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Issue 1 www.ipras.org IPRAS Journal 1

I P R A S J O U R N A L 

Aims and Scope 

T 

he purpose of THE IPRAS JOURNAL is to 

provide a rapid reporting of things of interest 

to IPRAS members. This includes all members 

of national societies who participate in the IPRAS 

organization. Because of the broad umbrella of IPRAS 

this includes matters of interest across a broad spectrum 

of sub-specialties including burn surgery, microscopic 

and reconstruction surgery, hand surgery, craniofacial 

surgery, and aesthetic surgery. In many instances it will 

include matters of interest to all specialties of plastic 

surgery combined. Matters of interest include, but are not 

limited to surgical techniques, patient care, patient safety, 

recognition and treatment of complications of surgery, 

humanitarian contributions, and schedules of pending 

meetings. Authors are encouraged to submit manuscripts 

for publication which will be evaluated by a peer review 

process. Letters to the Editor are encouraged and will be 

published if deemed contributory to the aims and scope of 

the Journal. 

2 IPRAS Journal www.ipras.org Issue 1

I IP PR RA AS S JJO OU UR RN NA AL 

L 

General Secretary’s Message 

Dear colleagues, 

with great enthusiasm we introduce the first issue of the IPRAS Journal to you: it is the expression 

of an atmosphere of awakening, of new chances, new visions. 

A reliable cooperation within the Board of Directors and the Executive Committee has stood the 

test of time since 2007, but in the beginning of 2010 we experienced a remarkable reinforcement: 

a dedicated enthusiastic young and yet experienced team under the leadership of Zacharias 

Kaplanidis, our new Executive Director, joined us. Together we opened new doors, crossed 

borders, expanded our humanitarian activities, developed visions. 

New concepts for congresses were developped, new cooperation partners found: 

together with the European Society of Prevention, Regeneration and Anti-Aging Medicine under 

the leadership of Professor Christos Zouboulis we designed an interdisciplinary holistic format for 

our congresses that will open our eyes for the achievements of other specialities, - insights that will 

result in benefits for our patients. 

The reaction of our colleagues, who we invited to join us on the faculties of this year’s events, was 

overwhelming: famous plastic surgeons from all over the world will join us in Bratislava for the 

IQUAM Consensus Conference. And CEN, the European Committee for Normalisation, will hold 

its first conference on European Standards in Aesthetic Surgery together with us in Bratislava. 

The Panafrican Section Congress in Nairobi and the Panarab Association Congress in Doha also 

will offer a unique scientific program. Besides the titles of the invited lectures we have received so 

many excellent abstracts, an impressive demonstration of the research activities going on in plastic 

surgery throughout the world. 

And when we were in search for a communication manager again we were fortunate: Tom Biggs, 

a unique ambassador of plastic surgery, a true cosmopolitan and citizen of the world, joined us to 

become the editor of our new journal - the IPRAS Journal. 

Four times a year it will inform you about our activities, new developments, striking news, but also 

about benefits of membership, new chances for cooperation and demonstration of solidarity. 

But this Journal is not meant to be a one way communication instrument from us to you. We 

want all of you to develop it to blossom. As Verena Kast, the Past President of the International 

Association of Analytical Psychology says: 

“It is possible to create new values: we can transform the current culture of dominance, in which it 

seems to be valuable to dominate or suppress others into a culture of relations, in which it is valuable 

to solve problems together in a better way and to experience joy together. Good self-esteem then 

does not result from feeling superior to others but from the joy of creating something together.” 

Cordially yours 

Marita Eisenmann-Klein 

Prof.h.c. Dr.med. Dr.h.c. 

General Secretary International Confederation 

for Plastic Reconstructive and Aesthetic Surgery Direktorin 

der Klinik für Plastische und Ästhetische, 

Hand- und Wiederherstellungschirurgie 

Caritas-Krankenhaus St.Josef, Regensburg, Germany 

phone +49-941-782-3111, fax +49-941-782-3115 


I P R A S J O U R N A L 

Editor-in-Chief’s Message 

EDITORIAL 

Welcome to the IPRAS JOURNAL. This is a periodical that will serve to bring you closer together 

in the wide world of plastic surgery. Our field is broad and varied, but we all have one thing in 

common: We’re dedicated to excellence, progress, and the well being of our patients. It is our 

desire to present to you a vital piece of communication on a regular basis so as to allow us all to 

focus more acutely on these goals. 

Our plan is multi-faceted. Our intention is to have the journal a review of previous meetings, 

both active and endorsed, and a summary of future meetings on our calendar. We’ll have a report 

from our Executive Director, Zacharias Kaplanidis. Also you will have regular updates about 

Humanitarian mission from Constance Neuhan-Lorenz, Cristian Echinard, Nelson Piccolo, Jan 

Poell and other humanitarian team members. Of course regular editorials from our Secretary 

General, Marita Eisenmann Klein. 

To be in continuous support of up to date scientific positions we’ll have at least one article per 

issue on an item of current interest written by a prominent member in that field. As we progress 

we’ll have a larger and larger collection of pertinent articles, accepted after undergoing a thorough 

review process by peers. Instructions to authors as to the process of manuscript creation and 

submission will be posted on the IPRAS website 

Each issue will have an interview with a “Pioneer” in a new and emerging pursuit in our specialty. 

Knowing that our Founders set up the organization to encompass the pillars of our specialty, 

Reconstructive Microsurgery, Hand, Burn, Aesthetic Plastic and Craniofacial Surgery, the 

planned interviews will incorporate all these interests, as well as some cross over pursuits such 

as IQUAM. Understanding that the future of any organization lies in the hands of its younger 

members our plan is also to feature a piece in each issue our “Star on the Horizon” about one of 

ours in the younger age group. We’ll feature a Safety and Warning section alerting members of 

recent items worthy of caution. 

Knowing full well the rapidity of change in all areas of endeavor we’ll work with the Website 

Committee to promote an interactive arena where members can go for comments or advice. 

Lastly, we want the IPRAS JOURNAL to be user friendly and rapid in its response to events of 

interest. We’ll strongly support a Letters to the Editor section and the Editor will respond when 

called upon. 

Your Editor-In-Chief is tremendously pleased, honored, and excited to be part of what is bound 

to be a significant arm in this revived body of this largest and to be most significant organization 

of plastic surgery in the world. 

Welcome to the IPRAS JOURNAL. 

Dr Thomas Biggs 

Editor in Chief’s 


I P R A S M A N A G E M E N T O F F I C E R E P O R T 

IPRAS Management Office Report 

01 January -31 June 2010 

Dear Members, 

From the first of January that we started working for 

IPRAS we are really enthusiastic and full of energy in 

order to achieve the goals of this year. 

Many honorable plastic surgeons are involved in 

IPRAS and serve its mission. But our goal for this 

year is all the members of IPRAS to get involved and 

be an active member of this Global Confederation. 

We want to welcome the new editor of the IPRAS 

Journal who as you all have noticed from this first 

journal is the amazing and always full of energy Tom 

Biggs. 

Welcome Tom! 

Every three months our visitors find a new issue of the 

IPRAS Journal. Our first priority is the continuous 

communication with our members in order to update 

them with the latest news about IPRAS, to inform 

them about the latest innovations in the 

field of plastic surgery or even to spread 

serious alarms like the P.I.P. alarm 

without delay. 

Till now we have collected the mailing 

list of 60 associations in order to 

achieve this target. So, for those, who 

have not yet sent the mailing list of 

their members, be so kind and help 

us to accomplish a more efficient 

communication. 

This means that we would like to 

achieve a constant and a direct interaction with IPRAS 

members. National Delegates as well as the individual 

members of every association are able from now 

on to be active members and promote the art and 

science of plastic surgery, to encourage education and 

research (especially in sections of IPRAS which need 

support like Pan African Section), and to encourage 

Our goal 

for this year 

is all the members 

of IPRAS 

to get involved 

and be 

an active member 

of this Global 

Confederation 

friendship among plastic 

surgeons and physicians of all countries all over the 

world. 

Particularly, the construction of the new IPRAS 

website satisfies the demands of this interaction with 

IPRAS members in the following ways: 

First of all every plastic surgeon has the opportunity to 

upload his/her profile, contact details, specialty as well 

as a link to his/her personal website on IPRAS website. 

A particular procedure has to be followed. We have 

sent to all of you the instructions. However, you may 

find all the instructions by visiting the IPRAS website 

(www.ipras.org). 

In that way the plastic surgeons can promote 

themselves through every patient who will visit the 

IPRAS website. Every plastic surgeon profile may be 

found by search through country and Specialty. One 

important notice is that the IPRAS website soon will 

get approximately 2.000.000 visitors 

annually. This is an opportunity that 

all of you have to take into serious 

consideration. 

Furthermore the new IPRAS website 

gives the opportunity to its members 

through the “forum” to exchange ideas, 

thoughts and experiences. 

So don’t hesitate to use the 

multifunctional and multipurpose 

IPRAS website!! 

You may also download the guidelines 

for the Associations who are interested in sending their 

bids for IPRAS world congresses. Every Association 

can find a fully updated list of logistics and criteria that 

every country must have in order to proceed to bid 

for a world congress. An important notice has to be 

underlined. The last day for accepting the bids of 2017 


IPRAS World Congress is on 24 th of September. 

Regarding 2010 budget the Management Office, 

in cooperation with the General Secretary Marita 

Eisenmann-Klein and our Treasurer Bruce 

Cunningham, elaborated and issued a realistic budget. 

New ways to increase IPRAS income have been found 

such us companies advertising through IPRAS website, 

income from the future events. We are quite confident 

that IPRAS will succeed in increasing its annual 

income as well as its activities. 

Furthermore IPRAS in order to promote plastic 

surgery specialty in Africa as well as in Arab Countries 

the General Secretary travelled Egypt, Qatar, 

Nairobi and Kuwait in order to promote together 

with the IPRAS mission, the aim of both congresses 

(Pan African congress in Plastic and Reconstructive 

Surgery and 12 th Conference of Pan Arab Association 

of Plastic Reconstructive and Burn Surgery). Another 

conference with a significant importance will take place 

in Bratislava. The “9 th IQUAM consensus conference” 

will take place in parallel with the “CEN meeting” in 

Promotion of IPRAS and its mission has been 

performed by the General Secretary Marita 

Eisenmann-Klein all over the world. She participated in 

congresses in: 

• Egypt, Sharm el Sheikh, 17 - 20 February 2010, 

National Congress of the Egyptian Society of Plastic 

Surgery 

• Brazil, Goania, Goias 10-13 March 2010, Jornada 

Centro Oeste de Cirurgia Plastica 

• China, Shanghai 14-18 April 2010, First Chinese- 

German Plastic Surgery Conference 

• Beijing, 17-18 April 2010, 1 st China Medical 

Women’s Congress 

• Uzbekistan, Tashkent, 12-14 May 2010, 2 nd 

International Central Asian Conference of Plastic 

Surgery 

• United Kingdom, Manchester, 27-29 May 2010, 

Annual meeting of EURAPS 

• Panama, Panama City, 1-4 June 2010, XVIII 

Ibero Latin American Congress of Plastic and 

Reconstructive Surgery 

• Turkey, Istanbul, 21-25 June 2010, International 

Society of Burn Injuries 

• Russia, St. Petersburg, 24-26 June 2010, 

International Plastic Reconstructive and Aesthetic 

Surgery Congress dedicated to the 200 Anniversary 

of N.I.PIROGOV 

order to declare a general consensus regarding safety 

rules towards plastic surgery procedures. 

The General Secretary will attend the following 

congresses later this year: 

20 Biennial Congress of ISAPS in San Francisco, 9th 

IQUAM Consensus Conference Bratislava, Annual 

ASPS Congress in Toronto, International Congress 

of Plastic, Aesthetic Surgery and Cosmetology of 

Georgia, along with the Third Congress of Plastic 

Surgeons of Armenia, Panafrican Section Congress 

in Nairobi, Congress of OSSC in Tokyo, Congress 

of the Korean Society of Plastic and Reconstructive 

Surgeons in Seoul, Congress of the Brazilian Society 

of Plastic Surgery in Vitoria, Congress of the Panarab 

Association of Plastic Surgery in Doha. 

In conclusion we would like to thank you for your 

cooperation with the Management Office. We are 

always at your disposal for any kind of productive 

collaboration. Please don’t hesitate to send us your 

comments. 

Proud to be an IPRAS member!! 

Zacharias Kaplanidis 

IPRAS Executive Director 

IPRAS Management Office 

Zita Congress 

Tel: +30 2111001770 - Fax: +30 2106642116 

e-mail: zacharias.kaplanidis@iprasmanagement.com 

URL: www.ipras.org 

Don't forget to visit the new IPRAS website!!! 


I N L O V I N G M E M O R Y 

Obituary Robert M. Goldwyn 

Plastic surgery has lost a giant. Robert M. Goldwyn passed away. 

Robert M. Goldwyn has been my hero since the early days of my 

residency: unforgotten his editorials in Plastic and Reconstructive 

Surgery, - full of wisdom, a unique sense of humour and a modesty, 

that reflected his greatness. 

His book on “The Patient and the Plastic Surgeon” is a perfect 

example of his outstanding talent to take a patient by the hand and 

guide him or her through the treatment. 

Working with Albert Schweitzer made him one of the first promoters 

of humanitarian responsibility in plastic surgery. 

Whatever he did he did it with love, - for his patients, his colleagues, 

his trainees and last but not least for his wonderful family. 

Robert M. Goldwyn was our editorialist and the first Hinderer 

Lecturer of IPRAS in 2007 in Berlin. Those who listened to him 

realized: he is one of the greatest we ever had in plastic surgery. 

Bob Goldwyn will be forever in our hearts. 

Marita Eisenmann-Klein 


H O N O R A R Y A W A R D 

Honorary Award 

Robert M. Goldwyn, M.D. 

Dr. Goldwyn was born in Worcester, Massachusetts 

in 1930. He attended Worcester Academy, Harvard 

College (A.B. 1952) and Harvard Medical School 

(M.D., 1956). 

He did his internship and residency in general surgery 

at the Peter Bent Brigham Hospital in Boston from 

1956 to 1961. During this time, he was the Harvey 

Cushing Fellow in Surgery at Brigham Hospital and 

Dr. Albert Schweitzer’s surgeon in Lambarene, Gabon. 

His plastic surgical training was at the University of 

Pittsburgh Medical Center from 1961 to 1963. He 

returned to Harvard Medical School, became Senior 

Surgeon at the Brigham Hospital and at the Beth Israel 

Hospital, where he was Chief of the Division of Plastic 

Surgery from 1972-1996. Since 1979, he has been the 

Editor of Plastic and Reconstructive Surgery and has 

authored or o-authored more than 300 articles and 

has edited several books: The Unfavorable Result in 

Plastic Surgery: Avoidance and Treatment (now in its 

third edition), Reconstructive Surgery of the Breast, 

Long-Term Results in Plastic and Reconstructive 

Surgery, Reduction Mammaplasty. He has written 

The Patient and the Plastic Surgeon (two editions) 

and The Operative Note, a collection of his editorials, 

as well as a book for the general public -- Beyond 

Appearance: Reflections of a Plastic Surgeon. With 

J. Saxe as translator, he wrote an introduction to G. 

Baronio’s Degli Innesti Animali, 1804 (On Grafting in 

Animals) and for the first complete English translation 

by J. H. Thomas, a facsimile edition, of G. Tagliacozzi’s 

De curtorum chirurgia per insitionem, 1597, (On the 

Surgical Restoration of Defects by Grafting.) 

Dr. Goldwyn was President of the Massachusetts 

Society of Plastic Surgeons, the New England Society 

of Plastic Surgery, the American Association of Plastic 

Surgeons, which made him an Honorary Fellow, and 

the Harvard Medical Alumni Association. 

In 1972, he founded the National Archives of Plastic 

Surgery, housed at Harvard Medical School and has 

since served as Chairman of the Archives Committee 

of the Plastic Surgery Educational Foundation. 

He was a founding member of Physicians for Social 

Responsibility and has written articles on world peace, 

opposition to chemical and biological warfare and on 

medical ethics. 

He has been Visiting Professor to more than 70 

institutions, universities and hospitals in this country 

and abroad and is an honorary member of more than 

a dozen national and international societies of plastic 

surgery. 

His other awards include the Diffenbach Medal, the 

Honorary Kazanjian Lectureship, Clinician of the 

Year of the American Association of Plastic Surgeons, 

the Special Achievement Award and the Presidential 

Citation of the American Society of Plastic Surgeons. 

He has also received recognition for his teaching and 

writing. 

In 2007 he was the first Hiderer lectures of IPRAS. 


S U R V E Y R E P O R T 

Personal recollections of a life 

dedicated to plastic surgery 

Like most surgeons of my generation, it was difficult to 

learn plastic surgery in a single department. In fact, 

in Brazil this medical specialty did not even exist. 

Therefore, I endeavored on a long journey through numerous 

centers in the U.S.A. and Europe, which would last the better 

part of the 1950´s. I was granted a scholarship by the Institute 

of International Education and was privileged to be a resident 

in the surgery department at Bethesda Hospital, Cincinnati, 

Ohio, under the supervision of Prof. John Longacre. 

A rotation to several other services led me to the Mayo 

Clinic in Rochester, New York and to Dr. John Marquis 

Converse. In Europe, I visited with Dr. Paul Tessier who 

was then fully occupied with the creation of the specialty 

of craniofacial surgery. Dr. Marc Iselin took me in as an 

“assistant étranger” at the Hôpital Americain in Paris, where 

I was taught the finer details of hand surgery. My stay in 

France included the Maison Departamentelle de Nanterre 

and also the Faculté de Médicine de la Univesité de Paris, 

under the supervision of Prof. Aubry. 

In England, I was invited to be a visiting surgeon by Prof. 

Kilner in the Churchill Hospital, Oxford. I then stayed at the 

Park Prewet Hospital in Basingstoke, under the supervision 

of Prof. Harold Gillies. Finally, Sir Archibold MacIndoe was 

very kind to accept me as an observer at the Queen Victoria 

Hospital, in East Grinstead. 

This extensive learning experience also included the 

acquaintance of the following surgeons: Prof. Rangell in 

Stockholm, Sweden; Dr. Schmidt, in Stuttgart, Germany; 

Drs. Tubiana and Morel-Fatio in Paris; and Dr. Malbec, in 

Buenos Aires, Argentina. 

Once I returned to Brazil I founded the first Service in 

Hand Surgery in Latin America, at the Santa Casa General 

Hospital of Rio de Janeiro (a charity institution founded over 

four hundred years ago by the Portuguese missionaries). I 

also became head of the Department of Burn Injuries and 

Trauma Surgery. However, I soon realized that it was difficult 

to practice what I had learned, because surgeons at that time 

did not give the necessary importance to plastic surgery. To 

further the cause of this nascent specialty, I decided to become 

involved in the training of young surgeons. 

Here are a few of my recollections that guided my first steps: 

Sir Harold Gillies emphasized the importance of 

commitment to research. He stated that “research is the 

result of observation. The more one observes, the more one 

accumulates experience and improvement. From then on, 

one has the chance of finding ‘the key’, which is an original 

technique that will help minimize difficulties and will bring 

solutions to even the hardest cases. Other than that, there 

are no miracles!”. 

Marc Iselin showed me the French spirit, the Cartesian side 

of life and the curiosity without limits. 

McIndoe was an outstanding surgeon, and taught me his 

knowledge and the technique of aesthetic surgery. 

Kilner showed me how to operate on cleft lips and other 

types of congenital deformities. 

Looking back on these giants of plastic surgery, I can affirm 

that the progress of humanity only occurs when the ones that 

follow us are capable of improving our results. To teach has 

been my perennial mission since those early days. 

The practice and teaching of plastic surgery became a reality 

in 1959 when, together with a close group of collaborators, 

we founded the 8 th Ward, later to be called the 38 th Ward, 

of the Santa Casa da Misericórdia General Hospital (SCM) 

in Rio de Janeiro. In this charity institution, poor patients 

from the city, and from other states of Brazil, come to seek a 

remedy to their problems. There was no shortage of people 

of all ages bearing congenital and acquired deformities, and 

our difficulty was to attend to these patients within the limits 

of a meager institution. 

The opportunity to create an academic course occurred 

in 1960, when this public infirmary was affiliated to the 

Pontifical Catholic University of Rio. This was the beginning 

of our Post-graduation Course in Plastic Surgery. Much later, 


we would expand our academic ties with the Carlos Chagas 

Institute of Post-Graduate Medical Studies. 

Since its beginning, it has been emphasized that surgeons 

that train in plastic surgery should be taught that the 

specialty involves a broad commitment to both reconstructive 

and aesthetic surgery. The graduation of the first class of 

residents was in 1962. 

A tragedy of huge proportions occurred on December 

17 th , 1961, when a circus full of children, the Gran Circo 

Norteamericano, caught fire, taking the lives of more than 

500 people, and leaving over 2,500 victims. This was to be 

the largest indoor fire ever. Together with my first team of 

trained residents, the burn victims received a comprehensive 

treatment. This event aroused the interest of the Brazilian 

community to the social importance of plastic surgery. 

In 1963, the Ivo Pitanguy Clinic was founded and was 

integrated to the Plastic Surgery Department of the 

Pontifical Catholic University. In this manner, we were able 

to give our residents training both in the public service as 

well as in the private setting. In 1964, the first extension 

course in Plastic Surgery, sponsored by the University of 

Brazil (now the Federal University of Rio de Janeiro) was 

held at the Clinic. This initiative served to attract the interest 

of the academic medical community to the many aspects of 

plastic surgery. 

The Ivo Pitanguy Study Center was then established, with 

the aim of aggregating the cumulative experience of the 38th 

Ward of SCM to the private clinic, significantly enhancing 

the scientific research of the post-graduate students, and thus 

becoming a valuable instrument for clinical research. 

The duration of the post-graduate course in plastic surgery 

is three years (1,890 hours), with full-time academic, clinical 

and surgical activities. This is done in a rotation system, 

divided in 18 blocks. External rotations (ie. in other hospitals 

outside SCM and the Clinic) are done for a period of two 

months in specialized areas of plastic surgery: reconstruction 

following oncological surgery (the National Institute of 

Cancer); microsurgery (the Hospital dos Servidores do 

Estado, a state hospital); pediatric plastic surgery (at the 

Jesus Municipal Hospital); burn care and rehabilitation (the 

Andaraí Hospital); craniomaxillo surgery (the Santa Cruz 

Hospital). This program has graduated young surgeons from 

all states of Brazil and more than 40 countries, and was 

officially approved by the Brazilian Society of Plastic Surgery 

in 1973 as a formal training program. Up to December 

2009 our course has graduated 542 young plastic surgeons, 

has received 758 fellows and has hosted over 5,000 visiting 

surgeons from all over the world. 

Through my personal efforts and the collaboration of the 

teaching staff and residents, working in the Ivo Pitanguy 

Study Center, scientific papers have been regularly 

published in the Brazilian medical community and in foreign 

publications: 

• 980 articles published in Brazilian and international 

literature 

• 54 book chapters published in Brazilian and international 

literature 

• 15 books 

• 48 prefaces published in Brazil and other countries 

• 1,978 conferences in Brazil and other countries. 

A final contribution to the training of our specialty was the 

creation of the Alumni Association of Prof. Ivo Pitanguy 

(AExPI) in 1974, with the aim of congregating present and 

past residents, in regular scientific meetings and continuous 

exchanges. International meetings have taken our school 

of plastic surgery to Berlin, Athens, Casablanca and Rome. 

Regular events have occurred in Brazil, and have proven to 

be valuable to the exchange of scientific ideas and to renew 

old and new friendships. 

In my almost 50 years of experience in teaching, I 

have accompanied the evolution of the International 

Confederation of 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 pursued 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 pursuing 

our common philosophy, which is train surgeons who will 

be capable of practicing plastic surgery, with its diverse and 

multiple 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. 

Ivo Pitanguy, MD 

Founding member I.P.R.A.S. 

Head-Professor of the Plastic Surgery Departments of the 

Pontifical Catholic University of Rio de Janeiro and the Carlos 

Chagas Institute of Post-Graduate Medical Studies. Member of 

the Brazilian Society of Plastic Surgery, 

the National Academy of Medicine, 

and the Brazilian Academy of Letters. 

Visiting Professor, I.S.A.P.S. FICS, FACS. 


I N T E R V I E W : P I O N E E R S 

Dr. Roger Khouri 

Dr. Biggs: Jose Guerrerosantos and Abel Chajchir and 

others have been using fat grafting for years but it’s never 

caught on in routine clinical practice. You seem to have 

developed something with which you’re having significant 

success. Can you explain this? 

Dr Khouri: Well, those men were great pioneers, 

as is Juan Cardenas from Colombia, Gino Rigotti 

from Verona, Emmanuel Delay from Lyon, and Syd 

Coleman from New York. My particular contribution 

has been in high volume grafting to the breast, which is 

different from the face or the buttock. 

Dr Biggs: How is it different? 

Dr Khouri: The face is a highly vascularized area 

requiring small volumes whereas the breast is just the 

opposite. 

Dr. Biggs: I’ve heard you speak and seen remarkable long 

term results. How do you account for this? 

Dr Khouri: Think of the farmer. What does he do for a 

successful crop? 

First he has to make sure his field is large enough to 

accept all the seeds he wants to plant. He also plows it 

so as to have a recipient site suitable for the plantings 

to survive. He can’t just throw seeds on hard dirt or 

cram tight large quantities in a small plat and expect 

them to survive. 

Second, he acquires his seeds or his plantings and he 

does so in a fashion so as to render as little damage as 

possible. After that he prepares the plantings, getting 

rid of leaves and debris that will interfere with survival 

and growth of the plants. 

Third comes the planting. He carefully sows the seeds 

in a manner that is optimal for growth. He knows he 

has to disperse them in the plowed field, such that 

each seed is surrounded by good soil. Seeds trapped in 

clumps die instead of sprouting. 

Fourth, he protects the vulnerable plants or seedlings 

until they’re sufficiently stable and can survive on their 

own. 

This is simply the process of a successful farmer and 

exactly what we do. Any deficiency along this orderly 

series of steps and the process will fail. Each of the four 

steps has to be optimized since the deficient one will 

be the bottleneck and cause failure. Because of this 

“weakest link” phenomenon, maximizing one step will 

not overcome the rate-limiting effect of the deficient one. 

Dr. Biggs: That’s a clear approach, but what do you do 

specifically to follow this process? 

Dr Khouri: For recipient site preparation I use the 

Brava system (an externally applied bra-like device 

that uses negative pressure to expand the breast and 

increase its vascularity). I get my patients to wear it for 

about three weeks, ten hours per day; most women get 

used to sleeping with it. We have absolute proof that 

this significantly increases the space and the vascularity 

into which we put the grafts. We have many pre and 

post Brava MRIs to show it. 

Dr. Biggs: How do you decide when the patient is ready 

for grafting? 

Dr Khouri: For cosmetic breast augmentation, I like 

to see the patient at least double her original breast 

volume and preferably triple it. Our series has shown 

that the single most important determinant of final 

long-term breast augmentation volume is the pregraft 

volume increase generated by expansion with a 

linear dose response curve and a 0.8 slope. This means 

that the final breast augmentation volume is usually 

smaller than the breast volume the patient achieves 

herself through Brava wear. This is important as it 

makes the patient responsible for her outcome. The 

larger she presents at the time of surgery, the larger 

her augmentation. Compliance is a major issue here. 


For a good expansion, the patient has to be compliant 

with the wear of the device and her tissues have to 

be compliant. Breasts pre-expanded by previous 

pregnancy and breast feeding will expand better than 

the tighter AA cup of a young nulliparous woman 

which in turn will expand better than the radiated 

mastectomy defects. 

Dr. Biggs: Ok, now that the recipient field is well 

prepared, what do you do to acquire the fat seeds for 

grafting? 

Dr Khouri: We feel it’s imperative to be as atraumatic 

as possible. We use a special syringe with a spring 

that maintains a constant vacuum suction of one-third 

atmosphere (250 – 300 mmHg). Others have shown 

that anything over one half an atmosphere damages 

cells. We also found that, while amply compensating 

for the lower vacuum force, increasing the number of 

holes in the cannula improves harvesting efficiency. 

Our preferred cannula is 12 gauge (2.7 mm), with 

twelve 1x2mm side holes. 

Dr. Biggs: What do you do to prepare the fat for grafting? 

Dr Khouri: I don’t use a centrifuge. Instead I use a 

hand operated spinner that spins at 300 RPM creating 

a G force 100 times lower than standard centrifuging. 

By preparing the fat this way we create loose slurry 

rather than a compacted paste and therefore we avoid 

injecting clumps. In order to further protect the seeds, I 

use a totally closed system so that the fat I suction in the 

spring loaded syringe goes through a valve directly into 

a bag that’s put into the spinner; and after spinning we 

drain out the sediment fluid and accumulate the fat to be 

injected in the bags. We graft the fat directly from these 

bags by connecting them to the injection syringe with a 

tube and a special non-clogging valve. So it’s a totally 

closed system throughout the entire process that is 

protected against room air contaminants and drying out. 

This way we also avoid having to constantly disconnect 

the cannulas, switch syringes, transfer fat from syringe to 

syringe, and accumulate racks on the side table. When I 

started fat grafting the breast five years ago the method 

then was inefficient and a bilateral augmentation used 

to take me in excess of 4-5 hours. This was prohibitive, I 

had to streamline the process, I therefore developed this 

closed system to predictably perform the procedure in 

less than two hours. 

Dr. Biggs: You’re now ready for grafting. What special 

techniques do you use? 

Dr Khouri: At this point I employ the brilliant 

concepts of diffuse microdroplets grafting popularized 

by Syd Coleman. I inject the fat while retracting a 

gently curved 15 or 25 cm long cannula connected to 

a 3 or 5 ml syringe. The cannula is 14 Gauge (2.4 mm) 

with a single side hole and essentially leaves no scar 

at the entrance site. That way, going through multiple 

puncture sites, fanning out in multiple angles and at 

multiple depths, I leave behind thin rows of fat that 

create a three-dimensional weave. Other than the gland 

itself I inject everywhere being careful not to inject 

anywhere in the same place twice. I need about 1,000 

cc. of aspirate to inject 350 cc into each breast and 

expect a decrease over time of about 10-20 %. 

While it is very tempting to keep on filling the breast 

with more fat, it is crucial to avoid overgrafting. I gauge 

the amount of fat I can safely graft by the amount of 

space the patient has given herself through external 

Brava expansion at the time she walks into the operating 

room. Grafting beyond the capacity of the recipient 

leads to crowding, increases interstitial pressure and 

eventually leads to total graft failure. It is important to 

stay well below the level of increased tissue turgidity. In 

a well-expanded breast I can diffusely graft 400 – 500 ml 

of fat and keep it soft, something one could not achieve 

without Brava expansion. 

Dr. Biggs: What’s your post op regimen? 

Dr Khouri: It’s very simple. Many patients are done 

as outpatients and they go home with a small bandage 

to deal with the minimal oozing from the multiple 

injection sites, and the next day I put them back on 

the Brava for six weeks, though the 10 hours per day 

regimen is not that stringent at this stage. Rigotti has 

shown the necessity of this. He feels, and I agree, that 

this phase has massive importance not only in acting as 

a stent to immobilize the grafts, but also by holding the 

space open, acting like a multitude of tissue chambers 

like the ones experimentally demonstrated by Wayne 

Morrisson to stimulate fat growth. 

There’s a gentlemen’s argument going on as to what 

actually incorporates the eventual grafted tissue… In 

the traditional engraftment hypothesis, the injected 

live adipocytes survive by plasmatic imbibition untill 

they revascularize in a mechanism similar to skin graft 

survival. Others, including Gino Rigotti, hypothesize 

that all the injected fat cells die and that the endemic 

mesenchymal stem cells present in the injected 

lipoaspirate step up to their regenerative role and 

differentiate into new fat. 

While I do not have the pretense to know what is 

really happening, I favor the traditional engraftment 

hypothesis because it conforms to well-established 


surgical principles. However, it is very likely that to 

a certain extent, both mechanisms act together in 

concert. Bottom line, I’m a clinician…. I know how to 

make a skin graft work but can’t get into the complex 

detailed cellular and molecular biological pathways 

of what really makes it work. I simply know that by 

conforming to the surgical principles, it works. I like 

to think of myself as the good farmer who empirically 

found a way to promote the survival of large amounts 

of fat while leaving the complex basic scientific 

elucidation to the non-farmer laboratory scientists. 

Not knowing the molecular mechanisms behind seed 

sprouting does not prevent the good farmer from 

having a successful crop. 

Dr. Biggs: The ASPS was against fat grafting to the 

breast. How do you deal with this? 

Dr Khouri: They were against it for two reasons. One 

was efficacy, the augmentations published by Bircoll 

in 1987 were modest at best, while the augmentations 

we can predictably achieve today with our technique 

are comparable to implant augmentations. Second was 

micro calcifications interfering with the diagnosis of 

cancer on mammograms. Radiologists are outspoken 

now as to the fact that our flaps and reduction 

mammoplasties also cause calcifications and that they 

now have the understanding and the tools to tell the 

difference between cancerous calcifications and fat 

necrosis calcifications. What makes me especially 

happy is I have four female radiologists in my series. 

Knowing the alternatives, these intelligent and wellinformed 

women selected fat grafting. 

Regarding cancer, Gino Rigotti has over 1,000 patients 

in his series and has seen very little cancer. He has a 

controlled series recently approved for publication 

in APS that compares two groups of patients both in 

a high likelihood for cancer (post op mastectomy for 

cancer) . He found very little difference in the grafted 

cohort than the non grafted. This gives us scientific 

support to what was before anecdotal impression. 

Dr. Biggs: How do you see this work affecting breast 

reconstruction? 

Dr Khouri: I’ve done hundreds of free flap breast 

reconstructions. In these, I take a block of tissue, divide 

it from its original blood supply, and reconnect the 

blood vessels at the recipient site. With Brava external 

expansion and fat grafting I have moved towards a 

radically new concept: tissue regeneration instead of 

tissue transfer. 

The “holy grail” of tissue engineering is a three 

dimensional vascularized scaffold that can be seeded 

with cells. Current tissue engineering is limited to 

a few cells thick sheets because of our inability to 

provide bulkier constructs with the functional vascular 

network needed for their survival. Brava external 

expansion generates in situ a huge three-dimensional 

scaffold that is very well vascularized. Seeding this large 

three dimensional framework with fat microdroplets 

generates, just where it is needed, the tissue equivalent 

of a transferred distant flap without any incision, any 

foreign material, or any vascular anastomosis. 

The degree of patient satisfaction with this regenerative 

approach, is much higher than the autologous free 

flap. Our post mastectomy patients truly feel they have 

recovered the breast that they lost, it is sensate, it is like 

their breast has gradually grown back again… 

Dr. Biggs: What are the important points you’d like the 

reader to take home after reading this interview. 

Dr Khouri: I want them to know fat grafting is real 

and it works. It’s minimally invasive, has minimal 

complications, leaves no scars, and is useful all over 

the body. In the breast it’s aided massively by the 

Brava system and can be used in all forms of breast 

problems….augmentation, correction of deformities, 

and total reconstruction. It probably won’t replace 

the breast implant for augmentation but is especially 

effective in the otherwise impossible congenital 

deformities, in the patient with severe capsular 

contractures and in the post irradiation deformities. 

We’ve seen numerous patients relieved from constant 

pain and some actually having regained sensation in 

previously numb areas. 

Something we’ve not mentioned is the improvement 

in the donor site. Virtually all of our patients have 

commented on their joy at seeing improvement in their 

hips, thighs, and abdomens. 

Dr. Biggs: Do you think this is a passing fad in plastic 

surgery? 

Dr Khouri: I think fat grafting will become one of 

the primary tools in not only the plastic surgeon’s 

armamentarium but in that of all surgery. The 

neoangiogenesis and possibly neoneurogenesis will 

become a great asset in many cases…..and many 

lives will be made better, but isn’t that our role as 

physicians? 

Dr. Biggs: Thank you, Dr Roger Khouri. 


I N T E R V I E W : S T A R S O N T H E H O R I Z O N 

Dr. Ozan Sozer 

Dr. Biggs: Dr. Sozer, we’re seeing your name more and 

more as a speaker in various parts of the world and 

seeing publications by you. Tell us a little bit about your 

background and what you’re doing now that has attracted 

so much attention. 

Dr.Sozer: I’m originally from Turkey but came to the 

U.S. after medical school. I did a full general surgery 

training at the University of Texas in Houston, a year of 

microsurgery fellowship at St. Joseph’s then two years of 

plastic surgery also at St. Joseph’s in Houston. I returned 

to Turkey for two years working with Onur Erol, then 

emigrated permanently and began my practice in El 

Paso, Texas, where I work now. Initially my practice was 

general in nature….I covered every emergency room 

in the cityand did general plastic surgery with a lot of 

free flaps, but gradually evolved into more and more 

aesthetic surgery, especially body contouring. 

Dr. Biggs: Why was body contouring so significant ? 

Dr. Sozer: There was a lot of demand. The Hispamic 

culture is very much into aesthetic surgery. The women 

have early pregnancies and lose their figures. 

Dr. Biggs: What is it about your body contouring work 

that’s attracted so much attention? 

Dr. Sozer: I can’t answer that exactly, but I do know 

that as I did more and more I found that I could work 

efficiently and with team effort do more and more at 

one sitting. 

Dr. Biggs: What do you mean,”more and more” ? 

Dr. Sozer: I began doing liposuction with all my 

abdominoplasties. I found if I left 1.5 to 2.0 centimeters 

on the flap I could suction the whole flap. 

Dr. Biggs: Did you preserve the perforators ? 

Dr. Sozer: No, but I was careful to leave that fat on the 

flap. No superficial liposuction. I’ve done over 200 that 

way and have never had any necrosis. 

Dr. Biggs: What els do you do that’s different. 

Dr. Sozer: I do a breast reduction or mastopexy then 

an abdominoplasty along with appropriate liposuction. 

Then, when things were going smoothly I move to the 

hips and thighs. If I were doing a total body sculpting 

I would begin with the patient in the supine position 

before doing the anterior body. Working as a team, 

two surgeons, each with an assistant, we operate 

simultaneously. I also follow the teachings of Jean 

Francois Pascal and am careful to leave the lymphatics 

intact with my initial incision in abdominoplasty…. I 

incise in a cephalic direction. This is very important and 

avoids seromas. 

D. Biggs: Were you doing things differently with the 

butrtocks ? 

Dr. Sozer: Yes, definitely. I do a myocutaneous flap 

based inferioly and fold it over to give fullness to the 

mid portion of the buttocks. I have some drawings to 

demonstrate this (see drawings ). 

Dr. Biggs: How about the arms? 

Dr. Sozer: Again like Dr. Pascal, I do a complete 

liposuction then excise redundant skin. 

Dr. Biggs: And the thighs ? 

Dr. Sozer: I follow the teachings of Lockwood. I do a 

liposuction followed by skin excision, then anchor to 

the periosteum of the pubis. 

Dr. Biggs: What do you see in the future for body 

contouring ? 

Dr. Sozer: More of the same with team work creating 

more surgery in less time using the team approach, 

then add in lipografting where indicated. With the 

great rise in obesity I feel this is a field that can only 

grow. 

Dr. Biggs: Thank you Dr. Sozer. 



The status of body conturing 

for the massive weight loss patient 

Joseph P. Hunstad 

Body conturing for the massive weight loss 

patient has become an area of keen interest and 

innovation for plastic surgeons. In reality, it has 

assumed the status of a subspecialty in itself. 

For patients to experience the great success of massive 

weight loss from either self determination or bariatric 

surgery and yet be faced with the body sequelae of 

loose redundant skin, hygiene problems, and an overall 

disturbing appearance has created a great deal of 

patient derived impetus towards the creation of safe 

and effective methods to rejuvenate the massive weight 

loss patients' body. When patients experience the 

success with weight loss, yet are presented with their 

body which often resembles a melted candle, they are 

very disturbed and motivated to seek care to correct 

this. 

The keystone procedure for all post massive weight 

loss body contouring procedures is the body-lift itself. 

The body lift, refer to by some as a belt lipectomy 

or circumferential abdominoplasty, achieves a 

circumferential body rejuvenation that dramatically 

improves the contour and shape of the abdomen, 

flanks, and buttocks. The body lifting procedure also 

improves the tone and shape of the anterior thighs and 

when properly utilized can improve the buttocks ptosis 

and atrophy as well. This technique has improved 

dramatically since the original description by Gonzalez- 

Ulloa. Instead of a panniculectomy or gross resection 

of tissues, attention to detail and focus to achieve 

the maximum aesthetic result and contour has been 

implemented by many plastic surgeons who focus 

on post bariatric body contouring. Elements of this 

procedure that have enhanced the final result include 

a very strong myofascial plication which returns the 

abdominal wall musculature to a point that achieves 

a beautiful silhouette enhanced waistline and a 

flattened abdominal contour. Concurrent liposuction, 

when indicated, throughout the areas of residual 

fullness further enhances the final shape and outcome 

delivering an enhanced silhouette and shape. When 

abdominal expansion has been significant, not only 

vertically but in a transverse plane, a fleur de leis type 

procedure also provides outstanding circumferential 

tightening. 

A common denominator to post massive weight loss 

body contouring is that "Patients tolerate a long scar 

for an excellent result." This fact has been documented 

and demonstrated by plastic surgeons performing 

these procedures globally. When patients look 

excellent in clothing, the underlying incisions become 

inconsequential. 

Once the foundation or keystone for all body 

contouring procedures following massive weight 

loss has been completed, the other areas need to be 

addressed. The treatment of the arms by extended 

brachioplasty which can even include the forearm, 

the entire arm, the axilla, and including the lateral 

redundancies and fullness of the chest and breast area 

can be safely performed to achieve a smooth even 

contour with delivery of markedly improved tone and 

shape to the arms. It is gratifying and impressive how 

many patients who have undergone brachioplasties feel 

comfortable in wearing sleeveless attire because of the 

shape of their arms has been so improved. The breasts 

often are extremely flaccid, flat, and long. Usually, with 

a complete weight loss patient, an implant is necessary 

as well as a full mastopexy. Techniques that utilize the 

redundant tissue, particularly in the lateral chest area 

and breast area for autologous breast augmentation 

have become increasingly popular and are desirable 

because the tissues rotated into the breast are well 

vascularized and create and autologous augmentation. 

Results with this procedure have been quite significant 

and gratifying for both the surgeon and the patient. 

The upper back area remains a significant challenge 

because of the forces that are put into play with the 

body lift and lower abdomen are not transmitted to 


the upper back because of the strong midline zone of 

adherence. The upper back lift also coined by some 

as the "bra-line back lift" has been highly effective in 

completely contouring the entire back removing the 

lateral folds and rolls and excising redundant skin 

from the inframammary fold in the anterior axillary 

line from one side completely across the back to the 

other. This technique creates a dramatic improvement 

with complete elimination of redundant rolls and folds 

providing the patient with a smooth lateral silhouette 

that is attractive and allows patients to wear form 

fitting clothing which previously was simply impossible. 

The inner thigh lift is usually not an adequate 

procedure for the massive weight loss patient. A 

vertical thigh lift, however, can provide a dramatic 

improvement in the contour of the thigh with a final 

incision line in the inner aspect of the thigh often 

going down to or even below the knee. Concurrent 

liposuction can be performed particularly for patients 

who have under experienced incomplete weight loss 

and this can be done in combination with a vertical 

resection. The vertical resection can be 'spiraled' 

upward as well joining the body lift incision to give 

further lifting and tightening of the superior anterior 

thigh. The thigh lift can even be extended below the 

knee contouring the calves as well. A notch at the 

level of the knee or Z-plasty is necessary to avoid a 

scar contracture across this joint just as one place as 

a similar notch or Z-plasty across the axilla or elbow 

when performing and extended brachioplasty. 

The buttocks is an important area for consideration. 

With the traditional body lift or circumferential 

abdominoplasty, all redundant tissues across the 

buttocks were excised and the buttocks achieved 

excellent elevation but frequently was noted to be 

somewhat flattened and atrophic. Instead of discarding 

this buttocks tissue, it can be deepithelialized, elevated, 

and rotated as a variety of flaps or sutured at the level 

of the superficial fascia to create a central mount, all of 

which add volume to the buttocks. The lower buttocks 

skin is an elevated and a pocket created above the 

gluteus muscle to accommodate this autologous tissue. 

This achieves a buttocks lift with simultaneous return 

of volume correcting atrophy and projection with lift 

being correcting ptosis. 

Finally the face, which is addressed more unusually 

than the other areas following massive weight loss, can 

occasionally be the number one focus of patients who 

would like to see this improved initially. All of the 

current methods of facial rejuvenation can be employed 

successfully to eliminate platysmal bands correct the 

laxity and fullness of the neck, tear trough, marionette 

line, strong nasolabial folds, tear troughs, and create 

rejuvenation with the currently available methods of 

forehead, eyelid, facial, and neck rejuvenation. Timing 

is an important question when it comes to caring for 

the massive weight loss patient. For those patients, 

who wish to undergo all the procedures for the body, 

breast, arms, back, and thighs, this procedure is often 

staged. It has been performed as a single procedure, 

but is somewhat controversial because the length of 

time is very significant, often extending for greater 

than 10 hours and requiring simultaneous work by 

a number of teams. More typically, particularly in 

a private esthetic practice, these procedures are 

staged. Most commonly, the body lifting is performed 

initially, which is the keystone of post massive weight 

loss body contouring. At a second stage, the arms, 

breast, and thighs can be addressed safely in a single 

setting. The back can be performed with the body 

lift or in combination with other procedures. The 

facial rejuvenation is usually performed as an isolated 

procedure because it can often involve all aspects of 

facial rejuvenation of the forehead, lids, face, and neck. 

Having performed my first body lift at 1988, I have seen 

an incredible evolution in post massive weight loss body 

contouring with wonderful contributions by thoughtful 

and clever plastic surgeons worldwide. Techniques 

are continually been conceived and advanced for our 

consideration to further improve patients results and 

safety. 

I apologize for any exclusion but would like to 

acknowledge physicians who have recently contributed 

to this field. 

Dr. Ally, Dr. Hurwitz, Dr. Rubin, Dr. Pitanguay, Dr. 

DeSouza Pinto, Dr. Hebel, Dr. Suldahna, Dr. Graf, Dr. 

Matassaro, Dr. Saves, Dr. Lockwood, Dr. Richter, Dr. 

Pascal and Dr. Downey. 

Joseph P. Hunstad 

M.D., F.A.C.S. 

TAD 


S UE R V E Y R E P O R T 

Current Status of HA Fillers 

and Radiesse 

(next report on permanent fillers and toxins) 

Brian M. Kinney 

Introduction 

Fillers are becoming increasingly important to the 

practicing plastic surgeon. Cosmetic non-invasive, 

minimally invasive procedures have grown 99% from the 

year 200 to the year 2009 in the US according to statistics 

from the American Society of Plastic Surgeons in a news 

release of April 27, 2010 (http://www.plasticsurgery.org/ 

Media/Press_Releases/ASPS_Reports_Cosmetic_Plastic_ 

Surgery_Down_In_2009_Up_69_In_First_Decade_of_New_ 

Millennium_.html). Injection of botulinum toxin type A 

leads the way with 4.8 million procedures. 

While accurate statistics are not available in many 

countries, it is safe to say the interest has exploded 

worldwide. This trend predates the worldwide economic 

downturn that started in late 2008. In my clinical practice 

patients prefer to avoid surgery if possible and begin 

interventions at a younger age. The public acceptance 

of cosmetic surgery has reached 48% as reported by the 

American Society for Aesthetic Plastic Surgery in a March 

9, 2010 press release (http://www.surgery.org/media/newsreleases/almost-half-of-americans-approve-of-cosmeticplastic-surgery-regardless-of-income). 

We all know this is true; now we have new data to 

confirm our clinical impressions. 

ASPS Statistics (April 27, 2010) 

Botulinum toxin type A 

4.8 million 

Soft tissue fillers 

Chemical peel 

1.7 million 

1.1 million 

Microdermabrasion 910,000 

Laser hair removal 893,000 

Meanwhile cosmetic surgical procedures decreased 9 

percent year over year and are down 20 percent since 2000. 

Breast augmentation 289,000 

Rhinoplasty 256,000 

Eyelid surgery 203,000 

Liposuction 198,000 

Abdominoplasty 115,000 

The competition in the filler market has gone from active 

to torrid. Many plastic surgeons may simply choose a 

product based on advertising, price, or personal preference. 

Average results may be obtained by injecting any of perhaps 

a dozen products; however, understanding fine details is the 

difference between those average results and excellence in 

clinical outcomes, complementing our surgical results and 

growing our practice. Making an intelligent choice based on 

logical clinical analysis, patient anatomy and filler chemistry 

is far more difficult than it would first seem. Not only are 

average results “average,” but they may be obtained with a 

modest amount of effort. Excellent results require much 

more. When only a few preparations were available, the 

choices were not so bewildering. Now they potentially are 

and command our attention. 

While ten years ago, a few countries like Italy enjoyed the 

benefits of a dozen or more products, now most plastic 

surgeons in the world are beset by as many as several 

dozen choices. Hyaluronic acids (HA’s) dominate our 

clinical use for good reason - they really do work well, 

they’re similar to naturally occurring HA and are generally 

safe. In a brief overview, it is not possible to discuss all of 

them in detail. Here is a quick reference for commonly 

available and widely used fillers. 

Adverse Events Common to All Injectables 

Minor adverse events common to all injectables like pain, 

erythema, tenderness, itching, bruising and asymmetry 

that occur in the low single digit rate, generally less than 

5%, are relatively straightforward to manage. Treatment 

may range from ice and makeup to a minor touchup 

injection 10-14 days later. 

Significant adverse events common to all injectables like 

nodule formation, hematoma and inflammatory reaction/ 

skin slough are much rarer, less than 1% to less than 

0.1%. Treatment for nodule formation generally includes 

either hyaluronidase or steroid injection. Hematoma 

often responds to simple massage or needle aspiration. 

Inflammatory reaction may potentially leave a permanent 

scar and requires multi-modal therapy, often consisting of 

hylaronidase, steroid, antibiotics and rarely incision and 

drainage with healing by second intention. 


Company Q-Med AB (Uppsala, Sweden) 

Family of Three Products 

Restylane – this is the product launched in 1996 in 

Europe that pioneered and popularized HA fillers. 

Long considered the gold standard, there are many 

other competitors in the marketplace today. It was 

approved in the US in 2003, and in China in 2009. Like 

all the currently available products this is a non-animal 

stabilized hyaluronic acid (NASHA) cross-linked with 

1, 4 butanediol diglycidyl ether (BDDE), which contains 

100,000 gel beads per ml, is hydrophilic and its metabolic 

by-products are water and carbon dioxide. Like all the 

HA’s Restylane’s breakdown is isovolumetric, thus it 

retains much of its initial volume during degradation, 

which takes about nine months in the nasolabial fold. 

Over 11 million injections have been carried out around 

the world. A lidocaine-containing preparation is now 

available in most locations. 

Perlane – this product is chemically identical to 

Restylane, but contains larger particles and only 8000 

beads per ml. Generally it is injected deeper than the 

mid-dermis and clinically may last longer than nine 

months. A preparation containing lidocaine is now 

available. 

Macrolane – this is based on Q-Med’s NASHA 

technology and was approved in Europe at the end of 

2007, the Middle East and Asia in 2009. It is specifically 

marketed for body shaping where there is less tissue 

cover (the VRF20 preparation) and more tissue cover 

(the VRF30 preparation). Follow-up treatment is 

recommended at 9-12 months with about 50% of the 

initial injection volume advised. Breast injection is an 

exciting new application; however after several years, the 

cost may exceed that of breast augmentation surgery. 

Product 

RESTYLANE ® - INDICATIONS AND SUMMARY TABLE 

Restylane 

(small particles) 

Perlane 

(large particles) 

Macrolane 

VFR20 VFR30 

Concentration (mg/g) 20 20 24 

Cross-linking (percent) 6 6 1% 

Needle (gauge) 27 27 22 - 25 

Indication 

Superficial and 

mid dermis 

Superficial and 

mid dermis 

Subcutanoues tissue / 

not in the face 

Duration (months) 9 9-12 9-12 

Company Teoxane (Geneva, Switzerland) 

Teosyal Family of Seven Products 

By precisely controlling the chemistry of their various 

preparations, Teoxane has created a family of HA’s 

for a variety of clinical indications. The cross-linking is 

BDDE like the Q-Med products. They have sold over 1.5 

million syringes since the company’s founding (personal 

communication with the CEO, April 12, 2010) and 

clinical use is accelerating. Widely available in Europe, 

clinical trials will likely begin in the US late this year 

or early 2011. Like other HA’s progressive absorption 

results in the end products water and CO2 and it can 

hold up to 1000 times its weight in water. With so many 

products it may be a bit daunting to know when and how 

to use each. Start with just a couple and learn them well 

before trying all of them on a regular basis. 

GAMME TEOSYAL ® - INDICATIONS AND SUMMARY TABLE 

TEOSYAL ® Product Meso 

First Global 

Deep 

Ultra 

Touch Up 

Kiss 

Lines Action 

Lines 

Deep 

Concentration (mg/g) 15 20 25 25 25 25 25 

Cross-linking None 1+ 3+ 3+ 3+ 4+ 4+ 

Needle (gauge) 30 30 30 30 27 27 25 

Indication 

Rehydration/ 

superficial 

dermis 

Superficial 

crow’s feet/ 

perioral 

Mid dermis/ 

facial wrinkles 

Mid dermis/ 

facial wrinkles 

Deep 

injection/ 

wrinkles 

Deep 

injection/ lip 

contours and 

volume 

Duration (months) 2-3 6 6-9 6-9 6-9 6-9 9-12 

Deep 

injection/ 

wrinkles 


Merz Pharmaceuticals (Frankfurt, Germany) 

Belotero Family of Three Products – Intense, Basic and Soft 

These products are described as being made with 

Cohesive Polydensified Matrix (CPM) technology. The 

first cross-linking with BDDE creates a monophasic gel 

of adjacent strands of stabilized HA. The second crosslinking 

step is also carried out with BDDE and leads 

to a monophasic gel with different zones of HA chain 

density. Satisfaction rates in the nasolabial fold were 

81% at six months and 66% at nine months in a study 

of 114 subjects published in July 2008. 

BELETERO ® - INDICATIONS AND SUMMARY TABLE 

BELETORO ® Product Soft Basic Intense 

Concentration (mg/g) 20 22.5 25.5 

Cross-linking 2+ 2+ 2+ 

Needle (gauge) 30 27 27 

Indication Superficial dermis Mid dermis Deep dermis 

Duration (months) 3-6 6-9 6-9 

Allergan (Irvine, California, USA) 

Juvederm Family of Products 

This is the only HA product cleared by the FDA for 

a 1-year duration. The formulation has a smooth 

consistency, high concentration and high degree of 

cross-linking. In addition, it has gained great market 

share in the US in a short time due to high physician 

and patient acceptance. 

JUVEDERM ® - INDICATIONS AND SUMMARY TABLE 

JUVEDERM ® Product Ultra Ultra Plus 

XC (lidocaine .3%) 

Ultra and Ultra Plus 

Concentration (mg/g) 24 24 24 

Cross-linking 6% 8% 6 and 8% 


Indication Superficial and mid dermis Superficial and mid dermis Superficial and mid dermis 

Duration (months) 9-12 12 9-12/ 12 

Mentor (Santa Barbara, California, USA) 

Prevelle Family of Products 

This is the newest family of products on the market 

with only the Silk variety available in the US. Prevelle 

Shape (Puragen) was approved in the EU in 2006, 

while Lift was approved in the EU in the fall of 2009 

and is just beginning to reach clinical practice now. 

The particle size is much smaller and allows for a 

lower extrusion force (ease of injection) and smoother 

contours. While not studied in the tear trough during 

formal clinical trials, early clinical reports have been 

favorable. Prevelle Lift is unusual for an HA in that it 

has a very high G’ (modulus of elasticity) making it very 

firm like Radiesse. 

PREVELLE ® - INDICATIONS AND SUMMARY TABLE 

PREVELLE ® Product Silk Shape (Puragen) Lift 

Consistency Soft Moderate Firm 

Concentration (mg/g) 5.5 20 22 

Cross-linking (percent) 12 3 (double cross-linked) 2 


Indication Superficial and mid dermis Superficial and mid dermis Superficial and mid dermis 

Duration (months) 4 – 6 4 – 6 12 


Calcium Hydroxyl Apatite in a Glycerin, Carboxy Methylcellulose Gel Carrier 

Bioform (San Mateo, California, USA) 

Radiesse 

This injectable is unique compared to the HA products 

as it contains calcium hydroxyl apatite in a carboxy 

methylcellulose gel carrier. Studied since the early 1990’s 

RADIESSE ® - INDICATIONS AND SUMMARY TABLE 

RADIESSE® 

Consistency 

Radiesse 

Firm 

Concentration (mg/g) 300 

Product (percent) 

30% Ca HA 

70% Gel 

Needle (gauge) 25 - 27 

Indication 

Mid and deep dermis 

Duration (months) 12 – 24 

and used since 1996 in urinary incontinence, it received 

FDA approval in the US for subdermal implantation in 

facial wrinkles and folds in December 2006. 

Summary 

While all the fillers may produce aesthetically pleasing 

results, it may not be possible to achieve clinical 

expertise in them all. Pick a few of them and learn 

them well. Understand their chemical characteristics, 

their handling properties and how patients respond to 

them. Be aware of complications and follow patients 

just as carefully as after any surgical procedure. 

Patient satisfaction rates are extremely high, the risk 

to benefit ratio is great and they add a significant 

capability to your clinical practice as patients shift 

towards earlier, more subtle intervention and natural, 

less noticeable results. 

Next issue update toxins and permanent fillers 

Contura (Soeborg, Denmark) 

Aquamid – this is a soft tissue volume filler, nonabsorbable 

hydrogel containing 97.5% water and 2.5% 

cross-linked polyacrylamide. It does not degrade over 

time, becomes fully incorporated into the tissue and 

stimulates a connective tissue reaction. Results will 

last for years, whether aesthetically pleasing or not. 

A five-year study indicated high satisfaction and it 

received a CE Mark in 2001 for facial augmentation. 

It is currently being studied in the US. 

Suneva (San Diego, California, USA) 

Artefill – this is a polymethylmethacrylate 

fillers consisting of microfine beads in a 

carboxymethylcellulose carrier gel. 

Allergan (Irvine, California, USA) 

Botox toxin A 

Merz (Frankfurt, Germany) 

Xeomin toxin A 

Ipsen Company (Paris, France) (UK subsidiary) 

Product Dysport toxin A 

Mentor (Santa Barbara, California, UA) 

Purtox toxin A 

Brian M. Kinney, MD, FACS, MSME 

Clinical Assistant Profecor 

of Plastc Surgery 

USC Scool of Medicine 

Los Angeles, CA USA 

Parlimentarial, Board of Directors, IPRAS 



PLASTIC AND RECONSTRUCTIVE SURGERY, October Supplement 2004 

It’s Not How You Say It 

But What You Say 

Robert M. Goldwyn 

Two recent comments in the media that I should have forgotten 

have stayed with me. The first was calculated gibberish from a 

government official speaking about the schedule of airlines at 

the beginning of this year in response to fears of Y2K mishaps: 

“There will be no delays, although there will certainly be 

slowdowns.” 

The second comment was from the surgeon who did an 

emergency quintuple bypass on television host David Letterman: 

“Dave has the heart muscle of a 22-year-old man.” 

I hope that Mr. Letterman, age 52, was duly encouraged. 

Telling the truth is not always easy, for several reasons. The first 

reason is that one may not know it. The second is that one may 

not want to say it. The third is that the listener may not want 

to hear it. If we do know the truth and are reluctant to voice it, 

then we devise ways to tell the truth the way that it almost is. For 

example, let us consider the situation of a 65-year-old woman 

presenting for a face lift. Although her anatomy is suitable, her 

personality is not. She is extremely hostile, demanding, unrealistic, 

and perfectionistic –the type who never accepts the first table 

offered, even in the most plush restaurant. How do you extricate 

yourself from being her surgeon if that is your choice? 

“Mrs. Killum, from a technical standpoint, you are ideal. However, 

you are an obviously difficult, if not inpossible, human being-too 

wearing on my nerves with which to have to deal.” 

“Mrs. Killum, you have clearly enunciated your expectations, to 

which you are entitled. I am just a simple plastic surgeon, one 

whose humble skills and ordinary hands would be inadequate for 

the great challenge that you have presented me.” 

“Mrs. Killum, my secretary, Ms. Gizzard, has just handed me our 

astrological printout. Your zodiac and mine are incompatible. 

You are a Tzoris and I am a Mitzah. The heavens would clash and 

disaster would ensure if we embarked on this surgical adventure. 

Oh, dear Lord, how could this have happened when I wanted so 

much to be your plastic surgeon?”, said as you put your head in 

your hands and begin wailing. 

“Mrs. Killum, scheduling at the hospital has become infinitely 

difficult. I do not think that I could fit you in until Y3K,” said as 

you begin to chuckle, then laugh violently, gasping for breath-all 

signs of sudden insanity. 

“Mrs. Killum, I specialize in Modigliani-type faces. Yours is not 

shaped like an almond, but more like a pecan or, from the side, 

a filbert. My esteemed colleague (here name someone whose 

malicious remarks led to your being sued), Dr. A. Sassin, is an 

expert. See him, but only him. He is a very modest man, the type 

that at first will refuse to operate on you, but do not give up. Insist 

on his devil-I mean- God – given skills. 

“Mrs. Killum, I am terribly sorry that you came for this 

consultation at the end of my career. My secretary should have 

told you that today is my last day in practice. Although I would 

have enjoyed operating on you, I will have to be thankful for just 

the privilege of having met you. Alas!”, said with a wistful look at 

the diplomas that line your walls. 

“Mrs. Killum, although your face is not as tight as you would 

like, it is not as loose as it could be. Believe me, I have seen 

much worse. You are in what we would call the ‘Middle Period’ 

(here you are an amateur Egyptologist), the transition between 

facial maturity and facial senescence. You are certainly not in 

the last throes of aging. Do not rush into an operation. I would 

recommend strongly that you begin facial exercises – for 2 years 

at least- to set the stage for ‘the operation.’ Timing is the essence 

of success. Knowing the proper moment for the knife to strike 

requires experience. I am so glad that you came to me. The kind 

of advice I am giving you, you would never get from anyone else.” 

“Mrs. Killum, you are an excellent candidate for a face lift. I 

recommend it strongly. I already have discussed with you the 

details of the procedure, but I have not gone into complications. 

Unfortunately, they do occur. I have had my share- oh, have I 

had my share! Everything, and I mean everything, from paralysis 

of the nerves of the face to sudden, almost catastrophic bleeding 

and very, very unsightly scarring. I would not want to give the 

impression that these complications are common, but when they 

happen, it is a disaster!” You conclude by shaking your head as 

Mrs. Killum pushes back her chair and flees from the office. 

The astute reader has probably wondered why I have not 

mentioned another stratagem: Increasing the fee beyond even 

exorbitance. 

The problem is that Mrs. Killum might eagerly pay it. 

Originally published in Plastic and Reconstructive Surgery 

in November 2000 (Plast. Reconstr. Surg. 106: 1421,2000) 

REFERENCE 

1.Grenson, S.L. Letterman has quintuple bypass. 

The Boston Globe. January 15, 2000:A3. 


H U M A N I T A R I A N W O R K 

Women for Women 

…is a charity programme supported by female plastic 

surgeons whose goal is to help women suffering from 

disfiguring or socially excluding injuries and trauma, 

with the goal of enabling such women to continue on to 

lead happy and prosperous lives despite their injuries 

and trauma they have suffered in the past. 

The programme was developed by the Secretary 

General of IPRAS, the International Society for 

Plastic Reconstructive and Aesthetic Surgery, Marita 

Eisenmann-Klein, MD and the Chairperson of 

Quality Assurance of IPRAF, the International Plastic, 

Reconstructive and Aesthetic Surgery Foundation, 

Constance Neuhann-Lorenz, MD. 

Women for Women’s first mission was conducted 2008 

in Jalandhar, followed by missions in Kulu, Palampur 

and Lucknow in 2009. 

The first mission in 2010 took us to Vijayavada, India 

Domestic Violence 

The United Nations General Assembly defines 

“violence against women” (VAW) as “any act of 

gender-based violence that results in, or is likely to 

result in, physical, sexual or mental harm or suffering 

to women, including threats of such acts, coercion or 

arbitrary deprivation of liberty, whether occurring in 

public or in private life.” 

Women in India often cannot escape domestic violence 

when they are subject to it, as they do not have the 

means to live alone, and their in-laws will not support 

them once they are married. With no means to support 

herself or her family, an Indian woman facing domestic 

abuse is stuck in a vicious cycle from which she cannot 

escape. There is a social stigma attached to divorce 

and separations, which means that women who are the 

subject of domestic violence will face pressure from 

their families not to leave their abusive spouse. 


Facts and Figures 

In India, 35 percent of women in the age 15-49 have 

experienced physical or sexual violence at some point 

in their life. 

At least one in seven of married and divorced women 

have suffered injury as a result of spousal violence. 

Paying and accepting dowry has been illegal in India 

for 40 years but it is still rampant. Indian Government 

statistics show that husbands and in-laws killed nearly 

7,000 women in 2001 over inadequate dowry payments. 

BBC article on dowry deaths 

Acid violence 

Acid violence seems to be almost unique to South Asia, 

with most incidents occurring in Bangladesh, India and 

Pakistan. Part of the reason is that acid is cheap and 

widely available. Many Indians use concentrated acid 

to sterilize their kitchens and bathrooms, as Americans 

would use bleach. The acid attack phenomenon is 

becoming increasingly common and widespread, with 

neither class nor caste nor creed nor any other variable 

serving as protective barriers, and with triggers ranging 

from unrequited love and marital discord (often over 

trivial matters) through family feuds and property 

disputes to enforcement of social diktats of various kinds. 

Local Support 

Through IPRAS, Women for Women is able to profit 

from a well functioning network of delegates in the 

entire world that help them with the organization and 

coordination of each mission on sight. Due to the 

worldwide Network of IPRAS, the local delegations 

play a crucial role in the process of selection as 

well as the selection criteria for the patients. The 

local coordinators also play a major part in helping 

the foreign team of doctors to prepare for possible 

challenges and working conditions in the countries. 

How can you contribute? 

Your funds are used for patient care only. We are 

self administrators. Donate money by financing travel 

expenses, instruments and medication. Offer other 

support by fundraising. 

Donations to: 

Women for Women 

K.Nr. 1384181 

BLZ: 70030300 

IBAN: DE 8170 0303 0001 3841 8100 

BIC REUCDEMMXXX 

Bankhaus Reuschel 

For detailed information on how to contribute please 

contact: info@womenforwomen-ipras.org 

How to participate 

We are thankful for every helping hand that wants to 

join our mission. If you are interested in participating, 

you can either: 

• Join the team of Doctors 

• Help spread the word 

• Give organizational support 

If so, please send a short letter of motivation and a CV 

with photo attached to info@womenforwomen-ipras.org 

Dr. med Constance Neuhann-Lorenz, MD 

Plastic Surgeon, Munich - Germany 

President Women For Women 

e-mail: dr.c.neuhann-lorenz@tonline.de 

dr.neuhann-lorenz@tonline.de 


S A F E T Y W A R N I N G S A N D C A U T I O N S 

Warning published 

by the German Federal Institute 

for Drugs and Medical Devices (BfArM) 

Affecting Silicone gel filled breast implants produced by the 

French company PIP (Poly Implant Prothese) 

French and German Health Authorities (Afssaps and 

BfArM) informed IPRAS in April that the French Health 

Authorities found out during an inspection that most of 

the breast implants produced by PIP since 2001 are not 

filled with the specific Silicone gel which should be used for 

this application. Therefore these implants do not fulfill the 

requirements outlined in the European Medical Device Law 

e.g. 93/42/EWG. 

At present French Health Authorities investigate whether the 

use of this material affects the safety of these implants. 

Afssaps and BfArM recommend that plastic surgeons who 

inserted implants produced by PIP should inform their 

patients and should stop using these products. 

Patients with PIP implants should contact their plastic 

surgeons. 


I P R A S W E B S I T E 

IPRAS Compliments to Individual Plastic Surgeons 

www.ipras.org 

Ïur redesigned website which can be found at 

www.ipras.org offers a great opportunity for 

the plastic surgery community to project our 

objectives, principles and values to a wider audience. In 

order to do so, we redesigned our website to be efficient, 

modern, unique and – free of charge. 

Also, we have taken into account the public’s and 

potential patients’ needs for more information regarding 

plastic surgery while it is easy to navigate. Plastic surgeons 

from around the world can exploit opportunities that 

IPRAS website offers, free of charge as they will be 

able to promote themselves and their work to potential 

patients through the information that the plastic surgeon 

has uploaded. 

The information that they can upload can be their 

contacts details, their scientific status their specialty and 

they can also provide a link to their personal website. 

You can register online and benefit from this free and 

effortless promotion of yourself. After you apply for 

registration your National Delegate, who has the updated 

list of his Association members will be able to identify you 

as a member. 

The advantages that you are able to gain by uploading 

your scientific status at the IPRAS website are: 

• Your colleagues from all over the world will have 

the opportunity to find your profile and your contact 

details on the IPRAS website 

• Potential patients, looking for a specialized plastic 

surgeon can search through “Find a doctor” section 

at IPRAS website by choosing country and specialty. 

In that way, they will be able to find all the plastic 

surgeons who have uploaded their profile and have 

chosen their particular specialty. 

• By uploading your scientific status you will be able to 

add a link to your personal website as well as a link of 

the clinic that you are employd. Thus, this is an excellent 

opportunity to promote yourself and your clinic. 

• You will be recognized as an IPRAS member and you 

will have the acknowledgment of IPRAS. 

Besides of having your profile uploaded every registered 

plastic surgeon will have the opportunity to participate to 

the IPRAS forum. In this section of the site you will be 

able to: 

• Exchange views, thoughts, ideas with your colleagues 

as well as to chat with them on several and diverse 

issues. All registered plastic surgeons will be able to 

follow the discussion and participate on it. 

• Every plastic surgeon can inform about events that will 

be interesting for the rest of his/her colleagues. For 

example National Meetings. 

• Upload any information, innovation and development 

regarding plastic surgery. 

• Upload safety regulations etc 

Lastly, from IPRAS new website you will be able to find 

all the future events with or without the endorsement of 

IPRAS, all the IPRAS journals, latest news at the field of 

Plastic surgery from all over the world, our Humanitarian 

work, news from WomenForWomen and more. 

Support our effort and help us to make IPRAS stronger!! 


I P R A S P A S T M A J O R E V E N T S 

What a moment 

Thomas M. Biggs 

“What a great moment” were the first words said by 

Secretary General Marita Eisenmann-Klein when 

she opened the General Assembly of the 15 th World 

Congress of International Confederation for Plastic, 

reconstructive, and Aesthetic Surgery in New Delhi, 

India, in the Ashok Hotel on 1 December, 2009. 

And what a moment it was. It was the flowering of a 

reorganized, rebuilt, and newly inspired IPRAS. Under 

the leadership of Marita and with the support of the new 

Executive Committee including Bruce Cunningham as 

Treasurer, Brian Kinney as Parliamentarian, and Manuel 

Garcia-Velasco, Fu Chan Wei, and Daniel Marchac 

as Deputy Secretary Generals, and the management 

skills of Zacharias Kaplanidis and his Zita Congress 

S.A., IPRAS has a new face, the proper offspring of the 

Founding Meeting which was held in Uppsala, Sweden 

,in 1955 under the leadership of Tord Skoog. 

The meeting in Delhi was preceded however by two 

outstanding meetings in the months prior. The first of 

these was the ESPRAS meeting, the European Section 

of IPRAS, held in Rhodes, Greece, 20-26 September 

under the guidance of Andreas Yiacoumettis who was 

elected the new President of ESPRAS. This outstanding 

conference brought more than 1,000 plastic surgeons 

and 300 accompanying people to this beautiful island 

and in addition to a scintillating social program included 

700 free papers, 24 round tables, 35 Master Classes, and 

24 Keynote Lectures. Epitomizing the broad range of 

excellence were many items including an outstanding 

lecture by Maria Siemenow on Face Transplant which 

brought together the union of finite facial anatomy, the 

science of the immune mechanism, exquisite surgical 

skills, and the orchestration of effective teamwork, 

all designed around the benefit to the patient…or…an 

excellent expression of plastic surgery in the 21 st 


Century. Added to that and the many other presentations 

was a “debate” between Roger Khouri and David 

Ross on breast reconstruction employing traditional 

approaches versus the newer fat grafting methods. 

In addition to all these the organizers set apart an entire 

day and created a cruise to the ancient Island of Kos, 

the site of the Asclepieron and the birthplace of the 

Hippocratic Oath. This outing included 950 participants 

with all the physicians renewing their oath in a dramatic 

ceremony. 

After Rhodes the Asian Pacific Section of IPRAS 

held their 10 th International Conference in the Hyatt 

Regency Hotel in Tokyo from October 8-10. Under the 

guidance of Motohiro Nozaki, President of the Japan 

Society Plastic and Reconstructive Surgeons a similar 

sensation was created with many free papers and panels 

along with Invited Lectures by Ted Huang, Kiyonori 

Harii, Kwan-Chul Tark,Marita Eisenmann-Klein, Yu 

Ray Chen, and Andrew Burd. In addition there were 19 

keynote Lectures. The Special Dinner included a show 

of fabulous classical Japanese performers who graced 

the audience by their presence after the show. 

When it came time for the Main Event in Delhi all 

members were ready. The Opening Ceremony was held 

in a beautiful, spacious auditorium, filled with the 1,000 

physicians and their guests. Welcoming speeches were 

made by significant dignitaries including Prof. Kiran 

Walia, Minister of Health and Family Welfare, Suresh 

Gupta, President of the World Congress of IPRAS, 

Bahman Daver, Co-President of IPRAS 2009, G. 

Balakrishnan, President, Association of Plastic Surgeons 

of India, and of course by our Secretary General, Marita 

Eisenmann-Klein. A welcoming speech that cannot be 

forgotten was made by Rajeev Ahuga who . by the force 

of his conviction, and the assurance of his personal 

estate, made it all happen. Without doubt one person 

cannot do it all alone and he was aided by a collection 

of hard working and dedicated colleagues, but when the 

years have passed and much is lost in our memories the 

one thing that will remain will be the magnitude of the 

contribution made by Rajeev Ahuja. 

The faculty came from around the world, presenting 669 

papers and 21 Master Classes. Attendees came from 73 

countries. 

The General assembly included the report of the 

outstanding Women for Women project, a unique thrust 

of humanitarianism, originated by Marita and Constance 

Neuhann-Lorenz and others. The Hinderer Lecture, 

given by Ian Taylor, kept us all expectant with the 

title: Keeping Abreast, and we were not disappointed. 

A touching report of work being done in Bangladesh 

and Afghanistan was made by Christian Echinard. 

Realization of the magnitude of IPRAS on the world 

scene was made by Marita Eisenmann-Klein, our 10 th 

Secretary-General when she looked out at the General 

Assembly on that Tuesday, the 1 st of December, 2009, 

and said,”What a great moment”. 

This GREAT MOMENT was the rebirth of a powerful 

IPRAS, and its claiming of its place as the world’s 

leading plastic surgery organization. 

Thomas Biggs 

1315 St. Joseph Pkwy, Hïuston, Texas, 77002 

e-mail: tbiggsmd@aol.com 


FUTURE IPRAS CONGRESSES & EVENTS 

“Don’t loose the opportunity to contribute to the consensus statement 

regarding safety regulations on plastic surgery procedures and devices” 

Organizing Committee 

Chairman: Fedeles Jozef Slovakia 

Neuhann-Lorenz Constance Germany 

Duskova Marketa Czech Republic 

Gulyas Gustav Hungary 

Palencar Drahomir Slovakia 

Garcia-Velasco Manuel Mexico 

Kaplanidis Zacharias Greece 

Hulin Ivan Slovakia 

Lascar Ioan Romania 

Mandrekas Apostolos Greece 

Scharnagel Erwin Austria 

Evstatiev Dimitrie Bulgaria 

Scientific Committee 

Chairman: Daniel Marchac France 

Co-Chairman: Brian Kinney US 

Eisenmann-Klein Marita Germany 

Neuhann-Lorenz Constance Germany 

Cunningham Bruce US 

Prantl Lukas Germany 

Yiacoumettis Andreas Greece 

Kubiena Harald Austria 

Yilin Cao China 

Piccolo Nelson Brasil 

Manfred Frey Austria 

Scientific Program Topics 

• Breast augmentation, reconstruction and the status of breast 

implants register in the country 

• Current status of other techniques for breast reconstruction and 

augmentation - tissue transfer, fat grafting, other injectables for 

breast augmentation 

• Suspension materials 

• Stem cell therapy 

• Tissue engineering 

• Wound healing 

• Shock wave therapy 

• Injectables (lipolysis) 

• Botulinum toxine 

• Injectable fillers 

• Microcirculation, high resolution ultrasound, science in antiaging 

medicine 

• Exchange ideas that will foster innovation in plastic surgery 

• Innovation in suture materials 

• Standard for aesthetic surgery services 

Contact 

1st Klm Peanias - Markopoulou 

19002 Peania, Attica, Greece 

Tel:+30 211 1001781 

Fax: +30 210 6642116 

Contact Name: Katerina Zerdeva 

Å-mail: katerina.zerdeva@zita-congress.gr 

Web: www.iquam2010.com 


“Support IPRAS, support our African Colleagues, join us in Nairobi!” 


President of Organizing Committee: 

Githae Bernard Kenya 

Chairman: Badran Hassan Egypt 

Co-Chairman: Abdulwahab Aref Egypt 

Agbenorku Pius Ghana 

Fouad Ghareeb Egypt 

Kaplanidis Zacharias Greece 

Khainga Stanley Kenya 

Mitich Badreddin Algeria 

Mugwe Winnie Kenya 

Nangole F.W Kenya 

Nnabuko Richard Nigeria 

Rida Franka Mohammed Libya 

Wangeri Kimani Kenya 

Yiacoumettis Andreas Greece 

To be confirmed: 

Lamont Alastair South Africa 


Chairman: Marchac Daniel France 

Co-Chairman: Githae Bernard Kenya 

Zaidi Mustafa Libya 

Abdulaziz Nefzi Tunisia 

Al-Basti Habib Qatar 

Biggs Thomas US 

Evans Gregory US 

Goran Jovic Zambia 

Holle Juergen Austria 

Kadry Mohamed Egypt 

Kouppas Andreas Greece 

Madaree Anil South Africa 

Papadopulos Nikolaos Greece 

Piccolo Nelson Brazil 

Reilly Debra US 

Tazi El Hassan Morocco 

Zaki Mohammed Sobhi Ahmed Egypt 

Scientific Program Topics 

1. Fat Graft Instructional Workshop 

2. Burn Wound Care 

3. Guidelines for flap surgery 

4. Principles and latest advances in 

microsurgery 

5. Panel on Humanitarian Projects 

6. Rhinoplasty 

7. Facial Rejuvenation 

8. Body Contouring 

9. Breast Aesthetic 

10. Breast Primary and Secondary 

Reconstruction 

11. Preventive,Regenerative and Anti- 

Aging Medicine 

A. Cardiology 

Pre-Clinical and Clinical Studies on 

Applications of Human Myoblasts 

in Regeneration of Post Infarction 

Heart 

TBA 

B. Orthopaedic 

Common ageing-associated bone and 

joint diseases and their treatment 

TBA 

C. Urology 

Prostate Cancer - Prevention 

and Treatment Kidney 

Stones 

Kidney Stones - Prevention 

and Treatment 

Testosterone and PDE5 

inhibitors in the aging male 

Dr. Christian Chaussy, 

Germany 

D. Gynecology 

Breast Cancer, Gynecologic 

Tumors and Hormones 

TBA 

E. Oncology 

Tumors Of The Abdomen 

TBA 

F. Dermatology 

Aging Skin 

TBA 

Contact 



Tel:+30 211 1001782 

Fax: +30 210 6642116 

Contact Name: Nikos Antonopoulos 

Å-mail: nikos.antonopoulos@zita-congress.gr 

Web: www.pacprs2010.com 


With the support of Euro-Mediterranean Council for Burns and Fire Disasters 

and the European Society of Preventive, Regenerative and Anti-Aging Medicine 

“Be there and catch the challenges!” 


Chairmen: Al-Basti Habib, Qatar 

(Member of PAN ARAB & GCC) 

Khalid AL-Hammdani, Qatar 

(Member of PAN ARAB) 

Co-Chair: Eisenmann-Klein Marita, 

Germany 

(General Secretary of IPRAS) 

AL-Jaber Hamad, Qatar 

(Member of PAN ARAB) 

Members of PAN ARAB Association: 

Rida Franka Mohammed, Libya 

(General Secretary 

PAN ARAB Association) 

AL-Tamimi Noora, Qatar 

Bishara Atiyeh, Lebanon 

El-Khatib Hamdy, Qatar 

Kaladari Saeed, Qatar 

Seif Makki Ahmed, Qatar 

Talal AL-Hetmi, Qatar 

Members of PAN ARAB & GCC: 

Chonah Thomas, Oman 

International Members: 

Ahuja Rajeev, India 

Chajchir Abel, Argentina 

De Mey Albert, Belgium 

Firmin Francoise, France 

Foustanos Andreas, Greece 

Mutaz Habal, US 

Ninkovic Milomir,Germany 

Pallua Norbert, Germany 

Zouboulis Christos, Germany 


Chairman: Al-Basti Habib, Qatar (Member of PAN ARAB & GCC) 

Co - Chair: Musleh Al Abdulwahab, Qatar (Chairman Qatar Health) 

Members of PAN ARAB Association: 

Rida Franka Mohammed, Libya (General Secretary PAN ARAB 

Association) 

Araji Zakaria Y., Iraq 

Khalid AL-Hammdani, Qatar 

Zaidi Mustafa, Libya 

Members of PAN ARAB & GCC: 

Chonah Thomas, Oman 

Eed Mohammed D. Ali, Saudi Arabia 

Numairy Ali, Emirates 

Saeed Tarik, Pakistan 

International Members: 

Eisenmann Klein Marita, Germany (General Secretary of IPRAS) 

Kaplanidis Zacharias, Greece 

Social Committee 

Chairman: Saed Kaladari 

Members: Khalid A. Haji 

Attalla Hamouda 

Ali Shaker 

Mahmoud AL-Sharkawi 

Mahmoud AL-Thalathini 

Contact 



Tel:+30 211 1001780 - Fax: +30 210 6642116 

Contact Name: Gerasimos Kouloumpis 

Å-mail: gerasimos.kouloumpis@zita-congress.gr 

Web: www.panarabprs2010.com 


“The world’s best reconstructive and aesthetic surgery in one meeting” 


Organizing Committee Chair: Dr. Don Lalonde 

Scientific Program Chair: Dr. Peter Neligan 

Local Host Committee Chair: Dr. Richard Warren 

Finance & Sponsorship Committee Chair: Dr. Gordon Wilkes 

International Relations Committee Chair: Dr. Ronald Zuker 

Executive Director CSPS, Committee Coordinator: Ms. Karyn Wagner 

Scientific Program Committee 

Chair, CSPS Scientific Program: Dr. Patricia Bortoluzzi 

Pediatric Plastic Surgery: Dr. Louise Caouette-Laberge 

General Reconstruction: Dr. Kenneth Murray 

Hand Surgery: Dr. Douglas Ross 

Aesthetic Surgery: Dr. Walter Peters 

Craniofacial Surgery: Dr. Christopher Forrest 

Breast Surgery: Dr. Peter Lennox 

Burn Surgery: Dr. Edward Tredget 

Microsurgery: Dr. Steven Morris 

Basic Research: Dr. Michael Neumeister 

Clinical Research: Dr. Andrea Pusic 

Scientific Program 

IPRAS 2011 Vancouver Scientific Program 

will offer: 

Scientific Program tracks including: 

• Aesthetic surgery 

• Reconstruction 

• Research 

• Education 

• Administration 

• Free Daily Master Classes 

• Invited lectures by established experts 

• Sessions highlighting young surgeons 

• Daily plenary sessions & panel discussions 

• Specialized subspecialty sessions 

• Session featuring Best National Society 

Meeting Papers 

• Video sessions 

• E-posters 

• Further information will be posted here 

as it becomes available. 

• Facilities at the Vancouver Convention 

Center are state-of-the-art. 

Contact 

IPRAS 2011 Vancouver 

4-1469 St. Joseph Blvd. E. 

Montreal, QC, H2J 1M6 CANADA 

(T) +1 514 843 5415 - (F) +1 514 843 7005 

Web: www.ipras2011vancouver.ca 


CO-OPTED SOCIETIES FUTURE EVENTS 

“Latest news in aesthetic surgery education worldwide.” 

ISAPS - 20th Congress - San Francisco, CA - August 14-18, 2010 

Location: San Francisco, California, USA 

Venue: San Francisco Marriott Hotel 

Contact: Catherine Foss 

Telephone: 1-603-643-2325 Fax: 1-603-643-1444 

E-mail: isaps@sover.net URL: http://www.isapscongress2010.com/ 

National Associations Future Events 

14 - 18 Sep 2010 

Deutsche Gesellschaft der Plastischen, 

Rekonstruktiven und Asthetischen Chirurgen, 

Annual Congress of the German Society of 

Plastic, Reconstructive and Aesthetic Surgeons 

Location: Dresden, Germany 

URL: http://www.dgpraec2010.info 

31 - 04 Nov 2010 

The faces of Jerusalem 

Location: Jerusalem 

Venue: The David Citadel Hotel 

Contact: Mr Sigal Avidan 

Telephone: 972-3-5639518 

Fax: 972-3-5639599 

E-mail: sigal_a@edan.co.il 

URL: http://www.facesofjerusalem2010.com 

01 - 06 Oct 2010 

PLASTIC SURGERY 2010 

Location: Toronto, Canada 

URL: http://www.plasticsurgery.org 

11 - 13 Nov 2010 

Congress of the Korean Society 

Location: Korea 

URL: http://www.plasticsurgery.or.kr 


IPRAS Journal Management 

Editor: IPRAS 

Editor-in-Chief: Thomas Biggs 

Editorial Board: Marita Eisenmann - Klein, MD 

Andreas Yiacoumettis, Prof. 

Constance Neuhann-Lorenz, MD 

Zacharias Kaplanidis, Economist 

Page Layout: “In Tempo” Athens Greece 

e-mail: panos@intempo.gr 

IPRAS Management Office 

ZITA CONGRESS SA 

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: www.ipras.org 

E-mail: zita@iprasmanagement.com 

Executive Director: Zacharias Kaplanidis 

E-mail: zacharias.kaplanidis@iprasmanagement.com 

Assistant Executive Director: Maria Petsa 

E-mail: maria.petsa@iprasmanagement.com 

Director of Accounting: George Panagiotou 

E-mail: george.panagiotou@zita-congress.gr 

Congress Organizer: Gerasimos Kouloumpis 

E-mail: gerasimos.kouloumpis@zita-congress.gr 

Director of Marketing: Kostas Chamalidis 

E-mail: kostas.chamalidis@zita-congress.gr 

Next issue: 

October 2010 

DISCLAIMER: 

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 

LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, 

DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR 

PRODUCTS THAT YOU OBTAIN THROUGH THIS JOURNAL. 

NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE 

OR DELAY SEEKING MEDICAL TREATMENT BECAUSE 

OF SOMETHING YOU HAVE READ ON OR ACCESSED 

THROUGH THIS JOURNAL. 

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 

of IPRAS.

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