:
USA
Authors:
ShihS,ElliottLF
Thepurposeistosharetheauthorsexperiencewithimmediate
megavolumefatgraftingtothebreastfollowingremovalof
breastimplants.Allpatients,whorequiredremovalofbreast
implants, were included in this study. Cases with ruptured
implants were excluded. Capsulectomy is performed only
for grade 3 and 4 capsular contractures. Fat is harvested by
Power-AssistedLiposuction(PAL)usinga3mmmulti-holecannula. The latter is also used to perform multidirectional
andmultilayeredtunnelingintherecipientsite,inawayto
fashion a matrix for fat grafting. Following fat preparation
by decantation, injection is carried out in multiple planes,
using multiple access points with a custom-made V-shaped
3 mm multi-hole-cannula, enabling simultaneous vibration
oftherecipientsiteduringfatinjection.Adrainisinserted
in the breast pocket before closure of the wound. Sizes of
theremovedimplantsrangedbetween200and400cc.The
injected volumes per session ranged from 300 to 600 ml,
takingintoaccounta1.5:1ratiooftransplantedfattooriginal
sizeofimplant.Theoperativetimerangedbetween50to70
min.Onlyoneinjectionsessionwasrequired.Thefollowup
period ranged between 12 and 36 months. Complications
included6.25%fatcysts.
The abdomen is still the leading donor site for autologous
breast reconstruction since the introduction of the pedicled
TRAM by Hartrampf in 1981. Microsurgical reconstruction
with msTRAM and DIEP flaps have become increasingly
popular due to the potential for improved blood supply
and decreased donor site morbidity. However, free flap
reconstruction is time consuming, requires significant
amount of resources intraoperatively and postoperatively as
wellasadifferentsetofskillsandadditionaltraining.
Theproposedgraftingstrategyholdsthefollowingkeypoints:
- Making use of the stretched breast skin envelope and
abundant third space following removal of implant
to immediately replace the volume with grafted fat.
- Exploiting the recipient site as a matrix by performing
subcutaneous tunnelization using the power assisted
liposuction technology to provide a larger space capavity
whilerespectingutmostcontactbetweenthegraftedfatand
recipientsite.
- Simultaneous vibration and tunnelization in the recipient
siteduringfatgrafting,optimizingdiffusionofthefatinthe
recipientandthusincreasingthevolumesoffattransfer.
95
DatawerecollectedretrospectivelyofallpedicledTRAMflaps
performed by one senior surgeon between 2011-2013. The
techniqueusedfortheTRAMprocedureisthatfirstdecribed
by Hartrampf where a muscle sparing method was used.
Patientdemographics,lengthofoperativetime,periopertive
mobiditiesandlongtermoutcomeswerereviewed.
Sixtyeightconsecutivepatientsunderwentbilateralpedicled
muscle-spaingTRAMforatotalof136flaps.AverageBMIwas
26.2.Averageoperatingtimewas188minutes(3hrs8mins).
There was one flap loss (1%). Eleven flaps had fat necrosis.
Meshwasusedin46%ofpatients.Abdominalwallweakness
wasdetectedinone(1.5%)patientthatrequiredmeshrepair.
ThepedicledTRAM,whenperformedusingmuscle-sparing
techniqueasoriginallydescribedin1981stillhasanimportant
roleinautologousbreastreconstruction.Thesurgerycanbe
performed expeditiously while the rate of abdominal wall
morbidity is similar to that of current microsurgical flaps.
Theauthorsadvocatetheuseofthepedicledmusclesparing
TRAMasatoolforbreastreconstruction.
Free Paper Session 12 - Plastic Surgery & Stem Cell Research
1655 153
PLASTIC SURGERY - QUO VADIS? CURRENT TRENDS
AND FUTURE PROJECTIONS OF AESTHETIC PLASTIC
SURGICAL PROCEDURES IN THE UNITED STATES OF
AMERICA
Presenter:
NiclasBroer,MD
Affiliation:
TechnicalUniversityTeachingHospitalMunich
Country:
Germany
Authors:
BroerN,JuranS
Whilepronetoeconomicfluctuations,aestheticplasticsurgery
haswitnessedanoverallsteadygrowthoverthepastdecades.
Theobjectiveofthispaperwastoevaluatepastandcurrent
trends regarding aesthetic surgeries in the United States
of America and to project future changes regarding such
procedures.Theresultsaimtoalertthemedicalcommunity
aboutthesetrends,inordertoplanandprepareinadvance.
Cosmetic surgery statistics from the American Society for
Aesthetic Plastic Surgery from 1997 to 2012 were analyzed
by sex, age and ethnic group. Then, utilizing the national
population projections from the U.S. Census Bureau based
onthe2010census,twoprojectionscenariosoftheexpected
number of aesthetic plastic surgery procedures were
generated.Thescenariosincludedthepresumedoccurrence
and non-occurrence of a recession of similar degree to the
crisisthatsetinin2007.
Basedonpasttrendsinproceduresandtakingintoaccountthe
changingage-andethnicstructureoftheU.S.population,in
theabsenceofanothersevererecession,aestheticprocedures
areexpectedtogrowfrom1,688,694in2012to3,847,929by
2030,representinganaverageannualgrowthpercentagerate
of7.1%.Shouldanotherrecessionofsimilardegreetotheone
in2007occur,procedureswouldonlyincreaseto2,086,994,
displayinganaverageannualgrowthpercentagerateof1.3%.
Since the age distribution of the patient population will
change,preferencesforspecificproceduresaccordingtoage
influence,andthusarereflectedin,futuredemandforthose
procedures.Further,theethnicprofileofpatientswillchange
significantly,with32%ofallproceduresbeingperformedon
patientsotherthanCaucasiansby2030.
Demandforaestheticplasticsurgicalproceduresisexpected
to continue to grow, while depending on the economic
performance at the macro level and changing demographic
dynamicsoftheU.S.population.Consideringallinvestigated
factors and trends among all patients, the most commonly
requested procedures by 2030 are likely to be 1. breast
augmentations,2.lipoplastiesand3.blepharoplasties.
1942 154
IN SEARCH OF A METHOD TO MINIMIZE PROSTHETIC
CAPSULAR CONTRACTURE: IN VIVO EXPERIMENTAL
MODELS USING FASCIA AND ACELLULAR DERMAL
MATRIX WITH AND WITHOUT RADIOTHERAPY
Presenter:
ErcanCihandide
Affiliation:
BahcesehirUniversityGoztepeMedicalPark
HospitalComplex
Country:
Turkey
Authors:
CihandideE,KayiranO,ErenAydinE,
UzunismailA
Introduction:Capsularcontractureofmammaryimplantsis
aproblemforwhichdefinitivesolutionsremainelusive.We
undertookaseriesofstudiestoassesstheeffectoffasciaand
regenerative tissue matrix as a biological barrier to capsule
formation around silicone implants and extended this to
includearadiotherapy-inducedcontracturemodel.
Materials and Methods: New Zealand female adult rabbits
were used in two studies and Wistar Albino rats in the
third. Textured silicone implant shells were inserted
into subcutaneous pockets the subjects with or without
thoracodorsalfascialflapandgraftinthefirststudyandwith
or without AlloDerm®-wrapping [Lifecell Corp., NJ] in the
lattertwostudies.Implantswereexplantedafter12weeksand
examinedmacroscopicallyandhistopathologically.Specimens
werecomparedintermsofadhesionstosurroundingtissues,
capsulethicknesses,structuralpropertiesandavarietyofcell
counts.SubsequentstudieswererepeatedinaradiotherapyinducedcontracturemodelwithandwithoutAlloderm.
Results: Capsules in the experimental groups were
statistically thinner and less cellular in terms of fibroblasts
and myofibroblasts compared with the control groups
(p<0.05). The inflammatory cell infiltrates were also less in
theAllodermgroup,butofborderlinestatisticalsignificance
(p=0.057).
Conclusion: A significant protective effect of fascia and
Alloderm interposition on capsule formation with textured
silicone implants is seen in irradiated and non-irradiated
implants.Thesubpopulationforwhomimplantreconstruction
hasbeenchosendespitetheneedforradiotherapyorinwhom
futureradiotherapymaybeapossibilityisagroupforwhom
thisstrategymightbeespeciallyuseful.
96
155
FAILURE OF SILICONE GEL BREAST IMPLANTS MECHANICAL TESTS TO DETERMINE THE SHELL
INTEGRITY
1884 155
FAILURE OF SILICONE GEL BREAST IMPLANTS MECHANICAL TESTS TO DETERMINE THE SHELL
INTEGRITY
Presenter:
DianaCostaSantos,MD
Affiliation:
CentroHospitalardeVilaNovadeGaia
Country:
Portugal
Authors:
CostaSantosD,BarrosoML,GomesN,
RamiaoN,MartinsP,CostaH
Background: The recent events surrounding Poly Implant
Prothèse(PIP)breastimplantshaverenewedthedebateabout
thesafetyofsiliconeimplants.Itisnownecessarytoimprove
the bifunctionality of breast implants at the biomechanical
level, taking the mechanical compatibility and toxicological
safety of the involved materials into consideration, thus
reducing the risks to public health. For this reason it is
necessary to understand the rupture causes by analyzing
the mechanical properties of failed and intact implants in
therecentgenerationofsiliconebreastimplants.Astudyto
evaluate the differences in mechanical properties of failed
and intact silicone implants marketed by PIP and Polytech
wasundertaken.
Methods: The mechanical tests were performed on a
mammaryimplantinitsimplantablestatetodeterminethe
resistance of the implant to fatigue, impact and the static
rupture;uniaxialtensiletestswerealsoperformed(testshell
integrity).
Results:Theimplantsweretestedforfatigue;nodeterioration
was observed in any of the implants tested. The evidence
presented suggests that the frequency used in test does
not cause any damage to the implant (up to a frequency of
3,3Hz).Thetestshowsthatinallcasesthesampleswithstand
the impact without rupture, regardless of height that been
launched. Static testing results showed that if the height of
theimplantincreasesthedeformationislarger,andachieved
amaximumrupturedforceof12988N.Theshellresistance
to tensile and tear stress was evaluated. It was observed
that Polytech sustain larger stresses than PIP implants.
Preliminary tests did not show evidence of significant
differences in mechanical properties of the shell material
betweenanteriorandposteriorparts.Howevercomparingthe
averageofthreespecimensineachimplantitispossibleto
observethatsiliconeshellsustainsahighertensilestrength
(Shellbase:x=12.70;FrontShell:x=11.59,whencomparedto
thepatcharea(x=5.186N).
Conclusion:Thisstudydemonstratedanincreasedweakness
ofPIPshellswithtimeandthereforesupportstheargument
forprophylacticremovalofPIPbreastimplants.Futurework
isrequiredtoevaluatetheetiologicalfactorsinfluencingthe
mechanicalproprietiesofbreastimplants.
97
1999 156
TUMOR NECROSIS FACTOR-?-ACCELERATED
DEGRADATION OF TYPE I COLLAGEN IN HUMAN
SKIN IS MEDIATED BY SUPERACTIVATED MATRIX
METALLOPROTEINASE-1
Presenter:
UrsulaMirastschijski,MD,PhD
Affiliation:
KlinikumBremenMitteandCBIBUniversity
ofBremen
Country:
Germany
Authors:
MirastschijskiU,CalianiA,TedelindS,
ChristensenL,AgrenMS
Long-term UV irradiation leads to wrinkling and loss of
skin elasticity. Sun exposure elevates tumor necrosis factor
(TNF)-±thatinducesmatrixmetalloproteinases(MMPs)that
are involved in tissue destruction. We have investigated the
effects and mechanisms of exogenous TNF-± on collagen
degradationinhumanskinexplantsculturedindefinedserumfree media with or without TNF-± (10 ng/ml), nonselective
MMPinhibitor,cycloheximideortheinterstitialcollagenase
MMP-1. Collagen degradation of incubated skin explants,
measured by fragmented collagen molecules, was timedependent, relied on de novo protein synthesis, accelerated
byextraTNF-±(p=0.0021),andaccomplishedprimarilyby
MMP-1. Neither MMP-2 nor MMP-14 were associated with
increasedcollagendegradation.TNF-±increasedsecretionof
MMP-1(p<0.01)but,surprisingly,hadnoimpactonMMP1 quantities in the tissue (p = 0.76). Immunohistochemical
analysis confirmed a similar stromal and epidermal MMP1 expression in control and TNF-± groups with epidermis
being the major source of MMP-1. Increased tissue-derived
collagenolytic activity with TNF-± exposure was not due to
down-regulationofthemajorphysiologicinhibitorofMMP-1
tissueinhibitorofmetalloproteinase-1.However,production
(p<0.01),tissuelevels(p<0.01)andcatalyticactivityofthe
endogenous MMP-1 activator, MMP-3, were increased with
TNF-±. Furthermore, type I collagenolytic activity correlated
with MMP-3 tissue levels and was attenuated by 60% with
the MMP-1-sparing MMP-3 inhibitor, UK370106. Our data
indicate that TNF-± augments collagenolytic activity of
MMP-1, primarily through up-regulation of MMP-3 leading
tograduallossoftypeIcollageninhumanskin.Addressing
MMPactivity,notablyactivatorssuchasMMP-3mighthelp
todecreaseskindamageseenafterlong-termsunexposure.
1840 157
EFFECTIVE LOW-COST NONINVASIVE DIAGNOSTICS
OF KELOIDS BY HIGH-FREQUENCY ULTRASOUND
Presenter:
ValentinI.Sharobaro,MD
Affiliation:
AVVishnevskyInstituteofSurgery
Country:
Russia
Authors:
SharobaroVI,TiminaIE,TrykovaIA,
RomanetsOP
Purpose:Developmentofaneffectiveandlow-costnoninvasive
technique of diagnostics of keloids that is important for a
choiceofthecorrectmedicaltreatment.
Materials & Methods:Comparativeultrasonicexaminationof
hypertrophic and normotrophic (n=54, group 1) and keloid
(n=22, group 2) scars was carried out on 76 patients with
scarsofvariousanatomicareas,whounderwenttreatmentin
DivisionofReconstructive&PlasticSurgeryofA.V.Vishnevsky
InstituteofSurgeryin2010-2013.Theageofpatientsvaried
from16to72years.TheDermcupdevicewithfrequencyof
sensorof20-50MHzwasused.Measurementsofthickness
ofepidermisanddermis,andalsoanassessmentofstructure,
echogenicity and features of a structural differentiation
of various scar types were made. Also the condition of
underlining tissues and structures was estimated for the
determinationofdepthofinjury.Morphologicalexamination
ofexcisedscarswasperformedtoverifytheirtypesaccording
totheultrasonicresults.
Results:Theechograficpictureofkeloidscarshadanumber
ofimportantdifferences:thelackofclearboundarybetween
scarandsubjacenttissuesthattestifiedtoinvasivenatureof
growthofkeloid;thedecreaseinthegeneralechogenicityof
a keloid with existence of unstructured areas, and also the
existenceoftheindividualarterialvesselsgettingintothescar.
Whilethestructureofhypertrophicscarsalmostcompletely
corresponded to structure of healthy skin at ultrasonic
examination.Ultrasoundresultswereconfirmedinallcases
with the morphological examination, including electronic
microscopy.
Conclusions: Ultrasonic examination with high-frequency
sensors (20-50 MHz) is the effective low-cost method for
differential diagnostics of keloid scars. This technique 1) is
noninvasive,2)isratherwidespread,3)isratherinexpensive,
and 4) at once gives the result. Therefore it is expedient to
carry out this examination at suspicion on the pathological
scarring with the subsequent adequate therapeutic and (or)
surgicaltreatment.
98
1956 158
EFFECT OF LOW LEVEL LASER THERAPY ON TRAM
FLAPS, IN RATS
Presenter:
IvoneS.Duarte,MD,PhD
Affiliation:
UniversidadeNovedeJulho&UNINOVE
Country:
Brazil
Authors:
DuarteIS,BezerraVA,FerreiraKC,
OliveiraBG,FujinoharaNC,ChavantesMC,
CamachoCP
1939 159
HISTOPATHOLOGICAL FINDINGS IN THE EXCISON
MATERIALS OF BREAST REDUCTION AMONG
TURKISH WOMEN
Presenter:
EmrahAslan,MD
Affiliation:
AnkaraUniversitySchoolofMedicine
Country:
Turkey
Authors:
AslanE,KayaB,IsilganE,SerelS,CanZ,
GultanSM
Breast cancer is the second most common cancer among
women. In Brazil, 12,705 women died from this disease in
2010.Breastreconstructioncanbeperformedbytransverse
rectusabdominismuscleflap(TRAM).Primarynecrosismay
occur,especiallyinsmokers.Nicotinehasdeleteriousactions
thatimpairtheflapirrigationandhealing.Inliterature,there
are studies using low level laser (LLLT) in order to increase
the viability of the flaps. In this study, TRAM flap surgery
in rats were treated with nicotine and low-level laser (LLL).
We have studied the effect of LLLT on the area of necrosis,
angiogenesis(CD-31)andinflammation(interleukindosage)
oftheTRAMflapstreatedwithnicotine,inrats.
Breast reduction surgery is a frequently performed surgery
byplasticsurgeonsinTurkey.Afterthesurgery,patientshave
the advantage of reducing their problems about neck and
backpainwithgoodaestheticoutcomes,aswellasdetecting
abreastcancerwhichcannotbefoundradiologically.Inthis
study, we planned a single-center retrospective study in our
hospital according to histopathological findings of excision
materials.
Methods:20ratsdividedinto4groups:G1(control):TRAM
flapsurgery;G2:Surgery+Nicotine;G3:Surgery+LBI;G4
:Surgery+Nicotine+LBI.
We retrospectively scanned 454 patients who undergone
breastreductionsurgerybetween2007-2012.Datascollected
frompatientfiles.Pathologicalfindingsclassifiedasnormal
breast tissue, proliferative and non-proliferative lesions.
Patientagesdividedintogroupsaccordingtodecades.
From 454 patients, in 328 patients were found proliferative
and non-proliferative changes. Only from 7 (%1,5) of this
group,werefoundatypicalintraductalandcolumnarchanges.
In6patients(%1,3),wehavefoundlobularneoplasiatype1-2
and3.Withinthestatisticalanalysiswehavefoundthatthe
incidenceisincreasingafter40yearsold.
Inthisstudy,wetriedtoshowthedatasamongTurkishbreast
reductionpatientsandtheeffectofbreastreductionsurgery
fordetectinghiddenbreastcarcinoma.
99
1709 160
A UNIQUE TECHNIQUE FOR TREATING LOW FLOW
VASCULAR MALFORMATIONS
Presenter:
JingHongLi,MD
Affiliation:
ChinaJapanFriendshipHospital
Country:
China
Authors:
LiJH,XinYL
160
A UNIQUE TECHNIQUE FOR TREATING LOW FLOW
VASCULAR MALFORMATIONS
The definitive treatment of low flow vascular malformation
(LFVMs) is one of the most controversial topics in medical
practice.Thebesttreatmentforitisunclearinpartbecause
of the variable outcome. Complete surgical extirpation is
oftennotpossibleexceptforsmall,well-localizeddiseaseor
themuscleswhichinvolvedareexpendable.Sothemorbidity
created by extensive resection has to be weighed against
the morbidity of the original disease. Electrochemotherapy
(EChT)isonemethodwithlittleinjuryformalignanttumors
emergedaround80’soflastcentury.Ithasbeenappliedon
vascular malformations since 90’s of the last century and
has got excellent results. Our Group Study, Patients, Totally
875patientswithLFVMstreatedwithEChT wereevaluated
retrospectively.
Treatment Methods: The anesthesia is needed, 18G trocar
wasusedtoinsertintodiseasedregionfrom2cmbeyondthe
marginoftumor.Theywereinaspaceof1-1.5cmbetweenone
another.Theelectrodeswereconnectedtoanodesandcathodes
of electrochemical therapeutic instrument respectively. The
treatingcurrentis100-180mAandthevoltageof6-12V.The
totalelectricityusedwasingeneral80?100coulombsper1cm
diseasedtissue.Theseverecaseswhichneededtobetreated
onceagainusuallywereoperatedafter6months.
Evaluation:Thetherapeuticeffectwasevaluatedas4grades
basedonourclinicalfollowupforthechangeofimprovement
of patients’ symptoms and functional impairment. Grade
1: clinical obliteration, functional impairment recover to
normal; Grade 2: most clinical symptoms disappear and/or
functionalimpairmentimprovesignificantly;Grade3:clinical
symptoms and functional impairment improve; Grade 4:
poor, little or no improvement of symptoms and functional
impairment.Grades1,2and3wereregardedaseffectiveand
thefinaleffectiveratewas96.4%.
Conclusion: It has been proved that EChT has a confirmed
therapeuticeffectontreatinglowflowvascularmalformation.
It has the advantages of fewer traumas, quick recovery,
less complication, being handled simply, being able to be
performedseveraltimesandbeingeasilyacceptedbypatients.
Itoffersacompletelyneweffectivemethodfortreatinglow
flowvascularmalformations.
100
2045 161
CUSTOMIZED 3D MODELING OF FACIAL IMPLANTS
Presenter:
RobertGuryanov
Affiliation:
Sechenov`sMoscowStateMedicalUniversiry
Country:
Russia
Authors:
GuryanovR,GuryanovA
As the other branches of medicine modern plastic surgery
is associated with state-of-the-art technologies and 3D
technologies are able to solve the problem of objectivity in
assessment of patients appearance. Thus, the surgeon has
an instrument which could precisely point at the required
changes, predict the results of operation and estimate the
efficacyoftheprocedures.
Abnormalitiesinthedevelopmentofthefacialbonesmaybe
reason for seeking plastic surgery. Young people with such
deformitiesfeelunhappywiththeirappearanceandareoften
notsociallyadapted.Becauseofthehighaestheticdemands
to the face, patients want to get an idea of his/her future
appearancebeforesurgery.Thedataofopticscanningcanbe
combinedwithother3Ddata(CT,MRI)asthemodelsofbones
andothersubcutaneoustissueshenceitispossibletoaccess
howthechangesinthatstructureseffectontheappearance,
this provide the detailed and combined approach to the
facial implantation and permits us to create the demanded
volumetricpatternofpatients
Furthermore, the use of standard facial implants is very
practical,butstilloftenrequiresfittingtheminplacebecauseof
incongruencetothelowerjaw,asymmetry,bonyprotrusions,
sharp transitions between the implant and the surface of
thejaw.Reliablefixationofprosthesesisproblematic,since
mismatchbetweenboneandprosthesisprofilesmayleadto
undesirable shifts. A lot of empirical experience is required
to select the appropriate size and shape of the implant and
correctly predict the future shape. In contrast, customized
implants can be optimized in shape and size, they do not
require adjustment during the operation, can simply be
alignedwithbonesandrarelydrift.
Virtual models of the patients anatomy are generated on
the basis of CT and optical surface scans. Changes of skin
contoursaresimulatedusingtheFiniteElementmodelingof
soft tissue mechanics. The simulation results are evaluated
bydirectcomparisonwith3-6monthspostsurgerydata.From
our experience, application of 3D modeling dramatically
increasesqualityassurancebyfacialimplantationaswellas
thepatientssatisfactionwiththeaestheticsurgeryoutcome.
101
1743 162
INFLUENCE OF NEGATIVE PRESSURE ON THE
VIABILITY OF ADIPOCYTES AND MESENCHYMAL
STEM CELL, CONSIDERING THE DEVICE METHOD
USED TO HARVEST FAT TISSUE
Presenter:
LuizCharles-de-Sá,MD
Affiliation:
VeronaUniversityandPontificalUniversity
CatholicofRiodeJaneiro
Country:
Brazil
Authors:
Charles-de-SaL,DantasD,HanJV,
AbudibJH,deCastroCC,LealPR,
deAraujoPL,LinkW,BorojevichR,RigottiG
Background: Currently, it is necessary to identify methods
and maneuvers that may minimize reabsorption rates and
provide long-term results more predictable and stable. The
long lasting result after fat transplantation is attributed to
some steps: harvesting, processing methods, bioativation,
transplantation methods and management of the recipient
site.Ourstudyaimstoidentifythebestmethodofharvesting,
aswellasthebestpressureregimeforfataspiration.
Methods: Thisstudyisaprospective,randomized,comparative
in15healthysubjectsofbothsexesagedbetween20-45years
old,undergoingcosmeticsurgeryoftheabdomen(complete
abdominoplasty, mini-abdominoplasty and liposuction),
withthemainobjectivetoassessthedegreeofcelldeathof
the adipocytes and mesenchymal cells (numerical figure in
percentage)amongthedevicesusedtoharvestfat,correlating
pressure level employed. From these data, we used these
devices (syringes and apparatus) to harvest samples of fat
tissue.Thesesamplesweresubmittedtohistologicalanalysis
in order to verify the integrity and functionality of the
adipocyteandmesenchymalcellsubjectedtopressurevalues
previouslymeasuredandassessed.
Results:Atotalof15patientswereoperated;Thequantitatively
adipocytes analyzed revealed a homogeneous quantitative
profile between all of samples. The Adipose mesenchymal
stemcell(AMSC)analysis,accordingtoFriedmanANOVA,
revealed no significant variation in the percentage of
mesenchymalcells(p=0.045)betweenthepressureregimes
Conclusions: The kind of device, nozzle diameter tip and
pressureregimeusedinthisstudyforharvestfattissue,did
not play an important role to the number of the adipocytes
andviableAMSCduringharvestingprocedure.
Key words: adipocytes, adipose derived mesenchymal stem
cells,fattissue,adiposetissuelipoaspiration.
2028 163
REGENERATIVE MEDICINE MITHS AND FACTS STEM
CELLS TISSUE TRANSPLANTATION
Presenter:
AbelChajchir,MD
Affiliation:
BuenosAiresPlasticSurgerySociety
Country:
Argentina
Authors:
ChajchirA,ChajchirG
Adipose tissue represent a source for excelent material
to graft with great clinical aplications in different areas for
regeneration.
The recent advances in molecular biology and tissue
engineeringgiveustoldsthatcanbeusedforimprovement
ofsurgery.
Harvestingautologouscellsfromadipocitetissuerepresenta
sourceforexcelentmaterialtograft.Greatclinicalaplications
withclinicalautologoustissuesopenthemselvestothefuture.
Weusetheadiposestromalcompartmentlikeanautologous
scafold. And we invade that space with an abundance stem
cells,endotelialcells,growthfactorsandthiscanproducein
the fat transplantation and excelent result. Some long term
resultscanbepresented.
1843 164
FAT GRAFT IN FACE
Presenter:
JavierVeraCucchiaro,MD
Affiliation:
ClinicaEsteticayLaser
Country:
Argentina
Author:
VeraCucchiaroJ
Inselectedpatientswithreplenishvolumeatthecheekbones,
chinandjawangle,theeffectofavolumetricfacelift,giving
satisfactoryresults.
Objectives:Topresentourroutinesettlingofadiposetissue
without growth factors, in some patients in isolation, and
othersassociatedwithafacelift.
Material and Methods:84patientswithfacialfatfillingand
about 68 patients associated with facelift, in the two-year
period(January2012toDecember2013)wereevaluated.
Result:Successfulpatientandphysicianwasachievedwitha
lowrateofminorcomplications,nomajorcomplications;the
mostcommonbeingtheasymmetryofthesecomplications.
Conclusions: The use of autologous fat tissue offers several
advantages, highlighting their low cost, low degree of
complicationsandtheversatilitytobeusedinisolationand/
orassociatedwithafacelift.
102
Free Paper Session 13 - Fat Grafting
1726 166
THE LOWER LEGS CORRECTION WITH FAT GRAFTING
Presenter:
VioletaSkorobacAsanin,MD
Affiliation:
SpecialHospitalDIONA
Country:
Serbia
Author:
SkorobacAsaninV
1811
165
CLINICAL RESULTS OF LARGE VOLUME FAT
GRAFTING BY BEAULI PROTOCOL
Presenter:
KlausUeberreiter,MD
Affiliation:
ParkKlinikBirkenwerder
Country:
Germany
Authors:
UeberreiterK,vonFinckensteinJ,HoppeD
Goals/Purpose: With the results of a prospective clinical
study,theauthorspresentanewandreproduciblemethodfor
easyandreliableharvestingandtransferringoflargevolumes
of transplantable fat. In this study a precise volumetric
quantification of the exact volume gain after fat transfer
has been done by comparative MRI investigations. The
authors named this method “BEAULI” (Berlin Autologous
Lipotransfer).Thepatientsarepresentlybeenrecalledforfive
yearsfollowup;weshallpresentthefirstresultsinRIO.
Methods/Technique:Theoperationwasperformedaccording
toastandardized(BEAULI)protocol.Thefatwasharvested,
separatedinthe“Lipocollector”andreinfiltratedbyaspecially
designed cannula (2.5 mm/150mm) without any further
processing. For quantification of the results, MRI`s of the
breasts were taken preoperatively and 6 months. Clinical
examinationsweredonepreoperatively,andonday1,after1
week,3monthsand6monthsand5yearspostoperatively.
Results/Complications:Inallpatients,asignificantincrease
ofsubcutaneousfattissuewasachieved.
Side effects: In about 5% of cases pressure-sensitive
indurations were observed which regressed on its own
after one year at the latest. They are not more seen in the
patientstreatedwithinthelast3years.Thevolumegainafter
comparativeMRIvolumetrywas76±11%ofthetransplanted
fat.Thefiveyearresultsshowacompletepersistenceofthe
fatgraftedandatypicalchangeinbreastform.
Conclusion: In aesthetic breast augmentation the average
amount of volume increase was about ½ cup size. For a
completebreastreconstructiondenovo(afterablation),4to8
transplantationsarerequired,dependingonpriorirradiation.
Patientstreatedwithautologousfatgraftingafterremovalof
silicone implants due to capsular contracture were mostly
satisfied after a single transplantation. For correction of
tuberousbreastdeformitiesfreefatgraftsappearsuperiorto
siliconeimplants.
103
Introduction:Remodelingthelowerlegswithimplantsgives
us the only aesthetic possibility and that is fattening in the
area of gastrocnemius muscles. If the problem is not only
the muscle but reshaping the entire lower leg, this kind of
surgerywouldnotprovidesatisfactoryaestheticresult.
Patients and Methods: In the 2006-2013 period we have
operated on 112 patients. Preoperatively, we measured BMI
the volume and MRI of lower legs before and six months
after operation. The fat was harvested with 3.0 cannulas
and vacuum syringe. Fat was partially rinsed and partially
centrifuged. Deep into the muscle it was injected rinsed
fat with large 3.0 cannulas, while in the other regions we
injectedcentrifugedfatwith1.2cannulas.Thesampleofthe
adipose tissue was processed with standard histolochemical
method and afterward stained by haematoxylin and eosin
stainmethod,aswellasappropriateimmunohistochemical
method used antibodies for detection of vascular spaces,
most of all capillary spaces, and antibodies for detection of
adipocytes.Aftersixmonths,wehavetakenasampleoffatfor
histological verification and immune-histochemical survival
adipocytesandcontrolMRIwithandwithoutfatsuppression.
Results: Patients have been monitored for a year upon the
surgery.At40%ofpatients,thefatwasaddedatthreemonths
period after the surgery. Percentage of fat survival was 7090%. Results have been measured and compared with fat
volumeinsertedinspecificregionoflowerlegs.BMIdidnot
changeafterthesurgery.WithMRIwemadetheverification
ofthefatinthesubcutaneouslevelandintothemuscle.The
histological and immune-histochemical examination of the
takenfatsamples,aftersixmonths,showsthehighlevelof
vitalityandpreservanceofcellstructureandvascularspaces
aswellaspersistenceofneo-vascularelements.
Conclusion:One’sownfattissueisdefinitelythechoicefor
totallowerlegsremodeling.Unliketheimplants,whichcan
beplacedexclusivelyinanatomicallyspecificregionandhave
specific shape, by fat transfer we can completely remodel
thethighs,lowerlegsandkneesbyfillingthemincircularly.
Postoperativecourseislessdemandingthantheonefollowing
theimplantsinsertion.
1987 167
DUAL PLANE INTRAORAL FAT GRAFT FOR MIDFACE
REJUVENATION: MUSCLE UNIT GRAFT
Presenter:
YongkyuKim,MD,PhD
Affiliation:
YKPlasticSurgeryCenter
Country:
Korea
Authors:
KimY,KangN,YimH
167
DUAL PLANE INTRAORAL FAT GRAFT FOR MIDFACE
REJUVENATION: MUSCLE UNIT GRAFT
Background: From a functional perspective, the face has a
functional region includes temporalis and masseter, and
expressiveregionwhichhasmanymimeticmuscles.Whenwe
performfacelifttoacquirefacialrejuvenationinaccordance
withregionalperspective,extendedSMAStechniqueaswell
as composite technique can bring about unnatural result.
Because those are the techniques that change anatomic
location of mimetic muscles of face. In western people,
lateralaspectofmalarfullnessafterfaceliftcanbeadvisable
but not in Asians. First of all, it is essential to understand
midfacebonyandsofttissueagingprocesstoobtainnatural
rejuvenation. In this respect, we considered fat graft as a
goodmethodtorecoverreducedboneandsofttissuevolume
during aging process without displacement of mimetic
muscles.WetryMuscleunitfatgraftanditisproposedtogive
moresystematizedfatgraft,andintraoralapproachisusedto
havelessswellingandbruisewitheasyaccessofdualplane
insertion:submuscularandsupramuscular.
Method: A retrospective study was performed, using the
medical records of 672 patients (621 women and 51 men)
operatedonbetweenFebruaryof2009andMarchof2014.
Theaverageageofthepatientswas43.7years(range,23to71
years). After harvesing fat, The infraorbital nerve block was
usedtoaccomplishregionalanesthesia.Smallstabincisions
aremadefortheplacementoffatthrough18-Gneedleonthe
mucogingivaoftheupper4thor5thtooth.Thefatwasinjected
through blunt-tipped cannulas 1 mm in diameter. In about
eighty percent of the Fat was placed above the periosteum
first,andtheinjectionsequenceisasfollows;1.Orbicularis
oculi,2.Levatorlabiisup.alaquenasi,3.Zygomaticusmajor
and minor, 4. Risorius. Approximately 5-6ml per each side
wasenoughtoshowgoodresult.
Result:Dualplaneintraoralmuscleunitfatinjectionthrough
intraoral approach is very sytemized procedure and shows
quickrecoveryofnaturalappearancewithlessswellingand
bruise due to protective effect of dermal plexus and SMAS
layerscar.
104
1762 168
AUTOLOGOUS FAT TRANSFER FOR AUGMENTATION
MAMMOPLASTY AND GLUTEAL RESHAPING, A VIDEO
PRESENTATION
Presenter:
AlbertoL.Caldeira,MS
Affiliation:
PlasticandReconstructiveSurgeryInstitute
AlbertoCaldeira
Country:
Brazil
Authors:
CaldeiraAL,RoblesM,MarrouW,BezbattiG
Inthis6:45minutevideopresentationweshowthetechnique
of autologous fat transfer for augmentation mammoplasty
andglutealreshapinginapatient.Itstartswithshowingthe
markingofthebreast,glutealandabdominalareawherethe
fat will be transferred. Afterwards dorsal liposuction takes
placeanddecantationofthefatoccursinthecanister.Then
the fat is transferred to 60ml syringes where it is decanted
forasecondtimeandinjectedintheglutealareawithatotal
volumeofapproximately300ccperside.
Whenautologousfattransfertotheglutealareaisfinished,
thepatientisturned.Infiltrationoftheventralabdominalarea
and liposuction is performed collecting and decanting the
adiposetissueasexplained.Beforeinfiltrationtothebreast,
fat is transferred from the 60ml syringes to 10ml syringes.
Infiltration takes place using microcanulas (1.5 - 1.7mm in
diameter)toinjectthefatinamultilayeredtunnelingprocess
into the subcutaneous and retroglandular areas of both
breast. The total volume of fat transferred to each breast in
thispatientwasapproximately300cc.
Afterwards, photos are shown comparing the preoperative
andimmediatepostoperativeresultsinthepatient.
The last section of the video shows some preoperative and
postoperativefollow-upphotosofsomepatientsat7,14and
36monthsaftertheprocedure.
1957 169
FAT TRANSFER IN PRIMARY BREAST AUGMENTATION
Presenter:
NunoGomes,MD
Affiliation:
HospitaldaPrelada
Country:
Portugal
Authors:
GomesN,MarquesMouraA,SequeiraH,
MatosMartinsJ,MaiaM
Introduction:ThedevelopmentofFatGraftTransfersbrought
apowerfulweaponinAestheticbodycontouring.Itallowsa
doublevantageofextractingfatfromanunwantedlocation,
and its transfer to an area of need. However fat transfer
has been generating a big debate regarding its indications
and risks. Controversy has also emerged with the diverse
techniques for fat harvest, processing and infiltration
described,withthegoalofpromotingfatsurvival.Theprecise
roleofFatGraftsforprimarybreastaugmentationinPlastic
Surgeryneedsyettobedefined.
Methods: The authors reviewed 107 cases of fat transfer
for primary breast augmentation in one year. By a patient
questionnaire,variableslikeage,bodymassindex,smoking,
weight loss, comorbidities, post-surgical care, functional
recovery, fat reabsorption in time and patient satisfaction
were analyzed. Technique and surgery variations like donor
area,harvesttechnique,fatprocessing,infiltration,associated
procedures,andcomplicationswerealsostudied.
Results:TheetiologiesforFatTransferwerebreasthypoplasia
(81%), breast asymmetry (15%) and tuberous breast (4%).
Liposuctionwithacannulaconnectedtoavacuumsystemwas
performedin84%ofthepatients,whilein16%liposuctionwas
performed with manual pressure with a syringe. Regarding
fat processing, in 85% fat was filtrated and washed with
RingerLactate,whilein15%fatwascentrifugedby2minutes
before component separation. Average fat volume injected
was136mlbybreast.29questionnaireswerevalidated,with
mostpatientsreferringvolumeaugmentationsof50%orthe
doubleofpreviousvolume.Fatreabsorptionwasof27%at1
month,43%at3months,51%at6monthsand54%at1year.
Overall satisfaction was over 90%. None of the variables or
techniquevariationcorrelatedwithaugmentedordiminished
reabsorptionrate.
Conclusion: Fat Grafts for primary breast augmentation
proved to be a safe, fast and reliable technique, with high
degree of satisfaction and low rate of complications. In
our study, none of the techniques proved to be superior in
diminishing reabsorption. None of the patient dependent
variables, or amount of volume injected, proved to alter the
reabsorptionrate,whichtendtostabilizeat50%in1year
105
1975 170
AUTOLOGOUS FAT TRANSFER FOR FACE AND BODY
PRESERVING ADCS (ADIPOSE DERIVED CELLS) WHAT
I HAVE CHANGED
Presenter:
HebertT.Lamblet,MD
Affiliation:
UNIFESP
Country:
Brazil
Author:
LambletHT
Goals/Purpose: Besides the fact that fat grafting gained
popularity,isolationofADCs(AdiposeDerivedCells)andfat
tissue manipulation still remains controversial. In 2001, a
putativeStemCellpopulationwasisolatedwithintheadipose
stromacompartment.Sincethen,manystudiesexhibitedthe
abundanceofadultmesenchimalcells,endothelialprogenitor
cellsandgrowfactorproducingcellsderivedfromhumanfat
tissue.Isolationofthosecells,itsactivationantheirimmediate
useforfattransplaststillremainsachallenge.Thepurposeof
thisstudyistoshowourevolutioninthatfield.
Methods/Technique:Adiposetissueiscollectedfrompatients
undergoing liposuction. In the very beginning we used the
ChemicaldisociationmethodtoaccesstheADCscellsfrom
half of the collected fat. The method already described by
us consiste the use of washing with Dulbecco’s Phosphatebuffered saline solution, Collagenase type I Sigma (1,5mg/
ml), Shaker Incubator, Centrifugation at 300g, cell stainer
of100nm,Completemediaforthefinalpurposeofobtaina
pelletthatwillbeaddedtothefreshfattissuefortransplant.
Recently we have been using the Mechanical dissociation
method that does not use the any digestion process and no
centrifugationinacloseprocedurewithnotissuedischarge.
Results/Complications: From february 2002 to October
2013, 391 patients benefited from autologous fat transplant
preserving ADCc cells. The first 272 patients had Chemical
Dissociationand119patientsMechanicalDissociation.60%
oftheproceduresperformed,wasaesthetic.Face:volumetric
enhancement of the face:naso-labialfolds, malar region,
teartrough,chin,mandibleandnose.Bodyprocedureswas
predominantlytheGlutealareavandcorrectionofliposuction
sequelae. 40% consisted of Recontructive procedures:
Secondary Breast Recontruction post-mastectomy, Polland
Syndrome, Sclerodermia and secondary reconstructive
surgeryoftheface.Theavaragefollowupperiodwas2years.
1838 171
FAT GRAFTING AS AN AESTHETIC REFINEMENT
PROCEDURE IN BREAST RECONSTRUCTION
Presenter:
DanielG.Leal
Affiliation:
UniversidadedoEstadodoRiodeJaneiro
Country:
Brazil
Authors:
LealDG,LealPR,deCastroCC,AboudibJH
Background:Breastcontourdeformitiesafterprimarybreast
reconstructionmayserveasamajorchallengetotheplastic
surgeon. With recent trends toward more conservative
mastectomies followed by innovations in reconstruction
techniquesthereisanincreaseddemandforbetteraesthetic
results from breast reconstruction patients. Autologous
fat grafting has proven to be a safe, simple and effective
techinique for the management of volume and contour
deformitiesthroughoutthebody,includingthereconstructed
breast.
Methods: The authors conducted a retrospective study in 15
patients(20breasts)whohaveundergoneimmediatebreast
reconstruction and posterior fat grating sessions to treat
volumeandcontourdeformities.Patientssatisfaction,tumor
recurrance rate, complications and the improvement of the
skinenvelopewereevaluated.
Results: The authors have experienced a high satisfaction
rate with the final cosmetic result and no complications
fromtheprocedureortumorrecurrenceswerepresent.The
improvementoftheskinenvelopewasnotedclinicallyeven
intheradiatedpatientswithanincreasedpinchtestofthefat
graftedbreast.
Conclusions: The use of fat grafting in the refinement of
breast reconstructions proved to be an effective technique,
oncologically safe, with predictable results, and a low
complicationrate.However,inordertoobtaingoodresultsit
ismandatorytohaveexperiencewithautologousfatgrating,
propersurgicalapparatusandacarefulselectionofpatients.
Conclusion: Up to now, ADC isolation and fat tissue
manipulation was done exclusively in laboratory and using
expensiveprocessingmachinesandcollagenase.Mechanical
dissociationhasshowntobereproductibleandcouldbean
alternativefortheuseofthosecellsinamoresafeandcost
effective.
106
171
FAT GRAFTING AS AN AESTHETIC REFINEMENT
PROCEDURE IN BREAST RECONSTRUCTION
1790 172
COMPOSITE GLUTEAL AUGMENTATION: OPTIMIZING
RESULTS USING GLUTEAL IMPLANTS AND PRPASSISTED FAT GRAFTING
Presenter:
MelindaL.Lacerna,MD
Affiliation:
LAPlasticSurgeryInc
Country:
USA
Author:
LacernaML
Introduction: Gluteal Augmentation procedures are on the
riseworldwide.Thetwomainproceduresarewithfatgrafting
orwithglutealimplants.Eachmethodhasdistinctadvantages:
Implants offer predictability, longevity of results, while fat
graftinghaslesscomplications,offerminimaldowntimeand
minimal scars. Combining both techniques in Composite
Gluteal Augmentation provides the best of both techniques
whileofferingenhancedaestheticresults,longevityandsafety.
Thetechniqueisidealforbothprimaryglutealaugmentation
orfromrevisionalprocedures.Thetechniquealsoallowsfor
the incresed projection and volumes that patients request
for, without compromising the safety of either technique.
Inaddition,addingthepatient’sPlateletRichPlasma(PRP)
enhancesfatgraftsurvivability.
Methods:TenfemalepatientsunderwentCompositeGluteal
Augmentation from June 2103-March 2014. Their ages
ranged from 22-52 (median 37). Eight patients presented
for primary augmentation and two presented for revisional
procedures following augmentation with gluteal implants.
The first revision patient complained of implant palpability
twoyearsafterimplantplacement.Herimplantwasmoved
from a sub-fascial location to an intra-muscular plane, and
PRPassistedfatgraftingwasperfomedlateralandsuperficial
to the implants. The second patient complained of implant
visibility and encapsulation; PRP assisted fat grafting was
performedaroundtheimplantto“blend”itsappearancewith
the surrounding anatomy. All patients also received laser
lipolysiswitha975nmDiodelasertodonorsitesfollowing
fatharvestforfurtherskintightening.
Results:Followupwasfromtwomonthstooneyear.There
werenocomplicationsandpatientsweresatisfiedwiththeir
results.
Conclusion: Composite Gluteal Augmentation is a
good technique for both primary and revisional gluteal
augmentation.Inaddition,thetechniqueimprovesthesafety
margin of gluteal implants. By allowing the use of smaller
gluteal implants and augmenting the lateral and superficial
volumewithfatgrafting,thereislesspossibilitiesofimplant
extrusionandpoorwoundhealingoftheinsertionsite.
107
1691 173
AESTHETICS OF THE LEG: THE ROLE OF FAT
INJECTION
Presenter:
AhmedG.ElSharkawy,MD
Affiliation:
CairoUniversity
Country:
Egypt
Authors:
ElSharkawyAG,ELSharkawyOA,EmaraD
1906 174
FAT TRANSFER: WHAT DO YOU WANT? VOLUME OR
TISSUE REPAIR?
Presenter:
MarcoAurelioPellon,MD
Affiliation:
ClinicaSaoVicente
Country:
Brazil
Author:
Pellon MA
Ananthropologicalstudy of120Egyptianfemalesagedbetwen
18and30yearswithnormalBMIwasundertakentoevaluate
theaveragemeasurementsoftheirlegs.Measurementsofthe
circumferenceweretakenatthelowerthigh,upperlegand
lowerlegabovethelateralmalleolusinadditionthedistance
between the head of fibula and the lateral malleolus was
taken.Theproportionsbetweendifferentmeasurementswere
evaluated. The results were considered the average normal
andwereusedasaguidetoevaluateaetheticsoftheleg.
The author discusses the physical and metabolic properties
ofadiposetissue,changesincytokineproductionthatoccur
afteritshandlinganditsapplicationinclinicalpracticefrom
simple volumetric corrections until changes in texture,
color and “rejuvenating” of the overlying skin. Techniques
for obtaining and handling of adipose tissue and their
different approaches to the specific properties of the tissue
andthedesiredresultsarereported.Ischemia,acidosisand
changesincellmembraneproducedbythetraumaofsuction
and manipulation alter the basal physiological behavior
of adipocytes and other cells present in lipoaspirate. These
changes result in activation of processes ranging from the
expressionofangiogenicandtrophicfactorstoapoptosisor
necrosisofthetransferredadipocyteandtriggersmechanisms
oftissueregenerationintherecipientarea.Theintensityof
thatreactioncanproducenoticeableeffectsontheoverlying
skin and are beneficial when we expect skin repair, but not
so much when we aim volumetric correction. In this case
maneuverslikehypothermiainthedonorareaandmanually
spin the syringe itself may decrease the activation of these
factors, improving the “take” of the adipocytes with few
localinflammatoryeffects.Thepuritydeterminedbyuseor
notthestromalvascularfractionandotherfactorsfoundin
lipoaspirate, influences the interaction between the grafted
adiposetissueandtherecipientarea.Mildhypothermiainthe
donorareaallowsforincreasedimpermeabilityandstability
oftheadipocytemembrane,andhelpspreventthecascadeof
reactionssetoffbyoxygendeprivation.Clinicalcasesasthe
useofadiposetissueinburns(intheacutephaseandinthe
sequels),improvingthequalityandappearanceofscarsand
aestheticvolumetricfilling,illustratethefactsmentionedby
theauthorandpresentsapracticaloverviewofthetherapeutic
properties of this important tool of the plastic surgeon.
Improvedvascularizationinacuteburns,aswellasthequality
oftheskingraftatlatefollow-up(3y.)waswelldocumented.
Aesthetic complaints of the patients were in the following
areas:averythinankleregionwithprominenttendoachilis,
defective medial calf region and prominent patella with
unsightlykneeregion.Fattransferwasusedtocorrectthese
aesthetic complaints. The end point for the volume used to
correct deformities of the ankle and the calf was guided by
theaveragemeasurementsestablishedbytheanthropological
study.Thiswasachievedinonesessionin60%ofcasesand
twosessionsin40%ofcases.Fatinjectioninthekneeregion
wasbasedonsubjectivejudgmentafterdiscussionwiththe
patient.Transferredfatvolumeaveraged60ccforeachankle
region,120ccforeachcalfregionand40ccforthekneeregion.
The outcome of management of 24 patients to correct
their deformities was satisfacctory in 21 cases. Two patients
complained of asymmetry to lat resorption of in one side
more than the other that needed correction and one case
complainedofindurationinthecalfregionthatwasdiagnosed
asfatnecrosis.
Conclusion: The techniques for removal, handling and
injectionofadiposetissuemustvarywiththeultimateeffect
expected,eitherintissueregenerationoraestheticpurposes.
108
1755
176
FAT TRANSFER AND MESENCHYMAL ADIPOSE CELL
THERAPY IN AUGMENTATION MAMMOPLASTY
Presenter:
AlbertoL.Caldeira,MS
Affiliation:
PlasticandReconstructiveSurgeryInstitute
AlbertoCaldeira
Country:
Brazil
Authors:
CaldeiraAL,MarrouW,RoblesM,BezbattiG
1997 175
TOTAL BREAST RECONSTRUCTION USING
LATISSIMUS DORSI FLAP WITH FAT GRAFTING
Presenter:
JorgeMarcos,MD
Affiliation:
ClinicaVitalis
Country:
Peru
Authors:
MarcosJ,MarcosH
Wepresentanewsurgicaloptionfortotalbreastreconstruction
with autologous tissue that fuses the best of the Latissimus
Dorsi Myocutaneous flap technique with fat grafting as
autologousfiller,thusavoidingtheuseofprostheses.
Patients and Methods: We included all patients with total
mastectomy that accepted and culminated her breast
reconstruction delayed with latissimus dorsi myocutaneous
flap and fat grafting in the period from January 2010 to
November 2013 at the Plastic Surgery and Burn Unit of
GuillermoAlmenaraHospital(Lima,Peru).
Results:Wascompletedreconstructionin10patients;thetotal
fatgraftingwas380to690ml(media525ml)in2to4sessions.
In the first session was Latisimus Dorsi Miocutaneous flap
and transplant in average volume of 332ml (260 - 400ml)
representing 65% of the total volume. On average 80% of
the initial volume (267ml) was injected into intramuscular
(180 - 300ml). In 40% of cases it was necessary to the
desepitelizacionoftheskinislandand30%thetransposition
flapsinthesideareaofthebreast.Allresultsweresatisfactory
withlowcomplicationrate.
Conclusions: The technique described is a good safe and
versatilealternativeforbreastreconstructiontotalusingonly
autologoustissues,withcomparativeadvantagesintheshort
andlongtermevaluation.
Introduction:Autologousfattransferisaprocedurethathas
attracted many surgeons in the last few years. Adipose cell
aspirate is a source of mesenchymal stem cells which are
embryologicallysimilartothosewithinthebonemarrow,the
most researched type of stem cell, with the advantage that
theharvestiseasiertoobtain,byusingadiposecellaspirates
collected during body contouring procedures in relation to
bone marrow stem cells. Knowing mesenchymal stem cells
proliferativeproperties,wearegoingtoevaluateautologous
fattransferasanalternativeforaugmentationmammoplasty,
aloneorcomplementarytotheuseofbreastimplants.
Methods: An observational study was performed between
2008and2014,recruiting59participantswhoweresubject
toaugmentationmammoplastyusingautologousfattransfer
inDr.AlbertoCaldeira’splasticsurgeryclinicand“Hospital
da Plástica” in Rio de Janeiro. 62 autologous fat transfer
procedurestothebreastweredone.Thepostoperativefollowupwasperformedmonthlyforthefirst6monthsandevery
halfayearafterwards,forthe6yearsthestudywascarried
out. Clinical examination and photograph comparison were
themainoutcomesusedtorateourresults.
Results: The surgical procedure of autologous fat transfer
to the breast showed us an immediate increase in breast
size with subsequent decrease during the next 4 months,
returning to the immediate postoperative size and
maintenanceofthevolumetricincreaseafter4monthsofthe
surgicalintervention.Thesefollow-upresultsarecompatible
with other recently published experimental trials using
Adipose-DerivedStemCells(ADSC)andenhancedVascular
Fraction(eVSF)exhibitingcharacteristicsofangiogenesisand
immunomodulation.
Conclusion:ADSChavedemonstratedproliferativeproperties
used to repair and substitute damaged cells or missing
tissue.Autologousfattransferisatechniqueusedtofillthe
breast and model malformations within it, thus promoting
avolumetricincreaseinbreastsizeandarestorationofthe
tissuesadjacenttothetransfersiteina significant,reliable,
long-lastingandsafeway.
109
2047 177
CREATION FOREHEAD BICONVEXITY BY FAT
GRAFTING MAKES THE FACE MORE ATRACTIVE
Presenter:
MohammadhosseinHesamirostami,MD
Affiliation:
MazandaranUniversityofMedicalSciences
Country:
Iran
Authors:
HesamirostamiM,KazemiashtianiA
177
CREATION FOREHEAD BICONVEXITY BY FAT
GRAFTING MAKES THE FACE MORE ATRACTIVE
Introduction: Forehead biconvexity? defined as mild
prominence of forehead in both vertical and horizontal
directions,confers beauty and attractiveness to upper third
of the face. It can cause youthfull and attractive highlight
of central part of the forehead. Our previous survey on
photographsof500rhinoplastypatientsrevealdthat%58of
themhadflat,irregularorconcaveforeheadsinatleastone
direction.
Patients and Methods:Fortytwopatientswhopresentedfor
correctionof forehead cotour irregularity with fat grafting
between May 2009 and december 2013 were considered.
Therewere3malesand39females.Inallcasesinjectionof
small harvested particles of fatty tissue supplemented with
prp 5:1 was done using a blunt tipped disposable needle
betweenskinandfrontalismuscleinseveraldirections.
Results:For30casesonesessionoffatgraftingwasadequate.
Twelve cases needed 2 sessions of fat grafting. Patient
satisfaction was evaluated by direct question from patients.
All cases indicated that their appearance improvedand that
they looked more beautiful, attractive and younger than
beforeinjection.
Conclusion: The highlight that is achieved subsequent to
creationofforeheadbiconvexitybyfatgraftingcanimprove
harmony between malar and chin prominences and slight
nasaldorsumconcavity.Theresultingslightbiconvexityalso
makesthefaceyoungerandwrinkleslessconspicuous.
110
1714
178
THE COMBINED USE OF NANOFAT GRAFTS AND
PLATELET RICH PLASMA IN MANAGING POSTBURN
AND POST TRAUMATIC SCARS; A CLINICAL STUDY
Presenter:
HusseinS.Abulhassan,MD
Affiliation:
UniversityofAlexandria
Country:
Egypt
Authors:
AbulhassanHS,AbulhassanAH,LashinHA
Background: Our work presents our experience in the
utilizationofadiposederivedstemcellsintheformofNanofat
grafts augmented by PRP (platelet rich plasma) to enhance
the tissue regeneration, facilitate healing and maturation of
postburn and posttraumatic scarring. These nanofat grafts
were harvested from the lower abdomen or inner thighs
usingspecializedmulti-holescannulasofsmallcalibers3-3.4
mm,andmechanicallyseperatedtoobtainMicroandNanofat
globules. The PRP was prepared by simple nonenzymatic
techniques. This novel work is suported by similar studies
presentedbyCervillietal&Tonnardetal.
Aim of the Study:Istostudytheeffectofinjectingacombined
NanofatgraftandPRPinpostburnandpost-traumaticscars
as a method of improving the quality of healing of these
hypertrophicscars.
Patients & Methods:35patientswitha3:1maletofemaleratio
andagerangingfrom4to54yearswithameanof36.6years
wereinjectedbetween2-4timeswitha2-3weekintervaltime.
Injectionsweredoneintralesionallyandsubcutaneouslyusing
an18Gneedlesandaderma-rollerforextensivescarringareas.
Scarsincludedareasoftheface,chest,armsandshoulders.
Digital photography and clinical evaluation of the injected
siteswasdoneat1,3,and6months.Caseswereevaluatedby
theauthor,patientandteamevaluationcomparingtheseries
ofphotographswithgradingfromexcellenttopoor(1-6scale).
Results: All clinical cases will be tabulated, discussed and
compared regarding skin texture, quality of overlying skin,
pliability of scars, and colour changes with amelioration of
theactivityofhypertrophicscars.
Conclusion: A novel technique of combining nanofat grafts
and platelet rich plasma harvested from patients sufferring
fromscarswereutilizedtoimprovethematurationofthese
scarswithrestorationofskinpliability,texture,qualityofskin
andcolourchangesatthesitesofscarsinjected.
111
Free Paper Session 14 - Reconstructive Aesthetic II
2017 179
DUAL PLANE DIEP FLAP INSET: OPTIMIZING
AESTHETIC OUTCOME IN SECONDARY AUTOLOGOUS
BREAST RECONSTRUCTION
Presenter:
AndreasGravvanis,MD,PhD,FEBOPRAS
Affiliation:
GeneralStateHospitalofAthens
Country:
Greece
Authors:
GravvanisA,SamourisG,PapanikolaouG,
TsoutsosD
179
DUAL PLANE DIEP FLAP INSET: OPTIMIZING
AESTHETIC OUTCOME IN SECONDARY AUTOLOGOUS
BREAST RECONSTRUCTION
Introduction:Wehavepreviouslyevaluatedthesingle-esthetic
unitsecondarybreastreconstructionthatensuresconsistently
betteraestheticoutcome.Inthespectrumofirradiatedchest
wall, the poor quality upper pole skin may present healing
problems and poor appearance following its dissection,
compromisingthecosmeticresult.
Purpose:Inthepresentstudy,weconductedavisualanalog
scale survey to compare the aesthetic outcome in delayed
autologous breast reconstruction following two different
abdominalflapsinset.
Patients and Methods: Twenty-five patients had their
reconstruction using the Single-esthetic Unit principle
(group-A) and were compared with 25 patients that their
breast was reconstructed using the combination of Dual
PlaneandSingleestheticunittechniques(group-B).Theskin
between the mastectomy scar and the new inframammary
foldwasdeepethelialised.Ingroup-Aapocketwascreatedat
theleveloftheupperpoleusingthestandardsub-cutaneous
plane,whilstingroup-Basub-muscularplanebysplittingthe
pectoralis major muscle without its release from the costal
marginwasgenerated.TheDIEPflapwasshapedandinserted
as a single unit from the mastectomy scar to the new infra
mammaryfold,reconstructingtheentirebreastlyinginfront
of pectoralis major in group-A, and simultaneously behind
andinfrontofthepectoralismajoringroup-B.Photographic
images were formulated to a PowerPoint presentation and
cosmetic outcomes were assessed from 30 physicians, by
meansofaQuestionnaireandavisualanalogscale.
Results: Our data showed that the dual plane flap inset
presents significant advantages over the traditional single
plane,duetooptimalhealingwithirradiatedchestskin,more
naturaltransitionfromnativeandreconstructedtissues,and
improved fullness of the upper pole. Moreover, patient selfevaluationofestheticoutcomeandqualityoflifeshowedthat
dual plane reconstruction is associated with higher patient
satisfaction.
Conclusion: The dual plane DIEP flap inset ensures the
vascularity of irradiated chest wall skin but also improves
breastshape,thereforeshouldbeconsideredthemethodof
choiceinanydelayedautologousbreastreconstruction.
112
1678 180
COMPARISON OF EXTERNAL NASAL VALVE
ENHANCEMENT AFTER USING RIB AND SEPTAL
CARTILAGE GRAFT OVER ALAR NASAL CARTILAGES
Presenter:
MarceloWulkan,MD,PhD
Affiliation:
ClinicaWulkan
Country:
Brazil
Author:
WulkanM
Externalnasalvalveofthenoseisthefirstbarriertotheairflow.
Itcanbedecreasedbyitslateralcomponent(e.g.,asaresultof
lateralcruralweakness/mal-position/priorsurgery)ormedial
component(i.e.,columellawidth/strength).Inordertoavoid
external nasal valve collapse, it is well known that one may
use structural graft over/under the lateral crura. However,
littledataexistsregardingspecificfunctionalimprovements
comparingthetwomostcommondonorsitesforstructural
grats: septum and rib. Understanding nasal physiology and
thecausesthatcanchangetheexternalnasalvalveiscrucial
toplanningatreatmentifcollapseoccurs.
This study was approved by the ethics committee of the
University of São Paulo. It measured ninety external nasal
valves using Autocad®. The author manufactured flat grafts
measuring 3.0 x 0.1 x 0.5 cm of septal and costal cartilage
thatwereinsertedoverlateralcrurawitharandomsequence.
Allgraftswerefixedbystitchesnexttothemarginalincisions
followedbystandardizedphotography.Allpicturesfollowed
theexactsamepattern;30weretakenbeforeanyprocedure
and60weretakenaftertheinclusionofthecartilagegrafts
overlateralcrura(30usingcostalcartilageand30usingseptal
cartilage). Bilateral extendeded marginal incisions of the
nostrilweremadeinordertodissectatightpocketaboveeach
lateralcrura.Outcomemeasureswereassessedusingamodel
forrepeatedmeasuresandANOVA(AnalysisofVariance).
Theanalysisoftheresultsleadtotheconclusionthatexternal
nasal valve is better enhanced by costal cartilage graft over
lateralcruraratherthanbyseptalgraft(noconfidenceinterval
formeandifferencecontainsthezerovalueandallP-values
arebelowthesignificancelevelof5%).
Therefore, when the patient presents external nasal valve
incompetence and the septum is not big enough to donor
cartilagegraft,ribcartilagegraftcanbeabetteroptiontosolve
theproblem,eveninaprimaryrhinoplasty.
1674 181
TAILORING THROUGH TECHNOLOGY: A SINGLE
SURGEON’S EXPERIENCE WITH IMPLANT-BASED
BREAST RECONSTRUCTION BEFORE AND AFTER
IMPLEMENTATION OF LASER-ASSISTED INDOCYANINE
GREEN ANGIOGRAPHY
Presenter:
SteveJacobson,MD
Affiliation:
MayoClinic
Country:
USA
Authors:
JacobsonS,HarlessC
Breastreconstructionaftermastectomysignificantlyimproves
the quality of life, including the psychosocial and sexual
well-being of women. Implant-based breast reconstruction
provides women with a rapid recovery and early restoration
of body image; however, reported complication rates in the
literature exceed 50%, with mastectomy skin flap necrosis
reportedtooccurinupto25%ofcases(1,2,3).Laser-assisted
indocyanine green angiography (LA-ICGA) technology
provides surgeons with an objective, real-time assessment
of skin perfusion allowing for optimal preservation of the
mastectomyskinflapwhileavoidingskinnecrosis(4,5,6).
The purpose of this study was to determine if outcomes of
breast reconstruction are beneficially affected by using LAICGA.
Atotal269consecutivewomen(467breastreconstructions)
undergoing immediate or delayed implant-based breast
reconstruction by a single surgeon (SJ) from 2008 to 2013
were examined. The complication rates of those who
underwentreconstructionpriortotheimplementationofLAICGAwerecomparedtothosewhowerereconstructedafter
implementationofLA-ICGA.
254consecutivebreastsreconstructionswereperformedprior
toimplementationofLA-ICGAand213breastsreconstructed
with the use of LA-ICGA. Both groups were similar with
respect to BMI, mastectomy specimen weight, history of
smoking, diabetes and hypertension. After implementation
ofLA-ICGASystemtherateofmastectomyskinflapnecrosis
decreased by 86% (6.7% vs 0.9%, p=0.02). The overall
complication rate prior to LA-ICGA was 13.8% compared
to 6.6% after the initiation (p=0.01). After LA-ICGA was
incorporated, the percentage of patients undergoing singlestagereconstructionincreasedfrom12%to32%(p=<0.001).
Implementation of LA-ICGA provides the surgeon with an
objectiveassessmentofmastectomyflapperfusionresulting
inanoverallreductionincomplications,aswellasan86%
decrease in the rate of skin necrosis and reoperation. This
objectiveassessmentofmastectomyflapperfusionallowedthe
plasticsurgeontotailorbreastreconstructionintraoperatively,
in real-time, accommodating for the individual patient’s
mastectomy flap perfusion which led to an increased
percentageofsinglestagereconstructionperformed.
113
1800 182
TRANSAXILLARY ENDOSCOPIC CORRECTION OF
CHEST WALL DEFORMITY WITH LATISSIMUS DORSI
MYO FLAP
Presenter:
ChunjunLiu,MD,PhD
Affiliation:
PlasticSurgeryHospitalPekingUnion
MedicalCollegeChineseAcademyofMedical
Sciences
Country:
China
Authors:
LiuC,LuanJ
182
TRANSAXILLARY ENDOSCOPIC CORRECTION OF
CHEST WALL DEFORMITY WITH LATISSIMUS DORSI
MYO FLAP
Objective: This prospective study aimed to investigate
the safety and effectiveness of using endoscope assisted
transaxillaryapproachtoharvestlatissimusdorsimyo(LDM)
flaptorepairchestwalldeformity.
Methods and Results: Approved by IRB, patients with postmastectomyamastiaorPolandsyndromewereenrolledinthe
study.Theinclusioncriteriawere1)Thoracodorsalarterywas
foundintactbyDopplerorCTangiography;2)Nosignificant
skindefectwaspresentintheanteriorchestwall.Informed
consent was obtained. Twenty-three patients, including 22
femaleand1male,wereenrolled.SixteenpatientswerepostmastectomyamastiaandsevenwerePolandsyndrome.The
patientwascriticallyevaluatedpre-operativelyby3Dscanning
technique.Thesofttissuedefectintheanteriorchestwallwas
marked and measured. A reverse design concept was used
to mark the geometric range of the LDM flap in the back.
Theoperationtechniquewasdetailedasfollowing:A4.5cm
incision along the axilla crease was made. Thoracodorsal
vesselswereidentifiedunderdirectvisionandpreserved.An
endoscope was introduced through the axilla incision as a
customizedretractorwithsuctionholeswasinserted.Supramusculardissectionwasundergonewithcauterytotheedge
ofthemuscle.Thensub-musculardissectionwasundergone.
Themusclewasreleasedfromitsattachmenttotheunderlying
muscle or fascia. Then the subcutaneous pocket in the
anteriorchestwallwascreatedwiththeaidofendoscope.The
LDMflapwastransferredtotheanteriorpocketandtheflap
edgewassecuredtothepocketborder.Abreastimplantwas
placedbeneaththeflapifneeded.Drainswereremovedwhen
below 40 ml per 24 hour. The dimension of the harvested
LDM flap ranged from 25cmx20cm to 35cmx30cm. The
meanoperationtimeforharvestingLDMflapwas1.5hours.
Allpatientsrecoveredwithoutanycomplications.Themean
follow up was 18 months. Satisfaction rate was 100%. Two
patientsreceivedfatinjectioninthebreastforbettercontour.
Conclusions:HarvestingandtransferringLDMflaptocorrect
chest wall soft tissue defect aided by endoscope via axilla
approachisareliableandsafeprocedure.Noscarleftinthe
back improves aesthetic outcome and patient satisfaction
significantly
114
1851
183
WIDE FACE REDUCTION
Presenter:
DooByungYang,MD,PhD
Affiliation:
JelimPlasticSurgicalClinic
Country:
Korea
Authors:
YangDB,YangJHKohKS
Purpose: Compared to Caucasians, North East Asinas are
relatively common in brachycephalic type. To reduce facial
width, we shoud control bizygomatic width, bigonial width,
stateofthementumandmaxillaryheight.
Method: Last three decades we performed over 3000 cases
offacialcontouringsurgery,wewillpresentaboutInfracture
techniqueinmalarreduction,multistagedcurvedostectomy
inMandibularcontouringsurgery,genioplastyandclock-wise
rotationofmaxillo-mandibularcomplex.
Results:Allpatientsachievedbalancedandharmoniousfaces
aftersurgerywithoutspecificcomplications.
Conclusion:Tocontrolwidefacereductionwithoutorthodontic
treatmentispurelyaestheticplasticsurgicalprocedures.It’s
main procedure is infracture technique of malar reduction
whichisabletoreducebigonialwidthasmuchaspossible.
1910 184
THE SCARLESS LATISSIMUS DORSI BREAST
RECONSTRUCTION: VASCULARIZED IMPLANT
PROTECTION IF THE PATIENT DEVELOPS
MASTECTOMY SKIN NECROSIS
Presenter:
MarkA.Lee,MBBS,FRACS
Affiliation:
St.JohnofGodHospital
Country:
Australia
Authors:
LeeMA,MiteffK,KnightR
Aim:TodemonstratethesafetyandreliabilityoftheScarless
Latissimus Dorsi Breast reconstruction as an alternative to
reconstructionusingAcellularDermalMatrix(ADM).
Methodology:Wepresentaconsecutiveseriesof85Scarless
Latissimus Dorsi breast reconstructions (52 patients) from
a single surgeon database. Complication rates, specifically
Mastectomy Skin Necrosis, explantation and reconstructive
failurearecomparedwithaconsecutivecohortusingAcellular
DermalMatrixreconstruction.Allresultsarecomparedwith
internationalmetaanalysisdata.
Results:TheincidenceofMastectomySkinNecrosis(7%)was
notsignificantlydifferentfromtheinternationaldata(7.4%)
the Scarless Latissimus Dorsi cohort had no implant loss,
implant infection requiring explantation or reconstructive
failure. The international cohort was 4.6%. All cases of
necrosis were treated conservatively without operative
debridement. The ADM group developed mastectomy skin
flap necrosis in 38%, an infection rate of 52%, explantation
andreconstructivefailurerateof43%.TheseresultsforADM
reconstructioninasmallseriesaresignificantlyhigherthan
internationalpublisheddata.
Conclusion: The Scarless Latissimus Dorsi Breast
Reconstructionprovidesfullvascularizedcoverofprosthetic
devices. Vascularized muscle provides predictable lifeboat
protection if mastectomy skin necrosis develops post
procedure. Necrotic skin can be treated conservatively, with
reasonable expectation of avoiding infection, exposure or
reconstructivefailure.
115
1689 185
USE OF FENESTRATIONS IN ACELLULAR DERMAL
ALLOGRAFT IN TWO STAGE TISSUE EXPANDER/
IMPLANT BREAST RECONSTRUCTION
Presenter:
JennaB.Martin,MD
Affiliation:
UniversityofCaliforniaIrvine
Country:
USA
Authors:
MartinJB,MooreR,PaydarKZ,WirthGA
The use of acellular dermal matrices (ADMs) in breast
reconstruction has increased in popularity. The authors
have utilized ADMs for breast reconstruction since 2006
and combined their experience since 2008. We believe that
alterationtotheacellulardermalmatrixbystrategicallyplaced
fenestrations, utilizing optimal overlap has improved the
reconstructiveexperienceandoverallcosmeticoutcome.We
presentaretrospectivechartreviewfollowingtwosurgeons’
experienceattheUniversityofCaliforniaIrvineAestheticand
PlasticSurgeryInstituteusingsurgeondesignedfenestrated
acellulardermalmatricesintwo-stagetissueexpanderbreast
reconstruction.Thisalterationtothetraditionalunmodified
inferior sling technique in tissue expander pocket creation
providesadditionaland more optimalsupport and shape to
thereconstructedbreast.Theadditionofspecificpatternsof
fenestrations is hypothesized to increase intra-operative fill
volumeanddecreasetimetofullexpansionwhileincreasing
cosmeticoutcomesandpatientcomfort.
1926 186
AESTHETIC AND FUNCTIONAL OUTCOMES
FOLLOWING RECONSTRUCTION OF THE
LOWER LIP USING THE NOVEL FACIAL ARTERY
MYOMUCOCUTANEOUS (FARM) FLAP TECHNIQUE
Presenter:
JeremyL.Wilson,MBBS,FRACS
Affiliation:
RoyalMelbourneHospital
Country:
Australia
Authors:
WilsonJL,LohnJ,ShuklaL,ShayanR
Background: The Facial Artery Advancement Rotation
Myomucocutaneous (FARM) Flap is a novel islanded
modification of the Webster-Bernard Cheek RotationAdvancementFlaprecentlydescribedbytheseniorauthorfor
aestheticreconstructionoffullthicknesslowerlipdefectsup
tototallowerliplength.TheFARMflapisraisedonthefacial
artery axis and provides a sensate, functioning lower lip by
preserving branches of the mental and facial nerves to flap
tissues which include hair bearing skin, vermillion, muscle
(including residual orbicularis and lower lip depressors)
and mucosa. This technique allows for subunit-based
reconstructionofanaestheticallybalanced,sensate,dynamic
lowerlipofnormallength.
Method:12consecutivepatients(20FARMFlaps)underwent
fullthicknesslowerlipreconstructionfrom2010to2014for
defectsof50-100%oflowerliplength.In3patientsthedefect
extended across the oral commissure onto adjacent cheek.
In 2 patients a unilateral FARM flap was performed with
another flap (1 Estlander Flap; 1 Osseomyocutaneous Free
FibulaFlap).Patientsaestheticandfunctionaloutcomeswere
assessedat1week,6weeks,andevery4monthsthereafterfor
atleast2years.
Results: No partial or complete flap losses were noted in
20 consecutive FARM flaps, even in the presence of active
smoking (n=4), previous radiotherapy (n=2), or previous or
simultaneous ipsilateral neck dissection (n=3). 2 patients
experienceddelayedwoundhealingatinsetmargins(bothhad
apasthistoryofirradiation).Mostpatientsdemonstratednear
normallowerlipsensation,mouthopening,oralcontinence,
speech,andspontaneoussmileby6weekspostoperatively.
Conclusions: The FARM flap has the advantages that it is
relativelysimple,canbecompletedinasinglestage,andcan
beraisedbilaterallyforreconstructionoflargerfull-thickness
lowerlipdefectsuptototallowerliplength.Mostimportantly,
the FARM flap allows for aesthetic balanced reconstruction
offullthickness,totallowerlipdefectswithsensate,dynamic
residual lip and non-lip tissues, impossible to achieve with
free tissue transfer procedures. The FARM Flap does not
violatetheupperlipandthusavoidsmicrostomiainherentto
lipswitchtechniques.
116
187
COMPOSITE SUBCISION - WITH UPWARD TRACTION
OF THE SOFT TISSUE DEPRESSED AREA WITH
LOOPING STITCHE
1990 187
COMPOSITE SUBCISION - WITH UPWARD TRACTION
OF THE SOFT TISSUE DEPRESSED AREA WITH
LOOPING STITCHE
Presenter:
OsvaldoJ.PereiraFilho,MD
Affiliation:
ClinicaJaneHospitalIlha
Country:
Brazil
Authors:
PereiraFilhoOJ,Bins-ElyJ,MachadoPauloE
Introduction: The purpose is treat scars and depressions
concerningsofttissueusingaclosedmethod.Thedepressed
area is pulled upward using looping stitches in single, criscross, or serial fashion. The retracted bands are cut in a
circular motion using needles or attached with miniblade.
The granulomatous tissue fill the depression or retracted
area,harmonizinginvariabledegreesthebodycontour.
Patients and Methods:40patientsconcerningn=77depressed
sites of the soft tissue were treated. The topographies were
classifiedinfivegroups:I-Face,8patients,n=8;II-gluteal,
16patients,n=46;III-mammary,7patients,n=10;IV-
abdomen,7patients,n=7;V-Inferiormember,2patients,n
=6.Allpatients,exceptonewerefemale.Themeanagewas
39years,rangingfrom22to55years.Thefollow-upperiod
rangedfromsixmonthstotwoyears.
Technique: Tomescent infiltration using 0.5% lidocaine,
epinephrine1/800.000isinfiltrated.Theloopingstitchesis
made using 2-0 or 3-0 nylon monofilament with a 2 - 3cm
curvedneedle.Itpasses0.5cmto1cmdeeptheretractedarea.
Thesuturearepulledupwardwithneedle-holderina single,
cris-cross, or serial fashion. A pink needle, BD30X12, BD
Nokorneedle16Gor18attachedtoa10mlsyringeorDoris
needleminibladeR-807,isinsertedattheperipheryofthe
retractableregion.Withacircularmotiontheretractedbands
arecutuntilthebidigitalpatencysignconfirmtheabsenceof
theretractablebands.
Results: The depressions independently of the topography
havebeenreleasedsuccessfullyinallpatients.Bruisesaround
thetreatedareaslastuntilthethirdweek.Moderateinduration
in the region released extended until three months. In the
groupII-glutealregion,sixpatients,withdepressioninthe
buttocksequalorlargerthan5cmdiameterpresentedseroma:
13% of the total sites treated at the buttocks. Drains were
indicatedfor15daysintwopatientsofthegroupII.
Conclusion: The method expands the possibilities of
traditional subcision. It is indicated for multiple entities
associated with depression of the soft tissue. In group II,
gluteusregion,thebestindicationisforretractionstype1A,
lipoatrophy;B,fibrosis,andC,combinationofbothtypes.
117
1728 188
COSMETIC BREAST RECONSTRUCTION BY THE
EXTENDED LATISSIMUS DORSI MC FLAP (ELD-MC
FLAP) WITH POCKET CUTTING
Presenter:
ShigemiSakai,MD,PhD
Affiliation:
InternationalUniversityHealthandWelfare
MitaHospital
Country:
Japan
Author:
SakaiS
For breast reconstruction after resection of breast cancer, I
preferthedelayedreconstructiontouseanextendedlatissimus
dorsi myocutaneous flap (ELD-MC flap) by including some
amountofthesurroundingsubcutaneousfatespeciallyiliac
crestareabeyondtheoriginofthelatissimusmusclewithout
using any foreign bodies like the silicone prosthesis. The
bestindicationofthisELD-MCflapisacasewhosepectralis
musclehaspreserved.
1) Skin Markings
Ifapatienthastheverticalscaronthebreastofcancerresection;
wemaketheverticalspindleskinislandonlatissimusdorsi
musclearea.Thepatienthasahorizontalorobliquescarafter
the resection of breast cancer, we draw spindle skin island
obliqueonthelumbararea.
2) Breast Mound Reconstruction
Forthecaseofahorizontalorobliquebreastscar,weusually
have to cut obliquely from almost center of the breast scar
to the inframammary line caudaly, because the horizontal
scarofcancerresectiononthebreastisusuallysotightinthe
horizontaldirection.Thenweusuallycutthatareatorelease
thetightnessofscarlikecuttingoftheentranceofthepocket
formakingmoreprotrudedbreastmound.Ifwedonotcut
thatarea,thereconstructedbreastbecomesadoublebubbled
shape. This is the most important point for the cosmetic
shape reconstruction with the horizontal or oblique scar of
thecancerresection.Sowecutobliquelyskinpocket.Andwe
putthelateralendoftheskinislandinthecuttingarealike
Z-plasty.Thenwecanmakeagoodshapemoundwithnipple
areolacomplexareaprotrudedandnotabubbledshapebreast.
1775
189
OPTIMIZING THE PEDICLED RECTUS ABDOMINIS
FLAP: REVISED DESIGNS AND VASCULAR
CLASSIFICATION FOR SAFER PROCEDURES
Presenter:
BouraouiKotti,MDPhD
Affiliation:
AntiCancerCenterofTunisia
Country:
Tunisia
Author:
KottiB
Background: The Rectus Abominis myocutaneous (RAM)
flapisoneofthemostusedflapsinreconstructivesurgery.
Manydesignshavebeenpublished.TheTRAM,VRAMand
obliquedesigns(ORAM)remainthemostindented.Themost
common complication described in the literature is partial
necrosisoftheflaps.Wedescribeanewvascularzoningand
classification regarding the abdominal wall perfusion while
harvestingTRAMflapstomakethemmoresecure.
Methods:FromFebruary2009toFebruary2013,weperformed
70pedicledRAMflapsforbreastreconstructionsaswellas
for pelvic and inguinal reconstructions after digestive and
gynecologic tumor resections. Clinical information about
flap skin vascularisation and before and after photos were
collectedprogressively,studiedandanalyzedsimultaneously
and judged retrospectively. Observations were collected
focusing on partial flap necrosis faced with literature and
revisionsweremadeexcludingdoubtfulvascularterritories.
Results: No flap loss or complications were noticed with
VRAMandORAMflaps.Threepartialnecrosisinthesame
territorywithTRAMflapsinvitedustochangeourapproach
andtodiscusstheclassicalvascularzoning.
Conclusion:Accordingtotheliteratureandtoourresultswe
discusstheabdominalskinperfusionwhileharverstingRAM
flaps in order to propose safer skin paddles based on our
classificationandtosecurebythewaycommonprocedures
likebreastreconstructionsusingTRAMflaps.
3) Results and Complication
We performed 1076 breast reconstruction in which 691
were with these ELD MC flap metods. Almost all cases got
symmetricalgoodresults.Butthecomplicationsare2partial
skinnecrosis,6partialfatmelting,15fathardness.Butthese
caseshavenotsomuchproblemsexceptskinnecrosisandfat
melting.
118
189
OPTIMIZING THE PEDICLED RECTUS ABDOMINIS
FLAP: REVISED DESIGNS AND VASCULAR
CLASSIFICATION FOR SAFER PROCEDURES
2026 190
COSMETIC SURGERY FACIAL SKELETON AND
HEALING TREATMENT OF OBSTRUCTIVE SLEEP
APNEA
Presenter:
FernandoGomezSr.,MD
Affiliation:
SanatorioLosArroyos
Country:
Argentina
Authors:
GomezF,AldazC,ComelliL
Introduction: Obstructive Sleep Apnea is a condition that
affects 6% of the world population. The Gold Standart
treatmentistheuseofcontinuoussysteminspiredair(CPAP).
Thistreatmentispalliativeandnotcurative.Presentaseries
of14patientswithmoderatetosevereapneasurgeryCURED
withmaxillomandibularadvancementandchin.
Materials and Methods: 14 patients were treated with
maxillomandibularadvancementandchinadvancementare
presented. Polysomnographic studies were performed pre
-andpostoperativeimagingstudiesandpre-andpostoperative
measurements of posterior retropharyngeal space pre and
post-operatory.
Results: All patients treated with this surgical technique
pasron of serious (over 30 episodes) have apneas and hypo
stopusingtheCPAPforsleep,reducingsymptoms(daytime
sleepiness, morning tiredness moderate apnea (over 10
episodes),nocturia,etc)anddecreasinglevelsofHypertension
tonormal.
Conclusion: Cosmetic Surgery Facial Skeleton is not only
functional and aesthetic problems of patients (joint pains,
phonatoryandswallowingproblems,earlyfacialaging)butalso
CURING efermedad which can have serious consequences
on the lives of people (strokes bleeding, acute myocardial
infarction,sexualproblems,etc.)cangiveadefinitesolution
topatientswhoareaffectedbythisendemicdisease.
119
1703 191
AUTOLOGOUS BREAST RECONSTRUCTION IMPLANT
AUGMENTATION (A.B.R.I.A.): INDICATIONS AND
OUTCOMES
Presenter:
ClaytonCrantford,MD
Affiliation:
WakeForestBaptistHealth
Country:
USA
Authors:
CrantfordC,PestanaIA,BondA,ReboweR
191
AUTOLOGOUS BREAST RECONSTRUCTION IMPLANT
AUGMENTATION (A.B.R.I.A.): INDICATIONS AND
OUTCOMES
Background: Autologous tissue has been employed at
increasing rates for breast reconstruction due to increasing
numbers of young women with normal BMI and advanced
stage malignancies. Traditionally, women with a paucity
of abdominal soft tissue have been considered candidates
for implant reconstruction alone or LDMC flaps +/- breast
implants. These reconstructive options associated with
avoidable morbidity, making them less than ideal. The aim
of this study is to describe ABRIA and its indications and
outcomes in order to satisfy soft tissue implant coverage,
volume and contour problems in this breast reconstruction
patientpopulation.
Materials and Methods:AnIRB-approvedretrospectivestudy
ofconsecutivepatientsundergoingABRIAfrom2011to2014
was conducted. Outcomes related to patient demographics,
indications for surgery, radiotherapy, operative procedure,
implant type, size, location and timing of placement, and
complicationswereanalyzed.
Results: Six patients with a mean age of 49.5 years and a
mean BMI of 22.1 underwent breast reconstruction with 8
autologousflaps.MusclesparingfreeTRAMwereusedin63%
(5/8)ofcasesfollowedinfrequencybyDIEPflaps(2/8)and
asinglepedicledTRAM.Indicationfortheuseofautologous
tissue included previous radiation (4/6), failed implant
reconstruction and level of activity. All patients underwent
delayed augmentation with a mean implant volume of 190
mL.Placementofimplantswasdistributedequallybetween
sub-flap (4/8) and sub-pectoral (4/8) pockets. Median time
frombreastreconstructiontoimplantaugmentationwas5.5
months.Therewerenoimplant/flapcomplications.Average
followupwas8.5months.
Discussion: We describe a technique that employs standard
microsurgicaltechniquesfollowedbyimplantaugmentation
similar to that employed for cosmetic breast augmentation.
Benefits of ABRIA include: a straight forward secondary
procedurebreastaugmentation,excellentimplantsofttissue
coverage, hidden donor site scarring, improved abdominal
contour,andminimaldonorsitefunctionalloss.Thisstudy
demonstrates that delayed autologous breast reconstruction
implantaugmentationcanbeasafeandeffectiveoptionfor
optimizingbreastreconstructionwithautologoustissue.
120
Free Paper Session 15 - Aesthetic Breast II
192
MORSI SUSPENSION MASTOPEXY TECHNIQUE
1710 192
MORSI SUSPENSION MASTOPEXY TECHNIQUE
Presenter:
AdelMorsi,FRACS
Affiliation:
TheAlfredHospitalandCleopatraPlastic
Surgery
Country:
Australia
Authors:
MorsiA,HsiehYH
Introduction: Mastopexy is a commonly performed, yet,
a challenging operation in Plastic Surgery. In modern
techniques, combining breast mound reshaping and
tighteningofskinbrassiereprovidesuperioraestheticresults.
However, soft tissue can migrate caudally under the effect
of gravity with time, resulting recurrent ptosis and patient
dissatisfaction. Morsi Suspension Mastopexy (MSM) is
designedtodefygravity.Breastmoundsarenotonlyreshaped
andrepositioned,butalsosuspendedtoclaviclescreatingan
internalbrassieresystem,thereforeachievinglongevity.
Methods: The technique involves creating a central pedicle,
recruitinglateralchestrolltissuetoincreasebreastvolume,
reshaping of the breast parenchyma using a purse string
suture around the central pedicle with 3/0 Ethibond.
Suspending the reshaped breast parenchyma to the clavicle
usingtwin-fixanchoranditssuspensionsuture.Verticalscar
designwillallowre-drapingoftheskinoverthewellprojected,
adequately positioned breast as well as reduction of lateral
chest roll. Leaves a vertical or a T-shaped scar if conversion
isneeded.
Results: 10patientswererecruited,20breastswereoperated.
Meanage=40(22-56),averagesuprasternalnotch-to-nipple
distance = 27.4cm (23-31). All patients have grade 2 breast
ptosis or above. Mean duration of follow up is 21.7 months
(7-28). Post operatively; 2 patients developed minor wound
complications;1patient(1breast)developedseroma,needing
1aspirationon2occasions.
Conclusions: Morsi Suspension Mastopexy is versatile and
reliable.Itcanbeappliedtobothsmallandlargeptoticbreast,
aswellaspatientwithmassiveweightloss.Althoughshortterm result is promising, long-term follow up would be the
judgeonthis revolutionarytechnique.
121
2052 193
EVALUATION OF SUBMUSCULAR BREAST
AUGMENTATION BY TRANSAXILLARY APPROACH FOR
HYPOMASTY TREATMENT
Presenter:
JosueM.Nascimento,MD
Affiliation:
SantaCasaDeSantos
Country:
Brazil
Authors:
NascimentoJM,FerrazdeAlmeidaAE,
ZanettaFP,DimencoQuadradoAL,ReisFC
Background: Breast augmentation is one of the most
performed cosmetic procedures in the world. Several
approchesandtechniquesareused,beingpresentedherewith
the transaxillary submuscular placement for patientes with
hypomastia. This study aims to evaluate the post operative
periodandpatientesatisfaction.
Methods:Retrospectivestudyof46patientsoperatedwiththis
techniqueintheperiod2011-2012.Theresultswereassessed
by two questionnaires completed by patients regarding
postoperativerecovery,satisfaction,andrecordsreview.
2042 194
SECONDARY MAMMOPLASTY SEQUELAE
Presenter:
FernandoC.Reis,MD
Affiliation:
SantaCasadeMisericordiadeSantos
Country:
Brazil
Authors:
ReisFC,NascimentoJM,QuadradoAD,
AlmeidaAE,BegliominiBD,ZanettaFP,
SilvaOA,OshiroFH
Introduction: Throughoutthehistoryofmankind,thebreast
hasalwaysbeenimportantfeatureoffemininity,symbolizing
motherhood and sensuality. The breast contour has been
widelyportrayedinthearts,literatureandfashion,withhis
concept of beauty closely associated with social standards,
withtheclimateandthepredominanttypeofclothingineach
region.(1).Abreastreductionisoneofthemostcommonly
performedoperationsinthecontextofplasticsurgery.Paulus
Aegineta (625-690 AD) had already described, long ago, a
techniqueofbreastreductiontocorrectgynecomastia.(2)
Results: We obtained a high satisfaction degree through
previously validated questionnaire (CSQ-8), associated with
a low complication rate. Only one patient (2.2%) had to be
reoperatedtoreplacetheimplant.Painreportedby39patients
postoperativelywasnoobstaclefortheearlyreturnofpatients
totheiractivities.
The mastoplasty should have the following objectives:
ensuring good in the medium and long term, to preserve
the glandular physiology, reduce the extent of scarring and
ensurethesensitivityofthisorgan.Thecorrectionofbreast
hypertrophy requires sensitivity and deep aesthetic sense
bytheplasticsurgeon.Thisshouldactpreciselyoppositeto
surgicalcomplications,includingconductingnewprocedure
wherethecosmeticresultislaggingbehind.
Conclusion:Submuscularbreastaugmentationbytransaxillary
approachisafeasibleprocedurewithlowcomplicationrate,
highdegreeospatients’satisfaction,andtechnicallyfeasible
obtainingpredictableresults.
Objective: Demonstrate an approach to the principles and
reasonedbasicsofplasticsurgery,minimizingthemaximum
tissuetraumaandassociatedrotationandadvancementflaps
inordertopreservetheanatomyandphysiologyofthebreast.
Case report: S.A.M., 22, female, white, natural and from
Norway, without comorbidities race, denied smoking and
alcoholconsumption.Shecamereportinghavingundergone
reductionmammoplasty75daysago.Onexaminationshehad
asymmetrical breasts with vertical scar dehiscence near the
groove,scartissuearoundtheareola-papillarycomplex,inframammary fold and lower pole of the breast loss bilaterally,
associatedwithextensiveareaofgranulationtissueandfibrin
inthebreastwhichalsoencompassedtherightlowerpoleand
theareola.Thediagnosiswasdefinedassequelaeofreduction
mammoplasty.Sequentialdressingswereperformedduring
fifteen days. The surgery was initially proposed breast
reconstructionwithcorrectionofasymmetryassociatedwith
skingrafting.Surgerywasperformedafter17days.Marking
ofthebreastwasperformedwithcaretopreservethegreatest
amountofviabletissueandskinenvelope.
122
194
SECONDARY MAMMOPLASTY SEQUELAE
2058 195
BREAST BASE ANOMALIES: TREATMENT STRATEGY
FOR TUBEROUS AND TUBULAR BREASTS
Presenter:
JaimeAnger,MD
Affiliation:
HospitalIsraelitaAlbertEinsteinSaoPaulo
Brasil
Country:
Brazil
Authors:
AngerJ,LetizioN
Goals:Thetubularandtuberousbreastdeformitiesarearare
entityaffectingteenagewomenunilaterallyorbilaterally.The
mainanatomicalfindingisaconstrictedringthatinhibitsthe
normaldevelopmentofthebreastpreventingtoexpandthe
tissues during puberty. The surgical techniques focused to
obtainamorenormaldistributionofthebreasttissuebased
intheliberationoftheconstrictedtissue.However,afterlong
followupwefrequentlyobservedistortionofthebreast,mainly
the central protrusion and the enlarging of the diameter
of the areola. In the unilaterally deformity with important
asymmetryitisverydifficulttoachieveareasonablebalance
mainly when using bilateral silicone implants. To improve
thelongtermresultweproposeinasymmetricbreastsanew
approachbasedinaspecifictissuebreastressectionandthe
useofsub-muscularbilateralsiliconeprosthesis.
Technique: From January 2005 to January 2014, 21 females
patients15to19yearsold,weretreatedwiththistechnique.
A vertical access was used. The breast parenchyma was
dissectedandfreefromthepectoralismajormuscleatitsbase
and from the tissues around. The breast parenchyma was
thanressectedincludingtheconstrictedbaseringstillleaving
minimum3cmlayer.Thesub-pectoralismajormuscleplane
wascreatedwiththeinferiorborderreleasedfromtherectus
abdominis fascia but maintaining the superficial pectoralis
majorfascia.Smoothroundsiliconegelimplantswereused.
Results/Conclusions: There were no complications. There
was no change in nipple sensation. The amount of tissue
removedwasfrom40to100gr.Theresultswereconsidered
excellentevenallthepatientspresentedsomedegreeofbreast
contourasymmetry(Fig2,3).Thistechniquewasconsidered
moreeffectivethanreleasingonlytheconstrictedrings.The
use of a vertical scar help us to remove the exact amount
and position of breast tissue, prevents the nipple enlarging
when using periareolar incision and corrects with more
accuracythebreastptosisfrequentlypresentinthispatients.
In unilaterally cases, the use of bilateral implants is more
likelytoachievesymmetryuptothedifferenceofskinlaxity
betweenbothsides.
123
195
BREAST BASE ANOMALIES: TREATMENT STRATEGY
FOR TUBEROUS AND TUBULAR BREASTS
2043 196
AUGMENTATION MAMMAPLASTY IN TUBEROUS
BREAST
Presenter:
JorgeR.Patane,MD
Affiliation:
PrivatePractice
Country:
Argentina
Author:
PataneJR
Appearance of tuberous breasts ranges broadly from minor
breastconstrictiontoseveredeformity.Sometimestuberous
breastishardtodetectandabreastenlargementcausesthe
deformitytobemuchmoreobviousandcanevenresultina
markeddoublebubbleappearancetothebreast.Thepresent
study includes mammary augmentation with tuberous
breasts in 34 female patients, ranging from first to third
degreeaccordingtotheGrolleau’sclassification.Thereisnot
astandardprocedureforsurgicaltreatmentwhenitcomesto
correcting Tubular Breast Syndrome; it is necessary to cope
with ptosis, elevation of the inframammary fold, paucity of
skinand,sometimes,differentbreastvolume.Then,several
surgical strategies are used alone or combined, such as
loweringthefold,reducingtheconstrictionoftheglandand
the size of the nipple area, mammary augmentation with
implantsofdifferentsizes.
Conclusion: This study examines the possible surgical
proceduresthatcanbeusedineachindividualcase.
124
1745
197
POWER ASSISTED LIPOSUCTION MAMMAPLASTY
(PALM): MAXIMIZING BLOOD SUPPLY TO NIPPLEAREOLA COMPLEX IN BREAST REDUCTION
Presenter:
MarwanH.Abboud,MD
Affiliation:
MAClinic
Country:
Belgium
Authors:
AbboudMH,DiboSA
1924 198
PREVENTING LATE BOTTOMING -OUT IN PATIENTS
WITH GIGANTOMASTIA USING DERMAFASCIAL FLAPAN EXPERIENCE IN 14 PATIENTS
Presenter:
RajeshVasu,MBBS,MS,MCh
Affiliation:
DivineProportions
Country:
India
Author:
VasuR
Contemporary reduction mammaplasty techniques
emphasize parenchymal reshaping and resection as a key
practice for maintaining shape. The authors share a new
concept of breast reduction that provides a safe and quick
procedurewithagoodaestheticoutcome.
Reduction mammaplasty using the Hall Findlay technique
is an accepted procedure of choice even in patients having
macromastia.Goodtoexcellentresultshavebeenreportedby
variousauthors.
The power assisted liposuction mammaplasty (PALM)
techniqueisproposedwiththefollowingkeypoints:
-Maintainingthemaximalbloodsupplytothebreast(arterial
and venous) by basing the NAC on the central, lateral and
superiorpedicles.
- Power assisted breast liposuction, as the main breast
volume-reducingtool,facilitatingparenchymaltransposition
andminimizingtheamountofparenchymaltissueresection.
- Creation of upper pole subcutaneous pocket to fit the
elevated and transposed breast tissue comfortably without
anytensioninadditiontoprovidingupperpolefullness.
- Glandular suspension using dermal-chest wall sutures to
maintainandensurelongevityoftheupperpolefullnessand
recreatetheinframammaryfold.
-Woundclosureinvertical,Jshaped,orshortTscars.
NAC elevations up to 27 cm, and lipoaspirate volumes up
to3000ccperbreasthavebeensafelyperformedusingthis
technique,withoutoccurrenceofareolanecrosis.
ThepresentedPALMtechniqueisasafeandreliablealternative
and option in reduction mammaplasty. By preserving the
maximal blood supply to the breast it constitutes a good
indication for gigantomastia and extensive breast ptosis,
ensuring lasting and aesthetically pleasing shape with
superiorpolefullnesswithoutbottoming-outorboxinesson
longtermfollowups.
125
Although late complications like bottoming-out are
common,preventive measures by using locally available
tissueshavenotbeenreportedtoaddressthisproblem.
Wereportasimpleandinexpensivealternativetotheuseof
acellulardermalmatrixusingautologousdermafascialflapsto
addressbottoming-outofthebreastsinthelatepostoperative
period.Atotalof14patientswithbilateralmacromastiahave
haddermafascialflapsinadditiontothestandardprocedure
of reduction. Follow up in these patients has revealed good
results.
2057 199
COMPARATIVE STUDY ON SUTURES NIPPLEAREOLA
COMPLEX
Presenter:
RaquelS.Camelo,MD
Affiliation:
HospitaldosServidoresdoEstadodoRiode
Janeiro
Country:
Brazil
Authors:
CameloRS,HaesbaertCM,CasagrandeFA,
NetoAJ,DePaolaDQ,SilvaPP,MoreiraBS,
LeiteEP
199
COMPARATIVE STUDY ON SUTURES NIPPLEAREOLA
COMPLEX
Introduction:Severalbreastreductiontechniqueshavebeen
described in the literature, however little is said about the
sutures in the nipple areola complex (NAC) and its results.
Sincetheresultofthissutureisoneofthemostimportant
aspectsofthissurgeryforthepatientsandrealizingthatnot
allpostoperativescarsoftheNACarepleasantforthepatient
and/orsurgeon,weperformedacomparativestudybetween
thetwomainsuturestraditionallyusedforsynthesisofNAC:
PerseusLemossutureandintradermalsuture.
Objective:Ourobjectiveinthisstudyistocomparethetwo
mostusedsuturetechniquesforsynthesisoftheNACinthe
breastreductionsurgery.
Materials and Methods: Retrospective study in which 22
patientswhohadbreastreductionsurgerywhiththeclassic
Pitanguy technique and Dr. Lyacir Ribeiro’s type I pedicle
between october 2010 and april 2012 were included. The
patients were divided in two groups based on the kind of
suture used on the NAC, without relation to the technique
chosen for the breast reduction. The suture technique was
chosen based on the surgeons preference, not on technical
aspects.InthefirstgroupweusedPerseuLemostechnique,a
Gillessuturewiththeknotintheareolaskin.Ingrouptwothe
intradermalsuturewasused.Allpatientswerefollowedfor6
monthspost-operatively.
Result: In the second month of follow up, four patients of
group one presented with hypochromia, but on the sixth
monthonlytwohadsignificanthypochromia.Ongrouptwo
onepatienthadasmalldehiscenceontheNACsuturewhich
solved with local dressings, and in the sixth month only a
small area of hypochromia remained in that spot. Three
patientsofthisgrouphadadiscretehypertrophicscaronthe
NACbutnoneofthemcomplainedaboutit.Allotherpatients
hadnocomplaintsorsignificantcomplications.
Discussion/Conclusion: Both techniques are good options
for NAC synthesis, but in this work we were not able to
conclude if there were any significant superiority of one of
the used techniques over the other, maybe because of the
smallnumberofpatientsofthisstudyorbecauseofprobable
confusing factors that may have occurred, like the patients
differentfototypeordifferentsizeofthebreasts,etc.
126
1684 200
EXTENDED FASCIAL PRESERVING SUBFASCIAL
BREAST AUGMENTATION AND REVISION WITHOUT
ELECTROCAUTERY A NOVEL TECHNIQUE PROVIDING
UNIQUELY SUPPORTED CONTROL OF BREAST SHAPE
AND AESTHETIC APPEARANCE
Presenter:
RianA.Maercks,MD
Affiliation:
TheMaercksInstitute
Country:
USA
Author:
MaercksRA
Thesubfascialplaneinbreastaugmentationhasgainedrecent
support in mainstream literature with supporters claiming
merritsofmorenaturalshape,bettersupportandlongevity
oftheresult.Theproblemsresultingfrompectoralmuscular
movements are reduced or eliminted and better control is
achievedmediallyandlaterallytooccupythetrue“footprint”
of the breast. The thin but strong mm layer is perhaps the
most debated structure in breast augmentation surgery.
Presented is a novel technique intended to optimize the
benefitsofthesubfascialplanebyeliminatingelectrothermal
damage, maintaining a completely contiguous extended
fascial envelope, maintaining direct visualization to control
breastshapethroughcreationofacustomfascialbrassierre.
Subcutaneoustunnelandfascialplaneoftheintendedbreast
shape is infiltrated with tumescent solution containing
1:250,000 epinephrine and Marcaine 2.5g/kg. The entire
procedure is completed under direct visualization with
fiberoptic lighted retractors and 13” curved Metzenbaum
scissors, a sharpened hockey stick dissector sound, facelift
scissorsandscalpelthroughthetransaxillaryapproachunless
mastopexy access is indicated. Contiguous fascial envelope
is continued into serratus fascia and inferiorly as indicated.
Submuscularrevisionsconvertedtoa“neosubfascialplane.”
Only low-profile or lowest profile anatomic shapes are used
inthistechniquewithageneralpreferenceforAllerganstyle
410FM,Style10orSientraclassicovalimplants.Placementof
theimplantsisassistedbyuseofafunnel.
Thecoldtechniqueanddirectobservationallowdissectionof
afullstrength,customshapedfascial“brassiere.”Anaturally
drapedformisproducedthattheauthorhasbeenunableto
attainwithothertechniquessuchassubglandular,subpectoral
anddual-plane.Interoperativeendoscopicevaluationreveals
atruewhitefasciathatisloadbearing.Theprojectionattained
withlowprofileimplantsdemonstratesthatthefascia,notthe
implantisresponsibleforbreastshaping.Presentedisafour
yearexperiencewithdemonstrationinprimaryaugmentation,
secondary/tertiary revision, primary mastoaugmentation in
varyingbodytypesandsizesofaugmentation.
127
200
EXTENDED FASCIAL PRESERVING SUBFASCIAL
BREAST AUGMENTATION AND REVISION WITHOUT
ELECTROCAUTERY A NOVEL TECHNIQUE PROVIDING
UNIQUELY SUPPORTED CONTROL OF BREAST SHAPE
AND AESTHETIC APPEARANCE
1807 201
A NEW TECHNIQUE OF AUGMENTATION MASTOPEXY
WHICH SPARES THE ABDOMINAL PART OF THE
PECTORALIS MAJOR MUSCLE
Presenter:
VadimN.Zelenin,MD
Affiliation:
ScientificCenterofReconstructiveand
RestorationSurgery
Country:
Russia
Authors:
ZeleninVN,ZeleninNV
Post-lactationchangesinthemammaryglandstogetherwith
sagging are a natural process occurring as the female body
ages. Women who experience this change and who seek
helpfromplasticsurgeonsaremostconcernedwiththeloss
of breast volume, changes in the shape of the breasts, and
flaccidity.
However, it is difficult and controversial task to increase
thebreasts’volume,improvetheirshape,andliftthemtoa
higherpositiononthechestbecauseinpatientswithbreast
ptosis,theskinenvelopehasbeencompromisedanddoesnot
holdtheimplantinpositionastightlyasrequiredtoproperly
securetheimplant.Allthismakesaugmentationmastopexy
one of the most challenging of all the aesthetic procedures
performedonthebreast.
Methods:On35patientswithbreastptosisbreastaugmentation
with silicone implants and mastopexy according to the
developedtechniquewereperformedasaone-stageprocedure.
Theauthor’sapproachisbasedontwoconsiderations.First,
inordertoprovidesupport fortheimplantagainstgravitation
and to prevent its displacement in an inferior and lateral
direction,wesparetheabdominalpartofthepectoralismajor
muscles.Second,asthemammaryglandparenchymawhich
hasdroppedbelowtheinframammaryfoldcannotbeproperly
repaired,weelecttoremoveit.Followupforallpatientswas
atleastoneyear.
Results:Therewerenomajorcomplicationsintheimmediate
post-op. In the late post-op, all the patients showed stable
position of the implant against the submammary fold and
weresatisfiedwiththeoutcome.
The technique suggested in this paper provides for stable
goodresults.Itneitherincreasesthetimetakentoperform
the surgery nor makes the surgery more complicated, and
itsolvestheheretoforeintractableproblemofsimultaneous
augmentation and shape correction of a ptotic mammary
gland.
1950 202
LIPOFILLING IN BREAST AESTHETIC SURGERY:
CORRECTION AND AUGMENTATION
Presenter:
SauliusViksraitis,MD
Affiliation:
SauliusViksraitisPlasticSurgeryCenter
Country:
Lithuania
Authors:
ViksraitisS,ZacharevskijE,DaunoraviciusD
Introduction: Recently after decades of experience and
improving lipofilling became a novel strategy for body
contouring and reconstructive purpose. Now different
liposculpturetechniquesareusedasasupplementforstandard
aestheticproceduresorevenchangethem.Lipofillinginbreast
augmentation surgery has several benefits: natural tissue
density and tenderness, rippling prevention in case of thin
softtissuelayerabovetheimplant,skinqualityimproving.
Material and Methods: For breast augmentation and shape
correctionweharvestthefatwith3and4mmcannulasmostly
fromthigh,hip,abdomenregionsandusespecialcleaningand
filtrationsystemforfatpreparation.Fattransfertobreastis
performedwith14Gstraightandcurvedcannulas.Lipofilling
isusedasanadditionalprocedureforshapecorrectionafter
mastopexy operation and breast enlargement with implants
and getting more popularity - breast augmentation with fat
alone.
Results:From2012to201404fattransfertobreastareawas
performedfor112patients.Firstgroupofpatients(42cases)
- breast augmentation with implants and additional shape
correction with fat; second group (10 patients) - mastopexy
andmostlyupperpolecorrectionwithfat;third-fattransfer
asamainprocedureforbreastaugmentation(60cases).
Allpatientswereconsultedafterapproximatelysixmonthspost
operation.Resultsforthefirstgroupofpatientswereperfect.
Inthesecondgrouptwopatientswereoperatedadditionallyin
localanesthesiaforshape(lipofilling)andnipple-areolazone
correction. In the third group for 10 patients we performed
second lipofilling procedure and 3 patients determined to
makebreastaugmentationwithimplants.
Discussion:Fatgraftingisanimportantarmamentariumfor
plastic surgeon. Liposuction supplemented with lipofilling
gives additional potential for correction and aesthetic
liposculpturing.Howeverinbreastaugmentationsurgeryfor
somecasesresultsareunpredictableandadditionalcorrection
isadvisable.
128
1676 203
CORRECTION OF BREAST ASYMMETRY AND MINOR
PTOSIS WITH INTERNAL MASTOPEXY AND MUSCLE
SPLITTING BIPLANE BREAST AUGMENTATION
Presenter:
HoriaR.Siclovan,MD
Affiliation:
MedLifeGenesysHospital
Country:
Romania
Author:
SiclovanHR
1895 204
A UNIQUE CAUSE OF A RARE DISORDER, UNILATERAL
GIANT MACROMASTIA DUE TO EXTENSIVE
FIBROADENOSIS OF THE BREAST
Presenter:
AnkurBhatnagar,MCh
Affiliation:
SanjayGandhiPostGraduateInstituteof
MedicalSciencesLucknow
Country:
India
Author:
BhatnagarA
Background: Current techniques for correction of breast
asymmetryandminorptosisrequiresincisionsonthebreast
butoftenthepatientsaredissatisfiedwithscars.
Objectives and Methods: A technique combining muscle
splitting biplane breast augmentation with internal suture
mastopexythatconsistofsuturesplacedinthedeepsurfaceof
theglandfromtheupperpartofthesplittedpectoralismuscle
ispresented.Thistechniqueleavesnoscaronthebreast.
Results:Thisprocedurewasperformedon32patients,with
ameanfollow-upofthreeyears.Pleasingresultshavebeen
obtained and the patients and the surgeon have expressed
satisfactionwiththeprocedure.
Conclusions: The internal mastopexy combined with
musclesplittingbiplanebreastaugmentationisaneffective
alternativeinselectedpatients.
Keywords: Breast asymmetry, breast ptosis, internal
mastopexy,musclesplittingbiplanebreastaugmentation
Macromastiaandinparticularunilateralmacromastiaisarare
clinicalentity.Itrelatestomassiveenlargementofthebreast
innon-obesewomen.Thiscaseseriesof3patientsdescribes
massive breast asymmetry occurring in a young females
unrelated to pregnancy. Patient complained of extensive
breastpainandtenderness.Theenlargedbreastextendedto
theinguinalregion.
No discrete lesion was seen on imaging and no significant
abnormalities were seen in her blood chemistry. Surgical
treatment was a reduction mammoplasty with free nipple
graftandonaverage1Kgofmammarytissuewasremoved.
Grossly, there was spongiform subcutaneous tissue with
diffuse extension. On histology, this consisted of a highly
complexanddiffusepatternofinfiltrationandofcavernous
empty channels lined by a delicate attenuated endothelium
whichwasconsistentwithFibrocysticdisease.
Fibro adenosis has not been previously described in breast
tissue leading to such large breast enlargement and only a
single case report exists for such a lesion in axillary tissue.
Treatmentofsuchlesionsbysurgicalexcisionisverydifficult
and excision without being radical can be impossible. All
principals of formal breast reduction with free nipple graft
wereusedforreconstruction.
Followupofourpatients,showsnoevidenceofrecurrencein
thispatient.
Our case series describes the Reconstructive Strategies,
clinicopathological features, differential diagnosis to be
considered and treatment, in addition to reviewing the
relevantliterature.
129
Free Paper Session 16 - Aesthetic Breast III
1817
205
TRANSAXILLARY REVISION AUGMENTATION
MAMMAPLASTY WITH ENDOSCOPIC ASSISTANCE
Presenter:
LiYu,MD
Affiliation:
Shanghai9thPeopleHospital
Country:
China
Authors:
YuL,ZhengDN,WangJ,ZhangB,ZhuC
Background: Traditionally, revision breast surgery, such
as breast implant extraction with capsulectomy, capsular
contracture treatment and implant malpositions treatment
areperformedwithtransareolarapproach.Butsuchapproach
is not acceptable by Chinese patients who have been
undergonetransaxillaryaugmentationmammoplastyforthe
additionalscarformation.Wepresentourexperienceinusing
transaxillary endoscopic assistance without the need for an
additionalincision.
Methods: The former trans-axillary incisional scar for
augmentationmammoplastyisused.Thebluntdissectionis
madetotheoutersurfaceoffibrouscapsule.A30-degree,5
or 10mm endoscope is placed through the axillary incision
to dissect the outer surface of capsule. After finishing that,
the capsule is cauterized open and extraction is completed.
The transaxillary capsulectomy and capsular dissection is
performedundertheendoscopiccontrol.Thereimplantation
is performed with non-touch technique after an adequate
pocketiscreatedinacorrectposition.
Results: The treated patients were undergone the 4 to 6
monthsfollow-upperiodwithfavorableresults.Noscarwas
leftonthebreastandnoadditionalscarwasmade.
Conclusions: Breast implant extraction with capsulectomy,
capsular contracture and implant malpositions treatments
couldbecompletedthroughaxillaryincisionwiththefibrous
capsulesuccessfullyremovedundertheendoscopiccontrol.
The technique eliminated the incision on the breast and
createdoneincisionfarawayfromthebreasttocompletethe
procedure.
1914 206
SUSPENSORY THREAD TECHNIQUE OF MASTOPEXY.
LONG-TERM RESULTS
Presenter:
MarlenSulamanidze,PhD
Affiliation:
ClinicofPlasticandAestheticSurgery
TOTALSHARM
Country:
Russia
Authors:
SulamanidzeM,SulamanidzeGM,
SulamanidzeKM,GulyaevIV
Inbreastsurgerythemostdifficulttaskistosavetheformof
thebreastaftermastopexy.Thesecondtaskistoprovidethe
highandstablepositionofthebreast.
Mostwell-knownsurgicalapproachesproposedtosolvethis
problemturnoutrelativelyoftenuntenable:suchprocedures
ofmastopexyascutaneoussupport,cranialredistributionof
theglandulartissueanditssuturingtothefascia,muscular
strengthening,etc.,donotseemtoalleviatetheproblemofthe
gravitationalpostoperativeptosisinthemoreorlessremote
period.Thesupportingskinisknowntosag,thesuturesonce
applied weaken and on the background the nipple-areolar
complexremainingtheelevatedposition,thewholestromaof
themammaryglandgraduallyslidesdownbringingtonaught
theinitiallyobtainedrelativelygoodaestheticoutcomes.
WehaveinourClinicdevisedatechniqueofsuspendingthe
mammary gland to the clavicle, an operation performed by
meansofaspeciallydesignedatraumaticsuturematerial.
The so-called “subcutaneous-brassiere” technique was for
thefirsttimeappliedandtestedinJune2002inthreecases
of mastopexy without removing excess skin by means of
meshed implants. We achieved very promising outcomes
andafterayearofmodificationswecommencedusingthis
procedureduringotherbreastsurgeries.Amongstthemare
classicmastopexywithexcisionofexcessiveskin,mastopexy
usingtheAPTOSNEEDLEmethod,reductionmammoplasty,
and augmentation mammoplasty. The classical technique
andprocedureoftheseinterventionshavingbeingsubjected
toconsiderablealterations(modifications).
In all the cases, the mentioned approach while performing
theseoperationsturnedouttoprovidelong-termmastopexy
persistingovertime.
130
1907 207
SILICON BREAST IMPLANT INJECTOR A NOVEL
DEVICE FOR AUGMENTATION MAMMAPLASTY
Presenter:
SuBenTsao,MD
Affiliation:
DrTsaosClinicofPlasticSurgery
Country:
Taiwan
Authors:
TsaoSB,HsiehCS,LeeCC
Comparing to silicon breast implant insertion by surgeons
and assistants fingers during augmentation mammaplasty,
the insertion procedure assisted by the novel silicon breast
implantinjectordevicehasthefollowingadvantages:
1)shorteningincisionlengthto3cm.
2)shorteningimplantinsertiontime,within1minute.
3)decreaseimplantinjurybyfingerinsertion.
4)decreasetraumatoincisionmargin.
5)decreaseharmtosurgeonsandassistantsfingers.
Duringtherecent5years(sinceNov.2008),wehaveperformed
175 cases silicon implant augmentation mammaplasty with
the assistance of this silicon breast implant injector. The
incision site including periareolar and axillary, the pocket
planeincludingsubfascialandsubmuscular.Allreceivedthe
abovedescribedadvantageswithoutanycomplication.
The implant injector was invented by the first author, and
hasreceivedTaiwanpatentonMay.2008;andUnitedStates
patentonJan.28th2011.
The operative procedure, result and current device
comparison,willbepresentedduringmeeting.
1953 208
BARBED SUTURES IN VERTICAL SCAR BREAST
REDUCTION: THE Z-TECHNIQUE
Presenter:
TimS.Peltz,MD
Affiliation:
UNSW
Country:
Australia
Authors:
PeltzTS,GianoutsosMG,WalshWW,
JonesPJ,SpringettNS,BertolloNB,ParrWP,
PelletierMP
Broadly speaking there are two independent yet related
componentstoconsiderwhenapproachingabreastreduction.
Thesearethechoicesofpedicleandskinexcision.Methods
arecontinuallybeingrevisedinordertoimproveoutcomes.
Verticalscartechniquesbecamepopularisedduetoincreased
patientsatisfaction,reducedscars,decreasedoperatingtime
andgoodoveralloutcomes.
No matter which vertical scar technique is utilized, one
surgical detail remains, the vertical skin closure. It is
important to reduce the distance between the inferior pole
ofthenipple-areolar-complex(NAC)andtheinframammary
fold (IMF) with this step, since in a vertical scar technique
breastreductiontheNACtoIMFdistancetechnicallyremains
toolong.
The shortening of the vertical scar length is an important
step and is mostly achieved by gathering or pleating the
tissueduringclosurewithaseriesof4pointboxstitches.Box
stitches are unfortunately technically challenging and time
consuming and place extra tension at various points along
the closure. Also the remaining knots in the wound can be
potential harbours for pathogens and are often locations of
granulomaformationsandwoundhealingirregularities.
Barbed sutures have been utilised extensively within plastic
surgeryforwoundclosures.Theydistributetensionalongthe
wholesuturinglineanddonotneedknottingtosecurethe
construct.
This study describes the development of a new technique
intheclosureandlengthreductionoftheverticalwoundin
breastreductionwithauni-directionalbarbedsuturedevice.
ItemploysaspecialZ-technique.Theadvantagesofthisare
three-fold. Firstly operating time is reduced, secondly no
knots remain in the wound, thirdly significant reduction of
suturelengthcanbeachieved.
This study compared the use of the new barbed suture
Z-technique with the conventional box stitch technique in
a ex-vivo laboratory study using pig skin. Endpoints were
operating time, amount of reduction in suture length, scar
smoothnessandrepairstability.
Additionallyclinicalcasesarepresented.
131
208
BARBED SUTURES IN VERTICAL SCAR BREAST
REDUCTION: THE Z-TECHNIQUE
1967 209
CHARACTERISTICS OF WOMEN WITH COSMETIC
BREAST IMPLANTS THAT MAY BE ASSOCIATED WITH
INCREASED SUICIDE RISK
Presenter:
YezenSheena,BSc,MBBS,MRCS
Affiliation:
CambridgePlasticSurgeryResidency
Program&ListerHospital
Country:
UnitedKingdom
Authors:
SheenaY,LabirisG,KarakitsouN,KiakasD
Background: The American Society of Plastic Surgeons
(ASPS)reportedthat1.6millioncosmeticsurgicalprocedures
wereperformedin2012whichrepresentsa2%increasesince
2011.Amongthem,cosmeticbreastaugmentationisthemost
popularwitha35%increasefrom2000.
Methods: We reviewed the literature investigating the
characteristics and general psychosocial and psychological
status of breast augmentation patients in an attempt to
identifyfactorsassociatedwithincreasedsuiciderisk.
Results: We identified seven epidemiological studies
addressing the issue of breast augmentation and suicide,
eleven studies focusing on the psychosocial outcomes
and psychological characteristics of women who have had
breast augmentation and ten studies identifying several
characteristics (demographic, lifestyle, psychiatric history)
of women with cosmetic breast implants. Life stressors
(relationship, financial, other psychosocial issues) that are
not part of a routine medical history may be important in
predictingsuicidebehaviourandshouldthereforebeincluded
inpre-operativecosmeticpatientassessment.
Conclusion: We propose a suicide risk model for the
augmentation mammoplasty patient, which includes three
interacting areas each containing independently significant
suicideriskfactors.Ourmodelisspecifictowomenseeking
augmentationmammoplastyandisbasedonthebestcurrent
literatureonsuicidepredictors.Itiscriticaltounderstandthat
practitioners can assess suicide risk, but cannot predict the
suicideitself.
Level of Evidence III (Retrospective cohort or comparative
study; case-control study; or systematic review of these
studies).
132
1753
211
DOES THE REDUCTIVE MASTOPEXY WITH IMPLANT
APPROACH PREVENTS THE LATE BOTTOMING OUT?
Presenter:
AbelMounir,MD,MSc
Affiliation:
BridgewaterHospitalManchester
Country:
UnitedKingdom
Authors:
MounirA,MahdiSM,ClarkPC
1682 210
ACELLULAR DERMAL MATRIX FENESTRATIONS AND
THEIR EFFECT ON BREAST SHAPE: A MATHEMATICAL
MODEL AS PROOF OF CONCEPT
Presenter:
DonaldS.MowldsJr.,MD
Affiliation:
UniversityofCaliforniaIrvine
Country:
USA
Authors:
MowldsDS,GuidottiP,SalibianAA,
NguyenA,PaydarKZ
Background: Acellular dermal matrices (ADMs) are
increasingly being utilized in both primary and secondary
breast reconstruction as they confer several advantages,
including soft tissue enhancement at the inferolateral pole
ofthebreast.Theseniorauthorshaveaddedfenestrationsto
the ADM to allow for more rapid expansion and improved
breastaesthetics.Thepurposeofthisstudyistodescribethe
benefitsofADMfenestrationusingamathematicalformula
asaproofofconceptfortheeffectsofthesemodificationson
breastshape.
Methods: The aggregate effect of symmetrically arranged
fenestrations on the ADM’s mechanical properties is
explained by a uniform reduction in the effective Young’s
modulusofthegraftinadirectionperpendiculartothechest
wallintheareaofgraftfenestration.Asymmetricreduction
of the Youngs modulus is achieved by concentration of the
fenestrationsateitherthecephalicorcaudalendsoftheADM.
Results:TherelaxedYoung’smodulusfacilitatesanincreased
deflectionoftheADMfromitsresting,unalteredstateunder
theweightoftheimplantortissueexpanderandismodeled
usingthefollowingequation:
The reduced inferior pole tension allows for enhanced
expansionundertheweightoftheimplantortissueexpander.
The effects of asymmetrically arranged fenestrations are
similarly modeled and appear to afford the surgeon greater
precisionincontrollinginferiorpolecharacteristics.
Conclusions: Acellular dermal matrix fenestration improves
aesthetic outcome by facilitating greater inferior pole
expansion. Mathematical models are provided to describe
themodificationsandelucidatethemechanismbehindtheir
effectonbreastshape.
133
After breast surgery, the late upward rotation of the nippleareola complex and the increased of the fullness at the
lower pole of the breast have been defined as a Bottoming
out.Althoughseveralstudieshavefocusedonthesafetyand
complicationrateoftheonestageaugmentation/mastopexy,
there is no clear recommendation how to prevent the late
complicationof“bottomingout”.
Methods: A retrospective review was conducted of 48
consecutive patients who underwent one- stage mastopexy/
augmentation using the reductive approach. Data collected
included the following: patient’s characteristics, implant
information, operative technique and postoperative results.
Complicationandrevisionrateswereassessedtodetermine
theefficacyofthereductivemastopexy/augmentation.
Results:Allpatients(N=48)wereavailableforfollow-up,an
average18monthspostoperatively.Overallcomplicationrate
was 14.5 percent. No severe complications were recorded.
The most common complication was wound separation
(02), followed by capsular contracture (02), and Bottoming
out(01).Sevenpatients(14.5percent)underwentsomeform
of revision surgery following the one-stage procedure. The
revisionrateduetobottomingoutwas2.2percent.
Conclusions:Whenperformingtheone-stageaugmentation/
mastopexy procedure, using the reductive mastopexy
approachdoeseffectivelyreducetheinternaltensionfromthe
lowerpoleofthebreastandhelpstopreventtheoccurrence
ofbottomingout.
1853
212
CAN POST-OPERATIVE BRA SIZE BE PREDICTED
USING 3D TECHNOLOGY FOLLOWING BREAST
AUGMENTATION SURGERY?
Presenter:
NinaMarieKing,MBBS
Affiliation:
PrinceofWalesHospital
Country:
Australia
Authors:
KingNM,LovricV,ParrW,WalshWR,
MoradiP
1758 213
BREAST REDUCTION ASSOCIATED WITH
POLIURETHANE IMPLANTS: LONG LASTING
FIRMNESS AND PROJECTION
Presenter:
EduardoL.Hentschel,MD
Affiliation:
ClinicaLangedeCirurgiaPlasticaEsteticaE
Reparadora
Country:
Brazil
Author:
HentschelEL
Aestheticsofthefemalebreasthasalwaysbeenachallenging
aspect for surgeons but particularly when counselling
patients and planning breast augmentation surgery. Female
patientstypicallypresenttothePlasticSurgeon’sofficewith
a plan to increase their bust to a certain cup size even if
they are unclear of what their pre-operative correct bra size
should be. It is often found in clinical practice that more
volumeisrequiredtoachievedthedesiredcupsizethanthe
increment 100cc traditionally reported. Although studies
have assessed anthropometric measurements of the female
breast, no studies confirmed this traditionally reported
increasebetweencommerciallyavailablebrassizes.Thelong
term goal is to establish a comparative catalogue of all cup
sizesandtheirassociatedvolumesforseveralbrabrandsthat
PlasticSurgeonscanutiliseintheirclinicalpractice.Theaim
of this study is to identify the volume of a bra cup and the
changebetweencupsizes.
Shorttermresultsofbreastreductionmayalreadyshowsome
sort of ptosis, despite an adequate result immediatelly after
surgery.Inaddition,patientsmaynoticealackoffirmnessand
upperpolefullnessastheswellingsubsideswiththecoming
months after reduction mammoplasty. As appropriately the
surgeryhasbeenindicatedandtechnicallyperformed,those
complaints are common in our practice and are motive
of frustration in previous satisfied patients right after the
surgery. In order to prevent this disatisfaction, to enhance
breastaestheticcontourandtomakeitlonglasting,theauthor
hasbeenperformingbreast reductionassociatedwithbreast
implants coated with poliurethane surface, preferably conic
shape.Thishighprojectionformatofimplant-volumerange
of150a180ml-enablesareducedbreasttobeanatomically
molded,projected,upperpolefulled,andspeciallysecured in
placebytheadesionbetweentheprosthesiswiththepectoral
muscleandwiththemammarytissuearoundit.Inanother
words, the conic implant function as a suspension bar,
sustainingthebreastinposition,volumizingtheupperpole,
andprojectingthebreast.Sincethecompetentadesionofthe
poliurethane with the surrounding breast parenchyma and
underneathpectoralmuscleisincomparablewithtexturized
ones, one more advantage of this association is a natural
palpationofthereducedbreasts.Limitingthevolumeofthe
implantupto180ml,190ml,permitsbothbrestsuspension/
volume and no risk of early ptosis at the same time. The
authorhasbeenusingthisapproachforthelastthreeyears,
in 57 patients in his private practice, beggining with round
and larger implant volumes, and evolving to the adoption
of conic and 150-180 ml superior limit volume. The breast
reductiontechniqueusediswisepatternstyleanddoesnot
involvea pediclecreation,sincetheimplantwillplaythisrole.
Theaveragerangeofbreastremovalvariedfrom280to800g.
The choice for a poliurethane implant for cases like this is
explainedbythefactthattheimplantbehaveasaglueimplant
betweentheparenchymaandthepectoralmuscle,andsuch
adesionisnotproperlyseenwithtexturizedimplants,more
pronetodragthebreastdownwithtime.
ThreesamplesofbracupsizesBthroughtoEcupallwitha
size12band,fromthreedifferentcompanieswereanalysed
for their volume capacity. Three methods were developed
and utilised to calculate the volume of the sample bras: 1)
linear measurements; 2) volume measurement via water
displacementand3)volumecalculationafter3Dreconstruction
of serial x-ray data (CT) using three dimensional modelling
software(Mimics,Materalise,Belgium).
Therewasarangeinvolumeincreasebetweenascendingsizes
aswellasawiderangeinvolumecapacityforeachbrasize
acrossthedifferentcompanies.FortheCT3Dreconstruction
technique,themeanincreasebetweeneachbracupsizewas
151cc, 108cc and 146cc for brands 1, 2 and 3 respectively.
Thevolumerangeacrossallthreebrandswas433cc-1053cc.
Clinical correlation of these results were made with twenty
post-operative breast augmentation patients and their postoperativechangeinbracupsizeandtheirimplantvolume.
134
214
MAMOPLASTY WITH LOWER FLAP PEDICLE
1976 214
MAMOPLASTY WITH LOWER FLAP PEDICLE
Presenter:
CarlosAmaral,MD
Affiliation:
SociedadeBrasileiradeCirurgiaPLASTICA
Country:
Brazil
Authors:
AmaralC,SarmientoAmaralCC
Introduction: The breast is the organ that represent the
woman’sfemininity.Mostpatientsmanifestdesiretoproject
the upper pole of the breast. The authors describe the
techniqueofreductionmammaplastywiththeinferiorpedicle
flapthatcanbeareolateornot.Thetechniquewasdescribed
in1969bytheauthorLiacirRibeiro,Robbins,etalGeorgiade
etal,observinggreaterprojectionoftheupperpoleandlower
driveswivel,alsoservestofillinthecaseoftumorresections
of the upper pole besides being a pedicle of safety in cases
of excessive resection. It is a dermolipoglandular flap with
irrigationfromtheperforantsof4th,5thand6thintercostal
spaces with venous and lymphatic drainage towards the
internalmammary.
Methods: Patients suffering from gigantomastia, medium
sizedbreastswithskinexcess,andwomenwithtumorsinthe
upperquadrants.
Surgical Technique:Markthebreastwithpatientsittingbythe
classicaltechniqueofPitanguyaddingmarkupoftheinferior
pedicle with the following measures width: 4-6 cm, length:
10-12cm,thickness:4cm.Patientonsupinepositionunder
generalanestesiaorepiduralblock.Westartwithinfiltration
of saline solution with adrenaline 1: 500,000, marking the
nipple with 4 cm diameter, periareolar and lower pedicle
flap des-epidermalization, insition over the mark until the
supramuscular plane with resection of the lateral triangles.
Fixationoftheinferiorpedicleflapatthe2ndintercostalspace
levelwithMononylon2.0.Mountbreast,dermalsuturewith
nylon4.0andintradermalskinsuturewith4.0Mononylon,
Placementofthehemobackdrainandpressuredressing.
Results:30patientswereanalyzedwithsatisfactoryresultsin
the projection of the upper pole. 3 patients had dehiscence
on the horizontal and vertical junction that healed in 2nd
intentionwithcurative.
Discussion:Theinferiorpedicleflapprovidessecurityincase
ofexcessiveresectionglandulartissue.Fillincasesoftumor
resectionintheupperpole.Projectionbreastwithautologous
tissue.
Conclusion:Themammaplastywithinferiorpedicleflapcan
beusefulforgigantomastiaandmastopexysurgerieswitha
satisfactoryresult.
Keywords:Mamoplasty,flap
135
1785 215
PECTORALIS MUSCLE LOOP FOR MAMMAPLASTY AUTHOR’S EXPERIENCE
Presenter:
FranciscoClaroJr.,MD
Affiliation:
SantaCruzPlasticSurgeryInstituteandState
UniversityofCampinasUNICAMP
Country:
Brazil
Authors:
ClaroJr.F,RoewerLF
1785 215
PECTORALIS MUSCLE LOOP FOR MAMMAPLASTY AUTHOR’S EXPERIENCE
Introduction: Some authors have reported results of
mammoplasty treated with pectoralis muscle loop, using
subjective parameters without a control group. In 2011,
Swansonproposedaobjectiveprotocolwithparametersnon
observer dependent, based on standardized photographic
measures for evaluation of breast surgeries. Based on this
information,thisstudyaimedtoevaluatetheinfluenceofthe
pectoralismuscleloopformammaplasty,comparingbreasts
treated with and without this technique, using photometric
measuresasproposedbySwanson.
Methods:Retrospectivecohortstudyinvolving18womenthat
underwentconsecutivebilateralprimarymammaplasty,bya
single surgeon, for breast ptosis and/or breast hypertrophy
from March 2010 to November 2012. The 36 breasts were
divided into two groups (18 breasts in the group in which
the breast was treated with muscle loop and 18 in the
group without it) and were evaluated by photometric study
preoperatively and six months after surgery. The results of
each breast were analyzed using the software “SPSS 20 for
MAC”.
Results: After matching the characteristics of breast in
each group (such as patient’s ethnicity and age, body mass
index,numberofpregnancies,smokingandresectedbreast
volume),alltheanalyzedvariablesweresimilar.Theaverage
improvement of breast projection elevation, in the muscle
loopgroupwas15.32±2.41%higherthanthegroupwithout
muscleloop(p<0.001,95%CI10.41to20.22).Thesamewas
observedintheprojectionoftheupperpole,whichwas24.2
±3.71%greater(p<0.001,95%CI16.65to31.82)thaninthe
groupinwhichthemuscleloopwasnotused.
Conclusion: Themuscleloopformammaplastywaseffective
forfillingtheupperpoleofthebreastandforthemaintenance
ofitsprojectionuptosixmonthsaftermammaplasty.
136
1876 217
PAM- PERIAREOLAR AUGMENTATION MASTOPEXYLIFTING THE GLAND WITH PERIAREOLAR APPROACH
Presenter:
RaulGonzalez,MD
Affiliation:
ClinicaRaulGonzalez
Country:
Brazil
Author:
GonzalezR
1993 216
RUNNING CIRCULAR SUTURE TECHNIQUE FOR
REDUCTION MAMMAPLASTY AND MASTOPEY
Presenter:
VaniaKharmandayan
Affiliation:
HospitaldaCRuzVermelhaDefeitosdaFace
Country:
Brazil
Authors:
KharmandayanV,deCamargoBuenoMA,
CalderoniDR,KharmandayanP
Therearenumerousmammaplastyandmastopexytechniques
described in literature. This study aims to present a novel
approch, which combines a number of techniques already
wellestablishedregardingrepositioningofthenipple-areolar
comple,reductionofthediameterofthebaseofthebreast,a
longtermretentionofmammaryconeprojection.
Method: Mammaplasty was performed using the inverted
T technique. The preoperative skin markings differed from
thosedescribedintheliteratureinthattheydidnotusethe
future position of the nipple areolar complex as the main
reference point. A running circular suture was used to fix
the breast to the pectoralis major fascia and the reduce the
diameter of the base of the breast, resulting in a reduced
horizontalscarintheinframammaryfold.Theskinmarking
techniqueallowedforbetterpostoperativebreastsymmetry
regardlessofpreoperativevariationinshapeandvolume.
Results: The outcomes were considered satisfactory in the
majorityofcasesbybothpatientandohysician.
Conclusion: The described technique results in a reduced
diameter of the base of the breast, repair of ptosis,
repositioningofthenippleareolarcomplexandalongterm
upperpolefullness.
Background: In 2012 the author published a periareolar
technique for breast augmentation and mastopexy called
PAM, Periareolar Augmentation Mastopexy, which has
proveneffectiveinlightcasesofbreastptosis.
Surgical Technique: 1- The periareolar approach is used
to detach the entire lower pole of the breast. 2 - Once the
glandulartissueisexposed,averticalincisionfromtheareola
to the infra-mammary fold is made to the muscle, creating
a retromuscular pocket. 3 - After the implant is inserted, a
verticalplicationisdoneontheglandtoachievetheintended
pexis.4-Formoreseverecaseswedetachtheglandfromthe
muscletoattachthelateralandmedialpolesasmediallyand
cephalicallyaspossible,thusproducingamoreeffectivelift
than the original technique permitted. We have named this
broaderapproachPAMII.
Results: From July 2011 through February 2014 we used
the technique in 86 patients. The immediate complications
observedwerethesameasthosedescribedbyotherauthors
- with similar statistics - in augmentation and mastopexy
performedbydifferenttechniques.
Discussion: Many reports of areolar enlargement, nipple
enlargement, breast flattening and recurrent ptosis have
been made in relation with periareolar techniques. Such
inconveniencesbegantofurtherrestricttheuseofperiareolar
approaches.Nevertheless,eventhoughanimplantcanreduce
breast flattening, it does not help to reduce the recurrence
of ptosis, especially when the ptosis is not mild, and when
theapproachisnotglandpexisbutrathertheremovalofthe
skin around the areola, known as “just skin”, or doughnuts
mastopexy.
This“justskin”periareolarmastopexyhasshowntobemore
beneficial to patients who need to raise a low areola rather
thantomanageamoresevereptosisofthegland.Theentire
panoramachangeswhentheglandisliftedandnotonlythe
skin.
Conclusion: The technique to be presented by the author
showarealpexisoftheglandtissue.Thisprocedureincreases
theprobabilityofsuccessfulaugmentationmastopexies,and
broadens its indication from very mild cases to moderate
casesofptosis.
137

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