Download pdf file - Ipras

Download pdf file - Ipras

13th Issue July 2013

The e-magazine for 37.000 Plastic Surgeons

Nefer by Ugo Dossi

105 National - Regional Societies ISSN: 2241-1275


• IPRAS Front Page Nefer by Ugo Dossi . . . . . . . . . 4

• President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 5

• General Secretary’s Message . . . . . . . . . . . . . . . . . . 7

• Honorary Editor in Chief’s Message . . . . . . . . . . . . 9

• IPRAS Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2nd ISPRES Congress



• Senior Ambassador . . . . . . . . . . . . . . . . . . . . . . . . 13

• Pioneer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

• Rising Star . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

• 10th IQUAM Position Statement . . . . . . . . . . . . 22

• ISPRES Section . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

• 2nd ISPRES Congress Surveys . . . . . . . . . . . . . . . 36

• Educational programs . . . . . . . . . . . . . . . . . . . . . . 50

Plastic Surgery Congress 2013



• National Associations’ & Plastic surgery

organizations’ News . . . . . . . . . . . . . . . . . . . . . . . . 56

• Historical Accounts . . . . . . . . . . . . . . . . . . . . . . . . 61

• Sir Archibald McIndoe . . . . . . . . . . . . . . . . . . . . . 70

Argentinean Society History



• National & co-opted societies future events . . . . 71

• Industry news . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

• IPRAS Website . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

• IPRAS past General Secretaries . . . . . . . . . . . . . 86

• IPRAS Benefits for National Associations

& individual members . . . . . . . . . . . . . . . . . . . . . . 87

Sir Archibald McIndoe



Issue 13 IPRAS Journal 3

Our Message to our Egyptian Brothers and Sisters

Niefer in Ancient Egypt was the Goddess of Perfection,

representing beauty, goodness, truth, maturity, strength,

health and eternity.

Ugo Dossi combines it in this image with an embryo:

the embryo symbolizes the growing power inside of us,

alive but notyet delivered.

We could not find a better symbol for our message to

our Egyptian brothers and sisters:

Egypt, the eternal beauty, carries a constantly growing

power inside, alive but notyet delivered. Rely on your

inheritage from your ancestors: beauty, goodness,

truth, maturity, strength, health and eternity will take

over again and carry you into a bright future.

We are proud of you and accompany this process with

our wishes and prayers and love for you and your unique


Your IPRAS family

IPRAS Front Page Nefer by Ugo Dossi

About the Art of Ugo Dossi

The art of Ugo Dossi is centered on unconscious

creativity, on sensual and extra sensual perceptions.

Ugo Dossi works with archetypical and collective

imaginations, with automatic drawing, subliminal

projections and psychic phenomena.

His installations have been shown

twice at Documenta (Documenta 6

and Documenta 8), at the Biennales

of Venezia (1986 and 2011), of Paris

(1975), of Buenos Aires (1999)

and in personal exhibitions in

numerous international museums.

The hologram series Nefer was

shown in numerous museums, e.g.

the Museum of Modern Art in

Vienna and the Egyptian Museum

in Berlin.

Ugo Dossi‘s work deals with systems and images that

open up spy-holes onto the intuition of the infinite and

they appeal to the part of us that would be capable of

peeping through for a look, if only we were capable

of finding it.

Henry Martin, Cat. The mechanic of Fascination, Gall.

Maeght Zurich 1979

Time and again in his artwork, Ugo Dossi uses

images and metaphors of endlessness to seduce and

induce the viewer to immerse in a realization of the

infinite. His tools of seduction seem also of unlimited

spectrum, ranging from tiny objects in small boxes,

which he calls “Worldmodels”, to large sculptures

in architectural space, to enormous “Art-Fields” in

the landscape. In his installation for Documenta 6,

he used the puzzling beauty of mathematical forms

to show what he called “the relative freedom”, and

for Documenta 8, he penetrated the world of the

subconscious imagination, through subliminal


Throughout the many facets of his

work, irradiates the light of a single

spirit, searching for expression

in so many forms; we perceive

this spirit as an intense and allpervading

echo of infinity.

Dossi´s programmatic new

approach changes art into

a metaphysical tool, into a

metachemical agent. His concept

contains a promise of inconceivable

significance: Art can supply the

subconscious artificially and artfully with those

associative elements, catalysts and stimuli, which

are indispensable for a more complete functioning

of the psychic metabolism. (R. Pontecorvo, Isomorphy,

Brochure Biennale Venezia 1986)

Even in an era, in which the concept of avantgarde

has turned into an ideology that promotes innovation

and the practice of permanently exceeding beyond

Iimits, Dossi´s ‘border crossings‘ retain their

irritating radicalism. They are continuing to venture

into regions that lie outside the boundaries set by our

conventions on art.

(Manfred Schneckenburger, Cat. Ugo Dossi, Hagen

Verlag München, 1990)

See also

4 IPRAS Journal Issue 13

P R E S I D E N T ’ S M E S S A G E

Board of Directors


Marita Eisenmann-Klein - Germany

General Secretary

Nelson Piccolo - Brazil


Bruce Cunningham - USA

Deputy General Secretary

Yi Lin Cao - China

Deputy General Secretary

Brian Kinney - USA

Deputy General Secretary

Ahmed Noureldin - Egypt

Deputy General Secretary

Andreas Yiacoumettis - Greece


Norbert Pallua - Germany

Executive Director

Zacharias Kaplanidis - Greece

Prof. Marita Eisemann-Klein

President of IPRAS

Dear colleagues,

it did not come as a surprise to us: the efficiency of training in plastic surgery, evaluated by the IPRAS Trainees

Association, revealed that there are deficits in aesthetic surgery training in most parts of the world. Exceptions are

found in South and Central America with Brazil and Mexico being outstanding role models for the rest of us.

Aesthetic surgery everywhere in the world is not a specialty of its own, it cannot be sparated from reconstructive

surgery. And we cannot ignore the fact that other specialties, too, have the right to perform regional aesthetic


With the foundation of the IPRAS Academy for Aesthetic Surgery Training we did the first step into the right

direction and we are eagerly awaiting our first Academy course immediately after and in conjunction with the

Balkan Association congress in Montenegro on September 8th this year.

Our hard working young colleagues on the IPRAS Trainees Association EXCO encourage exchange programs

and their congresses, too, with the next congress upcoming in Mumbai on November 30, will promote exposure

to aesthetic surgery as well.

And time has come to create more interfaces between other specialties and ourselves: in regenerative surgery, as

ISPRES has started very successfully, in Laser treatments, where Katharina Russe-Wilflingseder has prepared

the ground with her outstanding Laser Innsbruck congresses and in craniofacial surgery, where excellent

cooperations with maxillofacial surgeons, neurosurgeons and pediatric surgeons have been established in many

centers throughout the world. These cooperations are based on confidence and mutual respect.

Intermingling with other specialities, driven by commercial interests, however, endangers the future of our


Once more, our trustee and founding member of IPRAS, Ivo Pitanguy, has proven to be a visionary: his postgraduation

courses in Plastic Surgery with the inclusion of other specialties, started as early as 1960 at Pontifical

Catholic University in Rio, - a perfect role model for more university training programs throughout the world.

In the first issue of the IPRAS Journal Ivo Pitanguy wrote:

“In my almost 50 years of experience in teaching, I have accompanied the evolution of the International

Confederation for Plastic Reconstructive and Aesthetic Surgery (IPRAS), attending each and every one of its

meetings. Our goals are the same: to emphasize the importance of training in all fields of plastic surgery, in its

broadest sense: AESTHETIC AND RECONSTRUCTIVE, following sound basic surgical principles, which are

then further developed into new and innovative procedures.

As a final word, I should state that the strength and the will to spread the knowledge that I have acquired has come

from the interaction with my pupils and peers. The field of knowledge that we have persued, deals with human

being’s most intimate desires and the never ending quest for harmony, well-being and identification with one’s

own self image.

I congratulate IPRAS, its leaders and its members in persuing our common philosophy, which is train surgeons

who will be capable of practicing plastic surgery, with its diverse and mutiple subspecialties, taking our experience

to the world. This has been motivated by love for the human being and the sharing of knowledge, which, it is my

belief, is the true meaning of the Hippocratic oath, the essence of medicine.”

Cordially yours

Marita Eisenmann-Klein

IPRAS President

Issue 13 IPRAS Journal 5


• To promote the art and science

of plastic surgery

• To further plastic surgery

education and research

• To protect the safety of the patient

and the profession of Plastic,

Reconstructive and Aesthetic Surgery

• To relieve as far as it is possible

the world from human violence

or natural calamities through

its humanitarian bodies

• To encourage friendship

among plastic surgeons

and physicians of all countries

6 IPRAS Journal Issue 13

G E N E R A L S E C R E T A R Y ’ S M E S S A G E

As technology and techniques evolve, Plastic Surgeons

around the world are continuously presented with an evergrowing

number of options to be offered to their patients.

Although sophistication and/or simplicity obviously vary in

the choices we have today, I consider the current use of fat

grafting one of the more sophisticated, as well as one of the

simplest, techniques that we can use.

It is simple because it is right there, anywhere, everywhere!!!

The patients have been asking us to remove and to replace

fat since Professeur Illouz first showed us how to aspirate it

on the early 80´s. Techniques and suggestions for techniques

having gone through the natural history of evolution, and the

good ones were established with time.

It is sophisticated because it carries a wealth of options and

benefits !!!

The relatively recent finding of these cells having specialized

tissue, or tissue which could turn into a specific lineage of

cells, has turned our minds into different directions, when we

use fat as a filling, or as grafting.

Benefits are being shown by the day, with hundreds of papers

already published on this subject. Experts and exponents

appear in several corners of the world.

The good news - we know who they are! These experts came

Dr. Nelson Piccolo

IPRAS General Secretary

to Berlin, this June, to show the state of the art in fat usage.

These experts meet under a name – ISPRES, the International

Society for Plastic Regenerative Surgery.

Sydney Coleman was the President of ISPRES Berlin 2013 -

together with Norbert Pallua , local host in Germany and Gino

Rigotti ( from Italy ), President of ISPRES, under the auspices

of IPRAS and its President, Marita Eisenmann-Klein, and they

were able to put together a major meeting, with tens and tens

of presentations who brought us basic science, and from basic

science to the operating room table and to the Office, where

satisfied patients want more, and more, and more...

There was even a terminolgy consensus panel when these

same experts took a look at the bulk of the related published

material to see how we have been naming these findings and

this progress, and how we could implement a more “uniform

language“ when we publish or discuss our progress in this

field of Plastic Surgery.

We have been living in the internet age for a little over 20

years now. Search engines are a part of our everyday life.

These engines have an ability, after being given a key search

term, to “choose” the most frequently related search terms

for that specific subject, and multiply the area of search

enormously. If we were able to use a uniform set of terms on

our future discussions and publications, besides “speaking the

same language” with the consequently obvious benefits for

the Specialty, there would also be a gain in how our research

and our results could be found and distributed.

As another bonus from ISPRES Berlin 2013, IPRAS and

ISPRES is creating a task force to promote guidelines for

standardization of terminology of the emerging adipose

derived technology and techniques (including fat grafting,

adipose stem cells and SVF).

We are always happy to see Plastic Surgeons from around the

world working on improving the ways we practice, bringing

new benefits to our patients– we are always happy to see

Plastic Surgery at its best!!!

Dr. Nelson Piccolo, IPRAS General Secretary, Dr. Sydney

Coleman, ISPRES General Secretary, Dr. Ahmed Adel Noreldin,

IPRAS Deputy General Secretary

Dr. Nelson Piccolo

IPRAS General Secretary

Issue 13 IPRAS Journal 7


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H O N O R A R Y E D I T O R - I N C H I E F ’ S M E S S A G E

Ôhe past, the present and the future

of the Plastic Surgery

Ricardo Baroudi

The subject of these comments is not to bring the History

of Plastic Surgery to our readers, which has been already

reported in many text books with extreme detail regarding

authors, dates and contributions.

It is common knowledge that Plastic Surgery has

continuously evolved since ancient times into the modern

era, being that the First and the Second World Wars were

great “contributors” to major surgical improvements in

this Specialty. This crescent curve, also noted at the end

of the 20th century, with its consequent yield of new

technologies and research results will allow for future

generations to obtain incomparably better results than we

could achieve in the recent past and today. There is no

limit to human imagination and creativity.

Although the information I am writing in this report

is well known by the vast majority of plastic surgeons

around the world, I believe it may be useful for the new

generation as well as for the senior surgeon, in which

category I am included.

Plastic Surgeons around my age will remember that

in the ‘50s there was a reduced number of Plastic

Surgery National Societies as well a limited number

of professionals dedicated to our Specialty. The Latin-

American Society was founded in Brazil by our pioneers

in 1941, and the Brazilian Plastic Surgery Society was

founded in 1949. At that time, there were no more than

70 members in the entire country. By that time, surgeons

in the United States were already well organised, with

surgeons performing all sort of plastic surgery procedures

and publishing their results in specific journals, as well as

pioneering several programs.

Even in those days, for one to become a member of a

National Society, there was a mandatory requirement for

specific training in General Surgery, followed by two

to three years of training in Plastic Surgery in specific

departments. What we now call Reconstructive Surgery

was an integral part of any training program. Like today,

training in this area included all the malformations, hand

surgery, burns, dermatological procedures, and later on,

craniofacial surgery – only after this training would the

surgeon be allowed to perform aesthetic procedures,

although when one considers the aesthetic plastic surgery

results of that time, one could not really compare them to

what is done today.

Plastic Surgery procedures were usually sought after by

high economical class people, most frequently by those

who lived by the ocean areas and/or tropical regions where

more frequently there would be a desire for exposure of

one´s body. As a sign of the times, the reverse occurs today

in many countries where religion or cultural reasons will

forbid it, despite improvements in global communication.

Also, aesthetic plastic surgery was then considered with

a certain taboo – frequently, when one was asked about

having had facial surgery, the reply would be that it was

done for cosmetic reasons. Regardless, vanity has always

been present in human culture.

Expressive changes have slowly but continuously

occurred in the Plastic Surgery World as well as in other

specialties as a consequence of a progressively higher

consuming world population. In these present times, I

consider that we could summarize these new behaviors

as follows:

1. Medicine and Surgery have evolved to socialization

in many countries, with governments handling care

directly to patients – Plastic Surgery was not included

in these programs, so there was a boom in the number of

Plastic Surgeons, as a natural consequence. The World

Health Organisation determines that there should be a

plastic surgeon for every 50,000 inhabitants. In Brazil,

in general, we are now 1: 41,000 – in reality the overall

distribution is extremely disproportional. In the city

where I live, in the inland of the State of São Paulo,

there is 1 plastic surgeon for every 9,500 inhabitants (

1:9,500 ). Market law is pretty obvious and ubiquitous:

when there is a larger offer of a product, the price will

drop. Currently, one can even find a plastic surgeon

whom will receive payment in ten or more monthly


2. The secretive attitude of patients of the past, maintaining

the fact that they had a plastic surgical procedure almost

Issue 13 IPRAS Journal 9

as a “state secret”, slowly changed completely, with

every patient telling all friends that he or she had had

a procedure performed, as having plastic surgery done

slowly became a status symbol. This evolved to a point

where future patients and patients whom already were

operated upon frequently meet socially to compare

results, while also discussing who performed this or

that surgery, so to chose his or her future surgeon. The

name of the surgeon is always shared, even after a bad

operation, so he can be chosen or avoided.

3. Plastic surgeons are continuously selected by the

patients according to the quality of their results.

In time, most surgeons will be sought after for a

minimal number of surgical procedures, which may

involve one or two regions of the body. Similarly, on

publications, the surgeons become known for specific

types of operations. As every surgeon knows that

repetition brings practice and speed, it has become

very rare to find a surgeon who will perform a large

variety of procedures, being that this type of surgeon

has practically disappeared.

4. Also, as a reality, Plastic Surgery had its limits

fragmented. In other words, without making rhetorical

comments and without discussing the reason for this,

it is common knowledge that today´s specialists from

neighbor Specialties are performing plastic surgery

on their patients. The main reason for this : money –

one´s income is directly proportional to one´s number

of cases – the more you operate the more money you

make. We must be extremely concerned, above all, that

ethical and moral principles and respect for the patient

are kept at the highest standards at all times and that

we do not sell out our profession cheap so to get more

patients and/or to perform more procedures.

5. Blade x Needle . It is another borderline activity in

use in recent decades to improve the quality of the

results. Soon enough, plastic surgeons around the

world understood that a needle is less dangerous than

a blade, and many of them have substituted almost

all their surgical procedures for dermatological

treatments or are combining both in the same or

different stages. Plastic surgeons have also turned to

minimally invasive or non-invasive treatments (the

latter previously “belonging” to the dermatologists) in

attempt to improve their results and of course, also to

improve their cash inflow.

6. In the past, unacceptable results left patients unhappy.

Patients would go to another plastic surgeon to repair/

solve the problem and also talk badly about the one

who did not perform a good job. Recently, however,

the situation is different and more complex: patients

still do the same (changing surgeons etc ) but they

also sendtheir lawyers to talk to the surgeon whom

originally performed the procedure. This lawsuit

industry grew fast, to a point where some physicians

are only covered by insurance on specific procedures

whch they perform most. Even so, surgeons from other

specialties are continuously performing procedures

previously considered to be within plastic surgery

limits. Typical examples of this boundary being lost

are breast aesthetic operations done by mastologists,

dermatologists performing liposuction, gynecologists

performing all sorts of aesthetic procedures on the

torso and so on.

When I look to the future, I fear that all or most limits

of Plastic Surgery may disappear completely within

a progressive transitional model. I hardly believe

that these will be for good. The natural competition

among physicians, with different specialties, has no

limits nor frontier. This competition will continue, and,

not surprisingly, those with best results will prevail,

regardless of their specialty. All of us have seen one

or more excellent results of procedures done by a non

Plastic Surgeon – like blepharoplasties performed by

ophthalmologists, for example – and there is no magic

formula to reverse this situation.

In Brazil , and in many other countries, the Constitution

is clear in stating that any physician legally registered

on the Medical Council can perform any and all sort

of medical, interventional and surgical procedures.

However, in recent times, if a complication occurs and

a lawsuit ensues, one without a specialist title has a

stronger probability of been considered guilty. This has

always existed, and I believe, it will continue to be so.

In conclusion, I believe Plastic Surgery is an Art, and as

we do more and more of the same procedure, we improve

our performance as well as the procedure itself, and, of

course, we get better results. Countless examples in our

practice will easily demonstrate this fact. Most important

is to maintain the highest principles of ethical behavior,

always triaging the patients to one´s expertise.

Our armamentarium is continuously being improved

through the recent progress of nano-engineering activities

and the constant appearance of new apparatuses, improved

suture materials and instruments, modern implants and

transplant materials. The eventual “fall” of the homo

transplantation barrier, with total face transplantation

already in its initial stages, will keep open these new

frontiers and Plastic Surgery will continue to evolve – it

will always be a “non-stop” evolution.

Medical evolution is a continuum, where techniques are

created, modified, improved and some even abandoned

- It has also been called the science of momentary truths.

It has been so and it will continue to be this way. One

may want to criticize our professors of forty years ago,

but I am sure that we may also be criticized forty years

from now…

As I selected messages to bring to this Editorial, I felt

sorry that I was possibly not bringing any news to our

readers, at least, nothing that you did not already know.

As I mentioned above, these messages were aimed at

the future generations who will continue to bring new

techniques and technologies to this unlimited evolution

of our Specialty.

To conclude, I would like to be one of them, but I will

leave that opportunity for my grandson…

10 IPRAS Journal Issue 13

I P RThe A S IPRAS M A N A Board G E M Eof N T Directors O F F I C E informs R E P O R T

Our finances

IPRAS until 2006 was financed almost exclusively by the

membership dues from the national societies. This resulted in a

very small amount of working capital to fund the missions of the

largest international society of Plastic Surgeons. Only one world

congress to 2006 had resulted in a contribution to the sponsoring

organization IPRAS: in 1999 after the world congress in San

Francisco the American Society of Plastic Surgery ASPS donated

55 000 US-Dollar to IPRAS. This is a very unsatisfactory outcome

for any organization sponsoring large educational meetings, and

instructed us that IPRAS had to gain control of the finances for

their most important events: International Congresses.

But we had visions and dreams: a communication

forum with the individual members, more

educational support for developing countries, more

IPRAS representation in national congresses, more

assistance in founding new national societies, more

support for our young generation....

After multiple brainstorming session of the members

of the newly elected Board of Directors in 2007 we

realized that the only solution was to establish a

cooperation with a congress organization which

would allow IPRAS financial control of its future, and guarantee

a profit from the congresses.

After two years of unsuccessful negotiations with various congress

organizers we initiated an international bidding process. From

5 companies, which turned in a proposal, we selected the three

finalists whose bids seemed to be affordable and invited them to

Seattle for interviews.

Zita congress was the only company willing to work with us under

the outlined conditions: a guaranteed income of 300.000 Euro from

the international congresses, to be paid in advance of the congress,

with consistent revenue, on a biannual basis. There was also the

potential for splitting the revenue in excess of specific financial

targets between ZITA, IPRAS, and the local hosting Society. This

arrangement afforded IPRAS the working capital for projects, as

well as not requiring the Society to secure significant loan debt in

order to finance future congresses. In effect, ZITA took the risk

for future Congresses, instead of IPRAS. This arrangement has

allowed IPRAS to sponsor excellent Congresses, and to develop

programs that support plastic surgeons and patients throughout

the world.

ZITA Congress financial elements and annual balance sheets

are officially audited and published in at least 2 financial

newspapers every year and from 2012 are obligatory uploaded

on the ZITA Congress official website.

The annual financial reports and budget have to be approved

by the Executive Committee each year, and are reviewed

periodically. The finances of our confederation are audited

by official bodies. The tax accounts are prepared by an

accounting firm in the United States, and annual filings are

made by IPRAS to the American Internal Revenue Service.

After the Santiago World Congress, we sent the congress

income-expenses balance sheet to 104 national societies.

Whoever read it carefully saw, that ZITA provided services in

the range of 200.000 €, which exclusively burdened Zita’s profit

without affecting the finances of IPRAS, e.g. the

additional costs of the simultaneous translations

into Spanish and Portuguese, the extensive

decoration with large banners about the history

of IPRAS, the rich buffets during the business

lunches instead of lunch boxes, the covering of all

Board of Directors travel expenses and the mobile

telephone applications providing attendees with

the congress program.

Zita also financially supported the non-profitable

regional congresses which have been organized since 2010

under the auspices of IPRAS. In five of these congresses ZITA

closed with deficits that ranged from 15.000 € to 35.000 €. These

financial losses have been confirmed by the auditors. IPRAS,

according to the contract with Zita, did not have to share these

losses nor did the national societies or sections.

For ZITA’s management and all its services to IPRAS, which

includes the management of the IPRAS Journal and the creation

and continuous updating of the social media, ZITA is remunerated

with approximately the amount of 85.000 € annually.

This means that the cooperation with Zita Congress enabled

us to keep the annual dues for the national societies as low as they

were 50 years ago, - 6 US-$ per member for developing countries,

12 US-$ per member for developed countries.

Besides the moderate travel budgets for Board of Directors

members , which is similar to the reimbursement of most scientific

societies such as the ASPS in America, the Directors have spent

and continue to spend huge amounts of money from their own

pockets for participation in congresses and conferences, as do all

EXCO and Committee members.

Since its partnership with ZITA, IPRAS, for the first time in its

history, can rely on an income that enables the confederation to

finance and achieve its humanitarian and educational goals.

Marita Eisenmann-Klein


Nelson Piccolo

General Secretary

Norbert Pallua


Bruce Cunningham


Ahmed Noreldin

Deputy General


Andreas Yiacoumettis

Deputy General


Brian Kinney

Deputy General


Issue 13 IPRAS Journal 11

I P RThe A S IPRAS M A N A Board G E M Eof N T Directors O F F I C E informs R E P O R T

Our finances

IPRAS until 2006 was financed almost exclusively by the

membership dues from the national societies. This resulted in a

very small amount of working capital to fund the missions of the

largest international society of Plastic Surgeons. Only one world

congress to 2006 had resulted in a contribution to the sponsoring

organization IPRAS: in 1999 after the world congress in San

Francisco the American Society of Plastic Surgery ASPS donated

55 000 US-Dollar to IPRAS. This is a very unsatisfactory outcome

for any organization sponsoring large educational meetings, and

instructed us that IPRAS had to gain control of the finances for

their most important events: International Congresses.

But we had visions and dreams: a communication

forum with the individual members, more

educational support for developing countries, more

IPRAS representation in national congresses, more

assistance in founding new national societies, more

support for our young generation....

After multiple brainstorming session of the members

of the newly elected Board of Directors in 2007 we

realized that the only solution was to establish a

cooperation with a congress organization which

would allow IPRAS financial control of its future, and guarantee

a profit from the congresses.

After two years of unsuccessful negotiations with various congress

organizers we initiated an international bidding process. From

5 companies, which turned in a proposal, we selected the three

finalists whose bids seemed to be affordable and invited them to

Seattle for interviews.

Zita congress was the only company willing to work with us under

the outlined conditions: a guaranteed income of 300.000 Euro from

the international congresses, to be paid in advance of the congress,

with consistent revenue, on a biannual basis. There was also the

potential for splitting the revenue in excess of specific financial

targets between ZITA, IPRAS, and the local hosting Society. This

arrangement afforded IPRAS the working capital for projects, as

well as not requiring the Society to secure significant loan debt in

order to finance future congresses. In effect, ZITA took the risk

for future Congresses, instead of IPRAS. This arrangement has

allowed IPRAS to sponsor excellent Congresses, and to develop

programs that support plastic surgeons and patients throughout

the world.

ZITA Congress financial elements and annual balance sheets

are officially audited and published in at least 2 financial

newspapers every year and from 2012 are obligatory uploaded

on the ZITA Congress official website.

The annual financial reports and budget have to be approved

by the Executive Committee each year, and are reviewed

periodically. The finances of our confederation are audited

by official bodies. The tax accounts are prepared by an

accounting firm in the United States, and annual filings are

made by IPRAS to the American Internal Revenue Service.

After the Santiago World Congress, we sent the congress

income-expenses balance sheet to 104 national societies.

Whoever read it carefully saw, that ZITA provided services in

the range of 200.000 €, which exclusively burdened Zita’s profit

without affecting the finances of IPRAS, e.g. the

additional costs of the simultaneous translations

into Spanish and Portuguese, the extensive

decoration with large banners about the history

of IPRAS, the rich buffets during the business

lunches instead of lunch boxes, the covering of all

Board of Directors travel expenses and the mobile

telephone applications providing attendees with

the congress program.

Zita also financially supported the non-profitable

regional congresses which have been organized since 2010

under the auspices of IPRAS. In five of these congresses ZITA

closed with deficits that ranged from 15.000 € to 35.000 €. These

financial losses have been confirmed by the auditors. IPRAS,

according to the contract with Zita, did not have to share these

losses nor did the national societies or sections.

For ZITA’s management and all its services to IPRAS, which

includes the management of the IPRAS Journal and the creation

and continuous updating of the social media, ZITA is remunerated

with approximately the amount of 85.000 € annually.

This means that the cooperation with Zita Congress enabled

us to keep the annual dues for the national societies as low as they

were 50 years ago, - 6 US-$ per member for developing countries,

12 US-$ per member for developed countries.

Besides the moderate travel budgets for Board of Directors

members , which is similar to the reimbursement of most scientific

societies such as the ASPS in America, the Directors have spent

and continue to spend huge amounts of money from their own

pockets for participation in congresses and conferences, as do all

EXCO and Committee members.

Since its partnership with ZITA, IPRAS, for the first time in its

history, can rely on an income that enables the confederation to

finance and achieve its humanitarian and educational goals.

Marita Eisenmann-Klein


Nelson Piccolo

General Secretary

Norbert Pallua


Bruce Cunningham


Ahmed Noreldin

Deputy General


Andreas Yiacoumettis

Deputy General


Brian Kinney

Deputy General


Issue 13 IPRAS Journal 11


Homage to Dr Henry K. Kawamoto

By Seth Thaller M.D., D.M.D., Luigi Clauser

D.D.S., M.D. and Mimis Cohen M.D.

During the final weekend of December 2012, former

fellows and friends of Dr. Henry Kawamoto held a

surprise celebration at the Bel-Air Bay Club, in the Pacific

Palisades, California, to thank their beloved mentor for

his contributions to their education and careers. This

event did not justly define the extent of his contributions

to our specialty of craniofacial surgery. It rather signaled

a change of the direction that Henry will undergo as a

preeminent educator, and hopefully he will continue to

impart his vast clinical experience on future generations

of plastic and craniofacial surgeons.

Henry completed his medical and dental degrees at the

University of Southern California. This was followed by a

full training in General Surgery at Columbia Presbyterian

Medical Center and Plastic Surgery training under the

tutelage of Dr. John Converse at the Plastic Surgery

Institute at New York University. Upon completion,

he went to Paris to learn the infant sub-specialty of

Craniofacial Surgery from the pioneer Dr. Paul Tessier.

From this point on the young mentee became a worldacclaimed

surgeon, teacher and leader in the field. He

served as a clinical Professor at the Division of Plastic

Surgery at the University of California in Los Angeles

and director of the Craniofacial Surgery fellowship of the


Henry also became a founding member of the International

Society of Craniofacial Surgery and was instrumental in

expanding the horizons of Craniofacial Surgery through

constant technical improvements and innovations.

His academic impact includes authorship of numerous

seminal peer reviewed articles and book chapters as well

as infinite visiting lectureships in every corner of the

world. These activities have resulted in a vast array of

awards and honors.

Dr Kawamoto among a group of former craniofacial fellows.

Issue 13 IPRAS Journal 13

His most impressive achievement, however, remains his

effort and dedication to the education of young surgeons

through his Craniofacial fellowship at UCLA. Henry

was able to create a unique educational environment

which allowed him to share and pass on his tremendous

clinical expertiseto his trainees. Over the years, he

mentored a distinctive group of 32 fellows and fostered

the importance of mentoring surgeons to ensure optimal

care for their patients.

These former fellows owe the success of their academic

plastic surgery careers to their “samurai” leader and a

number of them have gone on to become leaders and

mentors in their own right. This unparalleled contribution

will serve as Henry’s most important enduring legacy to

our specialty.

Dr Kawamoto has always been very proud of his former

fellows and their achievements. In the introduction to

the book Craniofacial Surgery, published in 2008, Dr.

Kawamoto wrote among others: “The UCLA Craniofacial

Fellows represent a special breed.” And followed:

“The word mentor is derived from Greek mythology

and the epic tale, of Odyssey. However, the Fellows’

accomplishments are no myth. Each has developed a

successful practice in plastic surgery and, as is the hope

of all mentors, they have superseded their training.”

You have been without question a great teacher. What

is the secret of your incredible success? I never thought

myself as a "great teacher", which makes this question

thought provoking. I believe the "secret" is the great luck

in picking the right person. And, how is this done? Right

off the bat the applicants are told not to waste their time

applying if they are not going into academic surgery.

The second is to get accurate feedback from those who

wrote the letters of recommendation ... not an easy task.

Thus, we sent a mandatory questionnaire to all who wrote

letters with a note stating that the application would be

considered incomplete without its return. If we didn't get

a response from the letter writer, we would inform the

applicant that their application was incomplete and they

would not be considered ... that always led to a response

from the recommender!

Lastly, interviews were conducted only on one day by

the selection committee. Those who could not make

the selected date were told there were no exceptions ...

we considered this the first cutoff. Selection was by a

democratic vote.

I also felt that the Fellowship should start in mid July

rather than on the first of July. It gave the new fellow time

to move and settle down. In actual fact, they were also

so compulsive that they came on the 1 st of July anyway.

The advantage of this is that they got an idea of what was

expected and it eased their transition into the program. It

also created a bond between them. As you know, there

is a tremendous camaraderie between all the Fellows,

which I believe started with the overlap program. Once

into the training program, we allowed the Fellow to work

to their capacity. This was increased as they gathered

experience and they proved themselves. Fellows were

told at the initial interview that the senior resident always

had first shot and they were there to assist and learn

which eventually also made better teachers out of them.

I would chew out a resident but never the Fellow in front

of others; it was done on the side but rarely needed.

Based on many years of experience what advice would

you give to the new generation of Plastic surgeons?

Seek the best training that they can get. Read, especially

of the history of a procedure.

What in your opinion will be the new frontier for

craniofacial surgery? Regenerative surgery. We have

gone through the other "R's": Recognition, Resection,

Repair, Reconstruction and now in Replacement.

What should active plastic surgeons do to better

prepare themselves for retirement? I don't know.

Knowing when to retire should just come to the

individual. Active people will remain active by seeking

active things to do.

Dr Kawamoto will universally remain one of the most

influential plastic and craniofacial surgeons of our era.

The significance of Dr. Kawamoto’s career is not simply

a matter of his exceptional talent and contribution to

surgery and his positive impact on the life of his patients.

His legacy will continue since he was, is and will remain

a great educator and a shining example to all his peers

and colleagues.

14 IPRAS Journal Issue 13


Ruth Graf

Background: I was the fourth daughter in a family of

six children, the first in my family to have a university

education, and I still live and practice in the city where I

was born and raised.

Education: I received my medical degree from the Federal

University of Paraná in 1976, followed by my general

surgery and plastic surgery residencies. After working for

10 years at a Burn and Emergency Unit, and taking time

to start my family, I returned to more active academic

and scientific pursuits, and was invited to do additional

fellowships abroad. These included becoming a Visiting

Fellow at University of California San Francisco Medical

School (UCSF), under Stephen J Mathes, a fellow to

Dr. Bert Brent, a reconstructive ear specialist, in 1994-

1995, followed by a Plastic Surgery Fellowship with

Prof. Wolfgang Mühlbauer, in Munich, and in 1996, met

our own father of plastic surgery, Dr. Ivo Pitanguy, who

remains my dear friend and inspiration these many years

later. I have worked with the Residents Program at UFPR,

for 21 years now, and during this time, I became inspired to

pursue my own higher academic degrees, and completed

my Masters in plastic surgery in 2000 and my doctoral

dissertation in 2001, also in plastic surgery. At this point,

I began formally teaching, and in the past 11 years have

evolved from substitute and volunteer professor in plastic

surgery to Adjunct Professor of Plastic Surgery at UFPR.

A true highlight of my career was to be invited in 2009

by John Persing as Visiting Professor of Plastic Surgery

at Yale University.

In parallel to my academic and teaching careers, my life

participating in international congresses and societies to a

greater degree began, largely due to being noticed by Tom

Biggs at a congress in Fortaleza, Brazil, where I presented

over 1000 breast reductions. He visited me the next year to

observe my surgeries, (I think to see if I was doing a good

job…) and as then-President of ISAPS, he invited me to

speak at some congresses, and with his encouragement

and support, helped me share my techniques for breast

augmentation and mastopexy through co-publishing with

him. After this “launch” into the international world of

speaking and publishing, I was invited to submit more

articles, speak, teach, perform demonstration surgeries

all over the world, sit on editorial committees for our

most prestigious journals and hold offices including that

of the Secretary of ISAPS for Brazil, representing our

country worldwide, and enter a world where the most

interesting, innovative ideas are encouraged, critiqued

and shared for our mutual advancement. I was recently

invited by Carlos Uebel and Nazim Cerkes to be part of

the scientific committee of ISAPS organizing courses in

all Latino America.

Why surgery/plastic surgery: During medical school,

I first spent every spare hour working with a group of

anesthesiologists, where I discovered my passion for

surgery, then working with a group of general surgeons

to pursue this. In my final year, as on-duty physician at

Hospital Cajurú, I turned my focus to major and emergency

surgeries, including hand and facial reconstruction,

Issue 13 IPRAS Journal 15

thus leading me to plastic surgery as a specialty. My

surgical and plastic surgery residencies allowed me to

perform dozens of reconstructive and aesthetic surgeries,

confirming my choice of plastic surgery as my passion.

Pivotal events in my life:

• When I received my medical degree, of 180 students

in my class, there were only 20 women. Now, women

comprise more than 50% of graduating doctors. Even

so, I have found more acceptance abroad as a woman

who excels in surgery than in my own country and city.

My long quest to become president of our regional

chapter of the Society of Brazilian Plastic Surgeons was

only achieved in 2004. I proudly served for 2 years,

with the most significant achievements being bringing

a conference on small incision procedures to our region,

and raising funds for our own headquarters in Paraná.

• My family’s experience abroad during my foreign

fellowships opened not just my mind, but the minds

of my entire family, with my daughters participating in

international exchanges, and speaking English fluently.

Our lives were irrevocably changed and greatly enriched

by these fellowships.

Plastic surgery now: It is a more egalitarian specialization

now in Brazil, and perhaps worldwide, and our focus has

moved much more toward the wellbeing of the patient

on the whole, including the pursuit of ever-safer and

ever more natural looking procedures. Many practices

include nutritional and fitness counseling, skin care and

other health and beauty related services. Regenerative

medicine, including the use of fat and stem cells, is on the

near horizon as studies are being carried out to evaluate

their long term benefits.

Future: The future is here and now, as we move along

this continuum toward less invasive, more natural, more

rejuvenating treatments for people who are living longer

and want to live more healthily, more beautifully.

Balance: In addition to balancing my academic and

scientific pursuits, operating a large private clinic that

also serves as a teaching clinic, and devoting time to my

growing family, as my children have my grandchildren,

I always make time for physical exercise and recreation,

especially biking and swimming with my husband.

Plastic surgery is not a career for the weak-bodied, and

these sports can be enjoyed with family.

16 IPRAS Journal Issue 13


Alexis Hazen

Did you ever consider a different career than Plastic surgery?

If yes, what other options were you considering and what made

you finalize your selection?

I considered a career as a veterinarian when I was growing up. As

I got older - I realized I would be happy just to have a few pets and

that human medicine would be a better fit. I seriously considered

international health as my interest in medicine came from my

years as a Peace Corps volunteer in Honduras after college.

I fell in love with plastic surgery when I did the rotations in

medical school. I saw a TRAM breast reconstruction and thought

it was the most ingenious operation - and that solidified it.

You are a visionary: did you ever have doubts that the breakthrough

for your pioneer work will come?

When you are doing research in the lab, you so often fail. And it is

so hard to get all the moving parts ‘right’. I think dusting yourself

off after things not working in the lab to do it all over again is always

hard - yet usually in the end - worth it. I think anyone in scientific

research has to have an element of faith that things will work out.

Did you feel disappointed or discouraged about the skepticism

which the majority of plastic surgeons showed towards fat

grafting for a long time?

Fat grafting is now generally accepted, but I think a healthy

skepticism towards any technique is appropriate. We need to

prove things scientifically in addition to clinically. And when we

say something works clinically - we need to be rigorous about how

we prove that.

Some disappointing moments during your professional life?

Disappointing moments? Many! But far more high moments!

Mistakes you could have avoided?

Mistakes? I think a mistake many young doctors make at an

Academic medical center - is that they get pulled in too many

different directions. You are asked to do so many things for so

many people that it’s easy to lose focus and not do what you are

truly interested in. I wish I had gotten involved in the medical

missions much earlier in my career - Women for Women - as it has

been one of the most gratifying experiences for me.

Is there something you regret not having pursued?

No regrets yet - I still have time to pursue things I haven’t

completely mastered or projects I haven’t completed!

Which results of your research projects do you consider to be

most important?

I think the things I am most proud of is creating animal models

that allow us to study human lipoaspirate. The radiation model

and the fat transfer model I think are helpful additions to the

scientific community.

Briefly describe your current position and the variety of

patients you treat on a daily basis.

I am an Associate professor in Plastic Surgery. I am the Director of

the NYU Aesthetic Surgery Center. My practice is largely breast

surgery - reconstruction and cosmetic. My research interests

are in lipoaspirate and 3D animations as a vehicle for training

surgeons and educating patients.

So far, what were the highlights of your career?

The highlights of my career have been going on surgical missions

with Women for women, and being a host on doctor radio. Both

are not aspects of a career that I would have thought about at the

onset - but both are gratifying and interesting.

What are your goals for the next few years?

I would like to be able to spend more time on my areas of research

in the next years. I also think plastic surgeons should become

involved in the development of new technology - and I think that

is intimately tied to the long-term health of the profession.

What is the future of Plastic surgery in the US?

I think that the future is bright in plastic surgery - though there are

rocky roads ahead. The changes in reimbursement will make the

endless training and the expense of medical school seem untenable

- and to some extent it will be. I think medicine is a little broken

right now - but plastic surgery is always a great field!

What do you like to do in your free time; hobbies/sports?

What is your favorite book?

In my free time - I like hanging out with my children. I play golf

with my son, and paint with my daughter. I love to read - most

recently a book called ‘Give and Take’ by Adam Grant. I am

recently getting into yoga and meditation - midlife crisis?

Issue 13 IPRAS Journal 17

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Issue 13 IPRAS Journal 19

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Issue 13 IPRAS Journal 21




November 4, 2012

Constance Neuhann-Lorenz , M.D.


Theatinerstrasse 1

80333 München, DEUTSCHLAND

Phone: 49 89 348123 - Fax: 49 89 25540933


Manuel Garcia-Velasco MD


Vialidad de la Barranca SN-550

Huixquilucan Mexico City MEXICO 52763

Phone 5255 52469551


IQUAM issues its 10th Position Statement, which is for

use and reference by practicing physicians worldwide,

and by international healthcare and governmental


IQUAM, the International Committee for Quality

Assurance and Medical Devices in Plastic Surgery, is a

professional medical and scientific organization committed

to the surveillance of existing and new technologies

and devices in Plastic Surgery. IQUAM serves as the

clearinghouse committee of IPRAS, the International

Confederation for Plastic, Reconstructive and Aesthetic

Surgery. IQUAM is dedicated to the safe use of medical

devices, technologies and procedures in plastic surgery,

and to the guarantee of patients’ safety. IQUAM reviews

and evaluates updated literature and studies, scientific

data, and recommends standards of treatment for new

devices or technologies. IQUAM proscribes potentially

deleterious use of products, devices and technologies, or

their unintended application or application for unsuitable


Breast Augmentation and Reconstruction

The purpose of breast augmentation and reconstruction

is to improve the psychological and physical condition

of the patient. The breast augmentation method should

be chosen depending on the needs of the patient and the

compatibility in the individual case. 1-8

1. Alloplastic

1.1 Breast implants

A. Since IQUAM’s previous declarations, silicone

implants filled with either silicone gel or saline,

textured by various methods or smooth surfaced, or

covered by polyurethane 9-11 , continue to be widely

used internationally for breast implantation, with the

implant types varying by geographic region.

B. Some reports show that the textured surface covered

implants may have lesser incidence of capsular

contracture 12-13

C. Additional clinical studies have not demonstrated any

association between silicone-gel filled breast implants

and carcinoma or any metabolic, immune or allergic

disorder. These studies re-affirm prior data. 14

D. Between 2000 and 2010 a French company PIP

produced breast implants filled with industrial gel

instead of medical grade gel. These implants, marketed

under PIP implants, “M”- implants or “TiBreeze”-

implants, are associated with higher rupture rates and

inflammatory tissue reactions (15-17) .

E. Case reports about incidents of Anaplastic Large

Cell Lymphoma formation in capsular tissue raise

more and more concerns. Although the number of

patients is still low (currently 130 reports worldwide),

the identification of risk factors for this rare disease

should be given highest priority 18--22 .

F. Silicone-gel filled breast implants do not adversely

affect pregnancy, fetal development, breast-feeding

or the health of breast-fed children, based on current


1.2. Acellular Dermal Matrices

In breast surgery there is accumulated evidence that some

ADMs are safe to use in the breast and in association with

breast implants and tissue expanders. Those ADM’s that

have literature based safety and efficacy profiles should

be used preferably.

A. When implanted, Acelluar Dermal Matrices (ADM)

can undergo one of the following:

- Regeneration / integration

- Resorption

- Encapsulation

Only those products that have been demonstrated to

22 IPRAS Journal Issue 13

egenerate and integrate with the host tissue are to be

recommended for implantation.

B. ADM’s must be stored, handled and prepared

according to the manufacturer’s recommendations.

They also require appropriate surgical technique by

adequately trained surgeons. 25

1.3 Other materials

There is no currently available non autologous material

that satisfies safety and efficacy requirements for breast

enlargement or volume replacement.

2. Autologous

Surgical methods for breast reconstruction with autologous

tissue such as microsurgical tissue transfer, pedicled flaps

and local flap techniques undergo constant re-evaluation

and are well established for individual indications and

conditions. They have been employed in combination

with silicone breast implants without specific inherent

complications reported. 23-27

2.1 Fat grafting

Fat grafting for soft tissue defects has been performed

for over 40 years with low complication rates. Ongoing

studies show promising results of fat grafting procedures

for breast reconstruction and augmentation. There is

evidence that the volume of the fat grafts and its take can

be increased by the preoperative and postoperative use of

an external vacuum device.

No negative effects for mammography have been found.

More studies are encouraged to further evaluate the

efficacy and optimal duration as well as eventual side

effects of vacuum application. 28-31

3. Clinical Recommendations for Breast

Augmentation and Reconstruction

A. IQUAM believes it is important to advise patients

of potential hazards and risks, the possible need

for re-operations, as well as the benefits of breast

augmentation or reconstructive surgery. A detailed

and updated Patients Information and Consent Form

must be provided and discussed with the patient prior

to surgery.

B. A reasonable period of time should be allotted

following consultation as a cool-off period before

decision and performance of surgery.

C. It is recommended to postpone breast augmentation for

aesthetic indications until after the age of eighteen. Such

procedures in teenagers require in depth evaluation of

motivation and maturity before considering surgery,

even in medically indicated cases.

D. Patients with breast implants should be encouraged to

have regular and long term follow-up, preferably by

the operating surgeon.

E. No definite period of time has yet been defined for the

longevity of breast implants and recommendations for

routine replacement should be given under a careful

individual risk/benefit evaluation. The indications

for replacement should be based on specific patient


F. IQUAM calls for continuous clinical and scientific

research, for documentation and monitoring of breast

implants and patients and international coordination

of national/regional registries.

G. Advertising of breast implant procedures should be

restricted to the aspects of the surgery, and presented in

a professional dignified way and without exaggerated

claims. 32-40

H. IQUAM calls for the approval of medical grade silicone

gel filled breast implants according to national and

international standards and certifications for clinical

use and unrestricted availability to all patients.


The proper processing of multiple-use cannulas is especially

important considering the recent reports of mycobacterial

infections related to liposuction and fat injections. Cannulas

used for the removal and the placement of fatty tissue can

be multiple-use or single-use.

The reprocessing of multiple-use cannulas is a laborintensive

process, which requires meticulous attention

to detail particularly with regard to the non-visible

surfaces. Autoclaving should always be performed.

Thorough cleaning of all exposed and hidden surfaces

followed by removal of all cleaning agents is essential

before autoclaving. The autoclave must be used at

appropriate settings to eliminate bacteria and minimize

mycobacterium, prions and biofilms.

Exposure to some cleaning agents, especially in

combination with high temperatures, may cause

degradation of the cannula. Instruments showing

corrosion or damage should not be used.

If suitable reprocessing of multiple-use cannulas is not

available, single-use cannulas should be considered.

The manufacturer of such single-use cannulas must

process and package the cannulas according to good

manufacturing practices and in a fashion approved by the

FDA or a country or region’s regulatory agencies. This

process should assure sterility and appropriate packaging,

which prevents accidental contamination. 41-51

Minimally invasive laser-assisted lipolysis and skin

tightening is FDA approved. The emitted laser light

induces lipolysis and new collagen formation resulting in

thickening and tightening of skin. An optical flexible fiber

is guided through a temperature sensing cannula into the

tissue. The interstitial temperature should be measured

and recorded to a screen at any time of the procedure to

ensure safety and efficacy of the procedure. 52-57

Non-invasive laser and energy based devices for body

Issue 13 IPRAS Journal 23

contouring to improve skin laxity, subcutaneous fatty

tissue and cellulite deformities are available. The efficacy

of non-invasive fat removal is limited. Numerous devices

as lasers alone or in combination with vacuum suction,

cryolipolysis, focused ultrasound, radiofrequency and

radial shockwaves are still under review for safety and

efficacy, some are FDA approved. 58-62

Tissue Engineering and Wound Healing

Tissue engineering holds the promise of generating tissues

de novo. Adipose tissue is an ideal soft tissue surrogate to

redefine body contour defects due to its intrinsic plastic


Regenerative medicine is a promising road for future

advancements in plastic surgery. Laboratory cultured

constructs must consist of safe components before

implantation in patients. 63-66

1. Stem Cell Therapy

One of the most exciting frontiers in medicine today is

the use of stem cells. Unlike the controversial evaluation

of embryonic stem cells, adult stem cells deriving

from adipose tissue are easily available without ethical


National regulations for the use of adipose tissue derived

stem cells vary considerably.

Under investigation to date are treatments of radiotherapy

injuries and breast reconstruction after cancer. Stimulated

by encouraging experience with fat grafting, numerous

basic laboratory and animal model studies are underway

in many parts of the world. 67-72

2. Growth Factors

An increasing number of growth factors are becoming

commercially available for a wider range of indications,

either as a therapeutic agent or as an element of tissueengineered

constructs. IQUAM is concerned that application

of growth factors may occur before potential adverse effects

(uncontrolled cell divisions, malignancies) have been

diligently, adequately studied. Notifies bodies issuing CEmark

certifications should be aware of this. 73-74

3. Shock Wave Therapy

Recent studies suggest that Extra Corporal Shock Wave

Therapy originally developed for resolution of kidney

stones, is useful in the treatment of chronic wounds, burns

and tendon adhesion. More studies are needed to evaluate

the optimal techniques for application and duration. 75-77

Injectable Therapies

1.Lipolysis or Lipodissolve Injections by

Phosphatidylcholine Derivatives.

Phosphatidylcholine has been used for prevention

and treatment of fat embolism for many years, but

is currently being used double ‘off label’ (indication

and application subcutaneously) for dissolving fat in

aesthetic applications. Data concerning the efficacy,

outcome and the safety of its use for aesthetic indications

in the subcutaneous tissue have not yet been established.

Further basic science and clinical trials, such as PMA

trials underway are needed. 78-81

2. Botulinum Toxine

Botulinum Toxine A (BTxA) has been used extensively

for aesthetic purposes. BTxA in high dosages has been

used in various therapeutic clinical applications with

minimal reported significant adverse effects. Current

clinical data confirm the safety of BTxA’s for aesthetic

indications when used by experienced doctors under

sterile office environment. Patients should be provided

with detailed information, and a signed informed consent

should be obtained prior to performing the procedure.

3. Injectable fillers

Today more than 35% of the procedures performed by

plastic surgeons are no longer purely surgical. The use

of resorbable substances is preferable to the use of nonresorbable

fillers, as recommended by many national

health authorities or academic societies. Furthermore,

IQUAM stresses that degradability should be discerned

from resorbability.

The patient’s history and the long-term follow up are

important for documenting allergic or late reactions.

IQUAM recommends reporting complications of fillers

to regulatory bodies and mandatory registration of

adverse effects associated with injection of fillers to

better estimate the extent of complications. 82-85

3.1. Collagen Fillers

Collagen derived soft tissue fillers from bovine origin that

are in use for soft tissue augmentation lately have reduced

clinical impact and have few chemical or manufacturing

changes. Most of the available products can be employed

only after a negative allergy skin testing at least 6 weeks

before injection. This is not the case for a porcine derived

product where the local complication rate like infection,

granuloma , nodule formation, visibility or allergies have

not been reported so far. 86-88

3.2. Hyaluronic Acid Filler

Commercially available HA’s have a wide variety of

properties which have an impact on their use and clinical

outcomes. Combining objective factors that influence

filler chemistry with clinical experience will improve

patient care, make optimal results more likely, and should

decrease complications.

Regulation of these injectables varies widely from

country to country and approval is often gained after

24 IPRAS Journal Issue 13

short term studies of one year or less. To avoid confusion

in the use of materials, IQUAM recommends that users

verify the validation of the CE-mark or FDA approval

prior to clinical use. 89-95

Continued long-term post-marketing surveillance by

both industry and Notified Bodies is essential. Physicians

should stay alert to detect late adverse events and report

these to the competent authorities. Patients and users

need to be given updated information on the risks of

these materials. Supply of injectables should be limited

to trained physicians. 96-100

3.3. Cross Linked Polyacrylamide Hydrogel

Permanent fillers based on acrylamides have been

in clinical use for more than 15 years. The current

European manufacturer has attained CE certification,

with remaining monomer content below 2 ppm, which

is considered a non-carcinogenic level; and claims

superior production standards compared with earlier

acrylamide products, especially from non-E.U. countries.

Used strictly subcutaneously and in small volumes by

experienced surgeons this hydrogel has shown efficacy,

and comparable complication rates as resorbable fillers in

a European multicenter 8- year follow up study. Removal

of the gel is possible, but will require a surgical setting

and an experienced surgeon. 101-10

3.4. PolyMethylMethAcrylate /Collagen Injectable


In 2008 the FDA issued the first approval for a permanent

dermal filler for naso- labial folds. The approved product

has undergone multiple additional cleaning processes

(Suneva Medical). IQUAM emphasizes that this approval

does not include substances with similar or “comparable”

components from other manufacturers. Indications,

contraindications need to be regarded and injection by

experienced physicians are essential. 110

4. Gold Threads

The implantation of thin gold threads in flaccid facial

cutaneous areas has been developed by Caux 50 years ago.

Histologically the absence of foreign body reaction with

no macrophage cells or allergic reactions used as eyelid

correction for facial palsy or odontologic treatments is

proven. Only limited creation of reticulin fibers can be


However plication, rupture, palpability and migration of

the threads due to the mobility of the face are frequent.

Efficacy has not been proven and therefore these devices

cannot be considered as standard for facial rejuvenation 111

5. General recommendations regarding injectable


IQUAM urges governments to pass legislation to prohibit

the use of non-certified products and to protect patients

from untrained physicians and non-medical personnel

injecting or implanting materials for various indications.

Based on past experience IQUAM states that CE-marks

and FDA approvals are required steps in establishing

the safety of medical devices, but are not necessarily

sufficient. Post market surveillance revealing new

adverse information should lead to reconsideration of

the approval status. IQUAM will continuously monitor

the short and long term outcomes to protect the safety of


Objective medical and media reports contribute to the

reassurance of patients. IQUAM will continue to provide

updated information about medical devices in general,

implants in particular, injectables and new technologies.


1. Postoperative complications after breast implantation.

Chekaroua K, Trevidic P, Foyatier JL, Comparin JP,

Delay E:. Ann Chir Plast Esthet, 2005 Oct, 50(5):544-


2. The non-perfect results of breast implants.

Dionyssopoulos A:. Ann Chir Plast Esthet, 2005


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Black Q, Waisman JR, Silverstein MJ: Plast Reconstr

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1995 Jul, 11(4):248-50

6. Safety of Silicone Breast Implants, Report of the

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Institute of Medicine (hereinafter IOM). National

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p187. Internet address: www4.nationalacademies.


7. United Kingdom Report of the Independent Review

Group (hereinafter IRG) “Silicone Gel Breast

Implants,” 2008, p25.

8. European Parliament Directorate General for

Research, Scientific and Technological Options

Assessment (hereinafter STOA) “Health Risks

Posed by Silicone Implants in General with Special

Attention to Breast Implants – Final Study,” p22-

23. European Parliament Resolution on the petitions

declared admissible concerning silicone implants

Issue 13 IPRAS Journal 25

(Petitions Nos 470/1998 and 771/1998) (2001/


9. Report of the meme breast implant. Kerrigan C.[S.

L.: s.n.], may1989.56p. Prepared for the Minister of

Health and Welfare Canada. The Honorable Perrin


10. The polyurethane-covered mammary prosthesis:

facts and fiction. Hester T.R Prespect Plast Surg


11. Polyurethane-coated silicone gel breast implants

used for 18 years. Vazquez G. Pellon C Aesth Plast

Surg 2007;31:330-6

12. Capsular contracture in subglandular breast

augmentation with textured versus smooth breast

implants: a systematic review. Wong CH, Samuel

M, Tan BK, Song C Plast Reconstr Surg. 2006


13. Textured surface breast implants in the prevention

of capsular contracture among breast augmentation

patients: a meta-analysis of randomized controlled

trials. Barnsley GP, Sigurdson LJ, Barnsley SE. Plast

Reconstr Surg. 2006 Jun;117(7):2182-90.

14. Hvilsom GB, Hölmich LR, Henriksen TF, Lipworth

L, McLaughlin JK, Friis S. Local complications

after cosmetic breast augmentation: results from the

Danish Registry for Plastic Surgery of the breast.

Plast Reconstr Surg. 2009 Sep;124(3):919-2s

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silicone breast implants, recalled from the European

market in 2010. (Comment by Hammond 2012).

Maijers MC, Niessen FB. Plast Reconstr Surg. 2012

Jun; 129(6):1372-8

16. Discussion: Prevalence of rupture in poly implant

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and Niessen 2012). Plast Reconstr Suerg. 2012 Jun;


17. Bilateral supraclavicular swelling: an unusual

presentation of ruptured Poly Implant Prosthese

(PIP) breast implants. Manickavasagar T, Morritt

AN, Offer GJ. J Plast Reconstruct Aesthet Surg.2012

Jul 24. (Epub ahead of print)

18. Anaplastic large T-cell lymphoma and breast

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19. Discussion: Anaplastic large cell lymphoma and

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20. Anaplastic large cell lymphoma and breast implants:

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Young VL, van Busum K, Schnyer C, Mattke S.

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21. Anaplastic Large Cell Lynphoma involving the

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22. Silicone implant and primary breast ALK1-Negative

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23. Comparison of superior gluteal artery

musculocutaneous and superior gluteal artery

perforator flaps for microvascular breast

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Shaw W, Watson JP. Plast Reconstr Surg. 2009


24. Superficial inferior epigastric vessels in the

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breast reconstruction. Gusenoff JA, Coon D, De

La Cruz C, Rubin JP. Plast Reconstr Surg. 2008

Dec;122(6):1621-6.PMID: 19050514

25. Alternative autologous breast reconstruction using

the free microvascular gracilis muscle flap with

horizontal skin island. Schirmer S, Warnecke IC,

Frerichs O, Cervelli A, Fansa H. Handchir Mikrochir

Plast Chir. 2008 Aug;40(4):262-6

26. Breast reconstruction with the TRAM flap:

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29. Initial experience with the Brava nonsurgical system

of breast enhancement. Smith CJ, Khouri RK, Baker

TJ. Plast Reconstr Surg. 2000 Jun;105(7):2500-12;

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30. The Brava external tissue expander: is breast

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9; discussion 1690-1.Comment in: Plast Reconstr

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31. Bicompartmental breast lipostructuring. Zocchi,

M. L.; Zuliani, F.. Aesthetic Plast Surg 32:313-328;


32. Health Council of the Netherlands (hereinafter

Netherlands) “Gezondheidsrisico’s van siliconen–

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33. The Mentor Study on Contour Profile Gel Silicone

MemoryGel Breast Implants.Cunningham B. Plast

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34. Implant-based breast reconstruction using acellular

dermal matrix and the risk of postoperative

26 IPRAS Journal Issue 13

complications : Chun YS, Verma K, Rosen H, Lipsitz

S, Morris D, Kenney P, Eriksson E. Plast Reconstr

Surg. 2010 Feb;125(2):429-36

35. Inamed silicone breast implant core study results at 6

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37. United Kingdom Report of the Independent Review

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38. European Parliament Directorate General for

Research, Scientific and Technological Options

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26. European Parliament Resolution on the petitions

declared admissible concerning silicone implants

(Petitions Nos 470/1998 and 771/1998) (2001/


39. Health Council of the Netherlands (hereinafter

Netherlands) “Gezondheidsrisico’s van siliconen–

borstimplantaten – Health Risks of Silicone Breast

Implants” English Executive Summary, 1999,p34.

40. European Parliament Texts Adopted by Parliament

Provisional Edition : 13/02/2003 Breast implantsP5_

TA(2003)0063 A5-0008/2003

41. From the Centers for Disease Control and Prevention.

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42. Mycobacterium fortuitum infection following

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Christian, M. M., Moy, R. L. Dermatol Surg 26:

588-590, 2000.

43. Skin and Wound Infection by Rapidly Growing

Mycobacteria: An Unexpected Complication of

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J., Bofill, L., et al.. Arch Dermatol 136: 1347-1352,


44. An outbreak of Mycobacterium chelonae infection

following liposuction. Meyers, H., Brown-Elliott, B.

A., Moore, D., et al. Clin Infect Dis 34: 1500-1507,


45. Outbreak of Atypical Mycobacteria Infections

in U.S. Patients Traveling Abroad for Cosmetic

Surgery.Newman, M. I., Camberos, A. E., Clynes,

N. D., et al. Plastic and Reconstructive Surgery 115:

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46. Conservative management of local Mycobacterium

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lipofilling Dessy, L. A., Mazzocchi, M., Fioramonti,

P., et al. Aesthetic Plast Surg 30: 717-722, 2006.

47. Mycobacterium fortuitum abdominal wall abscesses

following liposuction Al Soub, H., Al- Maslamani,

E., Al-Maslamani, M.. Indian Journal of Plastic

Surgery 41: 58-61, 2008.

48. Conservative management of local Mycobacterium

chelonae infection after combined liposuction and

lipofilling ,Dessy, L. A., Mazzocchi, M., Fioramonti,

P., et al.. Aesthetic Plast Surg 30: 717-722, 2006.

49. Liposuction Suspended in all of Espirito Santo,

Brazil, (after death from infection after liposuction,

Feliz, C.). News article in MedNetBrazil, 2008.

50. Treatment of cutaneous infections due to

Mycobacterium fortuitum: two cases, Regnier,

S., Martinez, V., Veziris, N., et al., Ann Dermatol

Venereol 135: 591595,2008.

51. Mycobacterium chelonae wound infection after

liposuction. ,Kim, M. J., Mascola, L. Emerg Infect

Dis 16: 1173-1175, 2010.

52. Results of multicenter study of laser-assisted

liposuction. Apfelberg DB. Clin Plast Surg. 1996


53. 1,000 consecutive cases of laser-assisted liposuction

and suction-assisted lipectomy managed with local

anesthesia. Chia CT, Theodorou SJ. Aesthetic Plast

Surg. 2012 Aug;36(4):795-802

54. Laser-assisted lipolysis: a review. Fakhouri TM,

El Tal AK, Abrou AE, Mehregan DA, Barone F.

Dermatol Surg. 2012 Feb;38(2):155-69.

55. Evaluation of tissue thermal effects from 1064/

1320-nm laser-assisted lipolysis and its clinical

implications. DiBernardo BE, Reyes J, Chen B. J

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56. Quantification of human abdominal tissue tightening

and contraction after component treatments with

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implications. Sasaki GH. Aesthet Surg J. 2010


57. A Multicenter Study for a Single, Three-Step Laser

Treatment for Cellulite Using a 1440-nm Nd:YAG

Laser, a Novel Side-Firing Fiber, and a Temperature-

Sensing Cannula. Dibernardo B, Sasaki G, Katz BE,

Hunstad JP, Petti C, Burns AJ. Aesthet Surg J. 2013

Mar 27

58. Noninvasive body contouring with radiofrequency,

ultrasound, cryolipolysis, and low-level laser

therapy. Mulholland RS, Paul MD, Chalfoun C. Clin

Plast Surg. 2011 Jul;38(3):503-20

Issue 13 IPRAS Journal 27

59. Evaluation of a novel high-intensity focused

ultrasound device for ablating subcutaneous adipose

tissue for noninvasive body contouring: safety

studies in human volunteers. Gadsden E, Aguilar

MT, Smoller BR, Jewell ML. Aesthet Surg J. 2011


60. Low level laser therapy as a non-invasive approach

for body contouring: A randomized control study.

Jackson, et al. Laser Surg Med 2009; 41: 799-809.

61. Cryolipolysis for subcutaneous fat layer reduction.

Avram MM, Harry RS. Lasers Surg Med. 2009


62. Body shaping with acoustic wave therapy AWT(®)/

EPAT(®): randomized, controlled study on 14

subjects. Adatto MA, Adatto-Neilson R, Novak

P, Krotz A, Haller G. J Cosmet Laser Ther. 2011


63. Adipose-Derived Mesenchymal Stem Cells: Past,

Present and Future. Gino Rigotti Æ Alessandra

Marchi Æ Andrea Sbarbati, Aesth Plast Surg (2009)

33:271–273.DOI 10.1007/s00266-009-9339-7

64. Adipose-derived stem cells for soft tissue

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Med 4:109-117; 2009

65. Adult stem cell plasticity: fact or artifact? Raff, M.

Annu Rev Cell Dev Biol 19:1-22; 2003

66. Origin and potential of embryo stem cells, Stem cells

today: A. Edwards, R. G.. Reprod BiomedOnline

8:275-306; 2004.

67. Historical review of the use of adipose tissue transfer

in plastic and reconstructive surgery. Mojallal, A.;

Foyatier, J. LAnn Chir Plast Esthet 49:419-425;


68. Collagen matrices from sponge to nano: new

perspectives for tissue engineering of skeletal muscle.

Beier JP, Klumpp D, Rudisile M, Dersch R, Wendorff

JH, Bleiziffer O, Arkudas A, Polykandriotis E, Horch

RE, Kneser U., BMC Biotechnol. 2009 Apr 15;9:34

69. Adult bone marrow stem/progenitor cells (MSCs)

are preconditioned by microenvironmental “niches”

in culture: a two-stage hypothesis for regulation of

MSC fate. Gregory, C. A.; Ylostalo, J.; Prockop, D.

J. Sci STKE 2005:pe37; 2005

70. Human clinical experience with adipose precursor

cells seeded on hyaluronic acid-based spongy

scaffolds.. Stillaert FB, Di Bartolo C, Hunt,

Rhodes NP, Tognana E, Monstrey S, Blondeel PN.

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71. Adipose tissue induction in vivo. Stillaert FB,

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72. An arteriovenous loop in a protected space generates

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73. New therapeutics for the prevention and reduction

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74. Prevention and reduction of scarring in the skin by

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Occleston NL, Laverty HG, O’Kane S, Ferguson MW.

J Biomater Sci Polym Ed. 2008;19(8):1047-63.

75. Soft Tissue Treatment. Giménez Garcia MC,

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Zhou S (edg), Musculoskeletal Shockwave Therapy,

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76. Clinical outcome of ESWT for selected chronic

tendinopathies in physically active subjects. Goh P.,

3rd Congress of the ISMT - Naples. Abstract: 82,


77. Shock wave therapy for acute and chronic soft

tissue wounds: a feasibility study. Schaden W,

Thiele R, Kölpl C, Pusch M, Nissan A, Attinger CE,

Maniscalco-Theberge ME, Peoples GE, Elster EA,

Stojadinovic A., J Surg Res. 2007 Nov;143(1):1-12.

78. Treatment of lower eyelid fat pads using

phosphatidylcholine: clinic trial and review. Ablon

G, Rotunda Am. Dermatol Surg 2004;30:422-7.

79. Fat dissolving’ substance injects CCs of controversy.

Bates B. Skin Allergy News 2003; 34:1.

80. Lipostabil: the effect of phosphatidylcholine

on subcutaneous fat. Young VL.. Aesth Surg J


81. A new method to quantify the effect after subcutaneous

injection of lipolytic substances. Klein SM, Prantl,

Berner A, et al.,, Aesthetic Plastic Surgery 2008, Jul;

32 (4): 667-672.

82. Normal and pathologic tissue reactions to soft tissue

gel fillers. Christensen, L., Dermatol Surg, 33 Suppl

2: p. S168-75.2007.

83. Facial dermal fillers: selection of appropriate

products and techniques. Dayan SH, Bassichis BA

Aesthet Surg J. 2008 May-Jun;28(3):335-47.

84. Reversible vs. nonreversible fillers in facial

aesthetics: concerns and considerations. Smith KC.,

Dermatol Online J. 2008 Aug 15;14(8):3

85. Understanding, avoiding, and managing dermal

filler complications. Cohen JL. Dermatol Surg. 2008

Jun;34 Suppl 1:S92-9

86. Porcine filler for facial lipoatrophy associated with

human immunodeficiency virus treatment. Reytan N,

Rzany B.,J Drugs Dermatol. 2008 Sep;7(9):884-6.

87. The use of injectable collagens for aesthetic

28 IPRAS Journal Issue 13

ejuvenation., Matarasso SL. Semin Cutan Med

Surg. 2006 Sep;25(3):151-7.

88. A two-stage phase I trial of Evolence30 collagen for

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S, Hamdi M, Van Landuyt K, Blondeel P, Shiri J,

Goldlust A, Shoshani D. Plast Reconstr Surg. 2007


89. Comparison of smooth-gel hyaluronic acid dermal

fillers with cross-linked bovine collagen: a multicenter,

double-masked, randomized, within-subject study.

Baumann LS, Shamban AT, Lupo MP, Monheit GD,

Thomas JA, Murphy DK, Walker PS; JUVEDERM vs.

ZYPLAST Nasolabial Fold Study Group. Dermatol

Surg. 2007 Dec;33 Suppl 2:S128-35.

90. Facial dermal fillers: selection of appropriate

products and techniques. Dayan SH, Bassichis BA

Aesthet Surg J. 2008 May-Jun;28(3):335-47.

91. Effectiveness of Juvéderm Ultra Plus dermal filler in

the treatment of severe nasolabial folds. Lupo MP,

Smith SR, Thomas JA, Murphy DK, Beddingfield FC

3rd.,Plast Reconstr Surg. 2008 Jan;121(1):289-97.

92. The science of hyaluronic acid dermal fillers, Tezel

A, Fredrickson GH..: J Cosmet Laser Ther. 2008


93. Synthesis and Characterization of a Novel Double

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JE, Alexander, C Lockett C, White BJ, J. of Materials

Science: Materials in Medicine 13: (2002) 11-16.

94. The Polysaccharide of the Vitreous Humor, Meyer,

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95. Campoccia, AD, Doherty, P, Radice, M, Brun,

P, Abatangelo, G, Williams, DF, Semisynthetic

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96. DeBelder, AN, Malson, T US Patent 4,886, 787,


97. Zhao, XB, Alexander, C Fraser, J, US Patent 7, 226,

972, 2007.

98. Kablik, J, Monheit, G, Liping, Y, Chang, G,

Gershkovich, J. Comparative Physical Properties of

Hyaluronic Acid Dermal Fillers, Dermatol. Surg. 35:

(2009) Suppl 1: 302-12.

99. U.S. Food and Drug Administration, Restylane

Injectable Gel – P020023, Labeling Information and

Approval Letter December 12, 2003.

100. U.S. Food and Drug Administration, Juvéderm 30,

Juvéderm 24HV and Juvéderm 30HV Injectable

Dermal Filler – P050047, Labeling Information and

Approval Letter, June 2, 2006.

101. Complications of breast augmentation with injected

hydrophilic polyacrylamide gel Cheng, N.X., Y.L.

Wang, J.H. Wang, X.M. Zhang, and H. Zhong.

Aesthetic Plast Surg, 26 (5): p. 375-82.2002.

102. Normal and pathologic tissue reactions to soft tissue

gel fillers. Christensen, L., Dermatol Surg, 33 Suppl

2: p. S168-75.2007.

103. Biocompatibility and tissue interactions of a new

filler material for medical use. Zarini, E., R. Supino,

G. Pratesi, D. Laccabue, M. Tortoreto, E. Scanziani,

G. Ghisleni, S. Paltrinieri, G. Tunesi, and M. Nava,

Plast Reconstr Surg, 114 (4): p. 934-42.2004.

104. Biocompatibility of two novel dermal fillers:

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105. Polyacrylamide hydrogel injection in the management

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Spaggiari, and G. Guaraldi, Plast Reconstr Surg, 121

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106. Efficacy and safety of polyacrylamide hydrogel for

facial soft-tissue augmentation in a 2-year followup:

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107. Unacceptable Results with an Accepted Soft Tissue

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108. Augmentation of the malar area with polyacrylamide

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109. Complications from repeated injection or puncture

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El-Shafey el, S.I., Aesthetic Plast Surg, 32 (1): p.


110. ArteFill: a long-lasting injectable wrinkle filler

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Issue 13 IPRAS Journal 29




JUNE 6-9, 2013

Sydney Coleman

Congress President

ISPRES General Secretary

A paradigm shift has occurred in plastic surgery and

related specialties: the emergence of regenerative surgery.

The International Society of Plastic Regenerative Surgery

(ISPRES) was created to help the world share advances

in the science and clinical practice ofadipose-based

regeneration. The second annual Congress of ISPRES

convened June 6-9, 2013 in Berlin, Germany.

What is Regenerative Surgery?

Regenerative surgery involves the manipulation of our

own body’s tissues to treat and cure conditions, rather than

using drugs and more invasive, non-natural procedures.

This regenerative approach is no longer a dream of the

future, but has rapidly become part of our current clinical


How was the content of ISPRES Berlin 2013


The Scientific Committee and the Organizing

Committee devised the framework of ISPRES Berlin

2013 by nominating speakers and presenters from

every corner of the world. Each invited speaker was

asked to share his or her most clinically significant

research and/or relevant, recent clinical experiences.

We combined scientists with surgeons from around

the world to provide a fresh understanding of adipose

derived stem cells (ADS), stromal vascular fraction

(SVF) and fat transplantation. The program was not

just at the cutting edge of science, but also full of

clinical knowledge which surgeons can implement

into their practices.

From the left: Dr. Tsai-Ming Lin, Taiwan, Dr. Brian Kinney, US, (in front) Dr. Peter Rubin, US, Dr. Sydney Coleman, US, Dr. Marita

Eisenmann-Klein, Germany, Dr. Nelson Piccolo, Brazil, Dr. Ahmed Adel Noureldin, Egypt, Dr. Kotaro Yoshimura, Japan, Dr. Roger

Khouri, US, Dr. Gino Rigotti, Italy

Issue 13 IPRAS Journal 31

How was ISPRES different from other meetings?

ISPRES Berlin 2013 and its predecessor, ISPRES Rome

2012, were meetings that taught attendees by sharing

information about fat grafting and adipose-related

technology from every corner of the world. Instead of

having instructors teaching the audience, the meeting

focused on the sharing of innovations, or even revelations,

in the clinical use of fat grafting, stromal vascular fraction,

adipose derived stem cells and growth factors. Research

presented was primarily of a translational nature that will

most likely influence plastic surgery clinical practices

in the near future. Invited lecturers and faculty formed

the foundation of the meeting, but we relied heavily on

submitted abstracts. This combination of presenters

gave the attendees of ISPRES Berlin a truly international

perspective of adipose technology and regeneration, with

88 presenters from 45 countries: Argentina, Armenia,

Initial Sessions

After the opening ceremonies, the Congress launched

immediately into a review of the history of fat grafting in

plastic surgery by Riccardo Mazzola. The first sessions

of ISPRES Berlin 2013 provided the attendee with a new

understanding of how adipose derived stem cells work.

The early sessions laid the groundwork so the audience

Dr. Mimis Cohen, IPRAS Chair of the Scientific Advisory

Board, Mr. George A. Oram Executive Vice President, Sales

and Marketing of MTF, Dr. Gregory Evans, President of ASPS,

Mr. Bruce W. Stroever, President and Chief Executive Officer

of Musculoskeletal Transplant Foundation MTF, Mr. Patrick

Gostomski, International Sales and Marketing Manager at MTF

Conference Hall

Australia, Austria, Belgium, Brazil, China, Costa Rica,

Czech Republic, Denmark, Egypt, Estonia, France,

Germany, Greece, Hungary, India, Israel, Italy, Japan,

Kuwait, Latvia, Mexico, New Zealand, Nigeria, Norway,

Peru, Philippines, Poland, Romania, Russia, Saudi Arabia,

Serbia, South Africa, South Korea, Spain, Switzerland,

Taiwan, The Netherlands, Turkey, UK, Ukraine, United

Arab, Emirates, USA, Venezuela.

Dr. Magalon Guy, France, Dr. Peter Vogt, Germany, President

of the German Society of Plastic, Reconstructive and Aesthetic

Surgery, Mrs. Vogt, Dr. Anthony Joseph, Japan

could appreciate the revolutionary clinical studies

presented throughout the remainder of the Congress.

Gino Rigotti, ISPRES president, began the first scientific

talk with a discussion of the newly recognized entity, the

POSTADIPOCYTE, and its potentially integral role in fat

grafting. Brian Kinney foreshadowed the importance of

nomenclature in a brief talk that followed. Hans Hauner,

the first scientist who isolated and cultured human

preadipocytes, was our keynote speaker this year.

The following sessions began with descriptions of how

fat grafting affects the tissues into which it is placed.

Sydney Coleman related his early experiences in the

1980’s and early 90’s of witnessing improvement in the

quality of skin, diminution of wrinkles decrease in pore

size and improvement in skin color. He was the first to

notice and communicate to the world, the improvement

in scarring and radiation damage after fat grafting. Ali

Mojallal, Eckhard Alt and Wolfgang Wagner further

highlighted the dramatic changes in aging skin treated

with fat grafting.

Following that, much attention was devoted to

understanding the regenerative effect of adipose derived

stem cells and growth factors. Particular attention was

paid to the addition of stem cells and SVF to fat.

Understanding Adipose Derived Stem Cells

Considerable time was devoted to the understanding

of ADSC. Peter Rubin, Norbert Pallua, Dennis Von

Heimburg, Eckhart Alt, Lee Pu, Kotaro Yoshimura,

Renata Sonnefeld, Patricio Centurion, Degheidly Tamer,

Cheng Nai-Chen, Ramon Llull andFeng Lu all presented

insights into ADSC and approaches to understanding

their contribution to regeneration.

32 IPRAS Journal Issue 13

Maximizing Fat Grafts

Beginning on the first day, we had important sessions on

different methods for maximizing donor and recipient

sites for clinical fat grafting. Kotaro Yoshimura began

with an overview of enhancing regeneration after fat

grafting, and discussed many factors over the course of

the meeting that might enhance fat graft take. Ali Mojallal

discussed the effect of the size of the lobule on fat graft

survival. Peter Rubin reviewed experimental studies that

analyzed fat graft survival. Lee Pu gave a comprehensive

review of the recent advances in research, focusing on

the technical maneuvers for harvesting and placement.

External Expansion

Dennis Orgill from Boston joined us to present several

talks on the effect of mechanical forces on living fat, and

teamed up with Roger Khouri and Yvonne Heit to discuss

the effect of external volume expansion and Brava on fat

graft survival. Discussions of this technology continued

throughout the presentations of fat grafting in the breast.

Can additives improve fat grafting?

Valerio Cervelli and Pietro Gentile presented a large

positive experience with the use of PRP to enhance fat

grafting. Peter Rubin, Aldel Noreldin of Egypt, Dana Jianu

of Romania and many others expressed similar positive

effects of growth factors. Willemsen Joep demonstrated

that PRP added to facial fat grafting not only improved

the results, but also reduced recovery time.

Stromal Vascular Fraction

Stromal Vascular Fraction was highlighted at ISPRES

Berlin 2013 as an evolving technology that deserves the

utmost attention. Discussion of fat grafting was the only

topic, which was discussed more often than SVF. In

fact, SVF was discussed to some extent at almost every

session in the entire congress.

Carlo Tremolada, Camillo Ricordi, and others from Italy

discussed the rationale and potential clinical uses of

“LipoGems”. This new technology was presented as a

miraculous method of concentrating adipose derived stem

cells. However, many in the audience sharply criticized

LipoGems during the animated discussions that followed

the presentations

David Daehwan Park from Korea, Sundar Raj Swathi from

Dr. Peter Rubin, ISPRES founding member

India and Jae-Ho Jeong presented automated methods of

extraction. Florian Lampert presented an alternative view

of the technology of SVF.

The status quo was well represented by John Fraser from

California who gave an informative update on the SVF

clinical studies underway using the Celution® System.

He combined forces with Steven Cohen, also from

Conference dinner at the German Parliament.

California,and Guy Magalon from Marseilles to analyze

what is in SVF and how to determine the varying contents.

We had sessions on the use of SVF- enriched fat for an

amazing array of indications: for instance, rejuvenation,

combat injuries, scars, burn wounds, scleroderma, diabetic

ulcers, open fractures and many breast indications.We

also spent much time discussing potential problems

with the use of SVF, including safety issues, potential

complications, and government regulation of SVF.

Prof. Coleman, ISPRES Congress President, ISPRES General

Secretary and Prof. Eisenmann-Klein, ISPRES President during

the conference dinner thanked Musculoskeletal Transplant

Foundation MTF for their contribution.

Fat grafting to the breasts

Six hours of ISPRES 2013 were devoted to the use of fat

in the normal breast (Kolasinski Jerzy, Abboud Marwan,

Wettstein Reto, Amin KalaajiandDaniel Del Vecchio).

Extended sessions continued with presentations of fat

grafting in the reconstructed breast (Nolan Karp of USA,

Ali Mojallal, Paulo Leal of Brazil, Kosovac Olivera, Gino

Rigotti, Roger Khouri, Harder Yves and Broer Niclas). The

use of SVF enriched fat was then presented in extensive

talks by Kotaro Yoshimura, Pietro Gentile, Ramon Llull,

Aris Sterodimas of Greece, and Dan Del Vecchio.

Issue 13 IPRAS Journal 33

Glass dome at the German Parliament.

Can Fat Grafting Affect Breast Cancer?

The final session of the breast section was devoted

to safety. The effect of fat grafting on breast cancer

occurrence anddetection was discussed extensively by

Ramon Llull, Joern Kuhbier, Alessandra Marchi, and

Qing Feng Li. Norbert Pallua gave a thorough summary

of the worldwide experience so far with breast cancer

and fat grafting.

Craniofacial/ Maxillofacial Applications

These sessions began with Riccardo Mazzola tracing the

use of fat grafting in war injuries from WWI to today.

Mazzola’s talk was a great introduction to Peter Rubin,

who spoke on the treatment of craniofacial war injuries

and painful amputations with fat grafting. Ewa Siolo

offered up her extensive experience in the use of fat

grafts in craniofacial and cleft surgery. Fernando Molina

demonstrated his considerable experience in using fat

injections in craniosynostosis and syndromic craniofacial

deformities. Riccardo Tieghi of Italy presented an

overview of the application of structural fat grafting in

patients with congenital craniofacial deformities.

Aesthetic Facial Fat Grafting

Five hours were devoted to aesthetic facial fat grafting.

Especially interesting were the talks on the use of SVF to

supplement facial fat grafting given by Seung-Kkyu Han,

David Daehwan Park, Aris Sterodimas, Steven Cohen and

Gontijo de Amorim Natale of Brazil. The simpler, more

traditional uses of facial fat grafting were presented by one

of the first users of fat grafts, Abel Chajchir, as well as

Fernando Molino, Lin Tsai-Ming and Kotaro Yoshimura.

Correction of Chronic Conditions

Perhaps the most revolutionary sessions of the

meeting were devoted to the correction of previously

difficult to treat or untreatable chronic conditions

with fat grafting and SVF. Talks about systemic or

localized sclerosis were given by Guy Magalon of

France, Gino Rigotti, Caviggioli Fabio, and Isabella

Mazzola of Italy. Sandeep Sharma of India and

Stasch Tilman presented the use of SVF in diabetic

ulcers. Roger Khouri presented the use of fat grafting

for the correction of Dupuytren’s Contracture. Other

talks addressed the treatment of Lichen Sclerosis of

the Vulva (Casabona Francesco), radiation injuries

(Vasilyev and Alessandra Marchi) and even stress

incontinence (Florence Rampillon) with fat grafts.

Tissue Engineering

To obtain a glimpse into the future, many tissueengineering

presentations were given. Aris Sterodimas

of Greece showed us three-dimensional scaffolds used to

engineer an ear. Jorg Witfang presented combining bone

with stem cells for enhanced bone regeneration. Bosetti

Michela, P.Bauer-Kreisel, Feng Lu,Radke Christine,

Uysal Cagri, Dennis Orgill and Sin-Daw Lindescribed

methods for repairing tissue defects with fat grafting

combined with scaffolds.

Fat Storage

Lee Pu, Norbert Pallua, John Fraser, Jeffrey Hartog,

Lamblet Hebert,

Skorobac Asanin Violeta, andCarelli Stephanagave

conflicting views of the efficacy of freezing fat.

34 IPRAS Journal Issue 13

Dr Mauro André Arguello, Brazil, Dra Fabiana Corio, Brazil, Dr. Alessandra Marchi, Italy, ISPRES Assistant General Secretary, Dr.

B. Venkata Ratnam - Vice President of the Emirates Plastic Surgery Society, Prof. Gino Rigotti, ISPRES President, Dra. Natale Gontijo

de Amorim, Brazil, Dr. Romulo Mene, Brazil, Dr. Monica Piccolo, Brazil, Dr. Nelson Piccolo, Brazil, IPRAS General Secretary, Prof.

Riccardo Mazzola, Italy, IPRAS Historian

Regulations & Ethics concerning Fat Transplants,

SVF, ADSC & Growth Factors

Toward the final moments of the meeting, perhaps one

of the most interesting sessions was on government

regulation and ethics. Brian Kinney continued his

discussion from the first day, talking about the online

marketing of fat grafts and stem cells. Gino Rigotti posed

the alarming question,“Can Fat Grafting be Regulated

Like a Drug?” Greg Evans, current President of ASPS,

gave an update on the FDA and other regulatory agencies.

Rick D’Amico gave an update on the ASPS task force on

regenerative medicine. A lively discussion followed.


A course entitled “Fundamentals of fat grafting:

complementary and conflicting techniques” took place on

June 6, 2013, the afternoon before the Congress began.

This was a basic course comparing the varying techniques

that have evolved in fat grafting, contrasting the many

techniques that have developed for different indications,

looking at how they contrast with and complement each

other. The presenters were Roger Khouri of the US, Daniel

Del Vecchio from the US, Gino Rigotti of Italy, Sydney

Coleman, Nelson Piccolo of Brazil and Ewa Siolo from

South Africa. The differences and similarities of each

technique were highlighted.

We also presented some of the fundamentals of the

preparation of SVF using different methods and devicesat

the pre-meeting.

Also during that pre-meeting, we there was a specific

course by Lance Lancerotti of Italy,with the purpose of

educating practicing physicians about the nomenclature

of Cell Biology, which has rapidly become a part of the

plastic surgery literature. Another course, presented by

Peter Rubin of Pittsburgh, was a thorough guide to help

attendees understand and interpret scientific studies more


Conference dinner

A spectacular conference dinner took place at the German

Parliament on Saturday the 8th of June where ISPRES had

the chance to thank the Musculoskeletal Transplantation

Foundation (MTF), our major sponsor, for its generous

contribution to ISPRES Berlin 2013. Participants had a

fantastic time at this breathtaking venue with delicious

gourmet meal at the restaurant where only members of

the parliament are usually allowed to enter. The stunning

panoramic view over the city of Berlin from the glass

dome was astonishing. The amazing venue not only gave

attendees an amaz–ing culinary and visual experience,

but also was a great time to socialize.

ISPRES 2014 will take place in New York City. Stay

tuned for updates.

Issue 13 IPRAS Journal 35

2 n d I S P R E S C O N G R E S S S U R V E Y S

Autologous fat transplantation: an adjuvant treatment

for Limited Systemic Scleroderma

Mazzola I, Confalonieri PL, Musumarra G, Del Bene M.

Department of Plastic, Hand Surgery, and Reconstructive Microsurgery,

Ospedale San Gerardo, Monza, Italy

Corresponding author:

Dr. Isabella Mazzola:


Systemic sclerosis (scleroderma SSc) is a chronic

multifactorial systemic disease of connective tissue,

characterized by fibrosis and widespread vasculopathy.

According to the extension of cutaneous thickening the

disease is classified in diffuse (dcSSC) or limited systemic

sclerosis (lcSSc). LcSSc, in which sclerosis is confined to

the extremities and face, tends to have an insidious onset.

Digital ulcers, a typical feature of the hand's cutaneous

manifestations, occur either distally or over the bony

prominences, whereas in the face at a perioral level. The

aim of this paper is to report our experience by treating

these affected areas with autologous fat transplantation.

Material and Methods:

From 2010 to 2012, 15 patients (14 women and 1 man,

mean age 65 years) for a total of 37 digital ulcers and 9

perioral regions have been treated.

An extensive debridement of the digital ulcers and

concurrent fat grafting with autologous adipocytes

previously centrifugated is performed. 1-2 ml of pure

adipose tissue is injected in the dorsal surface of the

finger with 18G blunt cannulas, whereas 3-5ml with 21G

cannulas in the perioral area. Patients are allowed normal

hand use from the first postoperative day.


Improvement of scleroderma with fat grafting was

particularly significant with a total healing of 19 digit

ulcers at 3 months after one procedure. The remaining 18

ulcers showed a noteworthy decrease of their diameter and

accelerated rates of wound healing. Functional disability

of perioral regions showed an immediate improvement

and all patients reported a considerable reduction in the

local pain in the affected regions of the hands and face.

No complications were observed.

Intraoperative technique

Right hand

Left hand

36 IPRAS Journal Issue 13


Dorsal side of both hands

Current treatments (systemic and local) are only

moderately effective in reducing the severity of the

vascular manifestations caused by Scleroderma.

Autologous fat transplantation provides substantial

benefit in terms of healing or prevention of digital ulcers.

This safe and minimally invasive technique, as additional

therapy, facilitates wound healing and reduces drastically

recovery time.


Acute, subacute and chronic conditions treated with fat



No conflict of interest

Volar side of both hands

Issue 13 IPRAS Journal 37

“Cell-assisted Lipotransfer”

A critical Appraisal of Yet Another “Stem Cell Therapy”

Lampert FM, Grabin S, Torio N, Stark GB

Corresponding author:

Dr. Florian M. Lampert, M.D.

Building on findings from in-vitro and in-vivo

experiments that suggest a supportive role of ADSCs on

their surrounding cells in autologous fat transplantation,

the so-called „Cell-assisted-Lipotransfer“ (CAL) has

been invented to ameliorate the clinical outcomes of

autologous fat transplantation.

Despite of encouraging data from basic research,

evidentiary clinical data for these interventions is barely

provided, neither is information on security issues such as

the risk of inadequate differentiation or the development

of malignancies.

In order to remedy such unsatisfactory tendencies, we

conducted a systematic review in collaboration with the

German Cochrane Center. A thorough search strategy

was conducted in eight major scientific databases.

3161 publications were obtained. These were screened

by two independent scientific reviewers, leading to

228 potentially relevant publications, out of which

78 were judged relevant after full text examination by

the two reviewers (Fig. 1). Of the latter, only 14% (11

publications) were clinical studies (Fig. 2). Out of these,

only two studies met Evidence-Level III criteria. The

remaining publications had an Evidence Level of IV

or V. Considering all studies, a total of only 184 CALprocedures

is described. No follow-up exceeded 42

months, neither adequate data on oncological safety is

provided -especially alarming with regard to patients

who receive the procedure after oncological treatment,

e.g. for breast reconstruction.

In summary, not a single proof of the superiority of

CAL in comparison to the conventional method of fat

transplantation could be brought to light; security issues

are completely neglected or only inadequately referred to.

Prior to the implementation of this unquestionably

extremely promising technique into the armamentarium

of Plastic Surgery, we have to gain possession of

substantiated, high-grade evidence for its efficacy as well

as on safety issues. It is up to us as the serious exponents

of our discipline to provide this evidence.

None of the authors has any financial relationship or affiliation with any businesses whose products or services are

related to the subject matter of the presentation topic

38 IPRAS Journal Issue 13

Surgical Refinement

with Autologous fat grafting following reconstructive

surgery of the breast:

The influence of smoking and radiotherapy

Yves Harder, Allan A. Allan, Daniel Müller, Maximilian Eder,

Laszlo Kovacs, Hans-Günther Machens, Jan-Thorsten Schantz

Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar,

Technische Universität München, Germany


Autologous fat grafting (lipofilling) from processed

lipoaspirate is widely used to correct contour deformities

and volume asymmetries after reconstructive surgery

of the breast. Newer studies indicate that lipofilling of

the breast is associated with low morbidity, an almost

unaffected radiological follow-up and a predictable

resorption rate. [1-5] One currently assumes that active

smoking and irradiation of the breast after Breast

Conservative Treatment (BCT) respectively the skin

and the thoracic wall after mastectomy decrease the

engraftment rate of the fat due to impaired perfusion

conditions and limited angiogenic response. The study

aim was therefore to evaluate the resorption rate of the fat

in healthy irradiated and non-irradiated patients as well

as in smokers.

Material and Methods:

We concluded a consecutive analysis of 82 lipofillingprocedures

in 40 patients (56 cases; 64 reconstructions;

8 BCTs; 7 healthy breasts) during a 30-month period.

Demographics and risk factors (smoking, diabetes

radiotherapy of the thoracic wall and/or or breast

± axillar crease) were collected. After infiltration

of tumescence-solution, liposuction of the fat was

performed into a closed system. Thereafter the fat was

filled into 10ml syringes to be centrifuged for 2 minutes

at 3’000RPMs. The fat was then injected in a multilayer

and multidirectional way, sparing glandular tissue.

Documentation included a questionnaire (assessment of

shape, contour, symmetry and consistency of the breast),

standardized photography and volumetry (3-D surface

scan: Konica-Minolta ® /Geomagic ® ) before and after

surgery, according to a given timeline: preoperative and

postoperative 3 days, 4 weeks, 3, 6, 12 and 18 months.

Resorption rate was assessed in 4 different groups

healthy patients (n=12); smoking (n=10); radiotherapy:

(n=12); smoking and radiotherapy: (n=7)) as well as

between lipofilling-procedure 1 and 2 (interval 1: n=20)

and lipofilling-procedure 2 and 3 (interval 2: n=12).


The mean BMI of the patients was 25kg/m 2 body surface

(19-36). 33% of the patients were active smokers, 43%

had received neo- or adjuvant radiotherapy previous to

lipofilling. The mean injection volume per session was

151ml (30ml-490ml). The overall resorption rate of the

fat at 18 months (n=7) was 41% (37%-52%: Fig. 1A).

The resorption rate at 12 months of the 4 groups: healthy

patients: 43%; smokers: 41%; irradiated breasts: 43%;

smokers with irradiated breast: 41%; n.s. (Fig. 1B).

Also, no difference was observed with regard to the

resorption rate in patients receiving multiple lipofillings

(Fig. 1C). The procedure was associated with following

morbidity: Perioperative: None (infection, hematoma).

Postoperatively, we observed 4 palpable, painless

fat necroses. At the donor-site, contour deformity

(“denting”) and paraesthesia in the dermatome of the

lateral cutaneous nerve of the thigh was observed in 1

case each (Fig. 2A). 97%-100% of the patients reported

an excellent or a good degree of satisfaction for shape,

symmetry and consistency, whereas only 3% reported a

moderate degree of satisfaction (Fig. 2B-D, 3 & 4).


Surgical refinement with injection of autologous fat after

reconstructive surgery of the breast is a safe method of

addressing contour deformities and asymmetries. Fat

grafting is associated with a very low complication rate

and a very high patient satisfaction. Fat resorption does

not seem to be influenced, neither by active smoking nor

by irradiation of the recipient site. Follow-up studies

including more patients are needed to confirm both this

trend and the safety of the procedure.

Issue 13 IPRAS Journal 39







[%] [%]




Fig. 1: Fat resorption over 18 months shows a constant volume

decrease over 6 months that slows down over another 3 months.

Only then, stable conditions are reached with a resorption rate of

~40% (=engraftment rate of ~60%). Note the initial volume increase

with regard to baseline (preop), resulting from slight overcorrection

and swelling (A). Fat resorption at 12 months in healthy individuals,

2 x smokers, patients with a history of radiotherapy and active

smokers that have been irradiated previous to lipofilling. Note that

the resorption rate of ~40% is similar in all 4 groups (B). Also,

resorption rate between lipofilling no. 1 and no. 2 (interval 1) and

lipofilling no. 2 and no. 3 (interval 2) is ~40% (C).


Fig. 1: Fat resorption over 18 months shows a constant volume decrease over 6 months th

1: Fat resorption over 18 months shows a constant volume decrease over 6 months that slows



down over another 3 months. Only then, stable conditions are reached with a resorptio

n over another 3 months. Only then, stable conditions are reached with a resorption rate of

~40% (=engraftment rate of ~60%). Note the initial volume increase with regard to baseline

(=engraftment rate of ~60%). Note the initial volume increase with regard to baseline (preop),

resulting from slight overcorrection and swelling (A). Fat resorption at 12 months in

lting from slight overcorrection and swelling (A). Fat resorption at 12 months in healthy

individuals, active smokers, patients with a history of radiotherapy and active smokers t

iduals, active smokers, patients with a history of radiotherapy and active smokers that have

been irradiated previous to lipofilling. Note that the resorption rate of ~40% is similar in all

irradiated previous to lipofilling. Note that the resorption rate of ~40% is similar in all 4 groups

(B). Also, resorption rate between lipofilling no. 1 and no. 2 (interval 1) and lipofilling no. 2

Also, resorption rate between lipofilling no. 1 and no. 2 (interval 1) and lipofilling no. 2 and no.

3 (interval 2) is ~40% (C).

terval 2) is ~40% (C).




1: Fat resorption over 18 months shows a constant volume decrease over 6 months that slows


n over another 3 months. Only then, stable conditions are reached with a resorption rate of

(=engraftment rate of ~60%). Note the initial volume increase with regard to baseline (preop),

lting from slight overcorrection and swelling (A). Fat resorption at 12 months in healthy

iduals, active smokers, patients with a history of radiotherapy and active smokers that have


irradiated previous to lipofilling. Note that the resorption rate of ~40% is similar in all 4 groups

Also, resorption rate between lipofilling no. 1 and no. 2 (interval 1) and lipofilling no. 2 and no.

terval 2) is ~40% (C).




Fig. 2: Perioperative morbidity of the procedure showing neither infection (Inf) nor hematoma. 4 palpable, painless fat necroses were observed

in the 82 procedures (FN). 1 dent respectively 1 transient paraesthesia (lateral cutaneous nerve of the thigh) occurred (Par: A). Patient

satisfaction at 12 months for shape (B), symmetry (C) and consistency (D: n=40) was very high with only 3% unsatisfactory results.

40 IPRAS Journal Issue 13

ig.3 ig.3



g.4 g.4

Fig. 3: 56-year old patient after BCT and adjuvant radiotherapy of the left breast with a contour deformity in the upper inner quadrant

particularly visible on the oblique view and the surface scan (A). 2 years after 2 lipofilling-procedures of 100ml and 67 ml respectively, the

deformity has been completely corrected (B).



Fig. 3: 56-year old patient after breast conservative treatment and adjuvant radiotherapy of the left

Fig. 3: 56-year old patient after breast conservative treatment and adjuvant radiotherapy of the left

breast with contour deformity in the upper inner quadrant particularly visible on the oblique view

breast with a contour deformity in the upper inner quadrant particularly visible on the oblique view

and the surface scan (A). years after lipofilling-procedures of 100ml and 67 ml respectively, the

and the surface scan (A). 2 years after 2 lipofilling-procedures of 100ml and 67 ml respectively, the

deformity has been completely corrected (B).

deformity has been completely corrected (B).

Fig. 4: 42-year old patient after failed secondary breast reconstruction with pedicled latissimus dorsi flap and implant. Contour deformity

of the upper outer quadrant and volume defect after implant removal due to infection (A). 1 year after 2 lipofilling-procedures of 303ml and

160ml of the entire breast and nipple reconstruction. Note the symmetrization (B).

Issue 13 IPRAS Journal 41


1. Petit JY, Lohsiriwat V, Clough KB, Sarfati I, Ihrai T,

Rietjens M, Veronesi P, Rossetto F, Scevola A, Delay

E. The oncological outcome and immediate surgical

complications of lipofilling in breast cancer patients:

a multicenter study: Milan-Paris-Lyon experience of

646 lipofilling procedures. Plast Reconstr Surg 2011;

128(2): 341-346.

2. Rubin JP, Coon D, Zuley M, Toy J, Asano Y, Kurita

M, Aoi N, Harii K, Yoshimura K. Mammographic

changes after fat transfer to the breast compared with

changes after breast reduction: a blinded study. Plast

Reconstr Surg 2012; 129(5):1029-1038.

3. Veber M, Tourasse C, Toussoun G, Moutran M,

Mojallal A, Delay E. Radiographic findings after

breast augmentation by autologous fat transfer. Plast

Reconstr Surg 2011; 127(3): 1289-1299.

4. Herold C, Ueberreiter K, Cromme F, Busche MN, Vogt

PM. [The use of mamma MRI volumetry to evaluate

the rate of fat survival after autologous lipotransfer].

Handchir Mikrochir Plast Chir 2010; 42(2): 129-


5. Herold C, Ueberreiter K, Busche MN, Vogt PM.

Autologous fat transplantation: volumetric tools for

estimation of volume survival. A systematic review.

Aesthetic Plast Surg 2013; 37(2): 380-387.

Disclosures: None of the authors have any disclosures.

Conflict of interest: None

Funding: None

Financial or ethical concerns: None. Prospective data

acquisition has been approved by the local ethical review

committee of the hospital. All patients sign an informed

consent that allows using all pre- and postoperative

photographs and scans for scientific purposes.

Corresponding author:

Prof. Dr. med. Yves Harder

Senior consultant

Department for Plastic Surgery and Hand Surgery

Klinikum rechts der Isar, Technische Universität München


Ismaningerstrasse 22

D-81675 München, Germany

Tel: +49(0)89 4140 2171 secretariat; (-5536) office

Fax: +49(0)89 4140 4869


Category of the abstract:

1. Maximizing and Understanding Results of Clinical Fat


2. Fat Grafting to the Breast

42 IPRAS Journal Issue 13

Development of an Automated Device

for Point-Of-Care Isolation of Stromal Vascular

Fraction Cells from Adipose Tissue Lipoaspirate

Authors: Swathi SundarRaj*, Nancy Priya, Abhijeet Deshmukh,

Murali Cherat and Anish Sen Majumdar

Affiliation: Stempeutics Research Pvt. Ltd., Bangalore, India

*Author email:,


Stromal Vascular Fraction (SVF) cells derived from

adipose tissue have demonstrated clinical utility in

regenerative medicine and plastic and reconstructive

surgery. Adipose derived stem cells (ASC) and

endothelial progenitor cells present in SVF have shown

therapeutic efficacy in conditions requiring angiogenesis

and adipogenesis, particularly for soft tissue repair

and augmentation. Supplementation of fat grafts with

autologous SVF is thus becoming an important strategy

in such procedures. Isolation of SVF requires fat to be

harvested by liposuction, washed, enzymatically digested

and centrifuged to recover the cells. Manual processing

requires skilled technicians, expensive infrastructure and

laboratory with GMP and GCP compliance, which are

not available with most healthcare units. Isolation in a

certified external laboratory entails storage, handling,

logistic hurdles, and multiple patient visits. These

challenges can be overcome with a point-of-care, aseptic

and automated device to isolate and concentrate SVF

cells from a given volume of fat at the clinic in a matter

of hours for autologous application.

Aim of the study:

The objective of the study was to develop a stand-alone,

fully automated, closed-system, aseptic device for

isolation of clinical grade SVF cells at the point of care.


Human lipoaspirate tissue was obtained with informed

consent from individuals undergoing elective cosmetic

surgery, following approval from the institutional

committee for stem cell research and therapy, and the

institutional ethics committee.

For the purpose of automation, a proprietary process for cell

isolation was developed wherein the SVF was separated

from the aqueous fractions of digested lipoaspirates

using filtration technology. Briefly, lipoaspirate tissue

was washed and digested with collagenase enzyme. The

aqueous fraction of the digest was then separated from

the lipid fraction by phase separation and the SVF in the

aqueous fraction was recovered by sequential filtration

through multiple filters. The filter materials and poresizes

were standardized to optimize flow rate, SVF yield,

viability and composition.

The main operational modules of the cell isolation

system namely the tissue digestion chamber, heating

and agitation mechanism, and filtration unit were then

designed based on the process and assembled to develop

a prototype device controlled by a programmable user

interface. The SVF isolated using the device was then

rigorously validated for yield, viability, composition

and functionality, in comparison with the manual

centrifugation-based process.


We have established a proprietary process for SVF

isolation, comprising enzymatic digestion of lipoaspirate;

phase separation and extraction of SVF into the aqueous

phase of the digest; and recovery of SVF by retention

on membrane filters. The efficiency of this process was

found to be equivalent to the conventional centrifugation

method in terms of SVF yield and viability, and was

scalable from a volume of 50 ml to 500 ml of lipoaspirate.

The proprietary process was successfully automated in

the prototype device. The maximum processing capacity

of the prototype was found to be 500 ml of lipoaspirate

tissue where the SVF yield and viability were equivalent

to the manual process of isolation. Composition of SVF

obtained by the automated process included CD34+CD31-

ASC, CD34+CD31+ endothelial progenitor and CD34-

CD31+ mature endothelial cells, and the relative

percentages of the different cell types was comparable to

SVF isolated by the manual centrifugation-based method.

The functionality of the SVF isolated by the automated

process was demonstrated by the ability to form colony

forming units (CFU-F) representing self-renewal

capacity of the ASC in the SVF. Gene expression analysis

confirmed the presence of endothelial and progenitor

cells from the expression of CD31, CD34, VE-cadherin

and Von Willebrand factor. Production of angiogenic

and apoptotic growth factors was also confirmed from

expression of VEGF and IGF in the SVF.


We have successfully demonstrated proof-of-concept

for fully automated isolation of SVF using the prototype

Issue 13 IPRAS Journal 43

device. Concentration of clinical grade SVF cells without

the use of a centrifuge would significantly reduce the

unit cost and footprint, and ensure gentle cell isolation.

Following successful prototype testing, we are currently

working towards development of a beta unit that is

compliant for testing in the clinic. Such a device is

expected to greatly facilitate the penetration of affordable

SVF-based therapy in hospitals and clinics in all parts of

India and other markets.


We sincerely thank the following plastic surgeons for their

expert opinion and consultancy: Dr. Anantheshwar YN,

Dr. Ashok BC, Dr. Prashantha Kesari and Dr. Gunasekar



This study was completely funded by Stempeutics

Research Pvt. Ltd. All authors are employees of

Stempeutics Research Pvt. Ltd. and have no other

financial affiliations or conflicts of interest related to the

subject matter of this presentation topic.

44 IPRAS Journal Issue 13

Autologous fat grafting (lipofilling) for chronic ulceration

on the diabetic foot improves wound healing

T. Stasch, J.Hoehne, T.Huynh, R.Baerdemaker, S.Grandel

Luisenhospital Aachen, Department of Plastic and Reconstructive Surgery, Aachen, Germany

Main author: Dr. Tilman Stasch


Aim of this case series was to assess the healing progress

of chronic, non-healing lower-limb wounds in diabetic

patients following peri-lesional autologous fat grafting.


Chronic ulceration of the foot is one of the most challenging

conditions to treat for plastic surgeons. While autologous

fat grafting has been shown to improve the quality and

regenerative potential of chronically scarred tissues (1),

the effect on wound healing of chronic wounds has only

been reported on sporadically.


In this prospective case series, 19 patients with deep, nonhealing

chronic foot ulcerations in mostly diabetic patients

had previously been unsuccessfully treated at the hospitals

foot clinic using traditional methods for a mean of 11

months (range, 2-60). In all patients, peripheral vascular

perfusion had been optimized if possible. 2 patients were

excluded from the statistical analysis because wound size

exceeded the inclusion criteria (wound should be 10 cm 2

can still benefit from lipofilling by allowing formation of

granulation tissue which can later be skin grafted.


1. Coleman SR, Plast Reconstr Surg. 2006 Sep;118(3


Issue 13 IPRAS Journal 45

External Volume Expansion Increases

Subcutaneous Tissue Growth

Yvonne I. Heit, MD 1,2 , Luca Lancerotto, MD 1,3 , Ildiko Mesteri, MD 4 , Maximilian Ackermann, MD 5 ,

Maria Navarrete, MD 1,6 , Collin T. Nguyen, MSc 1 , Srinivasan Mukundan Jr, MD, PhD 7 ,

Moritz A. Konerding, MD 5 , Daniel A. Del Vecchio, MD 8 and Dennis P. Orgill, MD, PhD 1


Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery,

Brigham & Women’s Hospital and Harvard Medical School, Boston, USA


Department of Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke University of Magdeburg, Germany


Institute of Plastic Surgery, University of Padova, Italy


Clinical Institute of Pathology, University of Vienna, Austria


Institute of Functional and Clinical Anatomy, University Medical Center of the

Johannes Gutenberg-University Mainz, Germany


Department of Surgery, Pontificia Universidad Católica de Chile, Chile.


Dept. of Radiology, Brigham & Women’s Hospital and Harvard Medical School, Boston, USA


Back Bay Plastic Surgery and Massachusetts General Hospital – Harvard Medical School, Boston, USA

Corresponding author: Y.I. Heit –

Category: The Biology of Adipose Tissue, Stromal Vascular Fractions, Adipose Derived Stem Cells and Growth Factors

None of the other authors have any commercial or financial interests to disclose. This study did not receive any external financial support.


Background & aim:

Mechanical forces modulate biological responses,

including cell proliferation and angiogenesis. Mechanical

forces effect tissue expansion, and we showed that

tensile forces induced cellular proliferation and vascular

remodeling using in vivo models. Recently, mechanical

forces were proposed to account for the beneficial effects

in wound care of the Vacuum-Assisted Closure Device.

Fat grafting has re-emerged as an attractive approach

for soft tissue augmentation/reconstruction. Result

variability may be associated with techniques used or

characteristics of the donor or recipient site. An External

Volume Expansion device (EVE) was employed clinically

to stimulate breast enlargement (Brava System®) [1].

Del Vecchio and Bucky employed this device to prepare

recipient sites for fat grafting with pre-operative EVE;

they reported a 60-200% increase of human breast volume

by quantitative Magnetic Resonance Imaging (MRI) that

persisted long-term [2].

We hypothesized that mechanical stimulation affects the

structure, vascularity and metabolism of fat deposits.

We designed an in vivo mouse model and fabricated the

necessary apparatus to test this.


A dome-shaped rubber device with diameter 1 cm and

internal volume 1.0 ml was fabricated, and connected

to a suction pump (VAC Instill, KCI, San Antonio TX)

settled at a constant pressure of -25 mmHg (Fig.1.).

Study model. Adult female wild-type mice (Jackson

Laboratory, Bar Harbor, ME) were treated with suction

device (S, n = 10) or occlusive dressing (Tegaderm;

C, n = 10). Mice (n = 6 per group) were treated for 28

days continuously, then euthanized; treated tissues were

harvested en bloc, fixed in 10% formaldehyde, embedded

in paraffin and cut into 5 µm sections (Fig.1.).

Magnetic resonance imaging. Magnetic resonance

imaging (MRI) of the treated area was performed for

4 mice of the suction group and 4 of OD group on day

0, 7, 14, 21 and 28 using a 3-tesla MR system under


Histo/immunohistochemistry. Slides were stained

with H&E for cytology, and separately subjected to

immunohistochemistry for proliferation with antibody

for PCNA, and neovessel formation with antibody for

CD31 (PECAM-1).

Morphometry. Various parameters were assessed: 1)

dermis and subcutaneous tissue thicknesses were measured

following H&E staining of sections (10X photographs)

of treated areas; 2) the number of adipocytes in columns

from the panniculus carnosus muscle was calculated

using Image J software (NIH, Bethesda, MD); 3) cell

proliferation was assessed by counting in the number of

positively stained cells 40X fields (3/sample) of treated

areas and expressed as ratio PCNA+ /total nuclei; and 5)

blood vessel density was measured and expressed as the

number of PECAM-1+ vessels present in 40X fields (3


Figure 1: Animal model and timeline

46 IPRAS Journal Issue 13

Figure 2: Day 28: a) Tissue Swelling in area subjected to suction (arrow). B) Swelling seen in MRI section (white arrow); notice the presence

of the rubber dome-shaped device. C) Histological demonstration of increased thickness of the subcutaneous tissue obtained with suction

stimulation (arrow), corresponding with the “swelling” observed macrospopically. D) At quantifications, suction treatment (rhomboid) induced

significant increase of both subcutaneous tissue thickness and number of adipocytes piled in columns at comparison with controls (circle).

Figure 3: Proliferation rate: external mechanical stimulation induced significant increase of proliferation rate in the subcutaneous tissue of

stimulated areas

Issue 13 IPRAS Journal 47

Figure 4: Vessels remodeling. a) Corrosion casting of treated areas in stimulated and control mice on day 7, same magnification. Mechanical

external stimulation induced intense remodeling of vessels with reorganization, orientation, and major increase of lumen diameter. b and c)

External mechanical stimulation induced significant increase of vessels density on the subcutaneous tissue of stimulated areas.

Corrosion casting 4 mice of the suction group and 4

controls were perfused on day 7 under anesthesia. Vascular

access was established by cannulating the ascending

aorta after systemic heparinization and thoracotomy with

an olive-tipped needle. After flushing with pre-warmed

saline and fixation with 10 ml of 2.5% glutaraldehyde in

Ringer’s, the vascular system was perfused with ~15 ml

of a polyurethane-based casting resin (PU4ii; VasQTec).

After polymerization, the dorsum of the mouse was

immersed in 5% KOH for tissue dissolution around vessel

casts. After freeze-drying, specimens were mounted

with conductive bridges on stubs, coated with gold, and

observed using a Philips XL30 ESEM microscope.


Macroscopic observations. Treated areas demonstrated

local swelling by 21 days, which was not seen in the

control group and was without infection or tissue damage.

MRI at 28 days confirmed development in experimental

animals of swelling compatible with fat growth (Fig.2.).

Histological analysis. EVE induced in a 2-fold increase

in fat layer thickness (p

International Society of Plastic Regenerative Surgery (ISPRES)

Application For Membership

Family Name:




IPRAS national society/association or regional association Country member:


Board Certification in:






Hospital/Private Practice












My involvement / experience with fat research /application or other regenerative factors:




Please send the application at or fax it at 0030 210 664 5176

I attach a recent Curriculum Vita (one page)

I Hereby Declare that the above

mentioned details are true and correct

Full Name and Signature:

Issue 13 IPRAS Journal 49


Educating the Plastic Surgeon

in the 21st Century

David L. Larson, MD, FACS

Professor Emeritus of Plastic Surgery

Department of Plastic Surgery Medical

College of Wisconsin

ACGME Field Staff Representative

As physicians and plastic surgeons in the United States,

we are aware of the many changes in the practice of

medicine. In addition to the clinical innovations that have

been emblematic of our specialty, significant paradigm

shifts in our practice include transitioning from physician

autonomy to being a collaborator on a care team, using

evidence-based data in clinical care, and recognizing that

patients often are proactively involved in decisions related

to their care. In addition, there are new approaches in

the accreditation process for graduate medical education

programs and their sponsoring institutions. The following

paragraphs provide an overview of the New Accreditation

System (NAS), its rationale and the ways in which it will

aid in producing plastic surgeons ready to practice in the

21 st century.

The Accreditation Council for Graduate Medical

Education (ACGME) was established in 1981 and is the

sole accrediting body for allopathic graduate medical

education (GME) in the United States. Its mission is

to “improve health care by assessing and advancing

the quality of resident physicians’ education through

exemplary accreditation”. The ACGME accomplishes

this by assuring that both core and specialty/subspecialty

requirements, established by each of the twenty-six

specialties, are applied to 9600 accredited residency

and fellowship programs and more than 700 institutions

sponsoring these programs. In the system in effect

through June of 2013, accreditation was given for a

specific time frame, with cycles ranging from 1-5 years,

depending on the Residency Review Committee’s (RRC)

decision regarding the program’s substantial compliance

with its published accreditation standards. This

traditional approach to accreditation created a substantial

administrative burden which was largely focused on

documentation and preparation for periodic site visits by

an ACGME Field Representative.

The accreditation standards were prescriptive, producing

compliance through strict confirmation and opportunities

for innovation by programs was limited. Other attributes

of the system included program directors that were

forced to manage problems rather than mentor residents,

burnout among overburdened program leaders was

common, passive involvement of many faculty and,

educational standards which, in many areas, lagged

behind delivery-system changes. To address these

problems in accreditation the ACGME established the

New Accreditation System (NAS) in 2010. 1

The aims of the NAS are threefold: “1. to enhance the

ability of the peer-review system to prepare physicians for

practice in the 21 st century, 2. to accelerate the ACGME’s

movement toward accreditation on the basis of educational

outcomes, and 3. to reduce the burden associated with

the current structure and process based approach.” 1 The

NAS is being introduced in 7 of 26 accredited specialties

in July, 2013; the remaining specialties, including Plastic

Surgery, will enter the NAS July, 2014.

A key element of the NAS is the development and use of

educational milestones that have been established in each

specialty. The milestones are developmentally based,

specialty-specific, observable achievements that describe

a trajectory of progress from novice to proficient to expert.

Determination of residents’ progress on the milestones

will be accomplished by using existing evaluation

tools and faculty observations. This information will

be aggregated and used by a Clinical Competency

Committee, to be established in each program and which

will triangulate each resident’s progress.

Aggregated, identified milestone data will be sent to the

ACGME semi-annually, and will be one data element

used in the NAS. Other data programs will supply

50 IPRAS Journal Issue 13

annually include changes in leadership, scholarship

of the faculty and residents, board pass rate on a 3-5

year rolling average, data from the ACGME’s resident

and faculty surveys, and data on residents’ procedures

and clinical experience. There will also be an annual

program evaluation (APE) involving all stakeholders of

the program (residents, faculty, etc.).

Using these annual evaluations and an aggregate of data

for the preceding years, each residency and fellowship

program will conduct a self-study every 10 years, which

will culminate in a scheduled ACGME self-study site visit.

Program’s first self-study cycles are being determined by

their RRC’s, based on the current cycle length and date of

the next scheduled site visit.

Unless a program has issues or trends that are identified

from the annual data submission and review by the RRC,

the 10 year scheduled visit will be the only site visit a

program will receive. This will eliminate more frequent

site visits for good programs, and focus on site visits for

programs having specific problems or demonstrating

trends concerning to the RRC. These site visits will allow

the team to provide advice and guidance to programs,

including the sharing of best practices identified via the

accreditation process. Programs that demonstrate high

quality outcomes will be free to innovate.

At the completion of their training, residents will have

achieved specialty-specific milestones to a level that

allows them to enter unsupervised practice. This process

moves the competencies “out of the realm of the abstract

and grounds them in a way that makes them meaningful

to both learner and faculty”. 2

Another important element of the NAS is a requirement

that residents be actively involved in quality improvement

activity or a project addressing patient safety. This will

make the trainee aware of the lifelong, ongoing need to

be aware of the importance of both these activities for

their entire professional career.

Another important element of the NAS is the Clinical

Learning Environment Review (CLER) program, which

entails a site visit to sponsoring institutions every 18

months with an emphasis on the quality and safety of the

learning environment of the institution in which residents

learn and participate in care. The CLER program was

developed out of a recommendation for added assessment

of the quality of the learning environment that became a

key dimension of the 2011 program requirements. Over

time, the CLER process will generate national data on

effective approaches to promote quality and safety in

teaching institutions intended to have a “salutary effect

on quality and safety on learning settings and ultimately

on the quality of care rendered after graduation”. 1

In summary, the NAS will provide annual, prospective

information on all training programs and their institutions

using specialty specific milestones. In this way, residents

and faculty alike can monitor educational progress at any

point in time, including suitability to enter unsupervised

practice at the completion of training.


1. NascaTJ, Philibert I, Brigham T, Flynn TC. The next

GME accreditation system—rationale and benefits.

NEJM 2012;366:1051-1056.

2. Green MI, Aagaard EM, Caverzagie KJ, Charting

the road to competence: developmental milestones

for internal medicine residency training. J Grad Med

Educ 2009;1:5-20.

Issue 13 IPRAS Journal 51

52 IPRAS Journal Issue 13

Issue 13 IPRAS Journal 53

54 IPRAS Journal Issue 13

Issue 13 IPRAS Journal 55


“April in Melbourne”

Tony Kane

Chairman Continuing Professional

Development Committee,

Australian Society of Plastic Surgeons

June 2013

“April in Paris”, the classic 1952 musical film starring

Doris Day and Ray Bolger, was the inspiration for many

tourists to explore the wonders of that beautiful European

city. By any measure, Paris is a magnificent city, but while

its streetscapes shiver in April as temperatures hover

below 10 degrees celsius, on the other side of the world,

Melbourne Australia shimmers throughout April with the

temperature averaging a balmy 22 degrees Celsius.

The slow April transition into our southern hemisphere’s

Autumn brings subtle changes to the landscape as it

shifts from the


of summer to

subdued tones of

winter. Against

this backdrop, the

city of Melbourne

was the perfect

setting for our

Plastic Surgery

Congress,21 -

27 April 2013,

jointly hosted by

the Australian

Dr Geoff Lyons, President Australian Society of Plastic

Society of Plastic Surgeons, delivers the Surgeons and the

Sonnet for ANZAC Day, 25 April 2013, New Zealand

Ceremony of Remembrance

Association of

Plastic Surgeons.

Our prestigious list of international guest speakers

included: Nazim Cerkes (Turkey), Gregory Evans (USA),

Jeffrey Fialkov (Canada), Joseph Gruss (USA), Gabrielle

Kane (USA), Roger Khouri (USA), Peter Neligan (USA),

Michael Neumeister (USA), Julian Pribaz (USA), Bryant

Toth (USA) and Michael Yaremchuk (USA) .

More than 850 delegates, the largest number of participants

to attend our national congress to date, enjoyed the

hospitality of Melbourne. The Melbourne Convention

Centre (MCEC), a high tech convention facility with its

sweeping architectural lines, accommodated the main

congress program as well as the workshops, symposiums,

forums and an expansive exhibition area. Four cadaver labs

were also held at the College of Surgeons anatomy labs.

In 2013 we introduced the inaugural Wound Management

Forum, which proved to be enormously popular and

successful. Held in collaboration with the Australian

and New Zealand Burns Association and the Australian

Wound Management Association, the Forum offered

a multidisciplinary exploration of wound care. A

distinguished panel of expert International and Australian

faculty represented the full spectrum of research,

academic practice and clinical practice.

With a wealth of international speakers, the Congress

attracted broad media interest, giving us the opportunity

to highlight our new Breast Device Registry and the

International Collaboration of Breast Registry Activities

(ICOBRA). Effective media engagement resulted in

the publication of 39 news articles, 3 radio reports and

one TV interview. The total circulation reached over 20

million unique viewers. Other relevant issues addressed

included medical tourism, face transplantation and

cosmetic surgery reform.

The Congress

also marked the


the Australasian

Foundation for

Plastic Surgery

Limited (the

F o u n d a t i o n )

on Thursday

25 April 2013.

As part of its

launch, the

Foundation was

proud to present

face transplant

pioneer Julian

Pribaz as the

i n a u g u r a l

Dr Tony Kane, Chairman CPD Committee,

Australian Society of Plastic Surgeons,

welcomes delegates to the Gala Dinner, 24

April 2013

56 IPRAS Journal Issue 13

Foundation BK Rank Visitor. Dr Pribaz is one of the world

leaders in face transplant surgery, and, together with his

Harvard Medical School affiliated team at Brigham and

Woman’s Hospital in Boston, he has performed five

facial transplants including the first full facial transplant.

The Foundation BK Rank Lecture is held biannually in

honour of Sir Benjamin Keith Rank, a world leader in the

field of plastic surgery and considered by many to be the

father of plastic surgery in Australia.

The Australasian Foundation for Plastic Surgery Limited

(the Foundation) also hosted the official signing of a

Memorandum of Understanding for the International

Collaboration of Breast Registry Activities (ICOBRA).

Seven national PRS Societies signed the MoU with the

objective of adopting a standard minimum data set for

breast registries. The objective of the Agreement is to

establish a minimum data set, made up of standardised

and epidemiologically sound data, that is internationally

comparable. At the heart of the Agreement is the core

ethic and commitment to improving patient outcomes.

As the Congress coincided with ANZAC Day, the

anniversary of the first major military action fought

by Australian and New Zealand forces during the First

World War and a national day of remembrance, a special

Ceremony of Remembrance was organised. Convened by

Air Vice-Marshall Hugh Bartholomeusz OAM, Surgeon

General of the Australian Defence Force Reserves, the

Ceremony allowed all Australians, New Zealanders and

international attendees to pay tribute to those who served

our countries in times of war.

As a Specialty, the Ceremony had particular significance as

it commemorated the men and women who made ground

breaking contributions to the craft of Plastic Surgery

during periods of conflict. We were honoured to have the

participation and support of our special guests, including

Brigadier General W. Bryan Gamble MD, Deputy Director,

TRICARE Management Activity (TMA).

Program Snapshot

Overall, the scientific program consisting of plenary and

concurrent sessions was varied and engaging covering

both the reconstructive and aesthetic components of

plastic surgery. Surrounding the core program, the

Congress also included:

• Intensive Facial Aesthetic Cadaver Workshop;

• Advanced Facial Injecting Symposium;

• Intensive Facial Aesthetic Surgery Symposium;

• Wound Management Forum;

• Advanced Rhinoplasty Symposium;

• Rhinoplasty Cadaver Workshop;

• Private Practice Staff Forum;

• Craniofacial Approaches Cadaver Workshop;

• Registrars’ Conference.

Our next Plastic Surgery Congress is 6-10 May 2015 in

the tropical paradise of Brisbane. Each Australian capital

city has a unique personality and landscape. We welcome

you in 2015. Save the date now!

Twilight skyline and a reflective moment, Melbourne Convention Centre, PSC 2013.

Issue 13 IPRAS Journal 57

The Emirates Plastic Surgery Society, the national association

of Plastic Surgeons of the United Arab Emirates, has recently

elected its new Board of Directors, whose tenure will be for

a period of three years, from 2013 to 2015. Their Board of

Directors members are the following:

President: Dr. Marwan Al Zarouni

Vice President: Dr. B. Venkata Ratnam

Secretary: Dr. Jamal Jomah

Scientific Committee: Dr. Luiz Toledo

Cultural Committee: Dr. Khalid Abdulla Al Awadhi

EPSS has already organized two general meetings. The first

one was on April 25th 2013 held at JW Marriott Marquis

Hotel and the second was on May 27th at Habtoor Grand

Beach Resort & Spa, Jumeirah Beach. They will be holding

their general meetings on a monthly basis.

For further information, please do not hesitate to contact us.

Emirates Plastic Surgery Society

Telephone: +971 4 380 6063

Fax: +971 4 346 6069




58 IPRAS Journal Issue 13

Review of the XLIV National Congress of Mexican Association

of Plastic, Aesthetic and Reconstructive Surgery (AMCPER)

Puerto Vallarta, Jalisco

As is the tradition, AMCPER members came together

for the annual meeting, which gives us the opportunity

to share scientific news of our specialty and to affirm the

bonds of friendship that unite us through coexistence while

different social cultural activities adorned our congress.

This time we came together in Puerto Vallarta, where we

were greeted by the familiar hospitality and a pleasant

climate that allowed a large number of activities.

Left to right José Luis Haddad, M. D. (President), Alfonso Vallarta,

M.D. (Vice president), Eric Santamaria, M. D. (Treasurer)

The academic activities of our Congress began

dramatically with pre-congress courses on Tuesday and

the national competition of residents. On this ocasion

we selected the following courses: Pre-Congress Facelift

Course, coordinated by Dr. Ramon Vila-Rovira and

Pre-Congress Course in Dehiscence Management in

Plastic Surgery, Complex Wound and V.A.C. Therapy

coordinated by Dr. Eugenio Rodriguez Olivares.

The National Resident Competition "Dr. Fernando Ortiz

Monasterio" took also place. There we saw ideas and

innovations that allow us to say that Mexican plastic

surgery is on the vanguard.

Simultaneously, the Certification and Recertification

Examination of the Mexican Council took place, led by

the President of the Mexican Council of Plastic, Aesthetic

and Reconstructive Surgery, Dr. Jesús María Rangel


We had national and international teachers from Argentina,

Austria, Brazil, Canada, Colombia, Spain and the United

States and as a special guest for the closing keynote

we had the famous Bachelor ARMANDO AGUIRRE

SOURCES better known as “CATON”.

Like every year we broke the record of attendance. In the

city of Merida there were registered 1062 attendants. Now

we had 1253 registrations, a true record of attendance.

This demonstrates the union, harmony and interest of

the members in a great partnership. Puerto Vallarta is a

true jewel: peaceful, clean, tidy, renovated, growing and

especially, secure. It is the ad hoc convention center for

this type of events.

The conference itself began on Wednesday in 2 spacious

lounges filledwithtopicsofinterestonbothReconstructive

and Aesthetic Surgery. The inauguration ceremony took

place at 3 pm with the presence of naval government

representatives and our AMCPER authorities headed by

Dr. Jose Luis Haddad, while Dr. José Guerrerosantos was

the representative of the governor of Jalisco.

The Council Dinner, was organized by Dr. Rangel at

the “CAFE DES ARTISTES”, restaurant famous for its

excellent food and service, where a number of former

presidents of this council as well as advisors and guests

showed up, and turned it into a very pleasant evening.

Left to right Déctor Jiménez, M.D., Pilar Rivera, M. D.,

Ma. Del Mar Vaquero and her husband (Spain)

The Opening Dinner was a great event in an elegant hotel

on the beach of the hotel “LAS VELAS”. All domestic

and foreign attendees enjoyed a delicious dinner and a

very nice party in the rhythm of marimba, mariachi and

a folk group. Rightly, Dr. Haddad with his directive

placed the evening groups separated from the evening

of Teachers,which gave us the opportunity to meet both


The groups chose their places and enjoyed the camaraderie

that students and alumni can experience. The faculty

Issue 13 IPRAS Journal 59

dinner was mystical, as it it took place in the CASA

VELAS, adjacent to the hotel with the same name, in a

beach house where we saw a sunset dream and the place

José Mena, M.D. , Calixto Hárada, M. D. (General Secretary),

Alfonso Vallarta, M.D. (Vice President)

was bathed in multicolored lights! There was romantic

music by the Trio Boleros, an excellent dinner, dessert

and coffee by the sea, where the following honorees were

mentioned: Dr. Mario Becerra Caletti and Dr. Sergio

Zenteno, and comments from several foreign teachers

followed under the leadership of Dr. Haddad.

The business session was smooth and as relevant points

the following sites were chosen: LOS CABOS for

2015 and VERACRUZ for 2016. Dr. Arturo Ramirez

Montanyana won for Mexico an ISAPS course in LOS

CABOS in 2014.

We especially appreciate the participation of the business

(commercial) houses! Thanks to their support and

willingness our event was truly enhanced.

The Closure of the XLIV Congress was characterized by

the tributes to distinguished members of our association.

The tribute to Dr. Mario Becerra Caletti was given by

Dr. Teresita Silva and the tribute to Dr. Sergio Zenteno

was given by his son Sergio Zenteno. At the closing a

remembrance of Dr. Fernando Ortiz Monasterio was

presented by Dr. Eric Santamaria.

Mr. ARMANDO FUENTES or"CATON" made us laugh

and think, thus closing the academic activities. At night

we took our Gala dinner in the Vallarta Hall of Hotel Casa

Magna, of the MARRIOTT Hotel in Puerto Vallarta, with

excellent organization, dinner, environment, measured

speeches and lots of dancing.

Thanks to all members for their presence. See you next

year in Mexico City!

Endoscopic Facial Rejuvenation Symposium in Nicaragua

Guest professors with the symposium’s participants

Surgical procedures during the practical and theoretical

symposium with live broadcasting.

On May 30th - 31st the Nicaraguan Association of Plastic,

Reconstructive and Aesthetic Surgery organized the

”Endoscopic Facial Rejuvenation symposium” with the Institute

of Medical Sciences and Nutrition Salvador Zubiran from

Mexico DF and doctors Martin Iglesias and Patricia Butrón.

The honorable guests, Dr. Iglesias and Dr. Butrón, were the first

team performing an upper limb transplant in Latin America. Their

visit to Nicaragua was part of the success of the practical and

theoretical symposium. Members of the Nicaraguan Association

of Plastic, Reconstructive and Aesthetic Surgery (ANCP) as well

as residents in plastic surgery participated at the symposium.

ANCP supported the Symposium with the contribution of the

private Hospital Salud Integral.

We would like to thank our honorable guests for sharing the

expertise with us,

Sandra Gutierrez


60 IPRAS Journal Issue 13


Argentinean Society of Plastic Surgery

The Argentine Society of Plastic Surgery celebrated last

year its 60 th anniversary! It was in fact, in 1952, when the

society’s founders set out to build an institution to embody

the attributes of the best edifice. And so they erected over

time a stable, solid and enduring organization. They have set

it upon firm and stable grounds represented by high values

and profound scientific knowledge of its members.

The origins of the Argentine Society of Plastic Surgery are

set back in the 40s of the last century. At that time there

were only few doctors who performed plastic surgery and

published papers in the Bulletin of the Society of Surgeons

of Argentina. However, at the beginning of that decade there

was an event that would contribute to the development of

the specialty: in 1940, gathered among others at the Paulista

School of Medicine, in the city of Sao Paulo, Brazil, doctors

Antonio Prudente and Joseph Rebello from Brazil, Lelio

Zeno, Ernesto Malbec from Argentina, Rafael Alfredo Alcaino

Arzua from Chile and Enrique Predo Pedemonte by Apollo

from Uruguay. They were then the leaders of plastic surgery

in Latin America, and at such meetings was born the intention

to create a “Latin American Society of Plastic Surgery”.

They realized the above idea in July 1940 at the German

Hospital of St. Paul. For Argentina signed the founding act

Drs. Oscar Ivanisevich, Lelio Zeno, Hector Marino, Ernesto

Malbec, William Armarrino, Ramón Palacio Posse, Eduardo

Allevi, Dellepiane Rawson, Cardozo Aguirre, Gonzalez

Loza, Ricardo and Roberto Ferrari Finocchietto.

The following year was conducted the 1st Latin American

Congress of Plastic Surgery in Rio de Janeiro, and in 1942

took place the 2nd Latin American Congress of Plastic

Surgery in Buenos Aires, in Argentina.

Soon after that, in 1945 Ricardo Finocchietto created within

his surgery service in Ward No 6 at the Hospital Rawson,

a section of plastic surgery with Dr. Hector Marino in

charge. There, were trained distinguished plastic surgeons

with the magnitude of Pasiman, O `Connor, Sapadafora and

Niclison. Later, Ward 7 was established in Rawson Hospital,

exclusively for plastic surgery.

In 1949 was founded the Brazilian Society of Plastic

Surgery. From 1949 began the organization of plastic surgery

academies in the Argentinean hospitals with presentations

involving cases of interest and reading of articles. The

meetings were gaining increasing scientific audience, which

led Dr. Marino to organize them in a more systematic way.

In this framework, the first Assemblies were held, and in

late 1951 was signed the draft statutes of the Argentinean

Society of Plastic Surgery. On March 24, 1952 was signed

the charter, and the first scientific meeting of the Society was

held on July 17 th , 1952 at the headquarters of the Argentine

Medical Association. The Drs. Beaux Alberto and José

Viñas drew up the first society’s statutes and regulations.

In 1953 took place the first Assembly of the League. The

inaugural Steering Committee was chaired by Dr. Ernesto

Malbec. In 1953 the 1st Assembly united to elect the first

executive committee. The 1st elected President was Dr.

Ernesto Malbec.

From the left: Sra Marta Benaim, Dra E Gafoglio, Dra Ayeray del Val, Dr. Abel Chajchir, Dr. Juan C Seiler, Dr. Gustavo Prezavento,

Dr. Luis A Margaride, Prof. Fortunato Benaim founding member of SACREP

Issue 13 IPRAS Journal 61

Below is a list of the successive presidents of the Argentinean Society:

Dr. Ernesto Malbec (1953)

Dr. Héctor Marino (1954)

Dr. Julián Fernandez (1955)

Dr. Alberto Meaux (1956)

Dr. Roberto. Dellepiane Rawson (1957)

Dr. Miguel. Correa Iturraspe (1958)

Dr. Guillermo Armanino (1959)

Dr. Jorge. Santamarina Iraola (1960)

Dr. Fortunato Benaim (1961)

Dr. Jorge Nicklison (1962)

Dr. Cornelio O Connor (1963)

Dr. Luis Monti (1964)

Dr. José Spera (1965)

Dr. Ángel Oghi (1966)

Dr. Jaime Fairman (1967)

Dr. Héctor Vieyra Urquiza (1968)

Dr. Alberto G. Albertengo (1969)

Dr. Jorge Quaife (1970)

Dr. Aníbal Tambella (1971)

Dr. Hugo Arufe (1972)

Dr. Francisco Arespacochaga (1973)

Dr. Eduardo Marino (1974)

Dr. Alberto Otero (1975)

Dr. Héctor La Ruffa (1976)

Dr. Néstor Maquieira (1977)

Dr. Ulises De Santis (1978)

Dr. Víctor Nacif Cabrera (1979)

Dr. Leonardo Barletta (1980)

Dr. Raúl Laguinge (1981)

Dr. Julio Frontera Vaca (1982)

Dr. Adrián Spadafora (1983)

Dr. Carlos Caviglia (1984)

Dr. Erdulfo Appiani (1985)

Dr. Mauro Daroda (1986)

Dr. Enrique Gandolfo (1987)

Dr. Alfredo Pardina (1988)

Dr. Pedro Mugaburu (1989)

Dr. Jacobo Sananes (1990)

Dr. Néstor Bravo (1991)

Dr. Orlando López (1992)

Dr. Osvaldo Orduna (1993)

Dr. Juan José Galli (1994)

Dr. Raúl Fernandez Humble (1995)

Dr. Jorge Herrera (1996)

Dr. Julio Cianflone (1997)

Dr. Manuel Viñal (1998)

Dr. Alfredo Santiago (1999)

Dr. Paulino Morales (2000)

Dr. Juan Bautista Albertengo (2001)

Dr. Osvaldo Cudemo (2002)

Dr. Rodolfo Rojas (2003)

Dr. Jorge Buquet (2004)

Dr- A. Aldo Mottura (2005)

Dr. Guillermo Faherty (2006)

Dr. Ernesto Moretti (2007)

Dr. Víctor Vassaro (2008)

Dr. Carlos Perroni (2009)

Dr. Carlos Reilly (2010)

Dra. Marta Mogliani (2011)

Dr. Luis M. Ginesin (2012)

Dr. Juan Carlos Traverso (2013)

As the Society’s scientific activities and other affairs were getting more complex to deal with, the members decided that the

President of the society should handle the part regarding all affairs and that the scientific part should be handled by the another

President. Therefore since 1996 the Society has two Presidents: a “President of the Society” and a “President of the Meetings”.

Past Meeting Presidents

Dr. Roberto Suriano (1996)

Dr. Luis Albanese (1997)

Dr. Rodolfo Ferrer (1998)

Dr. Abel Chajchir (1999)

Dr. Luis Aldaz (2000)

Dr. Enrique Gagliardi (2001)

Dr. Carlos Mira Blanco (2002)

Dr. Pedro Dogliotti (2003)

Dr. Carlos Rodriguez Peyloubet (2004)

Dr. Luis Margaride (2005)

Dr. Horacio Garcia Igarza (2006)

Dr. Adalberto Borgatello (2007)

Dr. Ricardo Yohena (2008)

Dr. Claudio Ghilardi (2009)

Dr. Juan Carlos Seiler (2010)

Dr. Hugo Bertone (2012)

Dr. Oscar Procikieviez (2013)

It is important to say that within the founders of the

Argentinean Society of Plastic Surgery, not occupying any

official positions but who played an important role, were Drs

Jack Davis, Viñas, Otermin Aguirre, Palace Posse, Sperne,

Goldemberg, Jarolavsky, Kirshbaun, Ribak, Rubinstein,

Schemper, and possibly others not mentioned here who earn

great respect and thanks.

41 years ago the Argentinean Society of Plastic Surgery

From the left: Dr Omar D Cucciaro Ventura, Dr Javier Vera,

Prof. Fortunato Benaim, Dr. Abel Chajchir.

held in 1971, in Bariloche, the 1st Argentinean Congress of

Plastic Surgery, presided by Dr. Hannibal Tambellael. The

secretary was Dr. Eduardo Marino, executive secretary, Dr.

Osvaldo Cudemo and the Treasurer was Dr. Alberto Otero.

From that year on, the Argentinean Congress is being held

every year without interruption. Each year achieving a

higher scientific level and increasing attendance.

We shall conclude this historical account with the inspiring

closure interpreting the thoughts and feelings of the

founders of the society, made by Dr. Martha Mogliani at the

42th Annual Congress of the Argentinean Society of Plastic

Surgery in 2012:

“Organizations that have an orderly conduct, members of

firm convictions and strong academic ethics, are intended to

last over time and excel in their field of action. Of course,

these values have to grow in the members and they shan’t

ever neglect them. …If you can dream it, you can do it. Ideas

are energies together. Thoughts are ideas formed. The words

express thoughts. Actions are words moving, …Κeep moving

always toward a promising future”.

Cordial thanks to Dra. Marta Moglian, Ex-President

of the society, who prepared the brief history of

the Argentinean Society of Plastic, Aesthetic and

Reconstructive Surgery.

62 IPRAS Journal Issue 13

History of the Finnish Association of Plastic,

Reconstructive and Aesthetic Surgeons

Susanna Kauhanen, MD, PhD, President 2012-2014

Helsinki University Hospital

Department of Plastic and Reconstructive Surgery

Contact Information:

The Finnish Association of Plastic, Reconstructive and Aesthetic Surgeons

Chirurgi Plastici Fenniae ry

How Finland became Finland

To give you an idea about what our association and

country represent today, I will share a few important

milestones in the history of Finland. This remote country

was first settled, when the last Ice age ended, around

9000 BC. In 1155, missionaries arrived in Finland from

the west and the country became part of the Swedish

realm. After medieval times, as part of the Swedish

Kingdom, the Lutheran religion dominated. In 1809

Sweden lost a war and Finland was ceded to the Russian

Empire. The Czar declared Finland an autonomous

Grand Duchy. Autonomy allowed Finnish nationalism to

emerge: music, art and literature in the highly distinctive

language blossom. Meanwhile, systematic infrastructure,

government and legislation was built up, as illustrated

by a painting by Akseli Gallen-Kallela. The October

revolution kept the Russians busy and Finland declared

independence on December 6, 1917. A tragic civil war

between “red and white” ensued. Right-wing oriented

whites won. Finland became a republic with a president

as head of state. In 1939-1940 the Soviet Union attacked

Finland and the Winter War is fought, followed by the

the Continuation War 1941-1944. Even with massive

superiority in military strength, the Soviet Union failed

to conquer the country. Independence, democracy and

sovereignty were maintained. Territorial loss resettled

an eighth of the population. The war reparations, paid to

the last cent, lead to rapid industrialization and turned

Finland from a war-ravaged agrarian society into one

of the most technologically advanced countries in the

world, with a sophisticated market economy, the lowest

corruption in the world and high standard of living. In

1952, the Olympic Games are held in Helsinki. In 1955

Finland joins the United Nations and Nordic Council. In

1995 Finland becomes a member of the European Union.

In 2002 The Finnish currency “markka” is changed to

Euros. According to a recent poll, Finns are reluctant to

join NATO.

Early times of Surgery and Plastic Surgery

The history and geography of our country has very much

reflected the history of plastic surgery. Academically,

impressions from neighbouring countries around the

Baltic Sea were strong .The University of Turku was

founded in 1641, yet many doctors were trained in

Germany, or at the University of Dorpat (Tartu) Estonia.

In the 1800s, reconstructive techniques were advocated

by Chief Surgeon Julius von Schymanowsky. He wrote

From the left: Kauhanen Susanna, President of the Finnish Association, Anna Höckerstedt and Pentscho Popov during the 17th IPRAS

world congress, Santiago, Chile 24 Feb.-1 March 2013

Issue 13 IPRAS Journal 63

a surgical textbook (in Russian),with emphasis on

reconstructive techniques. The book reached a wider

readership when published in German in 1870. Several

drawings and techniques re-appear in the textbook of

Plastic Surgery by Davis in 1919, e.g. the blepharoplasty

for correction of ectropium, also known as the Kuhn-

Schymanowsky technique.

On request of tsar Alexander II a chair in war-surgery was

established in the 1850s and Karl August Estlander was

elected. Estlander published his technique of lip-plasty in

1872. The next year he performed 14 such cases. In that

time, patients stayed in hospital around 6 weeks after a

lip-plasty. In 1876 Estlander travelled to the US, presented

his technique for a man named Abbe, who 14 years later

published a slight variation on Estlander´s technique.

Estlander technique of lip-plasty in 1872

Richard Faltin, professor of surgery at the University of

Helsinki 1917 - 1935, became famous for his skills in

war surgery and especially facial trauma. Anecdotally,

participating in seven wars (the Greco-Turkish war

of1897, The Russo –Japanese

war 1904-5, World War I,

from 1914-18, Abyssinian

War 1936, Winter War 1939-

40 and the Continuation War,

1941-44) he always found

himself on the losing side. In

World War I Faltin was sent

by the Finnish Red Cross

to establish a facial trauma

Center in Lithuania, and war

Richard Faltin

surgeons from all over the

region came there to learn.

Richard Faltin was a good

friend and student of Sir Harry Gillies. Until today, in the

Department of Cleft Lip and Palate Surgery in Helsinki,

a textbook by Gillies with Gillies´ own handed signature

has been preserved. The dedication reads: ”To Dr Faltin

From Dr Faltin’s textbook

and other friends of the wounded in Finland“. Richard

Faltin´s publications on midface trauma (traction and

immobilization methods) were mainly published in

Russian and Swedish. Faltin is regarded as one of the

greatest Finnish surgeons throughout history. The highlight

of the annual National Surgical Society in Finland is the

Richard Faltin Lecture and Award. An interesting piece

of history is that Richard Faltin performed the first blood

transfusion in Finland, in the year 1913.

The historical events taking place during and after World

War II produced generations of surgeons that make

the most of small resources, understand the need for

networking, whilst still standing on their own feet and

working extremely hard. This was reflected in the rapid

development of plastic surgery and a fearless attitude in

reconstructive surgery.

Whilst surgeons were scarce in the 1800s, the number

had increased to 80 in 1947 out of whom two were

plastic surgeons. Plastic Surgery was officially signed to

a subspeciality of surgery in 1947. The Nordic association

was founded in the early fifties, but the FinnishAssociation

had to wait a few more years, until December 1957, when

7 founding members came

together to form "Chirurgi

Plastici Fenniae": Per- Erik

Aschan, Henry Brummer, Uno

Gylling, Juuso Kivimäki, Aura

Pentti, Atso Soivio and Bö rje

Sundell. Mrs Aura Pentti was

the first plastic Surgeon fully

trained in Finland. She passed

away only two years ago. Many

of the contemporary Finnish

Plastic Surgeons had the

privilege to know her.

Börje Sundell

Cleft Lip and Palate

The first Finnish documentation of repair of a cleft

lip is in an epic song written down by the patient,

Tuomas Ragnvaldinpoika in 1763. The epic is long

and detailed, but the surgery was obviously successful

because Tuomas lived a long life and married 3 times.

Around the time of WW II the “Plastic Surgery Center”

for children was founded. In a small house with wood

heating, more than 2000 children with cleft lip and palate

were operated during a time period of 6 years. The postwar

baby-boom kept pioneers like Atso Soivio busy, yet

each child´s surgery was planned individually (Picture

6). This was the beginning of systematic centralization

and a multidisciplinary approach to treat cleft lip and

under the leadership of Aarne Rintala, resulting in high

quality outcomes in highly specialized surgery. The

center was also the foundation of what developed into

the Department of Plastic and Reconstructive Surgery at

the University Hospital, first led by Börje Sundell and

for many years by Sirpa Asko Seljavaara. Nowadays Mr

64 IPRAS Journal Issue 13

Cleft lip

Erkki Tukiainen is both professor

and head of Department. The logo

of the Finnish Association was

planned by the artist Erik Bruun

in 1969. The well-functioning

cleft- lip and palate department

contains nowadays also a high

volume center for cranioplasties,

and related research.

Sirpa Asko-Seljavaara

When the era of microsurgery began, Finland stood out

as a pioneer country among its Scandinavian neighbours,

quickly taking on and developing the latest techniques.

Names like Simo Vilkki (toe to hand) and Sirpa Asko-

Seljavaara (free style free flaps) are widely known.

Sirpa worked hard to popularize microvascular breast

reconstruction, and still in today´s Finland the use of

autologous tissue is as high as 80%.

Sirpa also worked very hard to create a geographically

equal network of plastic surgeons in public hospitals. She

has basically trained all senior surgeons in leading positions

in the country, but she was also sad to see some of her

well trained students “lost” to the more lucrative jobs in

the private practice. The country is nowadays covered by

a network of plastic surgeons in public hospitals, supply

and demand in rather good balance. As a pioneer in

development of modern burn care and microsurgery, Sirpa

Asko-Seljavaara was rewarded with the Evans Price by

the American Association of Burns and the Maliniac Price

by the American Association of Plastic Surgeons. She

received her professorship in 1994, but the first chair for

plastic Surgery was not founded in Helsinki until 2001.

Educational Programs

Five university hospitals train plastic surgeons at present:

Tampere, Turku, Oulu, Kuopio and Helsinki. The

Helsinki Department has a very international atmosphere,

and is known for its numerous short/long-term visitors.

Educational Programs supported by our National

Association include EURAPS Young Plastic Surgeons

Scholar ship, Academic Scholarship, the International

Master´s Degree in Microsurgery (Sinikka Suominen),

the EBOPRAS Board exam, and Emergency Burn Care

Surgery (Jyrki Vuola). Helsinki and Tampere are among

the recipient institutions for EURAPS Scholarships.

Helsinki is also part of the regular Nordic Courses for

trainees in Plastic Surgery. The Helsinki courses are

famous for open-minded, candid lectures and thorough



The past decade has been busy when the Association has

been trust to organize several international meetings in

Finland. The EURAPS meeting in 2001, Scandinavian

meetings in 2002 and 2012, The ECSAPS (nowadays

called EURAPS Research Council) in 2001 and 2010 and

, the European Federation for Societies of Microsurgery in

Turku in 2008 and the World Society for Reconstructive

Microsurgery in 2011, with more than 700 participants,

which is the biggest meeting of WSRM so far. Also the

Nordic Burn Meeting has been arranged. A small country

can never outdo its larger peers in resources or manpower,

but efforts are made (as shown in our history), to create a

warm and welcoming, personal yet professional touch.

Upcoming events on the international scene include

the EBOPRAS board examination in 2014. The Finnish

Association will also consider arranging the ESPRAS

Congress in a few years time.

Several members of the Finnish Association have been

involved in humanitarian activities organized by the Red

Cross, Interplast, Doctors without boundaries and Rotary

to mention a few. Also, a few Finnish Plastic Surgeons have

signed up for the IPRAS led Women for Women project.

In its 56-year history the Finnish Association has grown

from a small alliance to become a large society with about

100 full members (12 retired) and about 30 candidate

members. Fifty percent of the members are female.

Despite grand achievements by previous generations,

there is still a lot of work to be done.

Board of Directors 2012 - 2013

Susanna Kauhanen President

Johanna Palve Secretary

Catarina Svarvar Vice President

Jari Viinikainen Treasurer

Board members:

Ilmar Amjärv

Tiina Jahkola

Timo Pakkanen

Pentscho Popov

Ira Saarinen

Anna-Liisa Vesala- Salmela

Issue 13 IPRAS Journal 65

Brief Historical Account of the Mexican Association

of Plastic, Aesthetic and Reconstructive Surgery

The Mexican Association of Plastic,

Aesthetic and Reconstructive

Surgery was formed on November

18, 1948, with founding members

Mario González Ulloa, M.D as

president, Jorge Caraza Escobedo,

M.D as secretary, Héctor Fernández

Pérez, M.D as treasurer, and Jorge

García M.D and Yuri Kutler as

trustees. Along with these were also

Gonzalez Ulloa various other founding members,

Alfonso Díaz Infante, M.D, Roberto

Nava Rojas, M.D, Joaquin D’Ηarcourt, M.D, Francisco

Castillo, M.D, Cesar Laborde, M.D, Palemón Rodríguez,

M.D, Gloria Kirts, M.D, Jesús Lozoya, M.D, Alejandro

Velasco Zimbrón, M.D, Eduardo Stevens, M.D, Juan

de Dios Peza, M.D, Isidoro Gómez, M.D, and Román

Rivera Torres, M.D.

During the Nineteen-Twenties and Thirties, surgeons

like Doctor Dario Fernández and Velasco Zimbrón began

to show interest in the restoration of skin cover and the

ability to leave less surgical scars, and this was the seed of

the society’s creation. It was, however, during the 1940s

that Plastic and Reconstructive surgery really began to

become popular with general surgeons. at the General

Hospital of Mexico. In 1947, Mario Gonález Ulloa, M.D,

founded the Mexican Association of Plastic Surgeons,

marking the beginning of the discipline in Mexico. This

made him a pioneer in this specialty and the field of

medicine in general. Among the society´s achievements

are the first successful hand transplant, and to date having

brought together 1363 members.

The society continuously supports various medical

programs, both nationally and internationally, in the

form of various training conventions in the foundations

and theory of plastic surgery, as well as symposia and

sessions with experts via the internet. Furthermore the

Society undertakes various campaigns in reconstructive

surgery, in the lip, and cleft palates.

The society has various upcoming events; first is the 44 th

National Congress of Plastic and Reconstructive Surgery,

which will be held in Puerto Vallarta, Mexico, from

April 16 to April 21. For information go to http://www. Following this we have:

the 24 th National and International Course in Foundations

and Theoretical Developments in Plastic Surgery; The 45 th

National Congress of Plastic and Reconstructive Surgery,

in Mexico City from April 29 to May 03, 2014(www.; and the 20 th Latin American

Congress of Plastic and Reconstructive Surgery, in

Cancun from September 23-26, 2014(

At the moment the Board of Directors is comprised of:

José Luis Haddad Tame, M. D, President; Raúl Alfonso

Vallarta Rodríguez, M. D, Vice President; Calixto Harada

Prieto, M. D, General Secretary; Eric Santamaría Linares,

M.D, Treasurer; Ricardo Pacheco López, M. D, Trustee;

Carlos Gmo. Oaxaca Escobar, M.D Trustee; Raymundo

Benjamín Priego Blancas, M.D, Secretary; and Carlos

De Jesús Álvarez Díaz, M. D. Editor.

The association would be happy for members of the

specialty to contact it at:

Asociación Mexicana de Cirugía Plástica, Estética y


Flamencos No. 74 San José Insurgentes

C. P. 03900 México, D. F.

(525) 5615-49-11 / toll free (Mexico) 01800-711-87-32

Facebook: amcperac - Twitter: amcper

66 IPRAS Journal Issue 13

Polish Society of Plastic, Reconstructive

and Aesthetic Surgery (PTChPRiE)

the member in dynamic progress

Wojciech Witkowski M.D. PhD

National Delegate of PTCHPRiE to IPRAS

Military Institute of Medicine, Warsaw, Poland


The Polish Society of Plastic, Reconstructive and

Aesthetic Surgery (PTChPRiE) is the official scientific

organization for plastic surgeons working in the Republic

of Poland. The President of the Society is Professor Jerzy

Struzyna MD,PhD,D.Sc.,National Consultant in the field

of plastic surgery in Poland. Fifteen hospital departments

and a great number of private clinics and cabinets of

aesthetic surgery do our professional plastic surgery

work. The Society brings together 200 members with 160

specialists among them. The statutory authorities are: the

Board of Directors, the Revisory Commission, the Ethics

Committee, and the Arbitration of Fellow Members.

PTChPRiE has delegates in IPRAS, ESPRAS, IQUAM


The key moments in PTChPRiE history are joined with

family names of pioneers and enthusiasts of this specialty

such as Professor Michalek-Grodzki, and Dr Wladyslav

Dobrzaniecki, after the Second World War. The first

attempts to develop Polish plastic surgery had been made

by Professor Michal Krauss MD,PhD,D.Sc, who trained

for a few years in Professor Frantisek Burian’s Plastic

Surgery Clinic in Prague. It was the real beginning

ESPRAS 2009 Congress. From the left: Dr Martin del Yerro, Professor Andreas Yacoumettis, Dr Wojciech Witkowski, Dr Eric Auclair

Issue 13 IPRAS Journal 67

for the plastic surgery era in Poland. Unfortunately

50 years didn’t allow for a good climate in which to

quickly develop aesthetic surgery. Therefore, until after

70 years, aesthetic surgery as part of plastic surgery

was the ”unwanted child” for the National Authorities.

Thus Polish specialists at that time had many more

difficulties training in aesthetic surgery than colleagues

in other countries. Development, however, was a fact,

and primarily it was Professor Michal Krauss and then

Professor Kazimierz Kobus in Polanica-Zdroj Hospital,

and Professor Janusz Bardach and later Professor Jan

Goldstein, who encouraged plastic surgery education,

training and international contacts with leading plastic

surgery at clinics in Europe and worldwide. In the year

1957 The Generative Surgery Section was established

as a section of the Society of Polish Surgeons under the

presidency of Professor of Surgery Henryk Kania. In 1971,

the section changed its name to Section of Plastic and

Reconstructive Surgery of the Society of Polish Surgeons

(TChP).In 1986, the Section had been transformed into the

Polish Society of Plastic and Reconstructive Surgery and

three sections were formed; the Head and Neck Surgery

Section, Microsurgery Section, and Burns Management

as well. Finally the name of the Society was changed

in 1997 and it became The Polish Society of Plastic,

Reconstructive and Aesthetic Surgery, which has existed

until today. According to a recent decision of the Society

Board of Directors, given December 11 th , 2011, after a

few months of organisational work, and confirmation by

the Society General Assembly, the Section of Aesthetic

Plastic Surgery was created.

The President of Section is Doctor Maciej Kuczynski,

who is at the same time the Vice President of PTCHPRiE.

The Section is extraordinarily active and has organized

various international aesthetic surgery symposia.

Since 1986 thirteen National Congresses of our Society

have taken place, ten Congresses of the Society for

Burns Management, thirteen Burn symposia, organized

in cooperation with above listed societies by Poznan

University Chair and Clinic of Traumatology, and over

a dozen symposia on microsurgery, head and neck

surgery and microsurgery. All the information given

in this concise history of polish plastic surgery is the

evidence of the relative youth of this specialty in Poland.

A new era came after political changes in Europe and

the world which brought about new opportunities for all

Respectable mission from Romania, visiting in June 2013. Specialists were invited by Dr Witkowski to discuss water-jet technology

application in burns and other wounds debridement.

68 IPRAS Journal Issue 13

of us, incredible chances of unlimited cooperation with

plastic and aesthetic surgery world leading specialist and

masters of our specialty. The task of close cooperation

with IPRAS and ESPRAS and other scientific societies

as well is an absolute necessity for us. The second is to

join the plastic surgeons in a multidisciplinary approach

for the treatment of surgical diseases. We hope all will go

well. The next is the problem of joining in with European

specialty courses, and it may become an educational

process even to pass European specialty exams in the

future. Nowadays in Poland our specialty is in fact

divided by the National Health Foundation (NFZ) into

two categories. The first is medical care activity, which is

reimbursed by the system. The second is aesthetic plastic

surgery, which is not reimbursed by the nationally funded

NFZ. Official specialized health care providers like plastic

surgery wards and clinics have to perform mainly life

saving procedures and treatments. Planned operations of

reconstructive surgery are commonly financial losses for

the hospital. We all wait for reform of the system and hope

that a wise decision will give the requested effects for our

specialty. No aesthetic surgery can be done in hospitals.

It is a great disadvantage for education because in my

opinion the modern plastic surgeon has to be trained and

widely educated, not only in private clinics of aesthetic

surgery but at university and at the specialized hospital

level as well. Despite problems and impediments and

the disadvantages of the system our young doctors and

experienced plastic surgeons are present in European

and Worldwide scientific and educational activity. It is a

significant and dynamic progress for us. The Members of

PTCHPRiE present lectures, oral presentations, posters,

travelling everywhere to learn news and to assimilate

contemporary plastic surgery knowledge, applied

technologies and skills. The most important is the good

will of our colleagues and friends from abroad to share

their experiences, and take part in discussion on aesthetic


National Delegate of Polish Society of Plastic,

Reconstructive and Aesthetic Surgery(PTCHPRiE)

to IPRAS is the decent author of this text. He is a

plastic surgery specialist and former Vice President

of PTCHPRiE, a long term member of the society

authorities, and actually a member of the PTCHPRiE

Board of Directors. Dr Witkowski is the Head of The

Plastic Reconstructive Surgery and Burn Management

Department in The Central Clinical Hospital of The

Ministry of National Defense, The Military Institute

of Medicine in Warsaw. He has been a specialist

in plastic and reconstructive surgery since 1984,a

combustiologist, a known expert on wound healing,

especially burn and posttraumatic wound regeneration

and surgical reconstructive treatment methods, new

technology applications and development within wound

management as well.

Dr Witkowski had the opportunity for the first time in the

history of PTCHPRiE to be the official delegate to the

unforgettable Rhodes 11 th ESPRAS Congress 2009, being

simultaneously the attendee and the Co-Chair of one of

the scientific round table sessions on Biomaterials(clinical

and experimental).(Fig.1)

His experience in water-jet technology application in burn

wounds, and NPWT technology usage in the treatment of

wounds permitted him to share clinical knowledge and

understanding of the problem with respectable colleagues

and plastic surgeons from Russia and Romania, which

were the guests of Dr Witkowski and heard the lectures

and watched clinical presentations, not excluding the life

burn wound surgery performed with water-jet technology

or combined technologies and techniques.Fig.2

The 14th biennial Congress of the Polish Society of

Plastic, Reconstructive and Aesthetic Surgery will be

held on 18-19 th of September 2013 in Kazimierz Dolny,

located in Lublin Region. All exact information and

details are accessible on the web page of the Congress:

http:/ get information in

English please click the British flag at the upper right

corner of page.

Issue 13 IPRAS Journal 69

Sir Archibald McIndoe

Sir Archibald McIndoe, the pioneering plastic surgeon

based at the Queen Victoria Hospital in East Grinstead,

successfully treated in excess of 649 severely burned

airmen during WWII, 62 of whom are still alive today

worldwide, a testament to his skill and compassion. These

men later formed the now well known Guinea Pig Club, so

called because of the experimental nature of their treatment.

Less well known is that McIndoe also treated casualties

from other services and civilians. His wartime experiences

led McIndoe to believe that were was a need for strong

laboratory based research to

ensure that treatments of the

future were safe and effective

before they went to clinic.

In 1958 it was felt that the time

had come to make a serious

attempt to establish a Centre for

Surgical Research at the Queen

Victoria Hospital. It was realised

that the Ministry of Health, with

its sources already strained by the

expansion of the National Health

Service, would be unlikely to be

able to provide funds for such a purpose. Mr & Mrs Neville

Blond offered to donate the sum of £10,000 required to build

and equip the first building and further financial support

followed. The East Grinstead Research Trust was formed

to regulate the general policy and financial expenditure of

this new Centre.

On April 11 th , 1960, the Trust sustained a shattering

blow and an irremediable loss in the untimely death of

Sir Archibald McIndoe, who with his driving energy and

enthusiasm had been the spearhead and co-ordinator of

the whole project. However, the Trustees continued and

the laboratories were officially opened by the Rt Hon J

Enoch Powell MBE, MP, Minister of Health on March

22 nd 1961. In the course of his speech, The Minister

remarked on the importance of the generosity of private

individuals in sponsoring major projects of this kind

and of his wish to foster and encourage that which was

voluntary and independent in both medical research and

treatment. The Research Unit continues to this day as

the Blond McIndoe Research Foundation a registered

charity, still depending entirely on charitable donations.

The Blond McIndoe Research Foundation in collaboration

with The East Grinstead Business Association and

East Grinstead Town Council felt that a memorial to

this remarkable man, his patients and the Town of East

Grinstead, was long overdue and a project was launched

to erect a statue to Sir Archibald in a prominent position in

East Grinstead. The chosen sculptor is Martin Jennings,

probably best known for his beautiful statue of Sir John

Betjeman at St Pancras Station. When approached, Martin

revealed the amazing coincidence that his own father, a

Tank Commander in WWII, had been severely burned and

treated by McIndoe at East Grinstead.

What follows are the sculptor’s own words:

“I want to make more than just a statue of the great

surgeon. McIndoe's story is inseparable from that of the

Guinea Pig Club, his burned

'boys' for whom he was a cross

between compassionate parent

and strict figure of authority.

So I have represented him

with a patient (though not a

particular person) who has

burns to his face and hands but

still wears his RAF uniform, as

McIndoe insisted his patients

should be allowed to. The pilot

is turning his head to look back

up to the sky in which he can

no longer fly but also towards his doctor for reassurance.

McIndoe's hands are on the younger man's shoulders,

suggesting the communication of his extraordinary

confidence - his patients always refer in their memories

of him to his absolute certainty that they would go on to

lead productive lives despite the traumas they'd suffered.

Many of McIndoe's patients suffered terrible injuries to

their hands and "main en griffe" (claw hands) frequently

resulted. After his wartime burns, my own father's hands

were fixed in a claw shape for the remainder of his adult

life. I can remember when growing up how tentatively he

sometimes used to hold them and how he used to stretch

them when they ached. This is something I want to record

in that one small part of the statue.

McIndoe encouraged the people of East Grinstead to

involve themselves with the social rehabilitation of his

patients. I'm proposing that the statue should have a

continuous crescent of stone seating encircling it, so that

when the people of the town sit down around it they will

be helping symbolically to complete it. It seems to me to be

important that this monument should be seen not just as a

tribute to a great man but to his heroic patients as well and

to the community that did so much to support them.”

For more information about The Blond McIndoe Research

Foundation or the statue please visit www.blondmcindoe.

org or contact

70 IPRAS Journal Issue 13


05 - 07 Sep 2013

8th Congress of the Balkan Association of Plastic,

Reconstructive and Aesthetic Surgery (BAPRAS)

Location: Budva, Montenegro - Venue: Avala Resort and Villas

Contact: Mrs. Mina Ploumpi - Telephone: +30 2111001781 - Fax: +30 2106642116

E-mail: - URL:

10 - 14 Sep 2013

44th Congress of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC)

& 18th Congress of the Association of German Aesthetic-Plastic Surgeons (VDÄPC)

Location: Münster/Westfalen, Germany

12 - 14 Sep 2013

Congreso de Cirugía Plástica del Cono Sur Paraguay 2013

Location: Paraguay - E-mail:

12 - 14 Sep 2013

XV Dominican Congress of Plastic Surgery

Location: Santo Domingo, Dominican Republic

Venue: Hotel V Centenario


11 - 15 Oct 2013

Plastic Surgery The Meeting 2013

Location: San Diego, CA, USA - Venue: San Diego Convention Center


24 - 26 Oct 2013

Technology Innovations In Plastic Surgery /

4th International Congress of the Armenian Association

of Plastic, Reconstructive and Aesthetic Surgeons (AAPRAS)

Location: Yerevan, Armenia - Venue: Matenadaran

Contact: Mrs. Irene Katti - Telephone: +30 2111001783 - Fax: +30 2106642116

E-mail: - URL:

21 - 24 Nov 2013

15th International Course on Perforator Flaps

Location: New York, USA - URL:

E-mail: - URL:

Social Media Networking

IPRAS International Confederation

for Plastic Reconstructive & Aesthetic Surgery

Join our group!

IPRAS Facebook page

Follow our news!

IPRAS Twitter account

Connect with

our professional network!

IPRAS - professional page

IPRAS - group

Women for Women - group

Share our experience!

ISPRES International Society of Plastic Regenerative Surgery

ISPRES Facebook page

ISPRES Professional page

72 IPRAS Journal Issue 13





The cutting edge.

Where we are now.


Saturday, 14 th September 2013

Venue Location:

Centro Congressi Fondazione Cariplo

Via Romagnosi 6/8, Milano



Syringes for fat injection. From: Miller Cb., Chicago, 1926

** Iscrizione on-line:

** On-line registration:


The Rationale of Preventive and Regenerative

Using Skin derived ABCB5 cells in aesthetic



- A novelty

for Plastic

of pluripotent


stem cells.

News from Klentze Medical Faculty in Phuket

Plastic surgery has cemented its importance worldwide and a world without this specialty is


In 2005, Cellular there therapy were 10.2 has million evolved cosmetic quickly procedures over the performed last decade in the both United at the States, level an

increase of in of vitro 11% and from in 2004 vivo and preclinical a 38% increase research compared and with in clinical 2000 . Men trials. are Embryonic increasingly

undergoing stem cells cosmetic and non-embryonic surgery to enhance stem appearance, cells have all combat been the explored effects as of potential aging, and

improve therapeutic chances for strategies employment for in a competitive number of job diseases. markets. One type of adult stem

In spite cells, of mesenchymal this excellent income stem cells, potential, has plastic generated surgeons a great are looking amount for of new interest income


This is based on the situation that future development shows a decline in income,

The more developed a cell is (from embryonic to adult stem cells), the less

accompanied with a reduction in economic growth and an increase within competitive

is the ability to replace more than one tissue type. The reason for this can


be found









aesthetic medicine,

of the















invasive germ surgery layer (endodermal, of aesthetic medicine. mesodermal The demand and for ectodermal cosmetic surgery layers) and of services the body has

diminished tissue. with Among fluctuations the adults in the stem economy. cells, one To stay group ahead, is called surgeons mesenchymal must appreciate cells, and

understand which can the challenges be harvested of a private from practice. bone marrow, More and fat more skin. plastic A new surgeons cell population are switching

to the has field been of Anti-Aging, found , which preventive show in and their regenerative engraft capacities medicine not a only behavior because like itMSC


new cells, income but sources with but pluripotent because it power, offers a holistic thereby health replacing concept apoptotic for the patients cells of of plastic all

surgeons. three germ layers.

Many plastic surgical approaches may miss important health aspects. Using antioxidants and

hormones; ABCB5 finding cells the exact : diagnosis of aging markers of the skin and other target organs

for plastic surgery like breast gland and genitals; using regenerative techniques like cell

Among adult cells from adipose tissue, bone marrow and skin, Ganss,




with Frank

the skin


and subcutaneous

a new







and nerve supply


are all cells, aspects the that so physicians called ABCB5 can implement cells, which into their are practices Mesenchymal to improve cells, patient but outcomes have

and pluripotency satisfaction. These like embryonic facets of medicine or IPS are cells not and commonly which addressed have the in ability training, to and repair will

require and a special replace education. aged and damaged cells in all body tissues. ABC B5 means

Many ATP-binding of the plastic cassette surgeons sub-family today already B member assign 5 their also doctors known to as attend P-glycoprotein education in

Preventive, ABCB5. Regenerative This is a plasma and Anti-aging membrane-spanning medicine. They learn protein how to that diagnose in humans aging and is

non-age encoded related by disorders the ABCB5 in patients, gene. recognize ABCB5 depressive has been disorders suggested (frequently to regulate underlying skin

the request for plastic surgery), and they understand how to treat the biggest organ, the skin

in aging. chemotherapy drug resistance.

If a plastic surgery center becomes a point of medical care for all age related problems, it

will What gain the are trust and the confidence advantages of their patients. of ABC Customers B5 cells, will be compared

turned into patients,

as these with physicians adipose diagnose derived disorders cells. at a very ? early stage.

ECARE, the European Center of Aging Research and Education, offers a program of 2

One has to understand, that the term stem cell treatment involves only

years education with 8 modules, thereby teaching 80 medical protocols (PMI= Professional


as well.


But most


of the users


do not



to ensure



or extend


them. Usinto

the clinical practice of Plastic Surgeons worldwide. Modules run continuously allowing


the flexibility to join at any time.

Professor clinics Dr. use Michael devices Klentze which separate adult stem cells from fat tissue using a

Chief combination Scientific Medical of spinning Officer motions and chemical reactions with more or less

KLENTZE good results. MEDICAL The FACULTY disadvantage lays in the potency of these cells products.


Contact for more information.

Issue 13 IPRAS Journal 75

76 IPRAS Journal Issue 13

Issue 13 IPRAS Journal 77



Pan African



i n c o n j u n c t i o n w i t h t h e W i n t e r M e e t i n g o f t h e E g y p t i a n S o c i e t y

o f P l a s t i c a n d R e c o n s t r u c t i v e S u r g e o n s ( E S P R S )



March 2014

El Gouna, Hurghada - Egypt

s t a y t u n e d f o r m o r e i n f o r m a t i o n

Plastic Surgery The Meeting features education

that reaches across the specialty

The laid-back atmosphere and welcoming climate of

San Diego will provide a uniquely positive contrast to

the dynamic, cutting-edge and energized educational

events offered during Plastic Surgery The Meeting 11-15

October 2013.

Demonstrating the Society’s commitment to innovative

education that reaches across the specialty, and with a

reinvigorated focus on aesthetics, several new, original

and relevant cosmetic offerings. The 2013 American

Society of Plastic Surgeons/The Plastic Surgery

Foundation/American Society of Maxillofacial Surgeons

annual scientific meeting program will be packed with

an abundance of new aesthetic offerings – 14 devoted to

the breast or face – accompanied by several more courses

and panels targeting craniomaxillofacial, hand and upper

extremity, reconstruction and practice management.

Combined with 21 new courses give international

attendees the opportunity to bring home new information

to improve their clinic, Operating Room (O.R.) and

practice model – regardless of practice profile.

The upgrades and alterations installed for Plastic Surgery

The Meeting – both “reconstructive and cosmetic” – will

provide the ultimate learning experience for plastic

surgeons, as well as demonstrate to ASPS members that

their Society works continually to improve on their behalf,

according to ASPS President Gregory R.D. Evans, MD.

“We’ve listened – and more importantly we’ve heard

– our members as they’ve offered suggestions to improve

our annual gathering of the best plastic surgeons the

specialty has to offer,” Dr. Evans says. “We’re willing

and motivated to launch exhaustive searches for new

material, new people, new times, dates and events – and

to make these extraordinary changes to the program.

“I feel we’ve fully met this charge for Plastic Surgery

2013,” he adds. “Cosmetic surgery of the face, breast,

abdomen and other areas as well, are featured more

than ever in the educational offerings, as the speed of

innovation in these areas requires us to keep pace.

A two-day, dedicated Cosmetic General Session has

been created for plastic surgeons looking to focus on

one subspecialty area for an extended period each day

– for instance, the Cosmetic Session Module: Breast

Presidio view

Augmentation Part I involves four distinct sections, from

8-11:45 a.m. Sunday, 13 October: “Overview and Patient

Selection and Markings;” “Surgical Video Lectures;”

“Improving Outcomes;” and “Preventing and Managing

Complications.” The objectives are to create a symposialike

format with longer sessions, dedicated Q&A time

and an opportunity for plastic surgeons to concentrate on

each module – for several hours at once.

In addition, Plastic Surgery The Meeting will

commemorate The Republic of South Korea as its 2013

Honored Guest Nation.

The complete registration brochure with information

about Instructional Courses, General Sessions,

Panels and Scientific Abstracts is available at

Travel discounts are available for international travel.

Each airline requires a special offer code to redeem

the specials. To access the discount codes, information

on registration, travel and hotel accommodations, go to and click on “San Diego

& Travel” at the top of the page. Questions about meeting

registration? Please email Judy Myers, Member Services

Manager at

80 IPRAS Journal Issue 13

See You In

S a n


D i e g o

Register Today!

Plastic Surgery The Meeting is where the best and the brightest

plastic surgeons share their expertise and research, network with

• Sessions on rhinoplasty, breast augmentation, facelifting

and body contouring, plus non-invasive/minimally invasive


• 125+ research papers presented in key clinical areas

• San Diego features 90+ golf courses and eight state-of-theart


Conference: Friday, October 11 - Tuesday, October 15

Exhibits: Saturday, October 12 - Monday, October 14

Registration Now Open!

Visit to register

This activity has been approved

for AMA PRA Category 1 Credit



Plastic Surgery The Meeting values the continued contributions of our Premier Industry Supporters.





The Conference is expected to grant

European CME credits

(ECMEC) by the European

Accreditation Council for

Continuing Medical Education


Elisabeth Russe MD


New Perspectives on:



Photodynamic Therapy Acne/ Precancerous Lesions

Treatment of Vascular Lesions Hemangiomas/ Port Wine Stains/ Venous Malformations

Advances and Controversies in:







Treatment of Scars

Treatment of Tattoos

Body Contouring Fat & Cellulite - Invasive/Non Invasive - Hot/Cold

Skin Tightening Lasers, Radiofrequency, Ultrasound vs. Surgery

Soft Tissue Augmentation Fat or Fillers

Resurfacing: Fractional/ Non- Fractional, Ablative/Non-Ablative


Crisalix Patient Access from home

Crisalix launches its latest feature, the Patient Access,

which allows patients to see their 3D pre- and post- op

images from the comfort of their home, once a surgeon

enables this feature. The Crisalix Patient Access is a

unique tool in the field of plastic and aesthetic medicine.

It benefits surgeons as well as patients. Patients are now

able to see their professional 3D simulations from home

, can show it to friends and partner and even share it on

social networks and beauty platforms.

A tool designed for sharing

We are living in times of the revolution of online tools.

They already play a crucial role in daily activities of

companies and people around the world. Crisalix, aware

of the importance of these needs, has launched the Patient

Access enhancing the use of its state-of-the-art 3D

technology for professionals in the medicine / aesthetic

surgery field and anybody interested in performing a

plastic surgery procedure.

Thanks to this new feature cosmetic surgery patients can

see their simulations at home and via internet. This way

they can share their 3D imaging with their friends, asking

for their opinions and, in conclusion, take well informed

decisions on their procedures. The new patient viewer

application allows for easy screenshots and social sharing

on platforms like Facebook, Twitter, Pinterest or Realself.

Tele-consultation on the horizon

Considering altering the physical image is a process that

makes questions, doubts and insecurities show up in

patients’ minds. It is normal to expect that patients look

for the support of a professional to find answers about the

decision they are about to make. In order to help patients

to find answers and set their minds at ease the Crisalix

Patient Access opens the door for the practice of Teleconsultation.

Many doctors experience the phenomenon of patients

not living in the cities where they practice. The Crisalix

Patient Access creates a direct channel of communication

between the surgeon and the patient.

Tele-consultation is a field of ICT (Information and

Communications Technology) on the rise because it

makes easier to evaluate the patient needs and optimize

the time doctors are spending on each patient. In addition,

patients save time and money originating from transfer

fees and generally the medical services provided are

improved and so is patient’s level of satisfaction.

Higher satisfaction, optimizing time and

better results

With all this, the result is no other than the possibility

to offer a more detailed and customized service for each

individual who is interested in an aesthetic procedure.

Patients will be able to eliminate doubts about implant

sizes from the comfort of their homes, which ultimately

increases the consult to surgery conversion ratio.

84 IPRAS Journal Issue 13



The first website that gives you the opportunity

to upload your scientific profile for free!!

Take advantage of the opportunity to upload free

and easy, your scientific profile at the IPRAS

website. Gain the benefits of being under the

IPRAS umbrella. Sign up on and

follow the following steps:

1. Create an account by clicking “Member’s

login” on the top right-hand corner and then

select the “Create new account” tab.

2. Fill out your “Username”, “Email” and

“Password”, as required.

3. Select the option “Doctor” and your country,

under the section “If you are a doctor, complete

the following”.

4. Once all account details have been added,

click on “Create new account” button. Then

you click on “EDIT” and then on “DOCTOR


This is the section where all the information of

your scientific profile can be uploaded. You may

complete the fields with the information that

you prefer such us: Personal Picture, Hospital

Position, Affiliation, Special Field of Interest,

Contact Details, Memberships, Topics of Special

Interest, Publications etc. At the “EDIT” section

you may proceed to the appropriate corrections

at your account such us to change your password

or to update personal information. When you

complete the aforementioned steps there will

be one last step remaining for your details to be

uploaded on the IPRAS website. The application

must be approved by the National Association

you are a member. The application will be sent

at the Association of the country that you have

declared, ensuring that only IPRAS members of

good standing and high ethical principles are able

to upload their personal details. As soon as your

Association verifies you as a member, your profile

will automatically be uploaded at the website’s,

“Find a doctor” option in the “Members”section.

It is also up to you to decide whether your profile

will be classified as “private” or visible to all

visitors of the IPRAS webpage. Our aim, besides

facilitating communication among colleagues,

expands to allowing patients to verify the good

standing and high ethical principles of the doctors’

profiles hosted, allowing them to choose qualified

IPRAS members for needed procedures.

There are two new Sections at the IPRAS


• IPRAS-TA section where you may find

more information concerning the Trainees


• Congress Registry section where you may find

the all the plastic surgery related congresses.

If you face any difficulties please do not hesitate

to contact us at:

Always at your disposal!

IPRAS Management Office

Issue 13 IPRAS Journal 85


Tord Skoog


1955 - 1959

David N. Matthews


1959 - 1963

Thomas Ray Broadbent


1963 - 1967

William M. Manchester

(N. Zealand)

1967 - 1971

John Watson


1971 - 1975

Roger Mouly


1975 - 1983

Jean-Paul Bossé


1983 - 1992

Ulrich T. Hinderer


1992 - 1999

James G. Hoehn


1999 - 2006

Marita Eisemann-Klein


2006 - present

86 IPRAS Journal Issue 13

International Confederation

for Plastic Reconstuctive and Aesthetic Surgery



• Immediate information about safety warnings on devices, drugs and


• Information regarding the proper use of all materials, substances and

techniques related to Plastic, Reconstructive and Aesthetic Surgery

through IQUAM (the International Committee of Quality Assurance and

Medical Devices in Plastic Surgery) General Consensus statement, with

an update every 2 years

• Free electronic receipt of the IPRAS JOURNAL

• Information regarding harmonization of training

• Information regarding accreditation of Plastic Surgery Units

• Promotion of Patient Safety and Quality Management (in cooperation

with WHO)

• Protection of the Specialty and Promotion of its image world-wide

• Promotion of Individual Members of National Associations by uploading

their scientific profile on the IPRAS website

• Exchange of ideas, views, thoughts and proposals through the IPRAS

website and its FORUM section

• Certificate for Individual Members to display their IPRAS Membership

• Right to participate in all events organized by National Societies and


• Strengthening ties of professional cooperation and friendship with

colleagues beyond national borders all over the world

• Information regarding the developments of plastic surgery worldwide

• Association support for educational and research purposes

• Association legal & ethical advice according to international law and

practices and assistance with crisis management

• Promotion of local or regional news and Historical Accounts of IPRAS

National Associations through the Journal

• Information, promotion and reports of local or regional events, organized

by other National Societies and IPRAS, through the official IPRAS

management office

Issue 13 IPRAS Journal 87

13th Issue July 2013

IPRAS Journal Management


Honorary Editor-in-Chief:

Editorial board:

GS Print:


Post Editing:



Ricardo Baroudi, MD

Marita Eisenmann-Klein, MD

Nelson Piccolo, MD

Andreas Yiacoumettis, MD

Mimis Cohen, MD

Chris Khoo, MD

Zacharias Kaplanidis, Economist


William Greenall

Julian Klein

IPRAS Management Office


1st km Peanias Markopoulou Ave

P.O BOX 155, 190 02

Peania Attica, Greece

Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216

URL: • E-mail:

Executive Director: Zacharias Kaplanidis


Assistant Executive Director: Maria Petsa


Accounting Director: George Panagiotou


Association Management Director: Labrini Nikolopoulou

E-mail :

Commercial Director: Gerasimos Kouloumpis


Next issue: October 2013


IPRAS journal is published by IPRAS. IPRAS and IPRAS

Management Office, its staff, editors authors and contributors do

not recommend, endorse or make any representation about the

efficacy, appropriateness or suitability of any specific tests, products,

procedures, treatments, services, opinions, health care providers or

other information that may be contained on or available through this

journal. The information provided on the IPRAS JOURNAL is not

intended or implied to be a substitute for professional medical advice,

diagnosis or treatment. All content, including text, graphics, images

and information, contained on this journal is for general information

purposes only. IPRAS, IPRAS Management Office and its staff,

editors, contributors and authors ARE NOT RESPONSIBLE NOR








While every effort has been made to ensure accuracy, neither the

publisher, IPRAS, IPRAS Management Office and its staff, editors,

authors and or contributors shall have any liability for errors and/or

omissions. Readers should always consult with their doctors before

any course of treatment.

©Copywright 2010 by the International Confederation of Plastic,

Reconstructive and Aesthetic Surgery. All rights reserved. Contents

may not be reproduced in whole or in part without written permission


Not for sale. Distributed for free.

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