IPRAS

ISSN: 2241-1275

C O N T E N T S• President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 5• The PIP Breast Implant Scandal . . . . . . . . . . . . . . . 6• General Secretary’s Message . . . . . . . . . . . . . . . . . . 9• Editor-in-Chief’s Message . . . . . . . . . . . . . . . . . . . 12• IPRAS Management office Report . . . . . . . . . . . 14• Pioneers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19PAGE12IPRAS Presentation fromMr. Zacharias Kaplanidis (IPRASExecutive Director) during the 48th BrazilianCongress of Plastic Surgery• Rising Star . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23• Senior Ambassador . . . . . . . . . . . . . . . . . . . . . . . . 24• Humanitarian Works . . . . . . . . . . . . . . . . . . . . . . . 26• Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Humanitarian mission in TogoPAGE33• National Associations’ & Plastic surgeryorganizations’ news . . . . . . . . . . . . . . . . . . . . . . . . 50• Historical Accounts . . . . . . . . . . . . . . . . . . . . . . . . 63• Certificate of Membership . . . . . . . . . . . . . . . . . . 86• Congresses and Events . . . . . . . . . . . . . . . . . . . . . 90IPRAS Booth at the 1st ChineseEuropean Congress of PlasticReconstructive and Aesthetic SurgeryPAGE50• National & co-opted societies future events . . . 114• IPRAS website . . . . . . . . . . . . . . . . . . . . . . . . . . . 116• Industry news . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117• IPRAS Benefits for National Associations& individual members . . . . . . . . . . . . . . . . . . . . . 119Historical Account of BAPRASPAGE76Issue 7 www.ipras.org IPRAS Journal 3

A I M S A N D S C O P E• To promote the art and scienceof plastic surgery• To further plastic surgeryeducation and research• To protect the safety of the patientand the profession of Plastic,Reconstructive and Aesthetic Surgery• To relieve as far as it is possiblethe world from human violenceor natural calamities throughits humanitarian bodies• To encourage friendshipamong plastic surgeonsand physicians of all countries4 IPRAS Journal www.ipras.org Issue 7

I P R A S J O U R N A LP R E S I D E N T ’ S M E S S A G EBoard of DirectorsPresidentMarita Eisenmann-Klein - GermanyGeneral SecretaryNelson Piccolo - BrazilTreasurerBruce Cunningham - USADeputy General SecretaryYi Lin Cao - ChinaDeputy General SecretaryBrian Kinney - USADeputy General SecretaryAhmed Noureldin - EgyptDeputy General SecretaryAndreas Yiacoumettis - GreeceParliamentarianNorbert Pallua - GermanyExecutive DirectorZacharias Kaplanidis - GreeceDear colleagues,2011 was the year of solidarity.Solidarity with our brave colleagues in Japan– while we felt powerless and helpless; solidaritywith our colleagues during the unrests in the Arabworld, with our colleagues in countries which hadto face crisis and disasters.Solidarity with patients in developing countries:the number of missions and the number ofactive collaborators in our humanitarian projectsincrease considerably every year.Solidarity with patients who became victims of thePIP crime, is our latest challenge. These patientsneed all our support in their anxieties and intheir search for implant removal at affordableexpenses.Solidarity with our young residents: the evaluationform about training conditions will be launchedsoon and the first “Residents World Congress”will be held on November 1st , 2012 in Athens,Greece. There, we also plan to start the Academyfor Residents Training.With the foundation of our Board of Trustees,we span the generations from the youngest toour senior role models, our giants, our heroes.Recently we honoured our new Board ofTrustees members during the Brazilian Congressof Plastic Surgery: Ricardo Baroudi and IvoPitanguy. They do not only stand for progressand technical excellency in plastic surgery, theyare charismatic philosophers as well.2012 will be the year of pioneers in PlasticSurgery: Sydney Coleman has composed afantastic program for the 1st InternationalCongress of ISPRES in Rome, March 9-11, 2012.I am excited about the incredible amount ofresearch programs in plastic surgery which willbe presented in Rome.We feel overwhelmed by the interest of ourmembers in these innovative future orientedtechniques.I never before experienced having to close theregistration two months prior to the start of acongress!Prof. Marita Eisemann-KleinPresident of IPRASFor all those who missed registration: We decidedto offer online-participation. Just watch out forfurther announcements!Keep monitoring at our other congressannouncements too: exciting topics and excitinglocations are offered to you.There is a lot to look forward to this year!There is also a lot to thank for during the past year:Thanks, from the bottom of my heart, to all of youPresentation of Prof. Marita Eisenmann-Klein,Germany (IPRAS President) during the 48th BrazilianCongress of Plastic Surgerywho supported and assisted to develop IPRASfurther – our humanity, our skills, our identity.Thank you for your confidence in the IPRASleadership and in me personally.It is such a pleasure to serve you as yourPresident.I wish you all a year of happiness and joy and fullof chances to develop your identity as a plasticsurgeon even further!Cordially yoursMarita Eisenmann-KleinIPRAS PresidentIssue 7 www.ipras.org IPRAS Journal 5

within the range of statistically expected cases.Anaplastic Large Cell Lymphoma (ALCL) is a tumor of theimmune system. Worldwide 75 patients with breast implantsout of an estimated number of more than 10 million patientswith breast implants have developed this disease. Four ofthese patients died.It seems that the pre-disposition to develop this veryrare disease is multi-factorial and not yet completelyunderstood. Chronic inflammation usually plays a role inthe development of an ALCL. The risk of developing ALCLfor patients with breast implants is, according to the FDA, 1in 500 000 to 1 million patients. The FDA states: “Patientswith breast implants may have a small but increased risk indeveloping this disease”.What we still need to find out:We still don`t know the exact number of patients with PIPimplants and M-implants.The estimation is around 500 000 worldwide.We still do not know whether more M-implants are still inuse, may be even under a third name, either in Europe orSouth America.IPRAS conclusions:1. There is no further room for discussion. It is mandatoryto recommend the explantation of PIP and M-implants.2. Law suits against plastic surgeons should not besuccessful according to our legal advisors, since astockholder must rely on the quality of a product thathas been granted a CE mark.3. It is unnecessary to call for new laws. The existingMedical Device Laws are sufficient.The policies, however, should be changed e.g. inspectionswithout previous announcements.The European Commission invited me today to join theirSCIENTIFIC COMMITTEE ON EMERGING ANDNEWLY IDENTIFIED HEALTH RISKS WORKINGGROUP ON PIP IMPLANTS.The first teleconference will be held tomorrow. I am veryimpressed by the ambitious time table of our chairmanPhilippe Martin, with a deadline for the scientific opinionto be completed by January 30.4. This is not a scandal of the breast implant industry. Thisis a scandal of a group of criminal individuals who don`tmind to harm the health of 500 000 women.The high quality and safety standards of our breastimplant industry deserve to be relied on.5. We have to negotiate with health insurance companies andconvince them to provide the expenses for explantation.We also have to negotiate with our managers to providereplacement of implants at the lowest possible expenses.6. We all need to cooperate in order to implement patientregistries in order to get reliable data and to have a toolfor postmarket surveillance.7. Please bear in mind that our patients have to undergo aperiod of fear and insecurity. It is essential that we avoidpublic controversies regarding this issue.Therefore we appeal to all of you to accept the followingorganizations as the legitimate representation of all plasticsurgeons in the world:1. On national level: the national society of plastic surgeryexclusively.The national societies should also look for partners e.g.medical associations, health care providers, government,cancer societies, other scientific societies and consumergroups, which could be involved.The President of the German Association of Plastic,Reconstructive and Aesthetic Surgeons, Prof. Peter Vogt,was very successful in presenting the statement of thesociety together with the German Cancer Society and theGynaecological Society in a press conference.2. On regional level (such as African, Asian Pacific,European, Ibero-Latin-American, Pan-Arab): the sectionto which this area belongs should be responsible forstatements.3. For global activities and cooperation with WHO: IPRASand its quality assurance committee, IQUAM, are thelegitimate representatives of plastic surgeons.IPRAS is committed to serve the national societies and thesections with its network and expertise. We continue toprepare drafts for media releases and send them to you. Weshall only approach the media if you ask us to do so.Thank you all for reporting back to us. All the usefulinformation we received from you helped to clarify thesituation and come up with important information which noother institution or organization can provide.Please continue to inform us!Cordial thanks to all of you who supported our work. We arevery grateful for your cooperation and proud of our networkexcellency!Marita Eisenmann-KleinPresident IPRASNelson PiccoloIPRAS General SecretaryConstance Neuhann-LorenzIQUAM PresidentDaniel MarchacIQUAM General SecretaryAndreas YiacoumettisESPRAS PresidentIssue 7 www.ipras.org IPRAS Journal 7

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G E N E R A L S E C R E T A R Y ’ S M E S S A G EProf. Nelson PiccoloIPRAS General SecretaryI am very happy to say that, once more, Plastic Surgeryhas demonstrated its internationality and its boundlessfeatures. Over 2150 surgeons from 14 countries cameto Goiania, in the central part of Brazil, to attend the48th Brazilian Congress of Plastic Surgery. For me, thiswas an extra special moment, since I have been living inGoiania since 1963. Although I had lived away for 7 ½years, coming back to establish my practice and also tocontinue my family’s work in burns, in 1989, I certainlyconsider this my town. And it was a great honor and andunique pleasure to see this mega event happen here.For the Sociedade Brasileira de Cirurgia Plástica it wasalso a most special moment. There was a great homageto Past Presidents, which brought honor and greatvalue to their deeds in improving all aspects of PlasticSurgery in our country. Also, IPRAS President, MaritaEisenmann-Klein and IPRAS Executive Director,Zacharias Kaplanidis, were closely involved with allofficial ceremonies and also had opportunities to presenttheir work, as well as the work of IPRAS, in severalDuring the plenary session on “Women in Plastic Surgery”fields. Dr Eisenmann-Klein took a moment during theopening ceremony to honor Profs. Baroudi and Pitanguyas Members of the IPRAS Board of Trustees – certainlyone of the night’s highlights.48th Brazilian Cοngress of Plastic Surgery Homage to ExPresidentsIssue 7 www.ipras.org IPRAS Journal 9

48th Brazilian Congress of Plastic Surgery Opening CeremonyAnother first was the plenary session on Women in PlasticSurgery, when the audience had a chance to hear fromConnie Neuhann-Lorenz (Germany), Lucie Lessard(Canada), Antonia Marcia Cupello (Rio de Janeiro)and Vera Lucia Cardim (São Paulo) presenting theirexperience and trajectory as Plastic Surgeons and thedifferences and similarities with their male colleagues,in relation to career, profession and life.As I have mentioned in the past, I believe one of themost beautiful aspects of Plastic Surgery as a Specialtyis its internationality – how one can perform proceduresaiming at similar benefits for the patient, with knowledgeacquired though training and collective experience ofour colleagues and professors. We must, however, workharder to ensure adequate and uniform training for ourresidents, as well as adequate and uniform continuationof education for ourselves, practicing Plastic Surgeons.IPRAS is truly engaged in this! Our Board of Directors,under the leadership of Marita Eisenmann-Klein, iscontinuously searching (and finding) ways of ensuringthat this very precious aspect of Plastic Surgery isdistributed as uniformly as possible.There is, however, a lot of work still to be done for usto attain that goal – Sarah Lorenz of Munich, Germanyand some colleagues of her, also residents in PlasticSurgery, are launching a worldwide survey to ascertainthe quality, uniformity and content of training in PlasticSurgery. When the survey reaches you, please makesure you take a moment and help this dedicated groupof young surgeons to plan the world map in PlasticSurgery Training. We need to know, so we can continueto improve the equality of our already establishedinternationality.Prof. Nelson PiccoloIPRAS General Secretary10 IPRAS Journal www.ipras.org Issue 7

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I P R A S J O U R N A LE D I T O R - I N - C H I E F ’ S M E S S A G EThe bonds that unite usDr. Thomas M. Biggs, M.D.Editor-In-ChiefEDITORIALDuring the fall months, from September into early December, your Editor-in Chief has had the pleasureand honor of travel to various parts of the world and lecture, as well as speak with, colleagues onfour continents. My first stop was Lake Baikal, in Eastern Siberia, near the city of Irkutsk, whichwas a geographic experience. The meeting was hosted by our able colleague Vadim Zelenin andhad an attendance that exceeded 300 Surgeons. The faculty consisted of Brian Kinney from LosAngeles, Roberto Pizzamiglio from Marbella, Spain and your Editor. Also on the faculty were strongrepresentatives from St. Petersburg and Moscow, Irina Khrustaleva and Natalia Manturova. Thevast majority of the attendees were Plastic Surgeons from all parts of Siberia and the major topic ofdiscussion was the face, but all areas of Plastic Surgery were discussed. When I attend a meeting as alecturer I always try to give valuable information to the attendees and at Lake Baikal I was told thiswas the case. But likewise, when I attend as a listener, I hear the points of view of the other faculty andI leave a net winner in the information exchange.In all my trips I try to learn something about the area to which I’ve come. Lake Baikal was a hiddentreasure. Sadly for me, my knowledge of the geography of that part of the world was underdevelopedand I was not aware of the magnitude of Lake Baikal. There are too many aspects of it to be coveredin this short essay but it is known as the second largest lake in the world (the Caspian Sea is larger). Atone mile deep it is among the deepest and, by my own viewing, one of the clearest. It is a geographicmasterpiece and relatively unknown to the Western World.After Siberia I went to Madrid, where I participated as the only non-faculty member in a meeting puton by Jose Luis Martin Del Yerro, unquestionably one of the most skillful and knowledgeable PlasticSurgeons I know and someone whose worldwide recognition will soon soar .Dr. Riccardo Mazzola, IPRAS Historian, Dr. Thomas Biggs, IPRAS Journal Editor in Chief12 IPRAS Journal www.ipras.org Issue 7

After Madrid came Beijing, China, for the first Chinese-European Congress, with Yi Lin Cao as our host. Those whosaw the Opening Ceremony of the 2008 Olympic Gamesimmediately appreciated the powerful arrival of China as aworld player, and this Congress was of similar style.Afterwards on to Puerto Vallarta for the 38th Annual Meetingof Jose Guerrerosanto, a major institution in the world ofLatin American Plastic Surgery, put on by one of the titans ofworldwide Plastic Surgery, who has been kind enough to inviteme for many years.From Mexico, I went on to Goiania, Brazil, for their AnnualMeeting and this, my 37th visit to Brazil, confirmed what I hadlearned on my first visit in 1972: that Brazil is inferior to nonein Plastic Surgery. During this visit, I enjoyed the company offriends I have made over many decades. Among them was IvoPitanguy, who was my gracious host on my first visit there, 39years ago. The multitude of friends there is too great to nameindividually, but I was pleased to visit with our Secretary General,Nelson Piccolo, and felt the pleasure of knowing his hand will beon the wheel of IPRAS for several years.Finally I attended a meeting in the U.S. In New York City,The Cutting Edge Meeting of old friends Sherrell Aston andDan Baker. It was a booming success with attendees from 60countries. They had a large and diverse faculty, each speakerbeing limited to 10-15 minutes, but each session being followedby an intense questioning by either Dr. Aston or Dr. Baker.The questions being those the moderators felt were probablyforemost in the minds of the attendees.Finally, this message is being written from Miami, where I’vecome to visit Roger Khouri (the first “Frontiersman” in thisJournal). I’ve been staying with him, seeing new patients, shortand long term follow ups, and spending many long hours inthe operating room. In between, I’ve been working to help himassemble his thoughts for future publications.All of the above experiences have added immensely to mybody of Plastic Surgery knowledge. My travels have exposedme to the fact that many of our colleagues around the worldare performing operations in a way very similar to the way weperform them in our own facilities; there are also colleaguesdoing things differently, often with outstandingly good results.I’ve met colleagues with huge experience, who have neverspoken of their findings, nor have they published, but theirwork is outstanding. As Editor-in Chief, I’m making it a projectto bring these people out into the light, so we can all benefitProf. Ivo Pitanguy, Brazil (IPRAS Trustee), Dr. Thomas Biggs(IPRAS Journal Editor in Chief) on 2007.Dr. Thomas Biggs, USA (IPRAS Journal Editor in Chief) with Ms.Maria Petsa, Greece (IPRAS Assistant Executive Director) at theIPRAS booth during the 48th Congress of the Brazilian Society ofPlastic Surgery.from their excellence.What you’ve just read is true and extremely important to me….but there’s more.During my travels, I have found a great similarity in my lifeand the lives of those colleagues from half a globe away….from people with whom I often need a translator to adequatelycommunicate. There’s a similarity in the fact that our patientscome to us with a need and they carry with them the faith inus that we can help resolve that need. I’ve found we share thesame deep misery when some aspect of our surgery doesn’t goas we had planned, but we also share the same joy when we seea smiling face walking into our clinic and we know things aregoing well. The pink nipple rather than a blue one…a fingerwith full flexion and extension….a soft, well-shaped breastrather than one that is firm and contracted…..a happy smilefrom a young girl whose retruded maxilla is now in the rightplace. You, as surgeons, know what I mean…..the joys of ourwork…the Holiday card that says “Thank You”.All these things we share…whether it may be in Houstonor Hong Kong, Moscow or Montevideo, Denver or Dubai,Stockholm or Sydney.These are bonds, similarities of purpose, works done inrooms that have a similar appearance the world over, thesame relationship between the patient in need with the skillfulphysician who has the tools and experience to care for thishuman being with some kind of pain. We also share theknowledge, that in some areas our colleagues lack the tools toadequately play their role in healing and we share the desire toreach out and help.We, as Plastic Surgeons, are separated by languages, byborders and boundaries, and in some instances by cultures…..but the bonds that unite us are far, far greater than those factorsthat separate us. We truly are a family, brothers and sisters, allworking to take care of the family business.What is the family business?The family business is to make people’s lives better throughPlastic Surgery.Dr. Thomas M. Biggs, M.D.Editor-In-ChiefIssue 7 www.ipras.org IPRAS Journal 13

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 TOctober 2011 - December 2011Let’s give our answers to the ChallengesMr. Zacharias KaplanidisIPRAS Executive DirectorThere is no doubt that the international community isfacing multiple and, perhaps, the most complicatedchallenges of the last decades.Europe continues to tackle, with limited success until now,its fiscal issues; unemployment has reached dangerouslevels, especially in Southern Europe (in Greece alone ithas reached 20%), Europe and America’s problems havebegan to burden China’s exports and developmental rate(6,4% from 8,5% in 2010). Northern African and MiddleEast countries continue to be socially agitated, despitethe collapse of the dictatorship regimes (Egypt, Iraq,Libya and Tunisia)Dr. Gregory Evans, USA (ASPS President Elect) during hispresentation at the 1st Chinese European Congress of Plastic,Reconstructive and Aesthetic Surgery.And if all the above were not enough, the PIP scandal wasadded to the list of issues that trouble the InternationalPlastic and Aesthetic Surgery Community.So, where does all this lead us??- To the foresight of the Maya ancient tribe that the worldwill come to an end in 2012???- Or, on the contrary, to the perception that the “ship ofhumanity” needs a change of course, so that it is notleft stranded.Despite my utmost respect for the advanced civilizationof the Maya tribe, it is my belief that “we are going thewrong way”.It is entirely up to the leadership of the European countriesto solve their economical problems immediately and, atthe same time, Southern Europe must learn to complywith the rules of a prudent management. The “ArabSpring” must quickly come to the day-after decisions forthe benefit of its people. China, Brazil and all the otherrapidly developing countries must understand that theyare not “de facto” almighty, but depend on the peace andfinancial progress of other countries.Regarding the PIP case, the industry must respect thecommon interest, especially public health and focus onmeeting the needs of the public and not risk the public’shealth in order to make a larger profit.Finally, we, the people, are obliged to visit our doctorson a regular basis, whether we have undergonesurgery (even for aesthetic reasons) or not.The example was clearly set by our InternationalConfederation (IPRAS) which responded immediatelyand positioned itself effectively on the PIP issue, bysending its assessments to 101 National Associationsand 37000 Plastic Surgeons around the world. The mainpoints of the IPRAS statement were the condemnation14 IPRAS Journal www.ipras.org Issue 7

From the left: Mr Alexey Kovalsky, POLYTECH Health & Aesthetics Director POLYTECH Health & Aesthetics Ukraine, Mr. WilfriedHüser, founder and owner of POLYTECH Health & Aesthetics, Mrs. Katherine Lee Tai, USA, Dr. Paul Ling Tai, USA, Prof. Yilin Cao, China(President of CSPS, IPRAS Deputy General Secretary), Prof. Marita Eisenmann- Klein, Germany (IPRAS President), Mrs. Vivian Breinhild,POLYTECH Health & Aesthetics Director International Sales, EMEA, Dr. Albert de Mey, Belgium (member of the Scientific Advisory Boardof IPRAS), Dr. Philippe Blondeel, Belgium (member of the Scientific Advisory Board of IPRAS), Dr. Pericles Serafim Filho, Brazil (memberof the Scientific Advisory Board of IPRAS).Mr. Zacharias Kaplanidis (IPRAS Executive Director). IPRASpresentation during the 48th Brazilian Congress of Plastic Surgery.of the irresponsible companies, the recommendationto all doctors and patients to keep a calm status, thesupport to the healthy and serious industry of PlasticSurgery and the urge towards preventive check-upsof the patients.Conclusion: All of the above complicated challengescan be confronted with a wise and willing attitude,but can also lead the “humanity ship” to much more“tranquil ports” with a social, political and economicalcomplexion.IPRAS, in the last 3 months of 2011, came closer to itsmembers and to the National Associations of nationssuch as China, Brazil, Russia and Italy.The 1 st Chinese European Congress of Plastic,Reconstructive and Aesthetic Surgery took place inBeijing, China, from October 27 th to October 29 th withthe utmost success and attracted approximately 200Chinese and more than 300 distinguished foreign PlasticSurgeons. Apart from the scientific and organizingsuccess, this Congress could certainly be characterizedas a grand rehearsal for the IPRAS World Congressof 2015. Important conclusions were drawn, which willbe utilized when the time comes.Issue 7 www.ipras.org IPRAS Journal 15

Dr. Theodoros Voukidis, Greece (ISPRES founding member), Mrs. Katherine Lee Tai, USA, Prof. Marita Eisenmann- Klein, Germany (IPRASPresident), (at the back) Mr. Fabian Wyss (Crisalix Chief Marketing & Sales Officer), (at the front) Dr. Josef Fedeles, (member of the Training andAccreditation IPRAS sub-committee, IQUAM member), Prof. Yilin Cao, China (President of CSPS, IPRAS Deputy General Secretary), Dr. Paul LingTai, USA, Dr. Pericles Serafim Filho, Brazil (member of the Scientific Advisory Board of IPRAS), Dr. Ricardo Mazzola, Italy (IPRAS Historian).Mr. Zacharias Kaplanidis (IPRAS Executive Director), Mrs. CarolL. Lazier, USA (Staff Vice President and Chief Membership OfficerAmerican Society of Plastic Surgery), Dr. Phillip Haeck, USA (Former President of ASPS) at the IPRAS booth during 48th BrazilianCongress of Plastic SurgeryFurthermore, the IPRAS Executive Committee andthe Board of Directors convened during that time,with a large participation of its members and importantdecisions were made, such as the 2012 Budget approval.Our President, Prof. Marita Eisenmann-Klein, ourGeneral Secretary, Dr. Nelson Piccolo, the DeputyGeneral Secretaries, Dr. Yilin Cao and Dr. Ahmed AdelNoureldin, our Parliamentarian, Dr. Norbert Palluaand our Treasurer, Dr. Bruce Cunningham were allpresent at this very important event. Additionally,we must point out the impressive participation of theBrazilian Plastic Surgeons (approximately 60) and theRussian (approximately 70).We would like to thank the Scientific and OrganizingCommittee of the Congress, Prof. Yilin Cao, Prof.Andreas Yiacoumettis, the greatly missed (due to apersonal issue) and NIKE Med, Polytech, Crisalix andSilimed for its substantial contribution.Immediately after China, we traveled to the otherside of the planet, to Brazil, for the 48 th BrazilianCongress of Plastic Surgery, which took place in theadorable city of Goiania, the homeplace and permanentresidence of our General Secretary from November 10 thto November 15 th , Dr. Nelson Piccolo. With more than2000 participants, Brazil proved once more that, notonly is it one of the largest associations (2 nd after USA)16 IPRAS Journal www.ipras.org Issue 7

Mr. Zacharias Kaplanidis (IPRAS Executive Director) with Mrs. Liudmila Antonova, Russia (General Director of Nike-Med) and Mrs. AnnaPimenova, Russia (Nike-Med) addressing to Russian Plastic Surgeons concerning IPRAS benefits at the “NIKE-MED’s 15th AnniversaryConference “Happy to be Together”.in the world, but also that it is a great country on ascientific level and dedicated to more ethical values.For approximately 3 hours during the opening ceremony,important personalities were honored, such as Prof. IvoPitanguy, Prof. Baroudi and all the past Presidents of theAssociation.It was the most beautiful and emotional OpeningCeremony that I have ever attended so far.CONGRATULATIONSLet us hope that all the other National Associationswill follow this bright example of acknowledgementof personalities who have honored the field of PlasticSurgery in their countries with their achievements andethos.The truth is that I indeed experienced that same atmosphereagain in Cesme, Turkey, during the Congress of theTurkish Association of Plastic and Aesthetic Surgery. Itis truly a remarkable feeling.Our President, Prof. Marita Eisenmann-Klein,Executive Director, Mr. Zacharias Kaplanidis andAssistant Executive Director, Mrs. Maria Petsa,represented IPRAS in Brazil and had the opportunity tospeak to hundreds of participants on issues concerningthe Confederation’s co-operation with the BrazilianAssociation and its members.We thank them all for their absolutely wonderfulhospitality, but especially we would like to thank thePresident of the congress Dr. Carlos Calixto theScientific committee Member of the Brazilian Societyof Plastic Surgery, Dr. Pericles Filho, and, of course,our General Secretary, Dr. Nelson Piccolo and histruly beautiful family.In mid-December (12 th - 15 th ), the executive Director,Mr. Zacharias Kaplanidis, traveled to Moscow, wherehe met with members of the Russian Associationof Plastic and Aesthetic Surgery and discussed thepotential for organizing a workshop based on newdevelopments in the field. Another great opportunityto exchange scientific knowledge with a great country.We would like to express our gratitude to the NIKEmed Company for its hospitality and support.Our last journey in these 3 months took us to Italy andspecifically Rome (December 15 th to December 17 th ), wherewe participated in a special scientific event with highlydistinguished scientists from the Italian and InternationalWorld of Plastic Surgery, the 3 rd International Conferenceon Regenerative Surgery. The President of theConference, Prof. Valerio Cervelli, Dr. Sydney Colemanand Prof. Marita Eisenmann-Klein, Dr. Dan Del Vecchioand Dr. Gino Rigotti were just a few of the basic speakersof the Conference, which focused on the contemporaryissue of Regenerative Surgery and Fat-Grafting.After all the above, 2011 comes to an end. It has been ayear with tremendous challenges for all to face, but withthe appropriate response by the bodies of IPRAS and itsmechanisms.Zacharias KaplanidisIPRAS Executive DirectorIPRAS Management OfficeZITA CongressIssue 7 www.ipras.org IPRAS Journal 17

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P I O N E E R SAn interview with Dr. Rod RohrichDr. Biggs: Dr. Rohrich, with your work as Editor-in-Chief of the official Journal of the American Societyof Plastic Surgery, you play what I, and many others,see as the most significant role in education of PlasticSurgeons in the world and thus, the course into thefuture of Plastic Surgery. For this, we are proud todesignate you as our “PIONEER” for this issue ofthe IPRAS Journal.We would like to use this interview as an opportunityfor the 37,000 recipients of our journal, to get abetter understanding of you and what is behind yourdrive…and how you see the future.Let’s begin by your giving us a bit on yourbackground.Dr. Rohrich: I grew up on a ranch in North Dakotaand did not speak English until the age of five. Ilearned early on, that the best way to succeed wasto be focused, work hard, and that it does not matterwhere you are coming from, it’s where you are goingthat’s most important. This is indeed the ultimateAmerican dream.I did my Plastic Surgery training at the Universityof Michigan after completing Medical School atBaylor College of Medicine. I was highly motivatedand stimulated by Dr. Mel Spira, head of PlasticSurgery at Baylor, who became one of my earlyPlastic Surgery mentors. At the University ofMichigan, I worked with Drs. Grabb and Dingmanand was vastly influenced by these gentlemen, whoboth subsequently died during my six-year PlasticSurgery residency. I will never forget their totalfocus and dedication to the excellence in PlasticSurgery. Dr. Dingman instilled a sense of duty andto always do the right thing: he was amazing. I wasstrongly encouraged by Drs. Grabb and Dingman towrite, to promote and to give back to Plastic Surgery,because we get so much from Plastic Surgery. Thereis always time to give back and to contribute tothe advancement of the art and science of PlasticSurgery. I was then brought under the tutelage ofDr. Steve Mathes, who was my Chairman while Iwas Administrative Chief in Plastic Surgery at theUniversity of Michigan.These were highly formative years. I also spent asignificant amount of time doing Pediatric andCraniofacial Surgery in my elective year. I spent timeat Oxford University with Dr. Michael Poole doingCraniofacial Surgery and then met Drs. Marshacand Tessier, two outstanding Plastic Surgeons, inmultiple trips to Paris. I also had the opportunity tospend time with Dr. Fernando Ortiz-Monasterio inMexico City, in the pinnacle of his career.At the Massachusetts General Hospital/Harvardin Boston, Dr. James May taught me to focus onexcellence in all I do and always be better eachday. This continues to be a valuable life lesson. Irapidly learned that Plastic Surgery, as a specialty,does not have its own organ, such as the prostate forUrology or the brain in Neurosurgery. Instead, wehave our own innovation and that is something thathas been the glue that’s actually been the foundationfor our specialty. This has guided me in my role as APlastic Surgeon and has motivated me to give backto this wonderful specialty as a teacher, as a ProgramDirector and as a Chairman. We must teach the nextgeneration to pursue excellence, be innovative, createan environment for innovation and to give back byIssue 7 www.ipras.org IPRAS Journal 19

doing, not only superb clinical work, but to giveback by innovating and publishing in peer-reviewedjournals, as well as presenting our work worldwide.My interest in writing began as a medical student atBaylor College of Medicine, while working with Dr.Mel Spira.Dr. Biggs: I certainly agree with you about Mel Spira.I met him in the emergency room the afternoon ofmy first day as a resident at Baylor in Houston. I wasthe Surgery resident on call and he was the plasticsurgery resident on call, on his first day workingthere, like me. We became great friends then and stillare. He will always be my number one mentor….but to get on with the interview: tell us about whatyou’re doing in Dallas. You run probably the mostproficient and productive training programs in theU.S. and even the world. Tell us about it.Dr. Rohrich: You can always become and bebetter, no matter how good you are at what youdo. It is helpful always to surround yourself withpeople that have the same philosophy. I find thatthe key to success is in picking great people, bothin residency and faculty, that are better than myself.You have to be very selective and selfless in doingso; it demands conducting a regular 360-degreere-evaluation of yourself, so you can re-focus andrethink on areas which are important. You haveto be focused long-term. For example, at UTSW,we have taken a small division of Plastic Surgerywith a couple of faculty and staff, to a staff ofover one hundred and thirty, with twenty full-timefaculty, nine part-time faculty, six residents peryear and multiple fellows in Craniofacial, Hand,Cosmetic, Micro and Breast Surgery and research.We have multiple NIH grants and one of the mostlargely productive clinical and academic facultydepartments in the U.S. Becoming a Departmentof Plastic Surgery at UT Southwestern was pivotaland has provided us with a basis for growth andan example for other divisions and departmentsaround the country to succeed as well.How can we become better at what we do in PlasticSurgery? An “expert” is someone who is focused onexcellence through practice, focus and dedicationfor over 10,000 hours. This type of training andcommitment holds true whether you want to be aconcert pianist or Plastic Surgeon. If you want tobe an expert in what you do, you have to focus on itand dedicate a significant part of your career to thiseffort. The time to start doing this is now, while youare a young Plastic Surgeon.As I mentioned previously, I spent my formativeyears growing up on our ranch in North Dakota, withlimited resources, but my parents wanted a better lifefor all of us. They imparted to my two brothers andme a tremendous work ethic and that one must leadby example, like my parents did for us. I certainlynever ask a faculty member, resident, or anyoneelse to do anything I would not do myself. It keepsme grounded as well. One must lead by example tobecome a role model or mentor. We are influencedby and pattern our lives after these role models andmentors. I certainly remember one of my earliestrole models, besides my parents, was one of myscience teachers, Mr. Schimcke, who challengedme to find a new way to study Mendelian Geneticsusing fruit flies. He allowed me to do things I hadnever done before and to do them by myself. Justremember that you have to aim high in life if youwant to succeed. Therefore, aim very high becauseyou will get where you aim. If you don’t aim high,you’ll always get there, too, and you will not behappy for aiming so low. You must aim higher thanyou think is attainable and it will get you there. Agood work ethic is strong encouragement both athome, at school and in your personal life and wecertainly try and gender that into our residents.Coming from a high school class of twenty fourstudents, where I was one of the only ones thatactually finished college and went on to highereducation, helped me focus on setting high goals,working hard, and pushing myself to a higher level.That is what makes you succeed in life.Dr. Biggs: For the past few years I’ve heard youspeak passionately about Evidence-based Medicine.Please bring us up to date on that matter and how it’sbeing reflected in the Journal:Dr. Rohrich: I think one of the epic changes inMedicine and in Plastic Surgery is that we areowning our specialty, as we become more evidencebased.Plastic Surgery has been an “expert-based”specialty, where experts have driven the specialtythrough innovation. These experts are incrediblyvaluable and continue to be, but we must now goto the next level of excellence. That next level20 IPRAS Journal www.ipras.org Issue 7

of excellence is that of evidence-based medicine(EBM), where we must prove that what we learnedas experts can truly be done, not only by ourselves,but by others and can be shown to work in both aprospective and randomized manner. Whether it isa product, a technique or a technology, it must nowbe shown to truly work sufficiently, in a scientificmanner. That is the next level of excellence wemust achieve. Since becoming Editor-in-Chief ofthe journal of Plastic and Reconstructive Surgery in2005, we have pushed the technological envelope,evolving the journal from being a print-only versionto being online in all aspects (including the peerreview process to the upcoming development of theiPad app). Today, you can see, feel, and look at ourvideos in the PRS journal instantaneously. That isthe natural evolution. Innovation, aiming high andseeking new challenges brings you higher caliberarticles, as well as a higher caliber type of evidencebasedPlastic Surgery, which will help drive PlasticSurgery to a better place in Medicine. The bar inPlastic Surgery is being raised and we are pushingthat bar with evidence-based medicine. We need topush our entire specialty of Plastic Surgery to comeand join us, to make sure that we truly are and remainat the cutting edge, not only of innovation but thatof EBM, so we can show the rest of Medicine thatwhat we have done and what we continue to do isevidence-based.So, as a Plastic Surgery leader in the United States,I think it is important for us to show and leadby example, not only by our journal, but now inour clinical practice. EBM is rapidly changinghow we practice Medicine and how we practicePlastic Surgery. It will make us better. The goalis to provide a foundation for doing evidencebasedPlastic Surgery. There is no better way thanmandating that Plastic Surgery programs becometheir own departments; this must be solidified, sowe can allow for true innovation to occur, separateand apart from General Surgery, which, I think, isso critical. We are now, and have been for a longtime, our own specialty. Because EBM has provento be a highly effective methodology, the AmericanSociety of Plastic Surgeons and the AmericanSociety of Aesthetic Plastic Surgery, along withother Plastic Surgery and related specialty journalsand societies, convened at the first Plastic SurgeryEvidence-Based Medicine Summit in ColoradoSprings, Colorado in August 2010 (see Figure1). At that meeting we strongly encouraged all ofthe journal editors to work with the ASPS and thejournal of Plastic and Reconstructive Surgery tohave a single grading system for evidence-basedmedicine, similar to what we use in PRS, so we canmove forward together. A year later, in May 2011,at the Plastic Surgery Journals Editor Round TableMeeting in Vancouver, Canada (see Figure 2), PRSwas joined by other international Plastic Surgeryjournals and we all agreed to work on establishinguniform global EBM standards and Levels ofEvidence grading systems. At the Vancouvermeeting, we agreed to invite all of the world editorsof Plastic Surgery journals, as well as those of ourother related specialties, in Facial Plastic Surgery,Dermatology, Oculoplastic Surgery, to attend ournext EBM strategic planning meeting in ColoradoSprings in July, 2012. EBM is for Plastic Surgeryworldwide, and Plastic and Reconstructive Surgerystands as an advocate for unified, global EBMstandards among all Plastic Surgery and sisterspecialtyjournals.Dr. Biggs: How do you see the future of PlasticSurgery?Dr. Rohrich: The future of Plastic Surgery is verybright. It lies in innovation, autonomy, becomingdepartments, developing and expanding evidencebasedmedicine through the entire world, anddeveloping a uniform platform for the language inspace medicine. We will focus on where we are goingto take EBM in Plastic Surgery in the future, how wewill become better: better in what we do, better inour practice and better in improving EBM, becausethat is our future. After all, the goal is to improvepatient care, drive innovation, drive cost efficienciesand only then can we say we have given our best,given back and left the world a better place, both forMedicine and for PLASTIC SURGERY. That is mygoal and that is what I will continue to do.It pleases me to get this message out to your 37,000recipients and I want them to join me in this adventureof the EBM world of Plastic Surgery. It will be abetter place for all of us as Plastic Surgeons and forPlastic Surgery as well.Dr. Biggs: Thank you Dr. RohrichIssue 7 www.ipras.org IPRAS Journal 21

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R I S I N G S T A RAn interview with Dr. Bouraoui KottiDr. Biggs: Congratulations on being chosen as ourRISING STAR for this issue of the IPRAS Journal. Asyou know, we select someone under the age of 45, whohas shown great promise in their pursuit of excellence inPlastic Surgery. Tell the readers a bit about yourself. Beginby telling us your background and your education.Dr. Kotti: I was born in 1977 in Tunisia, a country of11 million people and 80 plastic surgeons. My primaryeducation was undertaken there, as well as my medicaleducation. I graduated in June, 2000, from the MedicalSchool of Tunis and followed that by a broad medical/surgical internship for one year.From 2002 to 2006 I did a residency in Plastic Surgeryand completed a dissertation on “Plastic Surgery for theManagement of Pressure Sores”. I graduated SummaCum Laude from the Tunisian Public Health Departmentand the Tunisian Higher Education, Scientific researchand Technology Department in Plastic Reconstructive &Aesthetic Surgery (October 2007) and made the decisionto move to France, where I continued my studies. Iworked in Nice and Paris in services including breastreconstruction, maxillofacial surgery, head and necksurgery, and general Plastic Surgery, including AestheticSurgery. I spent most of last year (to February, 2009)with Dr. Claude Lassus in Nice. My studies and workin France allowed me to be Certified from the FrenchCollege of Plastic Reconstructive and Aesthetic Surgery(November 2007) and, in May 2008, by the EuropeanBoard of Plastic Reconstructive and Aesthetic Surgery.Dr Biggs: And then you returned to Tunisia ?Dr. Kotti: Yes, and in 2009 I joined the “Salah Azaiz”institute (an anti-cancer centre) and have become Headof the unit of Plastic Surgery in the Surgery Department.Dr. Biggs: What Societies do you belong to?Dr. Kotti: Tunisian Society of Plastic, Reconstructive,Maxillofacial, and Aesthetic Surgery (STCPRMFE),ASPS, SOFCPRE, and ISAPS of which I’m NationalSecretary.Dr. Biggs: I looked over your list of publications andpresentations, over twenty in all, and fifteen posters.I noticed you have run the table on topics from digitalreattachment to abdominoplasty and blepharoplasty,breast reduction and reconstruction, to extensivemaxillofacial reconstructions, and to burns. That’s a lotof production for a young man and very impressive.Dr. Kotti: And there is a lot more to doDr. Biggs: Tell me about that. What do you predict andwhere do you see yourself in five years?Dr. Kotti: I see myself still in pursuit of better ways to domore for people. My interest lies more in reconstruction,but with an increased attention to its aesthetic aspects.My great hope is that the political situation in Tunisia willbe such, that I can expand my research capabilities andimpart progress made there into clinical applications.Dr Biggs: Thank you Dr. Kotti. Your great hope isshared by members of our Plastic Surgery family aroundthe globe and this is why I so often say that “the bondsthat unite us are greater than the borders, boundaries, andlanguages that divide us”Again, congratulations on being chosen our “RISINGSTAR”.Issue 7 www.ipras.org IPRAS Journal 23

S E N I O R A M B A S S A D O RDr. Riccardo F. MazzolaDr. Biggs: Dr. Mazzola, to those of us who have been onthe Plastic Surgery scene for a while you are a legend, butthis is an International Journal and many of our readers aresomewhat new to the field, so please give us a review ofyour educational and training background.Dr. Mazzola: I obtained my medical degree at the Universityof Pavia in 1967, magna cum laude. I passed my Boardexamination in ENT in 1970 at the University of Ferraraand my Board in Plastic Surgery at the University of Milanin 1974 (head Prof. G. Sanvenero Rosselli). I became anAssistant Professor of Plastic Surgery at the Universityof Milan in 1971 and I am currently Professor for Plasticand Reconstructive Surgery at the Postgraduate School ofENT, and Maxillofacial and Plastic Surgery at the School ofMedicine of the University of Milan.Dr. Biggs: Tell us about your Foundation.Dr Mazzola: In April 1975, I established the “FondazioneG. Sanvenero Rosselli” for Plastic Surgery, as a tribute to mylate uncle Gustavo Sanvenero Rosselli, founder of PlasticSurgery in Italy. The institution promotes various formsof teaching, fulfilling a continuous postgraduate trainingprogram, by arranging meetings, seminars and courses inthe field of Plastic Surgery. Directed by a Board of Trustees,the Fondazione has coordinated more than 150 meetingsand seminars and organized 48 theoretical and practicalcourses, with live surgery over the years. I am currently theVice-President of this Institution. The Fondazione housesmore than 4,000 books and boasts certainly one of the mostimportant rare book collections on Plastic Surgery in theworld. We have volumes dating from 1490 onward.Dr, Biggs: Tell us about your professional life.Dr. Mazzola: I am a Founding Member, Secretary General(from 1995 to 2001) and President (from 2005 to 2006) of theEURAPS (European Association of Plastic Surgeons). I wasSecretary of the Italian Society of Plastic Surgery (SICPRE)from 2001 to 2004, and am a member of over 15 Nationaland International societies, among them the prestigiousAmerican Association of Plastic Surgeons (AAPS).Dr. Biggs: How about presentations and authorships?Dr. Mazzola: I have participated in 450 invited panels,lectures, conferences and courses at National or InternationalMeetings and Congresses. I have organised 52 Congressesand Courses.I’ve been honoured to be the Keynote speaker in numerousInternational Congresses, and was awarded the Maliniaclectureship at the 2006 ASPRS Congress in San Francisco,USA.I am the co-Author of 3 textbooks (“CraniofacialMalformations”, Churchill Livingstone 1990; “VelopharyngelIncompetence”, Masson 1995, in Italian, “Fat Injection,from Filling to Regeneration”, Quality Medical Publishing,2009), 12 book chapters and 112 publications, 38 of them inpeer reviewed scientific journals.Dr. Biggs: What are your primary surgical interests now?Dr. Mazzola: My primary interests include Cleft Lip andPalate, Head and Neck reconstruction, Nasal Reconstruction,Fat injection, Rhinoplasty and History of Plastic Surgery.Dr. Biggs: Where do you see us going in Plastic Surgery?Dr. Mazzola: That is a good question, because I am bothoptimistic and, at the same time, somewhat despondent. I’mthe latter because Plastic Surgery, by not being independent,has less opportunity for research. Modern day Plastic Surgerybegan with a collection of ENTs, General Surgeons, and severalothers who had a common talent: innovation. Innovationwas necessary to deal with the massive wounds resultingfrom World War I, wounds never seen before, because theseunfortunate victims were the beneficiaries of medicine whichwas advanced enough to keep them alive but still lacking inskills to reconstruct them. My despondency lies in the fact thatour lack of independence limits us in our quest for advancedsolutions plaguing modern surgical problems.My optimism lies in the wonders that await us. Thesewonders include wound healing, tissue regeneration,concepts of neurogenesis, and many others.Dr. Biggs: Do you have any advice for our youngerreaders?Dr. Mazzola: Yes. Go back several centuries and see howbrilliant minds were dealing with some of the same problemswe are dealing with now. See how Leonardo Da Vinciunderstood anatomy, how concepts of wound healing haveevolved. Study the Masters and extrapolate their creativethought processes into your own.Dr. Biggs: Thank you Dr. Mazzola. You truly are a SeniorAmbassador for IPRAS and for physicians of all types.24 IPRAS Journal www.ipras.org Issue 7

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H U M A N I T A R I A N W O R K SHow to conciliate religionand humanitarian surgeryin Islamic developing countriesDr. Christian EchinardPresident, HumaniTerra InternationalPresident, IPRAS FoundationDeveloping Islamic countries are quiet and peacefulareas, most of the time. In some cases however, thework of humanitarian teams is not as easy as that… Thefollowing lines try to analyze the specific problems thatcould be encountered in some places, where the religionis dominating and ruling the public life and the culturalhabits in such a way, that things are becoming so differentand thus more difficult to understand for an occidentalmind. And after all, if we want to help them, we first haveto understand them….SPECIFICITY OF WORKING CONDITIONSFOR THE HUMANITARIAN TEAMSThe teams are faced, most of the time, with a triplespecific deal: the religion, the women’s condition and thecorruption …The religion• About Islam: Islam is a beautiful religion, spread allover the world. However, the territory where it is theA man in Kabul…predominant religion geographically extends, more orless horizontally, from the western part of Africa to theFar East end of the southern Asian continent, includingMalaysia and Indonesia. Historically and theologically,there are several “families” of Islam, such as Shiites,Sunnites, Kharijists… all of these groups coexist in amore or less complex harmony in the many developingcountries, where humanitarian teams are performingsurgical camps or missions.Moreover, Islam is, most of the time, a state religionand therefore this religion often becomes a realpolitical-religious rule.In fact, there are, as far as geography and culture areconcerned, several Islams… Because of local politicaland cultural factors, Islam in Maghreb is not exactlythe same as the one in Indonesia and is also differentfrom the Islamic beliefs of central Asia or Turkey, forinstance.The medical and surgical humanitarian teams workingin different parts of the world will be faced with a“soft” or “moderate” Islam in some places, or with a“hard” or “strong” Islam in other countries…• The Muslim population: it seems that the actualnumber of Muslims in the world reaches approximately1.5 billion people. Etymologically, the word Muslimcomes from the Persian “Musilman”, plural of Musilm,whose root is the verb “Aslama” (to be resigned, to besubmitted … to God, of course). This great number ofpeople and the strength of their faith put Islam as oneof the major religions in the world, especially in thepoorest parts of the world.• Their position towards illness and medical care is notidentical everywhere. Muslims of the world, thoughthey cannot really read and deeply study the enormousamount of rules of the Koran, are very faithful and,most of the time, respect the 5 main rules (five prayersa day, pilgrimage, Ramadan…) As far as illnessand medical care are concerned, there is, in fact, no26 IPRAS Journal www.ipras.org Issue 7

Women from the mountains in Afghanistanspecific rule. For some of them, illness is consideredas a punition of God and requires little care, for someothers, on the opposite, it is something that must betreated absolutely immediately.The women, of course, have a special status… Insome remote places they should not be touched by amale doctor… The problem is that, very often, thereis no female doctor… This is very frequently thecase in Afghanistan, where women die because theirhusbands refuse the help of a male doctor, especiallyfor delivery. This is, of course, an extreme point ofview. In most cases things are much simpler and thereal rule in the Islamic religion is that, when there is anecessity, women can be treated by any male doctor,Muslim or of any religion. Necessity creates the lawand the rule… a safe and good advice…The women’s condition: female mortalitycreates a terrible disorder• Gender mortality: this is a real economical anddemographical problem. In most of the Islamicdeveloping countries, the female to male ratio is, onaverage, 900/1000; It is the opposite in occidentalareas: 100 females for 90 males in Europe, whereasin Bangladesh and Pakistan the ratio is 100 women for106 males. Another interesting sign is that, in those twocountries, the average duration of life is the same in menand women (56 years); in Europe and America femaleslive approximately ten years longer than males…This over-mortality in the female population is due toseveral factors, such as the way of life, the number ofchildren, the amount work done by women… but alsodue to the high maternity mortality and the increasedlevel of violence towards them.• Materity mortality: in Afghanistan, one woman diesevery 21 minutes due to delivery problems! In centralAsia Islamic areas, 2000 female patients die in 100 000births! In Europe the average is only 10-20/100 000.• Violence towards women is also an important cause offemale over-mortality.It can be in the form of domestic and marital abuse. Itreaches 50% in some of these countries, the championbeing Bangladesh, where more than one wife out oftwo is regularly beaten. In Pakistan, 300 women arekilled every year by their husband, brother or son, inthe name of honor.Among the worst crimes, forced or induced suicidesby flame are very frequent in Iran, Afghanistan(especially the Herat area), Pakistan, Iraq, but also inAfrica (Zimbabwe, Egypt…)In Pakistan and Bangladesh, there are many acid attacksagainst women, committed by jealous or unsatisfiedhusbands. This type of acid burn on the face leads toextremely severe contractures and real disfigurations ofthe wives. Two NGOs have been created to fight againstthat, the “Acid Survivors Foundation” ran by ValerieKhan in Pakistan and Monira Rahman in Bangladesh.Apart from marital aggressions, these gender crimes canalso be the result of abusive punishment or usual violencesuch as stoning, rape, excision, any kind of mutilation(hand or nose…), sexual slavery and forced pregnancy.Moreover, many rapes have been committed in thesecountries as a war weapon, in order to humiliate theenemy. In Kuwait, over 5000 rapes were committedagainst the local women by the Iraqi forces, when theyinvaded this country in 1990. In Algeria, between 1995and 1998, rapes were committed in the name of the Jihadin order to render the females impure and dishonored…Issue 7 www.ipras.org IPRAS Journal 27

ules of our action. We must understand what they areand what they need and therefore respect their identity.But we must never betray our principles. We must adaptthem to the local situation. The most important rule is torespect three important things: the political and religiousauthorities, the local medical teams and, above all, thepatients whom we are suppose to treat.Teaching women rights in BangladeshThe corruption and … the narcotics business• Corruption: last year, the UNDP (United NationsDevelopment Program) classified Afghanistan atthe 155th rank out of 169 countries in the world fordevelopment and economy. Meanwhile, the NGO“Transparency International” stated that this countrywas placed third as far as corruption is concerned !• Narcotic trafficking: most of the time, corruption isconnected to drug trafficking … Afghanistan is by farthe first opium producer in the world; before the Talibanperiod (during the soviet domination) production wasestimated at 2500 tons per year. In 1999, at the endof the dramatic Taliban government, it reached 4600tons per year, proving that they did not do anythingagainst drug trafficking… In 2007, under the currentgovernment, opium production in Afghanistan nearlydoubled, and was evaluated yearly to 8200 tons! Andthis was of course very much to the benefit of thepolitical elite. The resulting gain from opium traffickingis probably one billion dollar per year. One gram issold in the country about 2 or 3 dollars. It is re-sold inEurope or America for 70 dollars. At the same time,we found that it is still difficult to find narcoleptics foranesthesia in a hospital in Kabul or Herat …• Position of the medical team faced to this problem: thisshows how the task of the humanitarian medical teamscan be difficult in such countries… corruption mustnot touch our teams. Everything possible must be donein order to avoid any kind of collision with anyone.And everyone must be aware that the manipulation ofthe team about this problem can be very easy and canbe a source of conflicts…WHAT MUST BE THE BEHAVIOROF THE HUMANITARIAN TEAM?In the face of such a situation, the behavior of theforeign surgical team must comprise of understandingand adaptation, as long as we keep in minds the ethicalRespect of the political and religious authorities• In every one of these countries the humanitarian teams,or their delegates, must try to have a meeting with thelocal or regional political authorities (governor, presidentof local assemblies, Shuras…). A complete agreementmust be established before any action is taken on thefield. This makes things much easier for the rest of themissions and always clarifies the situation.• Mullahs and religious assemblies should also becontacted, in order to explain to these dignitaries whatthe aim of the mission is and get a complete approvalfrom them. This is particularly useful when a NGO isworking on a prevention campaign, in which womenare involved, such as campaign against suicide byflame or against acid attacks. It is very important todiscuss with them, explain to them the work that willbe done, ask their opinion, see how they can help…Communication is extremely important and, withthe consent of the Mullahs, the behavior of men andwomen in the area will be very much in favor of theNGO. On one hand we must absolutely avoid beingconsidered as neo-colonizers by the local population.On the other hand, when we are supposed to deal withsituations related to women, we must avoid any kind offrustration or dishonor from the men. This is also thereason why it might be useful to work in collaborationwith a local NGO.Respect of the local surgical teams• Most of the time, the NGO surgical team is totallywelcome by the local medical teams, which areA men session during the anti self immolation campaign28 IPRAS Journal www.ipras.org Issue 7

They must be confident. Security is one of the mostimportant things. We must not appear as arrogantcowboys invading the country, and giving orders. Ourrole is to do the job as well as we do at home, or better,although the conditions are often much more difficult,due to a precarious situation or a lack of modernmaterial. Of course, professionalism goes together withsafety… “Safety first” is one of the phrases that wemust keep in mind. A small number of operations withgood results and good functional outcome is alwaysbetter than many operated cases with bad or mediocreresults… bad results are always interpreted and felt asbad work or, sometimes, as a humiliation.PROVIDE AN ADAPTED HELP:Considering all these parameters… what can we do…?• Build or Rebuild and help them to work in goodconditions: very poor countries, often belonging tothe Islamic area, have rather seldom good hospitalaccommodations. There is often a lack of hospitals orsurgical wards, a lack of well trained surgeons, a lackof paramedics…A good occidental NGO must be aware of that.Therefore, it is important for them to restore or evento build specific wards for surgery. Reconstructivesurgery in particular is not well developed in thesecountries. Our goal must be to help them to get newbuildings. In Islamic countries we try to build or restorespecific departments where physically abused womenTeaching afghan women how to fold the gauzecan be treated. HumaniTerra, for instance, has built apilot burn center, in which women have a completelyseparate ward from the men, just as if we had buildtwo burn centers… Physical rehabilitation is also donein a specific area.We have also been the leaders and initiators of theHOT program (Herat Operating theatre, 6 verymodern operating rooms), together with the help of theJapanese and Italian cooperation. This allows womento be operated in conditions as good as the men…An adapted help is, to try to study what will fit the bestto a specific situation, integrating the Islamic laws andhabits… To women, treatment is given by women.• Prevent them from bad habits and help them to geta better life: are we allowed to change the rules…?Certainly not… just because we are foreigners thereis no reason why we should try to make new laws.Nothing is justifying the fact that democracy is betterfor countries that are used to live under tribal laws…why would we interfere…? And after all, is Islamcompatible with democracy…? This is a questiondifficult to answer, although Turkey, for instance, is agood example showing that it is possible… on the otherhand, the Islamic countries of the “Arabic Spring” (Libya, Tunisia, Egypt…) have also shown proof ofthat… but we still don’t know what the outcome willbe in a few months…However, even if we do not feel authorized to give themlessons in life, the role of a NGO is to try to induce abetter way of life, a better equity between women andmen, a more reasonable sharing of knowledge, anequal chance of happiness for everyone and dignity forevery human being.Towards this aim, we have set up several Campaigns forthe dignity of women. In Afghanistan Two campaignswere organized, in cooperation with the local NGO“Voice of Women”, in order to fight against thishorrible endemic disaster of women forced to commitsuicide by flame. During the first campaign, Lecturesand discussions were organized for Women and formen, separately, pointing out the unjustified reasonsof the crime, the expansive, long and painful treatmentand the horrible outcome with so many sequelae …after one year, the percentage of suicide by burn inthe Herat Province, decreased from 43% of the totalamount of burn patients to 11%... very good results,but still not sufficient.. A second campaign is currentlyunder way with TV videos and meeting, aimed at aneven larger amount of people.In Bangladesh, a campaign against acid attack isalso actually being set up, for the numerous womenattacked by jealous men…This type of action from the occidental NGOs must,however, not be too visible to the public, as this can30 IPRAS Journal www.ipras.org Issue 7

Afghan women outside the mosquelead to local problems with the NGO. This is a reasonwhy actions should only be performed after a totalagreement with the political and religious authorities.They should also be carried out mostly by local NGOs,under the control of the occidental NGO.• Provide them with better surgical care and helpthem to survive: In the remote areas of some Islamiccountries, illness or trauma are sometimes stillconsidered a normal thing or a punishment of god(remember that the word Islam comes from the wordAslama, “to be submitted”…) In the poorest Islamiccountries, we see a lot of congenital malformations,traumas, awful burns, post-delivery problems… Ourgoal must be to reach these isolated people who cannotpay for a hospital stay and get in touch with them,wherever they are.Illness must not be considered for them as a maledictionor a fatality anymore. The poorest of them don’t evenknow that they can be treated. Burn contractures canbe treated, acid attacks must be cured, post deliveryvaginal fistulas must be operated, care should be takenof cleft palates at any age, in any of these remoteareas… whatever the religion is, whatever the strengthand the power of religious fanaticism is…Together with its partner NGO, Friendship,HumaniTerra is providing high quality proximitysurgical care in northern Bangladesh, where the Charspopulation cannot move from their semi-floodedislands, using two river hospital boats, on which theycan be operated in good conditions. This hands-onsurgery, in the small Islamic villages, is also performedin Pakistan, and southern Bangladesh, close to thesea. Very soon it will be also done in the Bengal gulf,thanks to a new sea hospital boat , the former “RainbowWarrior”, that has actually been transformed into asurgical boat, on which every NGO teams of SHARE(Surgical Humanitarian Aid Resources Europe) andHUGS ( Humanitarian Union for Global Surgery) willbe able to operate all year long.Consulting the local assembly in Asad Kashmere , PakistanIssue 7 www.ipras.org IPRAS Journal 31

IPRAS (Asia-Pacific Section) organizeda free Plastic Surgery Campat the Dr. Rajindra Prashad GovernmentMedical College of Kangra,at Tanda (Himachal Pradesh) Indiafrom 21st to 28th (31st)August 2011.The ConceptIt was during the visit of Dr. Rajeev B. Ahuja, to inspectthe newly introduced burn unit at the Tanda MedicalCollege, on behalf of the Government of India, thatthe idea of having a surgical camp at this location wasmutually discussed between him and the Principal, Prof.Anil Chauhan. The Principal showed enthusiasm for afree Plastic Surgery camp, as the area has a lot of poorpatients requiring Plastic Surgery and such facilities arenot available in the region, including the college.The LocationThe historical town of Kangra nestles in the valleyof Himachal Pradesh. For the believers it is a place ofpilgrimage, devoted to the Goddess Parvati, the consortof Lord Shiva. Over the years it has seen numerousinvasions, a grim reminder of its strength being the KangraFort, which sits atop a steep 1000-foot cliff, rising like aphoenix from the river bed. Kangra is derived from word“Kanghara” which means “doctors who repair ears”. Asper hearsay, in ancient times, this town was famous for itsPlastic Surgeons. The RPG Medical College is a fledglingCollege, which has only recently introduced post-graduatecourses. The College is a boon for the city and thesurrounding areas, which have scarce health care.The PlanningDr. Ahuja requested Dr. Chanjiv Singh (Chairman,Humanitarian Committee, IPRAS) from Jalandhar to visitthe college and issue a feasibility report. Dr. Chanjiv visitedthe college in June 2011. He assessed the patient loadand the facilities available for the venture. The Principaldeputed Prof. Sanjeev Sharma (General Surgery) to coordinatethe planning of this camp with Dr. Chanjiv.Dr. Ahuja, as Secretary General of IPRAS (Asia-PacificSection), invited senior surgeons from the Asia- Pacificregion to volunteer for this humanitarian mission. As thiswas the first mission of its kind in the area and the Hospitalis a governmental facility, the organizers went through alot of red tape to make arrangements for the camp.The team co-ordinated with the Lions Club of the nearbytown of Dharamshala to publicize the event and toaccomodate the visiting team. The Lions Club did extremelywell in sending out information to district hospitals in theregion, and publicized the camp to the public throughbanners and posters. Their efforts landed an overwhelmingnumber of patients for surgery at the camp.Dr.Chanjiv Singh visited the college again in July tooversee the boarding and lodging arrangements, to coordinatewith the hospital authorities for the provisionof supplies, to discuss with the anaesthetists and to coordinatewith the Lions Club.The TeamsThe Indian team, lead by Dr. Rajeev B. Ahuja, comprisedof other senior Plastic Surgeons, Dr. Vimla Rajan, fromNew Delhi and Dr. Chanjiv Singh from Jalandhar. Seniorresidents from Lok Nayak Hospital, New Delhi (Dr.Dhirendra Suman, Dr Vinish Shrivastava, Dr ManishChopra); DMC & Hospital, Ludhiana (Dr. ManishSehgal); Amandeep Hospital, Amritsar (Dr. SeemaMittal, Dr.Sandeep Kansal); and PGIMER, Chandigarh(Dr. Anil Kumar, Dr.Raja Tiwari) had volunteered forthe camp through their respective Heads of Department.OT assistants Mr. Harpreet, Mr. Gurnam Singh and Mr.Vikramjit Singh volunteered from DMC Ludhiana, Civilhospital, Jalandhar and Amandeep Hospital, Amritsar,respectively. The staff of the College itself workedaround the clock, beyond their duty time to assist in thecamp.The team from Thailand was headed by Prof. ApiragChuangsuwanich from Mahidol University, the Presidentof the Association of Plastic Surgeons of Thailand. Theteam consisted of a Plastic surgeon, an Anaesthesiologist,an OT assistant, nurses and volunteers and included32 IPRAS Journal www.ipras.org Issue 7

Team membersMr. Sirichai Kamnerdnakta, Mr. Thara Tritrakarn, Mr.Poom Tritrakarn, Mrs. Pensri Noocharoen, Ms. ThitimaChannawa, Ms. Susiri Charloenmit, Mr. ThanatpantManosittisak and Ms. Panipak Vareevanichaphan.Dr. Fong Poh Him from the Institute of Plastic Surgeryrepresented Singapore. The foreign teams providedtheir own instruments and materials. All overseas teammembers covered their own expenses of travel to thesurgical camp site.The MissionThe first day,August 21st, was used to inspect all facilities,instruments, autoclaving procedure, and instrumentturnaround after surgery, and the number of theatres thatcould be available. An informal inauguration of the campwas done on the 22nd, with the visitors being welcomedby the Principal and the President of the Lions Club, Mr.P.C. Dhiman. Although patient registration had started inJuly, the formal OPD for short-listing patients for surgeryand registering fresh patients started in the morning ofAugust 22nd. In spite of bad weather and constant rain,the OPD was bursting at the seams with the crowds.More than 140 patients were examined on the first day ofthe camp. Nearly 100 more patients were seen during thenext few days. Seeing the gush of patients, it was decidedto have four OT tables, as there were enough surgeonsand supporting staff. Dr Sudarshan Choudhary (HODDept. of Anaesthesia) and his senior colleague, Dr Shelly,joined with Dr Thara’s team and anaesthetists from Delhito manage anaesthesia for the four tables.Camp inaugurationin the hospital corridor.Issue 7 www.ipras.org IPRAS Journal 33

EntertainmentThe organizers were particularly concerned aboutproviding quality leisure time for all volunteers, toavoid fatigue set-in over the week, especially for foreignparticipants. The evenings were occupied by visits toMcleod Ganj (abode of His Holiness The Dalai Lama),Dharamshala, nearby temples and rivers. A couple ofpopular Bollywood movies (with English subtitles) werescreened on two days. A lot of friendship and bondingdeveloped between all participants and all of thempledged to attend future camps also.Dr Fong Poh Him lighting the inaugural lamp.Dr Apirag Chuwangsuwanich on extreme left.The surgeries started on the 23rd and continued untilthe 26th. A total of 91 surgeries were performed. TheOPD continued seeing the patient inflow on all days.The hospital authorities admitted all patients free ofcharge and also did not charge for the investigations. Thedocumentation and case recording was also done on thehospital stationery as per the prescribed norms.The spectrum of surgeries included patients with severepost-burn contracture and deforming disabilities, cleftlip and palate, syndactly, deforming scars, non healingulcers etc. Thirty-three beds were made available bythe hospital exclusively for this camp. Due to the sheernumbers of patients that were operated, many of themhad to be accommodated as day care patients.Postoperative examinations and change of dressingsstarted on the 25th in the OPD area and in thewards. Patients were instructed in post op care andphysiotherapy. Two residents stayed back after thecamp for postoperative care, stitch removal and adviceon follow up until August 31st.Press CoverageThere was extensive coverage in the press and mediaabout the camp. This further generated keen enquiriesabout future camps.Organizational structurePublicityThe Lions Club played a major role in the publicitycampaign for the camp, which started about a month and ahalf earlier. The pamphlets were distributed to peripheralhospitals and schools. The routine patients visiting thesurgical OPD were also handed pamphlets.Press ConferencePress reports34 IPRAS Journal www.ipras.org Issue 7

ManpowerThe visiting team comprised of 22 members (14 doctors,6 paramedics and 2 volunteers).Ten staff nurses from the Medical College were postedwith the team for operations and there were separatenurses on shift duties for postoperative wards.Two OT assistants were deputed from the hospitalstrength.Two consultant anaesthetists and two residents fromthe hospital joined an equal number of anaesthetistsof the visiting team to provide anaesthesia on 4 tablessimultaneously.Autoclaving was managed by one linear autoclave and onetable top autoclave in the side room of the operation theatre.All autoclave linen and dressing material was prepared inthe evening just after the day’s work was over.Boarding & Lodging arrangementsAll visiting members were accommodated by the Principalin the guest house of the Medical College. A kitchen wasset up in the guest house by the Lions Club for all cateringrequirements.ExpensesThe hospital spent more than 0.4 million Rupees onmedicines, sutures and accessories for the patients.Publicity and boarding costs was borne by the LionsClub, Dharamshala.International travel expenses were covered by individualsor sponsors.IPRAS Asia- Pacific Section covered license fees foroverseas doctors, transport of Indian teams and othermiscellaneous expenses.Future and PastAs this area has no facility for Plastic Surgery, it is proposedto have a camp at this same location every year. Earlier,Dr. K.S. Goleria had been conducting free Plastic Surgerycamps with his team at Zonal hospital, Dharamshala for22 years, in association with the Lions Club. This wasdiscontinued due to health reasons about 4 years ago.Seeing the need of the people, IPRAS “Women for Women”team also did a free camp in Jannani Hospital at Paprola(Palampur) a few years ago. You can view the documentaryon www.youtube.com. The camp was the brainchild of Dr.Marita Eisenmann-Klein, Secretary General of IPRAS andwas organized by Dr. Chanjiv Singh.The idea of “Mission India”, a NGO, was floated by Dr.Chanjiv Singh, so that American Plastic Surgeons of Indianorigin could work for the poor. It was created by Dr. KusumaShashidhar, President of ASIPS and his colleagues. Theydid a free Plastic Surgery camp in SR Hospital, Kalheli,Bajaura, dist Kullu, Himachal Pradesh last year. The campreport is on www.facebook.com as Kullu mission.Pictures from the Kangra camp can be viewed at www.iprasaps.orgSponsoring:1. Principal, Dr. Rajindra Prashad Govt. MedicalCollege, Kangra2. IPRAS-Asia Pacific Section3. Lions club, Dharamshala4. Bangkok Botanica, ThailandReport submitted by:Report prepared by:Dr Rajeev B. Ahuja(Secretary General,IPRAS-APS)Prof. Anil Chauhan(Principal, RPGMedical College, Tanda)Dr Chanjiv SinghChairman-IPRAS,Humanitarian CommitteeProf. Sanjeev Sharma(Dept. of Surgery,RPGMC, Tanda)Issue 7 www.ipras.org IPRAS Journal 35

Plastic Surgery Mission in Togo,Claudio Bernardi, MD (Italy)Togo is a “strip of land” between Ghana and Benin, in sub-Saharan Africa. In the small village of Afagnan, 80 km from thecapital Lomè, there is the renowned Saint Jean de Dieu Hospital,which is one of the most famous hospitals in the country. It wasbuilt in 1964 by the Hospitaller Order of Saint John of God.Since the early 1980’s several doctors and nurses from the ItalianSt John Calabita Hospital have participated in mission trips,offering voluntary medical assistance and teaching local staff aswell. Plastic Surgery missions have been carried out in the pastby French and Swiss surgeons, but these missions ended ten yearsago; therefore, my first mission in January 2007 was particularlyappreciated by local colleagues. Since then, I have been there sixtimes, for two to three weeks on each mission, trying to enlistthe help of other “friends”, with the aim of ensuring further andregular Plastic Surgery missions in the future.Saint Jean de Dieu Hospital - The hospital has a capacity of 269beds and serves a population of 100,000 inhabitants. It performsmore than 8,000 admissions a year with more than 3,000 surgicaloperations. Patients come from the surrounding area, from thecapital Lomè, as well as from the rest of the country and abroad.The surgical block is made up of four operating rooms which arein acceptable condition, considering the poor economic situationof the country and the hospitals, but it is very difficult to findsurgical instruments, drugs and medical equipment. A newoperating block has already been planned for the future and willbe constructed as soon as the funds are found.Close to the units there is a social area, where mothers or sisterslive during the patients’ medical stay, washing, cooking andresting together. The patients are informed of the humanitarianmissions of specialists by bill posting or relevant announcementson the local radio, so that they can come to the Hospital for a firstmedical examination and for surgical treatment, if required.Patients - A common characteristic among all the patients requiringmedical assistance is that they have not sought medical assistanceat an early stage, so their symptoms have worsened, limiting thepossibility of immediate medical or surgical treatments. A focuson their social and cultural life may explain the high incidenceof traumatic pathologies: the almost total absence of light in thestreets is responsible for several road accidents; children are oftenleft without any surveillance, running very close to fireplaces orbig pots of hot water, where there is a considerably high riskof burns. Infections are never recognized in time but only at alate stage, with striking symptoms (e.g. bowel perforation due totyphus or flexed limbs for post-burn scar contracture, etc). Aftera trauma, due to poor health education, they look for curers orsorcerers rather than doctors and, after months or years, whenthey decide to go to the hospital, it often takes days to reach it.Plastic Surgery procedures – I have generally found four kindsof pathologies in Plastic surgery: Keloids, scar contractures, lipand palate clefts, wounds and loss of skin. During my 2-weekstay, I operate on about 40 patients, which means more than 50plastic surgery procedures performed, as associated pathologiesare quite common in the same patient (i.e. post-burn contractureaffecting all the fingers or different parts of the body). Inaddition, the clinical cases are always complex, thus: no simplesprocedures are performed in Africa! Co-operation with the localstaff is good: I am frequently asked for consultation by other localspecialists or, when necessary, assistance in General Surgery. Inthis sense, a broad surgical mind is helpful!Humanitarian personal experience – After each mission, I returnto Italy with a great personal satisfaction that I rarely feel in mydaily work, although I really love it. Plastic Surgery missions areof vital importance for patients in underdeveloped countries but,at the same time, they are extremely useful experiences for thesurgeons too, even spiritually.I still have in front of my eyes the image of the children aftercleft lip repair, smiling for their first time, and their mothers, too.This is the best gift that a Plastic Surgeon may receive from hiswork.Claudio Bernardi, M.D.Plastic Surgery, Rome, ItalyVia Ennio Quirino Visconti, 5500193 – Rome - Italywww.claudiobernardi.it36 IPRAS Journal www.ipras.org Issue 7

Third International Conferenceon Regenerative SurgeryThe Lazio Regional Agency for Organ and TissueTransplantation, in collaboration with the University ofRome “Tor Vergata”, has organized the Third InternationalConference on Regenerative Surgery, which took place on14th - 16th December 2011, in Rome.S.Coleman, G. Rigotti, D. Del Vecchio, M. Lafontan focusedtheir speeches on fat transplantation, while E. Anitua, I. Martin,M. Marazzi, G. Stacy, G. Bauer, together with other researchers,presented the edge of progress on laboratory work.Plastic Surgeons, such as J. Planas, R. Mazzola, T. Tiryaki,From the left: Dr. Dan Del Vecchio, USA (ISPRES Founding Member), Mr. Zacharias Kaplanidis, Greece (IPRAS Executive Director), Dr.Gino Rigotti, Italy (ISPRES President), Dr Sydney Coleman, USA (ISPRES General Secretary), Prof. Marita Eisenmann-Klein (IPRASPresident), Dr. Theodore Voukidis, Greece (ISPRES Founding member)The Conference President, Prof. Valerio Cervelli, Directorof the Plastic Surgery Department at the University of Rome“Tor Vergata”, offered the participants a unique opportunityto follow the lectures of some of the world’s most prominentauthorities in the field of Regenerative Surgery.Not only Plastic Surgeons, but also the most active scientistson the relative topics, biologists, ENT, orthopedics,gynecologists, hematologists, dermatologists and traumasurgeons, were present there, to announce and discuss theirlatest achievements and experience, on the most promisingand upraising field of tissue regeneration, bioengineeringand nanotechnology.The rich Faculty of more than 80 scientists and doctors havethoroughly covered all the topics of the meeting.Prof. Valerio Cervelli, Director of the Plastic Surgery Department at theUniversity of Rome “Tor Vergata” during the conference dinner of the3rd International Conference on Regenerative SurgeryP. Gentile, V. Cervelli, F. Moschella, M. Klinger, K.Schlaudraff, T. Voukidis shared their experience on everydaysurgical praxis, emphasizing Aesthetic Regeneration on newcritical areas.Laboratory researchers, such as S. Pek, S. Akita, M. Dominiciand A. Orlandi gave their lectures on Bioengineering andNanotechnology and the new ways of pharmaceuticaladministration through new regenerative technologies.Practical issues on the application of the new medicalprocedures, in Europe and worldwide, were raised andanswered by experts, according to the present status onmoral, ethical and of course legislative data.The Conference, strongly supported by the Province ofRome, the Lazio Region and the Italian Ministry of Health,offered the opportunity to all the participants to enjoy thefamous excellent Italian hospitality together with typicalRoman entertainment.The appointment has been renewed for December next yearand the organizers guarantee a scientific meeting of equallyhigh standards.In the meantime, a more Plastic Surgery-orientated meetingwill be organized by the newly founded ISPRES (InternationalSociety of Regenerative Surgery) on the 9th– 12th of Marchin Rome, where all the new ideas and developments onRegenerative Plastic Surgery will be presented and discussedby an international faculty of experts.Theodore Voukidis MD, PhD, FACSISPRES Founding memberIssue 7 www.ipras.org IPRAS Journal 37

S U R V E Y SHonoured with the award of “Ivo Pitanguy”during the 48th Brazilian congress of plastic surgeryLiposuction induces a compensatory increase of visceralfat which is effectively counteracted by physical activityAuthor: Eduardo Montag aSub-authors: Fabiana Braga Benatti b ; Fábio Lopes Saito a ; RolfGemperli a ; Antonio Herbert Lancha Junior ba) Division of Plastic Surgery and Breast Surgery Group,University of São Paulo School of Medicineb) School of Physical Education and Sport –University of Sao PauloLiposuction is one of the most popular aesthetic surgeriesperformed worldwide, but its long-term impact on bodycomposition and on the metabolic profile remains unclear.It has been speculated that the immediate decrease in bodyfat may trigger feedback mechanisms of body-fat regain.In several species, surgical fat removal is accompanied byfat regain within a few weeks, mostly due to compensatoryfat growth in the intact depots. Recent data has confirmedthat women undergoing liposuction gain upper-bodyfat within six months, which may be associated withincreased cardiovascular risk. Importantly, no studyof the long-term effects of liposuction has controlledfor the subjects’ physical activity levels which may beconsidered an important confounder because exerciseper se is believed to improve body composition. Thus,the purpose of this study was to investigate the effectsof small-volume abdominal liposuction on body fatdistribution in normal-weight women, who were eitherexercise-trained or not after surgery. We hypothesizedthat liposuction surgery would cause body-fat regain inphysically inactive subjects, whereas a supervised exercisetraining program would counteract such detrimentaloutcomes. A six-month randomized controlled trial wasconducted. Thirty-six women underwent a small-volumeabdominal liposuction (20 to 35 years old; BMI: 23,8 ±2.2 Kg/m2). Two months after surgery, the subjects wererandomly allocated into one of the two groups (trained,T, n=18; or non-trained, NT, n=18). Trained subjectsundertook a four-month exercise program. Non-trainedsubjects remained physically inactive throughout thestudy period. Prior to the intervention (PRE), immediatelybefore the beginning of the exercise program (i.e., twomonths after surgery, or POST2) and at the end of thestudy (POST6), food intake and body composition wereassessed. Energy expenditure, dynamic strength andaerobic fitness were assessed at PRE and POST6. POST6 assessments were performed 60 to 72 hours after thelast training session in the trained group. Subjects wereinstructed to maintain their food intake pattern throughoutthe study. Liposuction was effective in reducing bodyweight, fat mass, and subcutaneous abdominal fat (SAT)(PRE vs. POST2, p=0.0001). Despite the sustained SATdecrease at POST6 (p=0.0001), body weight returned tobaseline values in both groups. The NT group showeda significant 10% increase in visceral fat (p=0.04) anddecreased energy expenditure (p=0.01) when comparedwith TR. TR showed an increased fat-free mass (p=0.03)and improved physical capacity (p

Honoured with the award of “Evaldo D’Assumpção”during the 48th Brazilian congress of plastic surgeryDevelopment of experimental model of avulsionof the flaps in the lower limbs of ratsAuthors:Dimas André Milcheski, MD aHugo Alberto Nakamoto, MD aPaulo Tuma Jr, MD aLucas Nóbrega, Medical Student bMarcus Castro Ferreira, Professor and Chairman aa) Division of Plastic Surgery, Faculty of Medicine,University of São Paulo, São Paulo, Brazilb) Faculty of Medicine,University of São Paulo, São Paulo, BrazilIntroductionDegloving injuries of the lower limbs are frequentlycharacterized as severe injuries and there is difficulty indeciding what the best surgical approach is1.PurposeThe aim of this study was to develop a deglovingexperimental model in rat hind limbs and to observe theviability of the flap after its repositioning to the bed wound,in order to study the changes related to this injury.MethodNinety male Wistar rats were divided into fourexperimental groups (G1 = 22, G2 = 24, G3 = 22, G4 =22). A degloving model was performed in the rats’ hindlimb based on four different pedicles as follows: G1 -proximal flow, G2 – distal flow, G3 – lateral flow, and G4– medial flow (Figures 1 and 2).After the incision mark, the skin and subcutaneous tissuewere incised. Four Backhaus clamps were positionedat the edge of the skin incision margin and progressivecontrary traction was applied, strong enough to producea degloved flap of the subcutaneous tissue and skin of thehind limb, resulting in a partial avulsion flap. After fiveminutes the flap was repositioned in its original situationand the incision was closed with continuous skin suture(nylon 5.0).The rats were observed daily for signs of flap necrosisfor 7 days (Figure 3), after which they were sacrificed byoverdose of thiopental.Measurements of the areas of necrosis in the flap, as wellas the total area of the flap, were performed after totalremoval of the avulsed flap. The flap wasthen laid on the operating table and photographed (Figure4). Photographs were taken of each rat and analyzed usingImageJ software2, which is suited for area calculation.Total flap area (cm2), area of necrosis in the flap (cm2) andthe ratio between the necrotic and total areas (percentage)were determined.Statistical analysis was performed using Kruskal-Wallisnonparametric test for independent samples among thefour groups. The Dunn test of multiple comparisons wasused to assess differences between matched group pairs.Significance level was 95% (p < 0.05). The statisticalanalysis was done with the software Prism 4b forMacintosh, version 4.0 (Graphpad Software, Inc, USA).ResultsAfter exclusion of animals by flap autophagy and death,17 rats remained in the G1 and G2 groups, 15 rats in theG3 group and 16 rats in the G4 group. The total flap areawas 12.41 cm2 for the G1 group, 5.63 cm2 for the G2group, 3.88 cm2 for the G3 group and 4.25 cm2 for theRatio between the necrotic areaand total area of the avulsed flap.Issue 7 www.ipras.org IPRAS Journal 39

1). The Dunn test showed significant differences betweenpairs G1 and G2, G2 and G3, and G2 and G4 (p < 0.05).There was no statistical difference between G1 and G3,G1 and G4 and G3 and G4 groups (p > 0.05).Degloving injury performed. Proximal flow flap(A and B) and distal flow flap (C and D).Degloving injury performed. Lateral flow flap (A and B)and medial flow flap (C and D).G4 group. The necrotic flap area (cm2) was 0.51 for theG1 group, 3.64 for the G2 group, 0.39 for the G3 groupand 0.75 for the G4 group (p = 0.0001). The ratio betweenthe avulsed flap necrotic area and total area in the G1group was 0.041 (4.1%), 0.39 (39%) in G2, 0.09 (9%)in G3 and 0.08 (8%) in the G4 group. The comparisonbetween the means showed a statistically significantdifference among the four groups (p = 0.0001) (GraphicPartial flap necrosison postoperative day 7.Flap removed and placedon operative table.DiscussionThe simple repositioning of the avulsed flap in clinicalpractice often results in partial or total necrosis oftissue repositioned3. Thus, it is useful to develop anexperimental avulsion flap model so that it is possibleto test therapeutic modalities, in order to improve theoutcome of the repositioned flap.We could find three avulsion flap models4,5,6. None ofthese models were performed in the lower limbs. It wasconsidered important to develop a hind limb deglovingmodel in rats, closer to that observed in clinical practicein trauma centers, because the lower limb is the area mostoften affected in this type of injury.In addition, by using four different flap orientations, it wasobserved that the distal flow flaps were the most affected,having the poorest prognosis. The avulsion model withdistal flow (G2) represents a more severe injury, comparedto other flap orientations (proximal, medial or lateral flows).It presents a greater degree of ischemia and congestion,resulting in a more extensive necrotic area.Thus, we suggest the use of the distal flowgroupmodel(G2)to test drugs with potential improvement of flap viability,since this reverse flow flap allows easier observation of thedrug effects in decreasing the necrotic flap area.ConclusionThe distal flow group (G2) had a larger area of necrosisin relation to the total flap area and is considered the mostsuitable for testing therapeutic agents in avulsed flaps.References.1. Mandel M. The Management of Lower ExtremityDegloving Injuries. Ann Plast Surg. 1981; 6 (1): 1-5.2. Image J 1.42q for Macintosh. Versão 10.2. WayneResband National Institutes of Health, USA. Availableat: http://rsbweb.nih.gov/ij/download.html.3. Milcheski DA, Ferreira MC, Nakamorto HA, TumaJr P, Gemperli R. Tratamento cirúrgico de ferimentosdescolantes nos membros inferiores – proposta deprotocolo de atendimento. Rev Col Bras Cir. 2010;37(3): 195-203.4. Oztuna V, Eskandari MM, Unal S, et al. The effect ofpentoxifylline in treatment of skin degloving injuries:an experimental study. Injury 2006;37:638-641.5. Kurata T, O’Brien BM, Black MJ. Microvascularsurgery in degloving injuries: an experimental study.Br J Plast Surg 1978;31:117-120.6. Wang ZT, Guo SZ, Xiu ZF, et al. A new model ofskin avulsion injuries in rats. Chin J Plast Surg2008;24:212-215.40 IPRAS Journal www.ipras.org Issue 7

Syndactyly Correction by “Duoderm-plasty”:An Original Model for Mastering Plastic SurgeryG.V. Yaghjyan, D.O. AbrahamyanPlastic Reconstructive Surgery and Microsurgery Centre, University Hospital № 1.58 Abovyan street, Yerevan, 375025, Republic of Armeniae-mail: plastam@yahoo.comSummaryА novel technique is presented for mastering skills inPlastic Surgery, using only improvised means, particularlythe self-adhesive Duoderm ® CGF ® , which is very similarto the human skin. An example of its application forsyndactyly correction by trilobed flap is shown. Theso-called Duoderm-plasty is an easy and cost-effectivemethod, which allows mastering and perfection ofdifferent Plastic Surgery ‘tricks’, planning a scheduledsurgery and can also serve as a measure for such skills ofthe medical students and residents.KeywordsResidency training; Surgery planning; Z-plasty;SyndactylyIntroductionTraining in the specialty of Plastic Surgery deals with theresection, repair, replacement and reconstruction of defectsof form and function of the integument and its underlyinganatomic structures. It is a long-lasting and laboriousprocess, requiring not merely an excellent, advancedknowledge of medical science, but also a well-developedspatial reasoning and ‘sleight of hand’. The latter can beimproved using different contemporary technologies andequipment offered by many companies.Prior to the 1950’s, the operating room (OR) representedthe only place to visualize surgery outside the classroom.The introduction of film allowed residents to build andintegrate verbal and pictorial representations of disease.Movies became particularly useful in surgical learning tohelp describe anatomic relationships and procedures. Inthe 1980’s computers became an additional tool, with thepotential to model the complexity of real tissues and togain insight into surgical outcomes through simulation. 1It is known that learners retain 10 to 15% of what is read,10-20% of what they hear, and 20-30% of what they see,but when audiovisual materials are integrated, knowledgeretention increases to 40-50%. 2Therefore, simple inanimate models have been developedfor practice of basic surgical skills. Synthetic skinsuturing models and computer simulations of surgery areemerging as a prime education tool at several surgicalskills centres in the West. 5,6Despite all these advances, the system of surgical skillsteaching in Armenia, as well as in many other developingcountries still remains on the 1980’s level because theabovementioned training systems are too expensive.Maintenance of well-equipped dissecting rooms andbiomedical laboratories is impossible in the presenteconomic status. Residents can hone their skills onlyat the OR, which is not so simple, because each expertsurgeons seek to achieve the best results and he/she willrarely agree to ‘rely’ on a novice’s skills. On the otherhand, patients or patients’ relatives always want to beoperated by the best, famous expert surgeons. Anotherproblem is that trainees often ‘wait’ for a specific case fora long time: there are many residents and trainees, morethan the specific cases.All this forced the authors to propose a model, whichwould facilitate and improve the skill acquisition process,at least to some extent, in one of the basic sections ofPlastic Surgery – integument (cutaneous) surgery.Model descriptionThe proposed model is based on the use of self-adhesivehydrocolloid dressings (Duoderm ® CGF ® ) as human-skinsubstitutes.That is why we called this method ‘Duodermplasty’.The unique elastic properties of Duoderm ® CGF ®Issue 7 www.ipras.org IPRAS Journal 41

Duoderm ® CGF ® and Hand modelare very similar to those of human skin, allowing one toperform incisions, dissections and suturing on it. Since2003 we have used Duoderm-plasty to illustrate andexplain to medical students and residents the differenttechniques of plastic skin-surgery (Z-plasty, V-Y-plasty,syndactyly correction etc.), in order for the residents andtrainees to master their skills.A ‘case’ of Duoderm-plasty for correction of ‘syndactyly’is presented below (Fig. 1-5). Syndactyly is obtained bypasting the Duoderm ® CGF ® on the 3 rd and 4 th fingersof the hand model (Internal Hand Structure Model,American 3B Scientific, Tucker, GA, USA) (Fig. 2). Flapmarkings are done as per description of the Niranjan andDe Carpentier trilobed-flap technique 6According to Niranjan and our experience with patients(Figures 6-7), skin grafting is not required in all casesDuoderm ® CGF ® pasted on the middle and ring fingers to achieve syndactyly. (A) Dorsal view. (B) Palmar view.Flap markings. (A) Dorsal view. (B) Palmar view.42 IPRAS Journal www.ipras.org Issue 7

Prepared trilobed and triangular flaps. (A) Dorsal view. (B) Palmar view.Flaps ‘sutured’ (pasted) in place. (A) Dorsal view. (B) Palmar view.Flap markings on patientPreparation of trilobed and triangular flaps on patientIssue 7 www.ipras.org IPRAS Journal 43

where the trilobed flap 6 is used. Therefore, if any uncovered‘defect’ remains after the performed Duoderm-plasty, itmeans that there has been an omission in the techniqueof flap harvesting and one should repeat the Duodermplastyuntil the ideal result is obtained.DiscussionResearch shows that motor skill acquisition occurs inthree phases. 7 Ideally, only the last phase of learningshould be performed on actual patients. In the first phaseof motor-skill acquisition, or ‘cognitive phase’, the learnergains an understanding of the task through explanationand demonstrations. Cognitive science studies showthat the power of a teaching tool is directly related tothe level of interactivity and the method of informationdelivery. 8 The second phase of motor-skill learning is the‘associative phase’, where the learner practices the taskand eliminates error from the performance. This phasecould utilize the suggested ‘Duoderm-plasty’ model thatplaces the learner in a lifelike situation providing almostreal-time feedback on decisions, actions and questions.Our choice focused on Duoderm ® CGF ® as this was theonly dressing available at our Centre at that time. In otherwords, any self-adhesive hydrocolloid dressing similar toDuoderm ® CGF ® can be used for Duoderm-plasty.The benefits of this model are different for novices andexperts. Residents in training can avoid causing iatrogeniccomplications in real patients, while still being exposed toa wide range of scenarios and complications posed by theexpert surgeon. It helps to develop the manual dexterityof the future Plastic Surgeon. Repetition and learnerfeedback, neither of which are easily accomplished in theOR, improve skill acquisition. Wanzel and Matsumotofound improved execution of Z-plasty skin closure byresidents in response to immediate faculty feedback. 5Scott and Young showed it took an average of 32repetitions to reach the 90 th percentile in performance. 4Thus, Duoderm-plasty can serve as a measure for skillsof the residents.For expert surgeons, Duoderm-plasty can be used tomaintain proficiency during times of absence from theoperating room, an academic sabbatical or family leave. Itis also very useful for planning the scheduled operations,as well as to show and explain to the patient and his/herrelatives the plan of the surgery to be performed.Thus, the so-called Duoderm-plasty is an easy and costeffectivemethod allowing the mastering and perfectionof different Plastic Surgery skills and the planning of ascheduled surgery and can also serve as a measure forsuch skills of the trainees.References1. Kawabata H, Kawai H, Masada K, Ono K. Computeraidedanalysis of Z-plasties. Plast Reconstr Surg1989;83:319–325.2. Mehrabi A, Gluckstein C, Benner A, Hashemi B,Herfarth C, Kallinowski F. A new way for surgicaleducation--development and evaluation of acomputer-based training module. Comput Biol Med2000;30:97–109.3. Dunnington GL, DaRosa DA. Changing surgicaleducation strategies in an environment of changinghealth care delivery systems. World J Surg1994;18:734–737; discussion 733.4. Scott DJ, Young WN, Tesfay ST, Frawley WH, RegeRV, Jones DB. Laparoscopic skills training. Am JSurg 2001;182:137–142.5. Wanzel KR, Matsumoto ED, Hamstra SJ, AnastakisDJ. Teaching technical skills: training on a simple,inexpensive, and portable model. Plast ReconstrSurg 2002;109:258–263.6. Niranjan NS, Azad SM, Fleming AN, Liew SH.Long-term results of primary syndactyly correctionby the trilobed flap technique. Br J Plast Surg2005;58:14–21.7. Rogers DA, Elstein AS, Bordage G. Improvingcontinuing medical education for surgical techniques:applying the lessons learned in the first decade ofminimal access surgery. Ann Surg 2001;233:159–166.8. Edmond CV, Jr, Wiet GJ, Bolger B. Virtualenvironments. Surgical simulation in otolaryngology.Otolaryngol Clin North Am 1998;31:369–381.44 IPRAS Journal www.ipras.org Issue 7

iPhone and iPad applicationsfor plastic surgeonsIssue 7 www.ipras.org IPRAS Journal 45

46 IPRAS Journal www.ipras.org Issue 7

By kind permission of JPRASIssue 7 www.ipras.org IPRAS Journal 47

Plastic Surgery Hyperguide:An Interactive ContinuingMedical Education Web SiteDr. Mimis CohenMD, FACS, FAAPAssociate Chief Medical Editorof the Plastic Surgery Hyperguide ®Professor and ChiefDivision of Plastic, Reconstructive andCosmetic SurgeryAnd Director Craniofacial CenterUniversity of Illinois Medical CenterChicago, IllinoisDr. Seth ThallerMD, DMD, FACSChief Medical Editorof the Plastic Surgery Hyperguide ®Chief and ProfessorDivision of Plastic SurgeryThe DeWitt Daughtry FamilyDepartment of SurgeryUniversity Of Miami Health SystemMiami, FloridaThe Plastic Surgery Hyperguide ® is a free interactivecontinuing medical education (CME) Web site for plasticsurgery professionals. It is available at any time fromany computer with an Internet connection. This site wasestablished in 2006 and is sponsored by Vindico MedicalEducation, an ACCME level 3 accredited provider ofAMA PRACategory 1 Credit(s)TM .The Plastic Surgery Hyperguide® is overseen by ChiefMedical Editor Seth Thaller MD, DMD, Professor andChief of Plastic Surgery at the University of Miami,Florida, and Associate Chief Medical Editor Mimis Cohen,MD, FACS, FAAP, Professor and Chief of Plastic Surgeryat the University of Illinois at Chicago. Assisted by anEditorial Board of experts from across the plastic surgeryspecialty, we ensure that the Plastic Surgery Hyperguide ®contains the most recent educational material that willbenefit the practice of any plastic surgeon. The site isconstantly updated and expanded to ensure that the mostrecent information is available, allowing users to targetthe information that is most relevant to their practice.The Plastic SurgeryHyperguide ® currently containseducational material in the following modules: AestheticSurgery, Bariatric Surgery, Breast, Congenital; Cleft/Craniofacial, Craniofacial Trauma, Head and NeckTumors, Patient Safety. Each module contains peerreviewededucational content focusing on cutting-edgetreatments, novel surgical techniques, and clinical reviews.All content submitted for publication goes through arigorous editorial and review process, which includes apeer-reviewed step where the content is reviewed by 1-2plastic surgery physicians.To register, one just needs to go to: www.plasticsurgery.hyperguides.com, select the Login button and follow theinstructions. Once registered and logged in, you will haveaccess to hundreds of articles, lectures and video’s to helpkeep you updated in the field of plastic surgery. Much ofthe content on the site is available for CME credit; you willjust need to complete a pretest, posttest and evaluation inorder to receive your credit. All credit earned on the sitewill be stored in your “MyCME” section so that you canalways go back and print out the certificates when youneed to submit them for you maintenance of certificationor maintenance of licensure.We hope that members of IPRAS will take advantageof this opportunity and register to the Plastic surgeryHyperguide ® .48 IPRAS Journal www.ipras.org Issue 7

48th Brazilian Congress of Plastic SurgeryGoiania, Brazil, November 10-15, 2011Brazilian Societyof Plastic Surgery(SBCP)It took place at the Brazilian“Planalto Central”...It was a sunny begining of the southern hemispheresummer, between November 10th and 15th, when the48th edition of the Brazilian Congress of Plastic Surgerytook place in Goiania, Brazil. The host city, Goiania,boasts to be the heart of the huge brazilian agriculturalinfrastructure, the birthplace of important traditions that,even to this day, markedly permeates the brazilian culturewith flavors, colors, accents, trends and fados. Hospitalitywas a the most abundant comodity!With 2146 registered participants this year, the BrazilianCongress has secured its place between the most acclaimedPlastic Surgery Continued Education events on the planet.The Brazilian Society of Plastic Surgery, founded in1948, has topped the 5000-member mark, and currentlycertifies 81 plastic surgery training facilities throughoutthe nation. Today, with many different departments tofullfil its needs, simultaneous translation to English inall the presentation rooms and an ever growing numberof foreign registered participants, its main goal is to goglobal.Evidence-based Medicine has played a key role in theselection of the topics and new, different presentationformats were introduced with a variable degree ofoverall satisfaction. This certainly reflects a worldwidetrend towards boosting the credibilty of our Specialty,saves money and assures that our patients will havegood Medicine at their disposal. The Brazilian ScientificOpening ceremony of the 48th Brazilian Congress of Plastic Surgery. Next to Prof. Marita Eisenmann-Klein (IPRASPresident) on the left Prof. Sebastiao Nelson Edy Guerra, Brazil (Former President of the Brazilian Society of Plastic Surgery),and on the right, Prof. Ivo Pitanguy (IPRAS Trustee)52 IPRAS Journal www.ipras.org Issue 7

coming back to the scene has everything to do with adisplay of good management principles and orthodoxy.IPRAS has recently pursued its goals by means of whatseems to be a mix of pragmatism and a globally orientedvision, focused on inclusion.For the years to come, the project of the Brazilian Societyis to upgrade its ties with other national Plastic SurgerySocieties in order to be able to share the expertise inAesthetic Plastic Surgery and other related topics that wehave acquired through the years, with colleagues fromDuring the opening ceremony of the 48th Brazilian Congressof Plastic Surgery. Prof. Ricardo Baroudi (IPRAS Trustee),Prof. Marita Eisenmann-Klein (IPRAS President)Commitee, composed by seven members and chairedby Dr. Osvaldo Saldanha, is actively involved withContinued Education and has worked hard to innovate,stimulate, access and control the processes involved inthis large Plastic Surgery gathering. This was the resultof a complex series of brainstorming and benchmarkingfrom previous editions, along with the knowledgeacquired from other national Plastic Surgery Societies.This Congress also marked, during the openingceremony, the triumphant come-back of IPRAS as anactive world confederation and major player. Dr. MaritaEisenmann-Klein, IPRAS President, alongside GoianiabornDr. Nelson Piccolo, IPRAS Secretary General, onbehalf of our World Confederation, together with Dr.Sebastião Nelson Guerra, President of the BrazilianSociety of Plastic Surgery, honored colleagues like Dr.Ivo Pitanguy and Dr. Ricardo Baroudi for their body ofwork throughout their lives as Plastic Surgeons. FormerPresidents of the Brazilian Society of Plastic Surgerywere also honored during that ceremony. The IPRASProf. Sebastiao Nelson Edy Guerra, Brazil (Former President of theBrazilian Society of Plastic Surgery) with Ms. Maria Petsa, Greece(IPRAS Assistant Executive Director) at the IPRAS Booth.distant corners of the world. We all, who compose thebody of the Brazilian Society of Plastic Surgery, awaitour colleagues from different countries, to visit us in theBrazilian Plastic Surgery booth, which is set to be presentat major Plastic Surgery Congress venues, during theyear of 2012.For the colleagues who came to Goiania this year, thankyou once again for your invaluable presence and for thosewho couldn’t make this year, our hearts and minds willallways be open to receive you in future meetings.“Planalto Central” stands for “Central Highlands” inPortuguese.Love from Brazil!Pericles Serafim FilhoBrazilian Society of Plastic Surgery,Scientific Committee MemberIPRAS, EXCO MemberIPRAS, Scientific Committee MemberIssue 7 www.ipras.org IPRAS Journal 53

1st International Meeting of the Cyprus Societyof Plastic Reconstructive and Aesthetic SurgeryDear Colleagues,It gives me great pleasure to report back on the successof the 1st International Meeting of the Cyprus Society ofPlastic Reconstructive and Aesthetic Surgery, which tookplace under the auspices of IPRAS on the 14th and 15thOctober 2011, in Limassol. This is the first time such ameeting has been hosted in Cyprus, and we hope that thiswill be the start of a fruitful and productive cooperationbetween our society and IPRAS.Close to 45 delegates participated in the Conference, witha large number of international attendees and over these2 days, a variety of extremely interesting topics werepresented by our invited speakers, as well as by localPlastic Surgeons. Of great interest were the talks pertainingto the exciting field of stem cell research and fat grafting,as related to all aspects of Reconstructive Surgery.Such meetings are of great importance to our Societyand its members, not only because they provide us witha unique chance to present our work to the wider medicalcommunity, but more importantly because we have theopportunity to expand our knowledge, interact with expertsand discuss clinical issues within an appropriate setting.From the left: Dr. Dana Jianu, Romania, Dr. Katharina Russe-Wilflingseder, Austria, Dr. Marco Klinger, Italy, Prof. MaritaEisenmann-Klein, Germany (IPRAS President), Prof. AndreasYiacoumettis, Greece (IPRAS Deputy General Secretary), Dr. RogerKhouri, USA (ISPRES Vice President), Dr. Theodoros Voukidis,Greece ( ISPRES Founding member), Dr. Hatem May, LebanonFrom the left: Dr. Christos Merezas, Cyprus (President ofthe Symposium), Dr. Kenan Arifoglu, Cyprus, Prof. MaritaEisenmann-Klein, Germany (IPRAS President), Prof. AndreasYiacoumettis, Greece (IPRAS Deputy General Secretary), Dr.Borman Huseyin, TurkeyAmong others: Dr. Kenan Arifoglu, Cyprus, Dr. AndreasFoustanos, Greece (Former President of HESPRAS), Dr. LefterisDimitriou, Cyprus, Dr. Georgia Koulermou, Greece, Dr. MichailStampos, Greece, Dr. Zavrides Harris, Cyprus, Dr. AnastasiosTsekouras, Greece, Prof. Andreas Yiacoumettis, Greece (IPRASDeputy General Secretary), Prof. Marita Eisenmann-Klein,Germany (IPRAS President), Dr. Marco Klinger, Italy, Dr.Katharina Russe-Wilflingseder, Austria, Dr. Christos Merezas,Cyprus (President of the Symposium), Dr. Giorgos Psaras,Cyprus (President of the scientific committee of the symposium),Dr. Dana Jianu, Romania, Dr. Sofoclis Nicolaides, CyprusThe breadth and variation of Plastic Surgery makes it thecentral link between many other medical disciplines andit is our duty to ensure that we maintain this diversity andeducate our colleagues correctly. Aesthetic Surgery formsa small part of our profession, and it is therefore essentialthat, as Plastic Surgeons, we protect this multifacetedspecialty and expand our autonomy. Through suchmeetings we are able to stay up to date with ever changingpractices, share our experiences and join forces on howwe can improve patient care.Christos Merezas,President of the Cyprus Society for PRAS54 IPRAS Journal www.ipras.org Issue 7

23rd Annual EURAPS Meeting,Munich, Germany, May 24-26, 2012Dear colleagues and friends,Having been appointed as the EURAPS local host, it is mypleasure and privilege to welcome you to the 23rd AnnualEURAPS Meeting, which will be held on May 24th – 26th,2012 in Munich, Germany. A cosmopolitan and hospitablecity with excellent infrastructure, Munich offers its guestsa unique atmosphere. Munich’s world-class transportationsystem allows visitors to easily reach the city by train, planeor car. In 2010, Monocle ranked Munich as the world’s mostliveable city.The meeting venue, The Bayerischer Hof, is a leadingworld-class luxury hotel, ideally situated in the old towndistrict of Munich, in direct proximity to the most importantsights and shopping opportunities. The hotel maintainstraditional Bavarian values (http://www.bayerischerhof.de). In addition, participants will be able to indulge in aspecial “Oktoberfest atmosphere” at the bavarian evening.Furthermore, a magnificent gala dinner at the BMW Weltwill be one of the social highlights of the meeting.EURAPS Meetings offer a great opportunity for all of us toupdate our knowledge, meet with both old and new friendsand colleagues and to enjoy each other’s company. This isthe best occasion to prepare the ground for fruitful scientificco-operation in the field of Plastic Surgery.The Scientific Program will focus on new developments inPlastic, Reconstructive and Aesthetic surgery, especially inthe multidisciplinary setting of Regenerative Medicine. Inparticular, the Program will concentrate on approaches fromdiagnosis to state-of-the-art, less invasive treatments. ThisMeeting will offer new insights, which will be a platform forscientific exchange and discussion.For the first time, all participants will have the opportunity toattend the best research paper of EURAPS Research CouncilMeeting on Thursday afternoon (May 24th, 2011) instead ofthe Refresher Course. This will be the last session of theEURAPS Research Council Meeting that will take place inMunich from May 23rd – 24th, 2012. With this idea fromthe new General Secretary of EURAPS Manfred Frey, wewould like to emphasize the importance of research workand give the younger generation an opportunity to attend theEURAPS Meeting.Apart from the exciting scientific schedule, you willcertainly have the opportunity to sample Munich’s artisticand cultural richness. This includes splendid and excitingconcerts, impressive exhibitions, culinary delights, sportingevents and excellent shopping. There is more to Munichthan meets the eye!For further information on the 23rd Annual EURAPSMeeting and booking details, please visit us online onWWW.EURAPS.ORG.I look forward to spending some inspiring days with you.Milomir NinkovicMD, PhD, EURAPS Local Host, Munich 2012German Association of Plastic, Reconstructiveand Aesthetic Surgeons (DGPRÄC) goes Web 2.0Tweets, posts, wikis and friends – the “Web2.0” calls for everyday interaction. Millionsof users work with Facebook, Twitter andWikipedia day by day – creating an “internetwithin the internet” on computers, cellphones and pads. The German Associationof Plastic, Reconstructive and AestheticSurgeons (DGPRÄC) is now also presenton these channels and welcomes you toparticipate:Hans Strömsdörfer• Facebook:www.facebook.com/dgpraecLog in and “like“ us. You will receive all new information aboutDGPRÄC (in German).• Twitter:http://twitter.com/dgpraecSign in for our Twitter account!• Wikipedia:http://de.wikipedia.org/wiki/Deutsche_Gesellschaft_der_Plastischen,_Rekonstruktiven_und_Ästhetischen_Chirurgen58 IPRAS Journal www.ipras.org Issue 7

Plastic and Reconstructive Surgery Day15th July, 2011Dr. S. Raja Sabapathy,MS, M.Ch, DNB, FRCS(Ed), MAMS Director& Head Department of Plastic Surgery, Hand Surgery,Reconstructive Microsurgery and Burns.Ganga Hospital, INDIAIncreasing the visibility and awareness of the possibilitiesof Plastic Surgery remains the concern of Plastic Surgeonsworldwide. To make it possible, the Association ofPlastic Surgeons of India, led by its President, Dr. S. RajaSabapathy, hit upon a novel concept of the creation of a“Plastic and Reconstructive Surgery Day”. The date wasfixed as July the 15th. Though it did not commemorate abirth or signal an event in the history of Plastic Surgery,the day was chosen for logistic reasons. It was also feltthat more than the date we choose, what we do with theconcept will count more.What was done on the Plastic &Reconstructive Surgery Day?A call was given by the President of the Associationof Plastic Surgeons of India, Dr. S. Raja Sabapathy,requesting all their members to do at least one freesurgery on that day. The day could also be utilized toconduct programs to popularize Plastic Surgery. PlasticSurgeons from all over the country responded with greatenthusiasm and the concept was a phenomenal success.Activities done on that day included:• APSI members performed free surgeries varyingfrom free flaps to replace a giant hairy nevus on theface and reattachment of a hand in a rural setting,to the correction of post burn deformities, repair ofThroughout the countrythe media responded very well.Replant for a poor child done in Nanded, MaharashtraState on Plastic Surgery DayIssue 7 www.ipras.org IPRAS Journal 59

Surgeons conducted meetings in the hospitals to make morepeople aware of their department on Plastic Surgery Day.cleft lip and palate and rhinoplasty. The surgeriesperformed covered almost the whole spectrum ofPlastic Surgery.• Press conferences were conducted by many PlasticSurgery departments. This gave Plastic Surgeonsthe opportunity to explain to the media the scope ofPlastic Surgery. The media responded very well andcarried the message to the masses.• Utilizing the concept of the day, Plastic Surgeonsin many places met senior government officialsand ministers to describe the local needs for PlasticSurgery services. Extra funds were sanctionedfor various schemes and for the creation of PlasticSurgery hospital beds exclusively for patients withHansen’s diseases who need tendon transfers. Someyoung surgeons even started their practices on thatday. Specialized services in hand injuries werestarted by some hospitals to coincide with the day.• Taken as a whole, the concept of Plastic andReconstructive Surgery Day provided the much neededopportunity for Plastic Surgeons to reach all sectionsof the society, from Government administrators to thepublic. Perhaps the most gratifying response was thatfrom the President of the International Confederationfor Plastic, Reconstructive & Aesthetic Surgery,Prof. Marita Eisenman-Klein, who suggested inher newsletter that July 15th, 2012 be celebratedas “World Plastic & Reconstructive Surgery Day”.Neighbouring countries like Sri Lanka have agreedto this concept. We do hope that this will help usprovide yet another avenue for Plastic Surgeonsworldwide to reach the masses. Since the responsewas overwhelming, the Association has decided tocelebrate this day every year.Hon’ble Minister for Health, Government of India, Shri. Ghulam Nabi Azad,commented the Association of Plastic Surgeons of India on their innovative idea.60 IPRAS Journal www.ipras.org Issue 7

Legalization of the Nicaraguan Societyof Plastic SurgeryEarly in 2010, the Nicaraguan Society of PlasticSurgery initiated the necessary procedures in order tobe legally registered for the first time after almost 20years of history, according to the prerequisites of thelocal laws.The first legal procedure was completed in March of thesame year. The legal foundation under constitutionalarticles, which was then followed by the application ofthe Nicaraguan Society of Plastic Surgery presented tothe National Assembly to possess legal status.The board of directors monitored the process untilthe 6th of July 2011, when the Nicaraguan NationalAssembly granted the Nicaraguan Society of PlasticSurgery status of a legal entity.The SNCP celebrated this important accomplishmentlast July, receiving recognition from the NicaraguanMedical Association for its organizational growth.Dr. Guillermo Echeverria, President of the EthicsCommittee of the FILACP was invited as a specialguest and gave a speech on “Ethics and Commerce inplastic surgery” suitable for the occasion, taking intoconsideration that as members of the Ibero-AmericanFederation of Plastic Surgery we all abide by ourlegislation and code of ethics. A fact that makes us arespected and solid Association.By being granted the long awaited legal status, ourassociation reached a milestone in its long and successfulhistory. We reaffirmed our position in the world ofFounding Board of Directors.Dr. Alfonso Pares Vice President, Dra. Rossana Trejos,Secretary, Dra. Carolina Franchini Treasurer, Dra. SandraGutierrez President, Dr. Leandro Perez, Fiscal.Plastic Surgery as a professional and experiences groupof scientists committed to the highest levels of service,quality and ethical values in the entire Nicaraguanmedical field.Dr. Pablo Mongalo President of the Nicaraguan MedicalAssociation Hans in Recognition Diploma to Dra. SandraGutierrez President of SNCP, for its Legalization.Nicaragua, election of the new board of theNicaraguan Association of Plastic SurgeryOn November 25th the Nicaraguan Association of PlasticSurgery conducted an election for the new Board ofDirectors which corresponds to the period of January 2012-January 2014.The event resulted in the reelection of Dr. Sandra Gutierrezas President, Dr. Alfonso Pares as Vice President andDr. Carolina Franchini as Treasurer accompanied by Dr.Edgard Ibarra elected Secretary, Dr. Juan Carlos Arguelloresponsible for fiscal issues, and Dr. Dolores Brockmann asspokesperson for the Association.On December 15th 2012, the Association will be holdingthe inaugural ceremony for the new board, as well as theend of the year General Assembly.2011 ends, and will remain in the Associations history asan important year, when one of the greatest achievementsin our history was recorded! We obtained our official legalstatus in July 2011.Dra Sandra Gutierrez.President. Nicaraguan Society of Plastic Surgery.Issue 7 www.ipras.org IPRAS Journal 61

Panamanian Association of Plastic, Aestheticand Reconstructive Surgery (APCPER)Here at the Panamanian Association of Plastic, Aestheticand Reconstructive Surgery (APCPER), having a verysmall number of plastic surgeons we are currentlyworking on projects relating to academic and socialfields. On November 18 and 19 we are holding a smallmeeting in Panama with the attendance of three veryimportant international professors. We named it the“first APCPER Journeys”, where topics in aestheticsurgery will be covered with open discussions of diversethemes. Professors Celso Bohorquez, Gabriel Alvaradoand Santiago Umaña from Bogota are attending afteraccepting an invitation by dr. Raul de Leon, president ofAPCPER. The purpose of the activity is to strengthenacademic activities for the APCPER.Also, “Operation Smile”, Panama Chapter, will beholding its annual mission at the beginning of next year,totaling 21 years of work in the country, offering surgeryfor the needed with birth and acquired defects.Dr. Raul de LeonPresidentAPCPERParaguayan Society of Reconstructiveand Aesthetic Plastic SurgeryThe Congress of the Paraguayan Society of Reconstructiveand Aesthetic Plastic Surgery in Asuncion, Paraguay onSeptember 8th to 10th, 2011.The proceedings took place in a context of warmth andfriendship among all the attending local and by foreignsurgeons of different nationalities. We had the joy ofwelcoming colleagues from France, Italy, Spain, Mexico,Brazil, and Argentina.It was nice to exchange scientific and cultural informationin parallel to the numerous scientific contributions.Some of the topics we talked about were, facialrejuvenation, rhinoplasty, breast surgery, hair implants,lip and palate surgery, burns etc.The event played a significant role to increasing theglobal knowledge on our specialties and in improving thehuman quality of the plastic surgeon generally.It is in our plans to continue conducting scientific eventsin partnership with countries of the region as well as therest of the world.We sincerely thank IPRAS for the support and lookforward to all our common future scientific events!62 IPRAS Journal www.ipras.org Issue 7

H I S T O R I C A L A C C O U N T SThe history of Plastic and ReconstructiveSurgery in AustralasiaPresented at the RACS AGM Plenary Session “75 Years of SurgicalProgress” on the 13th of May, 2002.Bruce Walton TaylorHistory can be said to be the story of man’s advances inthe world and of the contributions of individuals. Thus,the history of Plastic Surgery can be said to be based onthe achievements of individuals, who have advanced theirdiscipline, made contributions to science and, throughtheir work, have allowed evolution to occur in thisbranch of Surgery. Aristotle, in his work ‘On the Partsof Animals’, said: “Art indeed consists in the conceptionof the result to be produced, before its realisation in thematerial”. How true this is of the Art and Science ofPlastic Surgery, which has its foundations in the conceptof repairing and changing human tissues.As in art, imaginative and creative new ways of lookingat surgical problems have pushed Plastic Surgery towardsthe ever-advancing frontiers of surgery, resulting in“spin¬offs” that have affected many other branches ofmedicine.We should be grateful to all those surgeons whoseinnovations have made our speciality what it is today andto those whose vigilance has ensured that standards ofexcellence are maintained.The origins of Reconstructive Surgery procedures are tobe found in Antiquity and hidden in the mists of time.Amazingly, some of the original methods remain in usetoday. Perhaps those surgeons who have missed out onthe experience of “waltzing” a tube pedicle in multiplestages into position or the fixation of a cross-leg flap bythe use of plaster and broom sticks -along with the coatingof plaster on the nurses and an irate theatre supervisor ona floor liberally coated with slippery plaster -have beendeprived of some of the joys of the “Early Days”. Therewere many others, but surgical advances bring changes.But one thing never changes. To produce a result thatprovides a reconstruction with the minimal amount ofscarring in both the area of deformity and the donor siteis still the ultimate aim of all Plastic Surgeons.And we can be proud that Surgeons from Australia andNew Zealand have made significant contributions toPlastic Surgery, especially from the period following theFirst World War up until today.In the programme of the Inaugural meeting of our Collegeheld in Canberra in March, 1928, what stands out is thenumber of presentations the subject of which was PlasticSurgery. The first clinical paper was entitled “The PlasticSurgery of the Human Body”. I doubt whether any of uswould be so bold as to deliver such a paper today. HenryNewland (later Sir) gave papers on whole thickness skintransplants and pedicle skin grafting. There were othersdealing with facial injuries, hand injuries and bums.The Royal Australasian College of Surgeons became areality 75 years ago. It took another thirty years before thefoundation of the “Section of Plastic and ReconstructiveSurgeons of the RACS”. Of the 21 Foundation membersof the section, 6 were from N.S.W.; 6 from Victoria;2 from South Australia; 2 from Western Australia; 1from Tasmania and 4 from New Zealand. Some timeshould be spent in reviewing some of these individualsand their contributions. However, before doing this, itwould be interesting to mention three individuals who,prior to 1928, were carrying out early Plastic Surgicalprocedures.John Reissberg Wolfe (1823-1904) was a HungarianOphthalmologist, who worked in Scotland and was thefirst to report the repair of lower eyelid defects using fullthickness skin grafts. He practiced in Melbourne between1889 and 1901 before returning to Glasgow.In 1899, William Moore, a Melbourne surgeon, published“Plastic Surgery”, probably the first book written inEnglish on the subject. He received the first Master ofSurgery degree from Melbourne University and workedat both Melbourne Hospital and St. Vincent’s.And thirdly, Henry P. Pickerill, was a New Zealander fromDunedin, with both Medical and Dental degrees, who hadworked in England with Harold Gillies. Following hisreturn to Wellington, he wrote a book on Facial Surgeryin 1924. Later on, in 1934, he began annual visits to theRoyal North Shore Hospital in Sydney, in the capacity ofPlastic Surgeon, that position said to be the first PlasticSurgery post in Australia. He is remembered as the firstsurgeon to use a tube pedicle to close a palatal defect.Issue 7 www.ipras.org IPRAS Journal 63

It was, however, not until shortly after World War Twothat Plastic Surgery was truly recognized as a subsurgicalspeciality in Australia. At that time working inAustralia were Benjamin Rank in Melbourne; DavidOfficer Brown, Kenneth Starr and Basil Riley inSydney; Philip MacIndoe and Llewellyn Swiss Davies inBrisbane; Leslie Le Soeuf in Perth and Henry Pickerill,Bill Manchester, Frank Hutter, Joe Brownlee and LeslieRoy in New Zealand.In 1956 Sir Harold Gillies, a New Zealander by birthand then aged 74, attended the AGM in Christchurchand, believing that the time was overdue, gave greatimpetus for the further recognition of Plastic Surgeryas a Speciality. A letter signed by David Officer Brown,Phillip Macindoe and Benjamin Rank had already beensent to the College in 1950, suggesting the formation of aPlastic Surgery Section. But it took until 1956 before theSection was founded and the inaugural meeting was heldin Melbourne in 1957.The 21 Foundation members of the section were:Rank, Newing, Snell, Gunter, Hueston and Wakefieldfrom VictoriaRiley, Dey, O’Mara, Gibson, Officer Brown and Starrfrom New South WalesNewland and Robinson from South AustraliaLe Souef and McComb from Western AustraliaStephenson from TasmaniaHutter, Manchester, Brownlee and Roy from NewZealandSome of these surgeons had worked at Sidcup, England,at the Queen Mary’s Hospital, later named St. Mary’s.By 1917, this was a 600-bed hospital devoted toMaxillofacial and Plastic Surgery and was divided intoBritish, Canadian, New Zealand and Australian sections,while later on American casualties were treated as well.Sir Henry Newland, later to become the inauguralChairman of the newly formed Section of Plastic Surgery,was in charge of the Australian section. Born in Adelaide,be obtained his English fellowship in 1899, after whichreturned to practice in Adelaide. During World War Onehe served in the Middle East, Gallipoli and France, beforehis transfer to Sidcup. For his service he was awardedthe DSO. He returned to Adelaide after the war, wasawarded a CBE, followed by a Knighthood in 1928 and,amazingly, continued to work until the age of 78.He was the President of the Section of Surgery of theBritish Medical Association in Australia and of many otherorganisations. From 1929 to 1935 he was the Presidentof the Royal Australasian College of Surgeons and, evenmore importantly for us, he was the first Chairman of theSection from 1957 to 1960.The second Chairman of the Section was David OfficerBrown, from 1960 to 1962. A graduate of MelbourneUniversity, he also obtained his MD and MS degreesfrom that University. After a period in general practicehe obtained the FRACS in 1935. As was the custom,he trained further in the U.K., working with HaroldGillies, Rainsford Mowlem, Archibald McIndoe andT. P. Kilner who had joined Gillies in 1919, and on hisreturn to Australia he confined his practice to Plastic andReconstructive Surgery. When World War Two first brokeout, he worked in the Maxillofacial and Plastic Unit atthe 2nd AGH, coincidentally with Benjamin Rank.In 1940 he returned to the U.K. to work with Gilliesuntil 1942, when he rejoined the Australian Army inAlexandria. On his return to Australia he was appointedto St. Vincent’s and RPA Hospitals in Sydney and therehe trained many of the Sydney Plastic Surgeons.The third chairman of the Section, between 1962 and1965 was Sir Benjamin. Rank, a graduate of MelbourneUniversity who gained his English Fellowship in 1938also came under the influence of Gillies, McIndoe andMowlem (as a matter of interest, all originally NewZealanders).When war broke out, Rank joined the Australian ArmedForces and saw action in Egypt and EI Kantara, beforebeing transferred back to Australia to set up the Plasticand Maxillofacial Unit at Heidelberg Military Hospital inVictoria. In 1946 he took up the first Plastic Surgery postat the Royal Melbourne Hospital.Undoubtedly, Sir Benjamin helped to put Australiansurgeons on the international map, being honoured inGreat Britain, India, the United States and Canada. He hasbeen a Carnegie Fellow, a Sims Professor and MoynehanLecturer, as well as presenting the Gillies MemorialLecture in 1973 and the Syme Oration in 1976.In 1965 he was the President of the British Associationof Plastic Surgeons and Chairman of the British SurgicalColleges in 1967. From 1966 until 1968 he was thePresident of the Royal Australasian College of Surgeons,while in 1971 he was President of the InternationalConfederation of Plastic and Reconstructive Surgeons atthe 5th International Congress held in Melbourne, afterwhich he was knighted. Sir Benjamin retired just a fewyears ago, as the President of Interplast Australia. He wasthe author of several books and a distinguished painterin oils.William Manchester, the fourth Chairman of theDivision, was a graduate of Otago University in 1938.During his service in the New Zealand Army he was sentto England for training in Plastic Surgery under Gillies,McIndoe and Mowlem, after which he set up the Plasticand Maxillofacial Unit near Cairo. He was recalled toChristchurch in 1944 and after his discharge in 1945 heestablished the first Plastic Surgery Unit at Burwood.More training followed in the UK, after which he returnedto Middlemore Hospital in Auckland.Amongst many honours he received a knighthood and64 IPRAS Journal www.ipras.org Issue 7

was, importantly, the first Professor of Plastic Surgeryin the Antipodes. In addition, he served as GeneralSecretary of the Asian Pacific Section of the ICPRS andon the Committee of the International Confederation. Hewas Chairman of the Section from 1964 to 1966.Apart from the distinguished Chairmen we have justprofiled, there were other surgeons who deserve mentionbecause of their efforts in establishing Plastic Surgery asa speciality in Australia and New Zealand. It is so easy totake the present status of the speciality for granted, but weowe an expression of gratitude to those who can really betermed pioneers and who worked hard to establish PlasticSurgery as a separate entity.Kenneth Starr, an honours graduate from Sydney, workedat RPA. He too had worked with Gillies and McIndoein England before returning to Sydney in 1942 to setup a Maxillofacial Unit at the 13th General Hospital inConcord. Starr was President of the RACS from 1964 -66and awarded many honours, although he did not confinehis work to Plastic Surgery. He was knighted in 1971.Basil William Birkenhead Riley was born in Sydney in1885 and served in the First World War as a Lieutenant.He graduated in Medicine from Sydney University in1923 and trained at Royal North Shore Hospital beforemoving to London to work with Mowlem and Gillies.Back in Australia his return to North Shore was followedin 1937 by 18 months in Europe and the United States,studying Plastic Surgery. The Second World War saw himworking in the Plastic Surgery Unit at Concord Hospital,while at the end of the war he was appointed Surgeon-inchargeat the Royal North Shore Hospital and peripheryhospitals. He is remembered with affection by all whoknew him.Frank Leo Hutter graduated from Otago Universityin 1935. He worked in Palmerston North for a whilebefore moving to London, where he spent time in severalhospitals, including Great Ormond Street Children’sHospital, in 1938. In 1940 he joined the New ZealandArmy Corps, serving in Plastic Surgery and GeneralSurgery Units. After his discharge in 1945 he workedwith Gillies, McIndoe and Mowlem at East Grinstead.On his return to New Zealand, he was appointed PlasticSurgeon to Wellington and Palmerston North Hospitals.In 1952 the unit was moved to Hutt Hospital, from whichhe retired in 1973 to a farming career.Leslie John Roy was also a graduate of Otago Universityin 1936. Having worked in Christchurch, he travelled tothe U.K. and, like Hutter, he did a stint at East Grinstead,after which he was appointed as a Plastic Surgeon in theWest of Scotland. When war broke out, he joined theNew Zealand Army Corps, serving in Egypt and Italy.Following his discharge he returned to New Zealand toan appointment at Burwood Hospital in Christchurch.Philip Hudson McIndoe graduated from SydneyUniversity in 1935 and, after having obtained hisfellowship in Edinburgh two years later, was appointedto Prince Henry Hospital in Sydney. During the war heserved at Gaza Ridge in Palestine and later in Egypt,Greece, Crete and finally in New Guinea. In 1945 he wasappointed Officer in Charge of the Plastic Surgery Unitat Greenslopes, later working at Brisbane General as aPlastic Surgeon, before changing direction to becomeMedical Superintendent at Goulbourn Base Hospital inNSW.Llewellyn Swiss Davies was a Melbourne graduate whodid his residency at Brisbane General Hospital. Duringthe war he was posted to the Concord Military HospitalPlastic and Maxillofacial Unit, under Colonel K. W. Starr.Later he served in Moratai and Greenslopes in Brisbane.He remained in charge of the Greenslopes unit until afterthe war, when he became Senior Visiting Plastic Surgeonat the Royal Brisbane and Repatriation Hospitals, as wellas the Mater and Children’s Hospitals.We must not forget Thomas Graham Humby, a colourfuland controversial character who was an English 1935graduate. Whilst still a student at Guy’s Hospital, hemodified the skin graft knife then in use, introducing hismoveable roller, which allowed more precise skin grafts.His residency at Guys was anything but dull. He wasan understudy to Fred Astaire in “Funny Face”; gainedthe first gliding certificate in England and representedEngland in international yachting. He joined the BritishNavy in World War II and trained as a Fleet Air Arm pilotin Florida. The war over, he trained in Plastic Surgeryand was appointed to Stoke Mandeville Hospital. Again,he did not restrict his life to surgery but started a freightcarrier,”London Aeromotive Service”, using old RAFbombers.A bout of TB, farming in Dorset and a Plastic Surgerypractice in the West Indies occurred before he finallycame to Sydney in 1956. He went into practice as aPlastic Surgeon in Rose Bay, concentrating on CosmeticSurgery, one of the early surgeons to do so. There aremany tales about his eccentricities but these must remainuntold as it is impossible to confirm their authenticity.Ian Ross Wakefield, known to all as “The Vicar” -what else-graduated in 1941 from Melbourne University, gaining aMasters degree in 1946. During the war he was in the A1FMedical Corps. He obtained his Australian and Englishfellowships, then carried out Plastic Surgery training inEngland. Back in Melbourne he worked at The RoyalMelbourne, The Royal Women’s and Royal Children’sHospitals. With B.K. Rank he published a noted textbookon Hand Surgery. He was the first secretary of the Sectionand later its Chairman (1966-1967)Arthur Stephenson graduated from Sydney UniversityIssue 7 www.ipras.org IPRAS Journal 65

in 1941, gaining a Masters Degree in 1949. During thewar he served as a Captain in New Guinea and Tarakan.He settled in Tasmania, where he was Senior PlasticSurgeon at the Royal Hobart, as well as consultant to theRepatriation Hospital.Leslie Ernest Le Soeuf was a Melbourne graduate, 1922,obtaining a Doctorate two years later, before travellingto England to obtain his Fellowship. During the SecondWorld War he served with the A1F in Libya, Greece andCrete, being mentioned in despatches, and was awardedthe OBE as well as French decorations. He was also aprisoner of war in Germany. He held many official postsin Western Australia and served the Royal Perth andPrincess Margaret Hospitals for many years.There were other dedicated surgeons who impacted onthe recognition of Plastic Surgery as a separate entity.Men like Richard Newing, John Snell, George Gunter,John Heuston, David Dey, Ted Gibson, Max O’Mara,David Robinson, Harold McComb and Joe Brownleewere all Foundation members of the Section who servedthe speciality with dedication and enthusiasm and whosecontribution is not forgotten.In 1956, following the inception of the Section of PlasticSurgery, the first College Plastic Surgery examination washeld and by 1960 a Sub-Committee on Surgical Trainingwas founded. Due to the increase in trainee numbers in1970, a Committee on Surgical Training was elected,the chairman being David Robinson of South Australia,Harold McComb of Western Australia and Don Marshallof Victoria. In order that there be regional representation,the Committee was enlarged to include John Williams ofNew Zealand, Noel Sweeney of NSW, Trevor Harris ofQueensland and Arthur Stephenson of Tasmania. Lateron there were two additions, Ted Gibson of Sydney andWilliam Manchester of New Zealand.In 1977 the College determined that each speciality shouldhave a board, in order to determine their own destiny,under directions of the College. The first Chairman wasDavid Robinson, who served until 1980. He was followedby John Hanrahan, (1980-84), who later was electedPresident of the College and Tony Rieger (1984-1987).Originally, most of our Plastic Surgeons received theirtraining overseas. When Plastic Surgery residency postsfirst became available in our public hospitals, trainees wereselected by the hospital and normally remained in one placethroughout their training. However, in 1987, it becameobvious to the Board that this restriction to one hospitaloffered a limitation of experience. To ensure exposure toall facets of Plastic Surgery, a hospital rotation system wasintroduced, with the selection of the trainees being made bya sub-committee of Plastic Surgeons in each state on behalfof the Board, instead of the hospital administration.Regional sub-committees were set up, reporting to theBoard. These sub-committees kept close contact withtrainees who were selected on a state-by-state basis.Since 1990, the continuation and approval by the Boardin Plastic Surgery is required for each trainee. Regularinspections of hospital training posts are carried out byboard members to ensure they fulfil the requirementsfor the teaching programmes. On completion of theirtraining and the RACS exam, many go overseas forfurther experience in centres of excellence, chiefly inNorth America, the UK or other European destinations.In 1979 David David suggested annual week-long coursesfor trainees and these have been held in different centressince 1980.The late sixties and early seventies saw the beginning ofmany changes in the delivery of health care in Australia.Because the College of Surgeons is responsible only fortraining and standards and does not deal in the politicaland financial aspect of practice, the Australian Society ofPlastic Surgeons was incorporated in 1971 to deal withsuch matters, in an environment of constantly changingground rules. A similar Society was founded in NewZealand. ASPS is open only to Fellows who fulfil thePlastic Surgery training and examination standards laiddown by the College.An application was made in 1974 for establishingArmorial Bearings for the Society. In 1976 a Grant ofArms was made by the College of Heralds in London.The Kings of Arms noted that “the elements of the grantsymbolise the essence of Plastic Surgery in the mostpleasing and truly heraldic manner”.In 1998 the decision was made to dissolve the Division.However, while ASPS is now the sole body coveringthe day to day matters of the Specialty, all training andstandards remain, as it always had, under the auspices ofthe College via the Board in Plastic Surgery.As specialisation in individual aspects of Plastic Surgerybecame more widely spread, the Aesthetic Society ofPlastic Surgery was formed and Plastic surgeons alsojoined various hand, head and neck and burn societies,while small study groups continued to meet.As we have seen from the very early days of the speciality,Australasian surgeons have trained and made theirmark overseas. Internationally, following the SecondWorld War, Plastic Surgery as a speciality was gainingmomentum. In 1955 the first Congress of the InternationalConfederation of Plastic and Reconstructive Surgerywas held in London, coincidentally the year after twoAmericans from Boston, Joe Murray, a Plastic Surgeon,and Hartwell Harrison, performed the first human kidneytransplant in the world.Since that time, the Congress of the InternationalConfederation of Plastic and Reconstructive Surgery hasbeen held every four years. In 1971 the Meeting was heldin Melbourne, under the chairmanship of B.K. Rank, whilenext year the Congress will again come to Australia, to66 IPRAS Journal www.ipras.org Issue 7

Sydney. Australian Surgeons have played an active rolein the International Confederation with representatives onthe central Committee and the Asia Pacific section.Over the years since the inception of the College, greatadvances have been made in Plastic Surgery. In PaediatricSurgery, for example, craniofacial procedures, genitaliacorrection, velopharyngeal procedures and improvementsin cleft lip and palate offer new hope for children bornwith congenital abnormalities.Victims of trauma can receive replacement of severedbody parts such as fingers, hands, scalps and ears, whilethe treatment of burns sees an ongoing quest for everbetter methods of skin culture and grafting and post burnscar relief.Breast reconstruction, as well as reduction andaugmentation, the treatment of male and female genitalabnormalities and of facial palsy are only some of theareas in which plastic surgery advances provide a betterand more normal life to patients.With the use of the surgical microscope, osseointegration,plate fixation,tissueandboneexpansion,musculocutaneousflaps, free flap transfers, muscle and nerve transpositionand transplantation, vascularised bone grafts and bonesubstitutions, we have reached results in reconstructionundreamed of 75 years ago.The elixir of eternal youth or a magic wand have not yetbeen developed but the subperiostal face lift, brow lift,hair micrografting, liposuction, laser surgery, implants,collagen, abdominoplasty and so on offer ways of defyingthe physical signs of ageing or creating a new image forthe patient.Many surgeons from the Antipodes have made significantcontributions on the International scene. Moore, Pickerill,Rank, Wakefield, Hueston, Thompson, David, O’Brienand Morrison have written well known textbooks, whilethey and others have contributed chapters to PlasticSurgery literature worldwide. B. K. Rank, Ian Taylor,Wayne Morrison, Bernard O’Brien, to name just a few,have been major presenters at International Meetings.Some of the World’s first microsurgery procedures werecarried out and reported in Australia. Let’s look withpride at these examples.Replacement of completely severed digit (P.G.Lendvay and E.R Owen:1970)The first Free Transfer of tissue by vascularanastomosis (G.I.Taylor and RK. Daniel: 1973)The free vascularangeal bone graft (G.I.Taylor,G.D.H. Miller and F.1. Ham: 1975)Replantation of an avulsed scalp by microvascularanastonosis (G.K.H. Miller, E.1. Anstee and J.ASnell: 1976)*The iliac crest free flap (G.I. Taylor, P. Towns and RCorlett: 1979)Replantation of a completely avulsed ear (D.G.Pennington, M.F. Lai and AD. Pelly: 1980)“Wrap around” toe to thumb transfer forreconstruction(W. Morrison, B. O’Brien and AMacLeod: 1984)Since 1974 the B. K. Rank Travelling Professorshiphas been awarded annually, to a distinguished PlasticSurgeon from an overseas centre of excellence. The listreads like the Who is Who of the speciality. But it hasnot always been one sided. Australian Plastic Surgeonshave been awarded Overseas Visiting Professorshipsand, particularly in the Asia Pacific region, have servedto benefit the hospitals in their host nations.In addition, overseas visits by groups of Plastic Surgeonsfrom our area have been well organised and visits tocentres in the United States, China, India and Russiahave led to great interchange of ideas.Until recent times, there were no professorialappointments in Australia, however Wayne Morrisonwas the first such appointee and is now Professor ofSurgery at St. Vincent’s Hospital, Melbourne. The firstacademic Chair in Plastic and Reconstructive Surgery isheld by Michael Poole in Sydney at St. George Hospital.The University of Auckland New Zealand appointed SirWilliam Manchester Professor of Plastic Surgery in 1977,the first such appointment in our area.It should also be noted that a federally funded CraniofacialUnit exists in Adelaide, under the Chairmanship of DavidDavid. However, there are other Craniofacial units in otherPlastic Surgery departments. These all draw patients, notonly from Australia, but from countries near and far.Here we must make mention of Interplast Australia, whichis a medical relief organisation initiated in 1983, whichsends Australian Plastic Surgery teams to some twentydifferent areas throughout the South Pacific. These teamsconsist of two Plastic Surgeons, an Anaesthetist and nurse,all volunteers. Procedures are carried out in the field butthere have been some forty five patients who have beenbrought to centres in Australia, while approximatelyforty eight doctors and nurses from eleven different areashave secured valuable experience here, which they takeback to their country of origin. Since 1983, 286 teamshave examined over twenty thousand patients and carriedout over twelve thousand operations, assisted by localmedical and nursing staff.As previously mentioned, Sir Benjamin Rank was thefirst President of Interplast, followed by Don Marshall.When Plastic Surgery was first officially recognised as aSurgical Speciality by the College in 1956, there were just21 qualified Surgeons. Last year, 2001, there were 257.Like all other surgical groups, Plastic and ReconstructiveSurgery has had its problems; a lack of realistic level ofvisiting medical officers, shortage of Hospital beds andIssue 7 www.ipras.org IPRAS Journal 67

lack of funding and facilities for research and trainingposts.As we look back into the history of Plastic Surgery inAustralasia, we see that it is indeed an example of theparticipation of individuals in advancing a field ofmedical science. Time does not allow me to name all themany Fine Plastic Surgeons who have contributed to andreceived recognition for their part in the developmentof their speciality. Not all innovations have made theirway into textbooks but many have been shared withstudents and fellow Surgeons in the operating roomor via meetings, such as the one being held this week.There is no doubt that the advances in all branches of thisSurgical Speciality have been rapid and the future is veryencouraging.The progress that Plastic Surgery has made throughoutthe world and especially in our area during the past fewdecades has been remarkable. Plastic and ReconstructiveSurgery is truly at the forefront of the advancing frontiersof Surgery. Just as truly, it has played an important partin the history of the development of medical care inAustralasia.SELECTION OF FOUNDATION MEMBERS OF THE PLASTIC SURGERY SECTION OF RACSI-r: J.A. Snell, B.K. Rank, G. Gunter, J.T. Hueston, A.R. Wakefield, B.W.B. Riley, D.L. Dey, M.L. O’Mara,E.W. Gibson, D. Officer Brown, K.W. Starr, H. Newland, D.N. Robinson, H.K. McComb, A. Stephenson,W. Manchester, LJ. Roy. Not appearing: F.L. Hutter, L.E. Le Souef, R. Newing, J. Brownlee.PLASTIC SURGEONS WHO HAVE BEEN RACS PRESIDENTSSir Henry Newland1929-1935Mr Kenneth Starr1991-1993Sir Benjamin Rank1964-1966OTHER MEMORABLE PLASTIC SURGEONSMr John Hanrahan1966-1968H.P. Pickerill, L.S. Davies, P.H. MacIndoe, T.G. Humby, J.R. Wolfe68 IPRAS Journal www.ipras.org Issue 7

A combined historical accountof Plastic Surgery in India and theAssociation of Plastic Surgeons of IndiaJust as the Sun rises in the East, the science of PlasticSurgery first dawned in the ancient Indian civilization. InIndia, from the beginning of recorded history, offendersor sinners were punished with mutilation or severanceof the nose, ears or parts of limbs. Indian mythologyand history are replete with stories of Surpanakha andNakatapore i.e. ‘City without Nose’. Moreover, in Indiathe nose is considered to be the organ of respect andreputation, hence plastic surgical procedures to correctthese deformities were a necessity.The first detailed description of plastic surgical proceduresis found in the clinical text on Indian Surgery, the ‘SushrutaSamhita’ (circa 600 B.C.). Atharva Veda, the root ofAyurveda, the classical text of Indian medical knowledge,includes two seminal texts, Charaka Samhita, on medicinalaspects and Sushruta Samhita, which incorporates detailsof surgical tools and operative techniques. Sushruta wrotethis treatise based on the lectures of his teacher, the famoussurgeon king, Devadas (‘incarnation of Dhanwantari, theDivine Physician). In the fourth century A.D. Vagbhat, anIndian Physician, recounted the plastic surgical procedureswith more details than provided in Sushruta Samhita. Inhis book, ‘Astanga Hridyans Samhita’ he credits thetechniques to Maharishi Atreya. It is interesting to findmention of plastic surgical procedures such as rhinoplasty,otoplasty, tissue grafting, organ transplants, transfer ofembryo, cross-grafting of head and reattachment of limbsetc. in these ancient Indian Medical Treatise and PuranicLiterature.The gradual decline of this golden era of Hindu Surgerybegan at the time of Buddha (562- 472 B.C.). Buddhistscripture Mahavagga Jataka enforced strict prohibitionon Surgeons and Manusmriti prescribed special ritualsfor their purification. Contemporary teachings, basedon Ayurveda, basically supported medicinal treatments.Ayurveda forbade surgery, as contact with blood andpus was considered polluting. Hence, during this period,these great surgical skills were delegated to lower casteslike ‘Koomars’ or potters, who were known for theirmanual dexterity. They kept this valuable knowledgealive and passed it from father to son, as a family secret.Some of these families were identified in the latter halfof eighteenth century. Marathas of Pune, Kangharias ofKangra (Himachal Pradesh) and some families in Nepalwere practicing ancient Indian surgical skills; mostnotable amongst them being midline forehead rhinoplasty.In Kangra, forehead rhinoplasty had been practiced forcenturies by a family of Hakim nose surgeons called‘Kanghiaras’. They had been operating in Kangra sincethe time of Raja Sansar Chand (1440 A.D.) and had alsoobtained certification from Mughal kings. Hakim DinaNath Kanghiara was the last surviving descendent ofthe family, known to have performed such an operation.Details of their surgical skill appeared in Punjab MedicalJournal in 1967. Later still, Dr. Tribhovandas MotichandShah, the then CMO of Junagadh is said to have performed400 rhinoplasties by forehead flap.In fact, India and Egypt are considered as the fountainheadsfrom which the stream of knowledge flowed tothe Middle East, eventually to reach the Mediterraneancivilizations; the Greeks and the Romans. The ancientIndian medical knowledge was carried into Greece andArabia by Buddhist Missionaries. Further still, avenuesof trade were set up between Greece and India followingthe conquests of Alexander ‘The Great’. Arabs playedan important role in transmitting the surgical knowledgeto the West. The Persian hospital at Gandi-Sapor (6th– 10th century A.D.) was a great learning centre of thatera, permitting the amalgamation of Hindu, Greek andArab schools of thought. Here, the Sushruta Samhita wastranslated into Arabic and later into Latin. Arab physiciansof that time, Rhazes and Aviceruna, often referred to theteachings of Sushruta and Paulus Aegina. Paulus Aeginawas a 7th century physician who was responsible for theintegration of Indian and Western surgical knowledgeand summarized it in a seven-volume compendium.Further down the timeline, Aulus Cornelius Celsus (25B.C.) propagated this science to Rome in his book ‘DeRe Medica’. During 525 A.D. the Christian OrthodoxChurch started rising and the enthusiasm towards surgerydeclined. Surgical skills were now reared in the handsof people of lower status like barbers, a situation similarto what had happened in India centuries ago. SushrutaSamhita was translated into English by Kariraj AtrideoGupta Vidyalankar Bishangar (1950) and KavirajKunjalal Bhishagranta (1963).Issue 7 www.ipras.org IPRAS Journal 69

Despite these hurdles, reconstructive operations ofthe nose and face received an impetus in the Europeancountries during the 19th century. The German, Frenchand English Surgeons were introduced to the older Indianmethod. During that period, certain German scholars whostudied the original text in Sanskrit, British surgeons andFrench travelers, who saw for themselves the rhinoplastyoperations performed in India, revealed the wonders andpractical possibilities of this specialty to the Westernworld.It was, however, the discovery of anaesthesia (Morton,Long and Wells) and anti-sepsis (Lord Lister) whichrevolutionized the practice of surgery and made itpainless and infection-free. Modern Plastic Surgery inIndia started after World War II. During the war, therewere a couple of British Maxillofacial Surgery Unitsand a special mention was made about them by Mr.Tom Gibson (Canniesburn Hospital) at Bangalore andby Mr. E.W. Peet at Pune, during their visits to India.This kindled the interest in Plastic Surgery among a fewyoung Indian surgeons working then with the armedforces as “temporary commissioned officers”. After thewar, two of them, Dr. C. Balakrishnan and Dr. R.N.Sinha,specialized in Plastic Surgery, while Major Sukh pursuedhis interest in the specialty as a pioneer in the field ofPlastic Surgery at the Armed Forces Medical College andHospital, Pune.Plastic Surgery did not exist as a recognized specialtyin the country. While in training at Stoke MandevilleHospital, U.K., Dr. C. Balakrishnan sent a memorandumto the Director General of Health Services, New Delhi,proposing the development of a Department of Plastic& Maxillofacial Surgery, because there was a cryingneed for at least one such department in the country.After great persuasion, he was offered the post ofLecturer and Surgeon at Medical College and Hospital,Nagpur (at that time known as the Central Provincesof Madhya Pradesh and Bihar State). He accepted theoffer and started to develop a Department of Plastic andMaxillofacial Surgery. Dr. R.N. Sinha, who was trainedunder Prof. Kilner, on his return to Medical College,Patna (Bihar State) made pioneering efforts to educatesurgical colleagues, State and Central Government andthe Medical Council of India about the need to developPlastic Surgery as a specialty. He wrote numerousarticles in scientific journals and lay press to drive homethe point. This indeed was a great task, since there wereno books or literature available to read, learn from andreceive guidance about the new specialty. During thosedays, even minor progress was very difficult, because thedevelopment of specialties was generally frowned uponand frankly discouraged by General Surgeons. Slowly,even the patients started realizing that a person whoconcentrates in one field, does much better than one whois a “jack of all trades and master of none”. It requiredall the tenacity and dedication of a handful of pioneerIndian Plastic Surgeons, who made Plastic Surgery theircareer, to overcomethe initial difficulties. For almost 8to 10 years, these pioneers at Nagpur, Patna, and later atLucknow, Bombay and Calcutta, struggled hard for theirexistence and worked as sections in the departments ofGeneral Surgery.Dr. N.H. Antia, after his post-graduate training in PlasticSurgery in the U.K., started working in a private hospitalin Pune and was also engaged in Rehabilitative Surgeryat the ‘Kandhwa Leprosy Centre’ outside the city. Hecarried drums with sterilized linen and instruments fromPune to the leprosy centre. Dr. Antia worked here in amakeshift O.T. on absolutely voluntary and honorarybasis in spite of considerable hardship. His pioneeringwork on leprosy was rewarded by an invitation fromEngland to deliver the Hunterian Lecture at the RoyalCollege of Surgeons, London in 1955.Sir B.K. Rank visited India from Australia, on a goodwillmission under the Colombo Plan to advise the Governmentof India and his own Government about the possibilitiesof developing Plastic Surgery in India. He spent twoweeks in India and recommended the development ofa Centre of Excellence at Nagpur, under the dynamicleadership of Dr. Balakrishnan. This was to be aided upto 50% under the Colombo Plan and the rest to be grantedby Central and State Governments. Unfortunately, theplan never materialized. However, the first independentDepartment of Plastic Surgery in the country was finallycreated at the M.C. Hospital, Nagpur, in 1958.By 1955, there were about four to five Plastic Surgeons,devoting their full time to this specialty and there wasa desire to form an Association. Thus, in the AnnualGeneral Body Meeting of A.S.I. (Association of Surgeonsof India) held in December, 1956 at Indore, Dr. R.N.Sinharequired a resolution to this effect. A sub-committee wasformed with Dr. C.P.V. Menon of Madras as its Chairmanand Dr. R.N. Sinha as the Convener to frame By-lawsand Regulations for an Association of Plastic Surgeonsof India - as a Section of Association of Surgeons ofIndia. However, it was only in December 1987 that APSIbecame a Registered Society with the government.In the year 1957, considerable interest was created inMaharashtra, following the visit of Sir Harold Gillies. Hewas pleasantly surprised to see deformities being treatedby tube pedicles and other modern techniques of PlasticSurgery. He applauded the excellent work that MajorSukh was doing in the field of Rehabilitative PlasticSurgery at the Armed Forces Medical College, Pune. Itwas not only an eye-opener for all, but a surprise to Dr.Gillies himself. Many war casualties needed extensivestay in his unit for such procedures of rehabilitation. SirHarold Gillies also demonstrated various operations and70 IPRAS Journal www.ipras.org Issue 7

techniques at Kandhwa Leprosy Centre, where Dr.N.H.Antia was working. Dr. Gillies, as the founder of modernPlastic Surgery, was keen to propagate knowledge in thisspecialty in one of the most populous countries of theworld. He visited and lectured at several centers in thecountry including Nagpur, Calcutta, Delhi, Patna andJaipur. At Nagpur, in December 1957, he inaugurated theAssociation of Plastic Surgeons in India - as a sectionof A.S.I. The Association elected the following officebearers:Dr.R.N.Cooper PresidentDr.C.Balakrishnan First Vice-PresidentDr.R.N.Sinha Founder SecretaryDr.R.N.Sharma Founder MembersDr.N.H.Antia Founder MemberDr.Hirdeis Founder Member(ENT Specialist from Bangalore)This was indeed a great historic moment and Dr. Gillieswas made the first Honorary Member. Dr. Gillies stayedin India for about three months and, before leaving forEngland, he insisted on a token payment of Rs.100/-to Dr. Antia, as an inspiration to continue his effortsin establishing a Department of Plastic Surgery at theGovernment Medical College in Bombay. This provedto be a great morale booster and the first unit of PlasticSurgery started at J.J. Hospital, Bombay in December1958 with Dr. Antia as its Head.A Burns and Plastic Surgery Unit was established in 1961at K.E.M. Hospital, Bombay, by Dr. Charles Pinto. Mr.E.W. Peet of Oxford was a regular visitor to this unit.The first summer conference of the Association washeld at Nagpur in 1964. The most outstanding featureof the conference was the brilliant presentation onthe classification of cleft lip and palate by Prof. C.Balakrishnan; now known throughout the country as TheNagpur Classification. The first batch of post-graduatestudents trained in our country appeared for theirexamination from Nagpur and Patna Universities in 1962and 1963 respectively.In 1963, the Government decided to start a Departmentof Burns, Plastic and Maxillofacial Surgery at SafdarjungHospital in Delhi. Dr. J.L. Gupta had the honour of startingand developing this unit which, by sheer hard work anddedication, became a major unit of Plastic Surgery inIndia in a very short time.In 1964, during the first Post-graduate Medical EducationConference, convened by the Medical Council of India,under the Chairmanship of the then Union Minister ofHealth Dr. Sushila Nayyar at Delhi, the first curriculumand physical standards for MCh postdoctoral training inPlastic Surgery was drafted.In 1967, Dr. R. N. Sharma represented our Association atthe International Meeting held in Rome, and thus, APSIjoined the International Confederation of Plastic Surgeons.By December 1967, the Association had grown to about66 members (including 37 full members). By 1968, wehad 11 plastic surgery centers in the country at Nagpur,Inaugural ceremony of IPRAS 2009 at Siri Fort Auditorium on 29th Nov 2009. (L-R Dr. G. Balakrishnan, President APSI, Dr. Suresh Gupta,President IPRAS 2009, Dr Marita Eisenmann-Klein, Secretary General IPRAS, Dr. Kiran Walia, Chief Guest and Minister of Health inGovernment of Delhi, Dr. Rajeev B. Ahuja, Chairman IPRAS 2009, Dr. Rakesh Khazanchi, Secretary General IPRAS 2009).Issue 7 www.ipras.org IPRAS Journal 71

Patna, Lucknow, Bombay, Pune, Delhi, Chandigarh,Patiala, Madras, Madurai and Calcutta.In the last four decades there has been a tremendousgrowth of Plastic Surgery. The number of teachingcenters has increased in the country and today hardlyany student is going abroad for basic Plastic Surgerytraining. The Association has established severaltraveling fellowships for training within and outside thecountry (appendix I), as well as several Professorships(appendix II). A few specialized centers of excellencefor management of burns, Hand and Micro-vascularSurgery, Craniofacial Surgery and Aesthetic Surgeryalso developed, in different parts of the country, bydint of hard work and special interests. The IndianJournal of Plastic Surgery started in 1981, in order tobring together all the professionals involved and todisseminate and advance their knowledge. Very proudly,IJPS (India Journal of Plastic Surgery) is now a popularjournal, indexed with Medline and publishing papersfrom across the world.There are about 800 Full members and 150 Associatemembers of APSI today.India had the privilege of hosting the IXth and theXVth Congresses of IPRAS in Delhi, in 1987 and 2009,respectively. Dr Suresh Gupta and Dr Rajeev B. Ahuja,respectively, were principally responsible for the organizationof the events. Both the events were a huge success, withthe delegates who enjoying the Indian hospitality. APSIalso has the privilege of giving two Secretary Generals tothe Asia Pacific Section of IPRAS; Dr B.M. Daver (1997-2001) and Dr Rajeev B. Ahuja (2009-2013).APSI has recently established a Humanitarian activitycorpus and the interest from this will be available to anyAPSI member to use for a humanitarian project in thecountry. APSI has also leaded in proposing and observingJuly 15th as the Plastic Surgery Day, when all PlasticSurgeons are urged to contribute free services to the needyin their Region. IPRAS has promised to propagate thisconcept. APSI has also started professional developmentcourses, which are topic-based and held three times ayear, rotating across the country. They are delivered at nocost to students and APSI members, through sponsorshipfrom Ethicon. These courses are extremely popular andhave been a huge success.Past Presidents of APSI during APSICON at Goa in 2010. (L-R Dr K.S. Sekhar, Dr N. Pandya, Dr V. Bhattacharya, Dr Suresh Gupta,Dr Mukund Thatte, Lt Gen L.P. Sadhotra, Dr Rajeev B. Ahuja, Dr K. Sridhar, Dr. Rajasabapathy)72 IPRAS Journal www.ipras.org Issue 7

The upcoming events of the APSI are:20-22nd Jan 2012 ISAPS Course, Goa19-20th Feb 2012, APSI-Ethicon accredited course onReconstruction in Abdominal & Trunk.27-29th April 2012, APSI-Ethicon accredited course onBasics in plastic surgery.2-3rd Nov 2012-Preconference APSI-Ethicon accreditedcourse in cleft surgery. Lucknow6-8th Nov 2012 Main APSICON Conference, Lucknow4-8th March 2013, World Congress of IFSSHThe current Executive membersrepresenting APSI:President:Dr A.K. SinghPresident Elect: Dr Ashok GuptaImmediate Past President: Dr Raja SabapathySecretary:Dr Atul ShahTreasurer:Dr Sailesh RanadeEditor:Dr Surajit BhattacharyaCouncil Members: Dr.B.G. Tilak,Dr Amresh S. Baliarsingh,Dr Nitin Mokal,Dr Ravi Mahajan,Dr Subramanian Iyer,Dr Hari VenkataramaniTrustees:Dr K.S. Sekhar,Dr J.K. Sinha,Dr K. Sridhar,Dr Suresh Gupta,Dr Rajeev B. AhujaAppendix II.1. Plastic Surgeon of the Year award – from DR KSShekar endowment2. Honorary Membership Award3. Ethicon Visiting Professorship in Plastic Surgery4. Ethicon Visiting Professorship in Microsurgery5. Ethicon Visiting Professorship in Cosmetic Surgery6. Gen. N.C Sanyal - Armed Forces Professorship7. Peet Prize for best presentation during AnnualCongress in Award category8. Kilner Essay Award9. APSI Junior Best Paper Award at Annual congress.10. McNeil audio-visual award for best presentation by ajunior plastic surgeon at Annual congress.11. Kammath Memorial prize for best poster duringAnnual congress.12. N H Antia award for best publication from India.13. Army Endowment for best report.14. R. N. Sinha award for best paper Published in IJPS.Contact for APSIDr. Atul Shah, Secretary APSI20, Om Park, Near Andhra Bank, Stadium Road, Akota,Baroda. Gujrat 390 020, IndiaPh: +919825033832 ; +912652321769E-mail: secretary.apsi@gmail.com; secretary@apsi.org.inWebsite; http://apsi.org.inAppendix I.1. Ethicon Plastic Surgery Traveling Fellowship2. Ethicon traveling fellowship in Microsurgery3. Ethicon cosmetic surgery traveling fellowship4. R.G. Saraiya international fellowship –5. Brig. Kathpalia fellowship in hand surgery6. Myovatec fellowship for training in Plastic surgery7. Vasudhan Arjin Fellowship in Laser Surgery8. APSI sponsorship to attend APSICON9. IX IPRAS Congress fund international travelingFellowship.10. IX IPRAS Congress fund national travelingFellowship.11. K.E.M. Microsurgery fellowshipDr Rajeev B. AhujaTrustee and Past President of APSIIssue 7 www.ipras.org IPRAS Journal 73

TPCDHistory and present situationof Turkish Plastic Surgery50th Anniversary of the Turkish Societyof Plastic SurgeonsProf. Ibrahim Yıldırım MDPlastic, Reconstructive andAesthetic Surgery Department,Cerrahpaşa Medical Faculty,İstanbul University, İstanbul TurkeyIt is an interesting coincidence for me that this articleis written just on the 50th Anniversary of the TurkishSociety of Plastic Surgeons. The society was founded in1961.The history of Turkish Plastic Surgery goes back tothe 8th century. German scientists found 64 Turkishmanuscripts, dated 1902 – 1914 years ago, in theSincan region of “East Turkistan” (in present-day northwesternChina, where Uygur Turks live). These arethe oldest documents in Turkish and Turkish PlasticSurgery 1,2 ,written in three different alphabets: the Uygurversion of the Sogd alphabet, the Brahmi alphabetof Indian root and the Nestori/Suryani alphabet 1,2 .They are kept in the Brandenburg Academy of Sciencein Berlin and consist of mostly traditional medicaldocuments, dealing with subjects including nasal tumors,fascial palsy, head and neck tumors, skin lesions, woundhealing and other plastic surgical problems.At the beginning of the 13th century, the first TurkishMedical Book “Tuhfe-I Mübarizi” was written in Turkishby Hekim Bereket 8 .As it is known, the first University was founded in Istanbulin 1453, just after the conquest of the city by the OttomanTurkish Empire. Şerefeddin Efendi of Amasya 3,4,5,6 wasa pioneer in Turkish Plastic Surgery and he published asuperb and beautifully illustrated surgical book, named“Cerrahiyyetü-l Haniyye 3 in 1465, written in the Turkishlanguage. He described many different techniques andhe demonstrated these techniques with 140 diagramsin his two-volume book. Most of the cases were relatedto congenital problems and trauma. Additionally,gynecomastia, hermaphrodism, mandibular subluxation,and carcinoma of the lip, etc. were also described.In the 15th century, Mümin bin Mukbil 16 from Sinop,described techniques for the treatment of diseases andcoloured lesions on the eyelids and orbital region; inAll documents were read by Ord. Prof. Reşid RahmetiArat (Gabdul Raşid Rachmati Arat) in Berlin.Most of the Turkish physicians often used to work on morethan one subject and the languages of the scientific arenaat that time were Arabic and Persian 4 . One of them wasAviCenna 4 (Ibn-i Sina) (980 – 1037) from Harmaysan,near the Buhara; in his well-known book “Tıp Kanunu”(Law of the Medicine) he gave details about “Ectropionand Entropion” and the muscles of the eyelids.addition, blepharoplasty and special surgical instrumentsfor these procedures as well.After the “decline of the Ottoman Empire”, newunderstandings and modern establishments brought newhorizons to medicine. The first modern school of medicine 7was established in 1827 in Istanbul by Sultan Mahmud.The Second one was a military medical school 9,10 . In orderto be able to relate to the Western World, the teachinglanguage was converted to French, starting in1839 and,74 IPRAS Journal www.ipras.org Issue 7

accordingly, the methodology of teaching was mostlyFrench. This school was re-organized in 1866 – 1867, andthe linguafranca was converted to the native language; theschool was re-established with a civil section 11 . This was avery satisfactory situation; at the end of the 19th Century,there were many very well-trained phyicians.It is possible to see some plastic surgical articles 17 inthe of “Tıb Cemiyeti Mecmuası” journal (the MedicalJournal) between 1856 and 1906, such as “TagliocozziProcedure for the Repair of the Nose”, “Cleft Lip andPalate repair”, “Eyelid operations”,“Indian Flap forNasal Reconstruction (1858)”, “Partial resection of jaws(1868)”,“Epidermo-dermal Graft Application (1872),“Ollier-Thiersch Graft (1885) etc.The first modern literature in Plastic Surgery apperaredduring this period. Dr.Cemil Topuzlu 12 presented 120plastic surgical cases, among his series of 758 surgicalcases, between 1893 and 1897. He was the first surgeonin the world to recommend “Z-Plasty” for contractures ofthe Achilles tendon 12 and to use sutures to repair arteries.The period between the two World Wars was an excellenttime for Plastic and Reconstructive Surgery, both at homeand abroad. It is important to mention Dr. Cafer TayyarKankat, Dr. Şerif Korkut and especially Dr. Halit ZiyaKonuralp, who were the pioneers of modern Plastic Surgeryin the country at that time. Dr. Kankat 13,14 performed manyreconstructive and aesthetic operations; the first TurkishJournal of Plastic Surgery was published by him under thename of “Modern Cerrahi ve Nöroşirürji (Modern Surgeryand Neurosurgery)” in three sections: General, Neuro- andPlastic Surgery, between 1936 and 1947.Dr. Kankat 14 published “The First Penile Reconstruction”,“Cartilage Grafts for Impotence”, and aesthetic operationssuch as “Face Lifting”, “Rhinoplasty” and “Abdominoplasty”etc., in this journal. Later on, in 1953, he started publishingthe first journal purely for Plastic Surgery under the title“Plastik, Reparatris ve Estetik Şirürjisi”.Dr. Konuralp 15,18 performed many reconstructive surgicaltechniques, which he had learned from the book byKirschner and Nordmann (1927) and published severalpapers in surgical journals between 1930 and 1935. Dr.Konuralp founded the first Plastic Surgical Ward in Turkeyin 1938. It had 49 beds and was under the Departmentof General Surgery in Istanbul University Hospital.The first teaching program in Plastic Surgery was started atthat time. Many very well-known Plastic Surgeons visitedthis clinic. They included Maliniac (USA), Rose Tilley(Canada), John Conley (USA), Heuser (Germany), MiltonFreeman (USA), Griffith (USA), Polzer (USA), McDowell(USA), Schimitzu (Japan), Organe (UK), Broadbent (USA),Kilner (UK), Matthews (UK), Longacre (USA) , Skoog(Sweden), Bardach (Polonya) and others. These individualsvisited at various times. In one occasion, Dr. Kilner invitedDr. Konuralp to England, where he spent time with Gillies,McIndoe, Kilner, Mowlem, Matthews, Barron, Osborne,Peet, Reidy, Dennis Brown and Sedden. His first bookwas published in 1952, entitled “Main Priciples in PlasticSurgery” 2 . He was also one of the eminent Plastic Surgeons of the fırst IPRS Congress in Stockholm, in 1955.The second Plastic Surgery center was founded in theMilitary Medical Academy 11 in Ankara, in 1943, as “JawSurgery Center”, by Dr. Necdet Albay, but later, in 1958,it was changed to the “Maxillofacial and Plastic SurgeryDepartment” by Dr.Cihat Borçbakan 19 . As it has beenmentioned previously, the Turkish Society of PlasticSurgeons 7 was founded in 1961 in Ankara. The founderswere eight Plastic Surgeons, two general surgeons, andtwo ENT Surgeons. The first president was Dr. Konuralpfrom Istanbul.The first National Meeting 18,19 of this society was held inAnkara and Tord Skoog from Sweden was the honorary guestand speaker. Afterwards, the first Skoog fellow was sentto Upsala. The International Association of MaxillofacialSurgeons was founded in Leipzig and Dr.Konuralp wasfounder and elected vice-president in 1970.Turkish Plastic Surgery Society has organized NationalMeetings every two years, and, in 1983, a Symposiumwas added to the program. Since 1988, a NationalMeeting and Symposium have taken place each year.Some combined meetings and courses were arrangedtogether with other countries, such as the Turkish – French(Istanbul 1980), Turkish – Greek (Athens1988) andseveral Aesthetic Surgery courses of ISAPS, as well as HandSurgery courses held in different cities of the country.The Sixth European and the Fifth Asian – PacificCongresses were organized by the Turkish Society inIstanbul in 1989.Dr. Güler Gürsu from Turkey was the Presidentof ISAPS between 2000 and 2002 and she wasalso the President of the World Congress ofISAPS, which was held in Istanbul in 2002.Over the past twenty years, new establishments like theTurkish Society of Aesthetic Plastic Surgeons, the Societyof Interplast Türkiye, the Society of Hand Surgeons,the Society of Maxillo facial Surgeons, the Society ofAesthetic Face and Nasal Surgeons and the Society ofReconstructive Microsurgeons have become closelyaffiliated with the Turkish Society of Plastic Surgeons.Interplast Türkiye has, so far, offered its services tonearly 40 countries.There is a two-step national examination twice a year to enterthe specialty training. The first step is a foreign languageexam, the second part a professional exam, similar to theUSMLE in the USA. This is a fairly competitive exam.After passing the exam, medical doctors earn the rightto enter to the specialty programme. In Turkey, the totaltraining time in Plastic Surgery is five years, includingrotational programs in General Surgery, Pediatric Surgery,ENT, Orthopedics and traumatology, Neurosurgery,Anaesthesiology, Emergency Medicine and Anatomy.At the end of the five years residents, must have prepareda thesis, which is an experimental or a clinical researchstudy, conducted under the instruction of a tutor. Thecandidate must take an examination to earn the specialtydiploma, which consists of three steps:1. Thesis must be accepted by jury members2. An oral examination organized by jury members.3. A practical examination in the operating room with aIssue 7 www.ipras.org IPRAS Journal 75

andom choice of cases, watched by the jury members.The jury members are three lecturers from Plastic Surgeryand two lecturers from any other of the close specialtieslike ENT, Paediatric Surgery, etc.The first specialty exam for Plastic, Reconstructiveand Aesthetic Surgery took place in 1965.Training centers are allowed to conduct this exam onbehalf of the Ministry of Health. Diplomas are awardedafter successful examination. Any specialist with thisdiploma is entitled to have a practice, either in one of theofficial institutions or in the private sector. The publicstill looks at Plastic Surgery as Aesthetic Surgery. That iswhy this field is highly popular.Nowadays, we have 53 training centers all over the country,in University and State Hospitals. There are around 900Plastic Surgeons and nearly 300 residents for a 75-millionpopulation. Unfortunately, some Plastic Surgeons are notmembers of the Society. There are “Hand MiocrosurgeryCenters” in the large cities, mostly in the private sector andin University Hospitals.There are “Burn Units” in differentcenters, but not enough for the country.We owe thanks to Cemil Topuzlu, Cafer Tayyar Kankat,Halit Ziya Konuralp and Cihat Borçbakan who werethe leading Surgeons in the development of the ModernTurkish Plastic Surgery.Cemil Topuzlu1866 – 1958Halit Ziya Konuralp1903 –2005Cafer Tayyar Kankat1895 – 1955Cihat Borçbakan1912 – 1991The distribution of Plastic Surgeons is, unfortunately, notideal in the country; they mostly try to stay in big cities.In our field, the number of the Plastic Surgeons in Turkeywill be another problem in the near future.References:1. Arat, Reşid Rahmeti, Ord. Prof. Dr., Berlin BrandenburgAcademy of Science, Hand- written Collection,“Zur Heilkundeder Uiguren” (SPAW, Phil. Hist. Klasse, 1930 XXIV, Berlin 1930,page(451-473)2. Sertkaya Osman Fikri, “Kurzer Überlick Über Die UigurischenMedizinischen Texte” Kitap: Festschrift für Arslan Terzioğlu, Prof.Dr. Ing. Dr. med. habil., zum sechzigsten Geburtstag /sahife: s. s.125-1383. Uzel İlter; “Şerefeddin Sabuncuoğlu; Cerrahiyetü-l Haniyye”Türk Tarih Kurumu Yayınları, III.Dizi-Sa.15,I. cilt, 495 sahife,II. cilt 98+36 fasıl, 140 minyatür, Ankara 19924. Ağırakça. Ahmet; Prof. Dr., “İslam Tıp Tarihi; Başlangıçtan VII./XIII. Yüzyıla Kadar, 399 sahife; FesanBasımevi, Derya Ciltevi,İstanbul, 20045. McDowell, Frank, MD., Sc.D., “The Source Book of PlasticSurgery”, Williams and Wilkins Company,Baltimore,1977; 509pages6. Horton, Charles E. MD. “Plastic and Reconstructive Surgeryof the Genital Area”, 695 sahife; Little Brown and Company;Boston, 19737. Yıldırım İbrahim; “Plastic Surgical Training in Turkey, History,present situation and future”, EuropeanJournal of Plastic Surgery(Springer-Verlag), 16:115-117, 19938. Erdağı Binnur; “Anadolu’da Yazılmış İlk Türkçe Tıp Kitabı”,Türkbilig-Türkoloji Araştırmaları, 2001-2002, sahife: 46-55,TDV Matbaası, Ankara, Temmuz 20019. Terzioğlu Arslan Prof. Dr.; “İstanbul Tıp Fakültesi Tarihçesi 1”,Türk Dünyası Tarih Kültür Dergisi, İstanbul, Ekim 2010, s: 286,sahife 24-3210. Terzioğlu Arslan Prof. Dr.; “İstanbul Tıp Fakültesi Tarihçesi 2”,Türk Dünyası Tarih Kültür Dergisi, İstanbul, Kasım 2010, s: 287,sahife 43-511. Terzioğlu Arslan, Prof. Dr., “Gülhane’nin Kuruluşunun 110.Yıld.nümü Anısına, Son Araştırmalar Işığında Gülhane ve TürkTıbbının Gelişmesine Katkıları”, Türk Dünyası Tarih KültürDergisi, Ocak 2009, sayı 265, sahife 13-22, İstanbul12. Topuzlu, Cemil; “80 Yıllık Hatıralarım, (İstibdat-Meşrutiyet-Cumhuriyet Devirlerinde) ‘Cemil Paşa’nınCerrahî Yayınları’sahife 248-257, D.rdüncü Baskıya hazırlayan Dr. CemalettinTopuzlu, Topuzlu Yayınları, Üniform Matbaacılık, İstanbul 200213. Kankat, Cafer Tayyar; “Modern Cerrahî ve N.roşirürji Mecmuası”,Ekspres Basımevi, Kader Basımevi,İstanbul 1936-1947 yıllarıarasında 36 sayı çıkmıştır.14. Kankat, Cafer Tayyar; “Plâstik, Reperatris ve Estetik ŞirürjisiKitabı, 33 sahife, Kader Basımevi, İstanbul, 194615. Konuralp, Halit Ziya; “Plâstik Cerrahide Esas Prensipler”, 148sahife, İsmail Akgün Matbaası, İstanbul, 195216. Kâhya, Esin; “Onbeşinci Yüzyılda Yaşamış Bir Bilim Adamımız,Mümin B. Mukbil”, X. Türk Tarih Kongresi, Ankara 22-26 Eylül1986, Türk Tarih Kurumu Yayınları, IX. Dizi-Sa.10d, V. Cilt,sahife 2253- 2260, Türk Tarih Kurumu Basımevi, Ankara 199417. Sezer, Baha; “Plâstik Cerrahî”, Tıp Dallarındaki İlerlemelerinTarihi (Dünyada ve Türkiye’de 1850 yılından sonra), CerrahpaşaTıp Fakültesi Vakfı Yayınları:4, Editör: Prof. Dr. Ekrem KadriUnat, sahife:362-372, Gürtaş Matbaası, İstanbul 198818. Konuralp, Halit Ziya; Anıları “Personal Communication”, 1990-2005, İstanbul19. Cihat Borçbakan’nın kendi sesinden Anıları, “PersonalCommunication”, 1986 – 1990, Ankara76 IPRAS Journal www.ipras.org Issue 7

A history of the British Association of Plastic,Reconstructive and Aesthetic SurgeonsPreviously: The British Association of Plastic SurgeonsThe First MeetingThe inaugural meeting of the British Association of PlasticSurgeons was held at the Royal College of Surgeons ofEngland on 20 November 1946. It was chaired by SirAlfred Webb-Johnson (later Lord Webb-Johnson), whowas then the President of the Royal College of Surgeonsof England.The next day, the Association’s first President, Sir HaroldGillies, wrote the very first letter in the name of theBritish Association of Plastic Surgeons, to Sir AlfredWebb-Johnson:Dear AlfredI cannot let this opportunity go without putting onpaper the very deep appreciation of your mostlykindly and helpful intervention last night. Yourhandling of the inaugural meeting, your help to meand to others in the later discussions were superb,and I can assure you and the Council of the Collegethat our little association was happily started. Wenow also feel that the Royal College is our homeand that the President and his team are our friends.We trust that we shall be worthy members of thissurgical family.HDGBAPS had the objectives of relieving sickness andprotecting and preserving public health by the promotionand development of Plastic Surgery. The Associationalso undertook to advance education in all aspects ofPlastic Surgery.The need for Plastic SurgeryA Plastic Surgery Planning Committee chaired byProfessor T Pomfret Kilner, and whose other memberswere Sir Harold Gillies, Mr Wilfred Hynes, Mr ArchibaldH McIndoe and Mr Rainsford Mowlem, had in fact meton five previous occasions before the inaugural meeting.They had found that the specialised war time units,which were especially equipped for treating injuries ofthe face and jaw, burns and soft tissues losses, had givenfacilities for treatment and research greatly in advanceof those available in peace time. They also identifiedcivilian needs, such as some 700 cases of cleft lip andpalate each year, industrial injuries and many patients forreconstruction and repair after surgery for cancer.They noted that facilities in London and in the provinces(Stoke-on-Trent, Manchester and Birmingham) had beenoverwhelmed, and that even in November 1946 “the mostrecently established centre at Sheffield, with 40 beds, hadonly been open for five months, but already had a waitinglist of 70 cases and is compelled to refuse admission todeserving cases from surrounding towns”.The Committee was of the opinion that Plastic Surgeryunits should be based in general teaching hospitals andthat they would function best in association with otherdepartments, but retain their own individuality, withdedicated wards, operating theatres and offices, andwherever possible they should also support research.The First PresidentsThe inaugural committee had faced a difficulty as towho to put forward as the first President of the BritishAssociation. The two main contenders were Sir HaroldGillies, and Professor Kilner, (who was the holder of theonly chair in Plastic Surgery in the United Kingdom). Theinitial committee vote split, half for Professor Kilner andhalf for Sir Harold. A compromise solution of having twopresidents was rejected by both, and Archibald McIndoewas definite in his advice that Sir Harold Gillies shouldbe put forward, and this prevailed.Sir Harold was President from 1946-47, Professor Kilnerfollowed in 1947-48 (and was elected President again in1955), and they were succeeded in 1949 by ArchibaldMcIndoe.Harold Delf GilliesHarold Gillies was born in New Zealand in 1882, theyoungest of eight children. His father died when he was4 and he was sent to boarding school in England at theage of 8. Four years later he returned to school in NewZealand, and in 1901 came back to Gonville and CaiusCollege, Cambridge. He played the violin, developeda love of fly-fishing, he rode and played golf (reachingthe semi-finals of the amateur golf championship at StAndrews).He graduated from St Bartholomew’s Hospital, London,becoming a Fellow of the Royal College of Surgeons in1910 and he became assistant to Sir Milsom Rees, thesenior ENT surgeon at St Bartholomew’s. When warbroke out in 1914, Gillies, then 32, volunteered to servewith the Red Cross and was sent to France as a GeneralSurgeon in 1915. He was closely associated with CharlesAuguste Valadier and Varaztad H Kazanjian, whoIssue 7 www.ipras.org IPRAS Journal 77

stimulated his interested in maxillofacial injuries. Hevisited Hippolyte Morestin at the Val-de-Grâce militaryhospital in Paris and after watching him operate he wrote“this was the one job in the world I wanted to do”.Gillies transferred to the Royal Army Medical Corpsand with the backing of Sir William Arbuthnot-Lane, setup a special unit at the Cambridge Military Hospital inAldershot, in 1916. From the Battle of the Somme (July1916) 2000 casualties were referred. There were only200 beds and the facilities were overwhelmed.The Queen’s Hospital in Sidcup was established, withan additional 200 beds and when the old hospital waseventually knocked down many years later, a plaque wasplaced in the entrance of the new Queen Mary’s Hospital,Sidcup, to commemorate “Harold Delf Gillies, CBE,FRCS 1882-1960, whose work at this hospital attractedworldwide recognition and led to the foundation of PlasticSurgery in Great Britain”.BAPS Between the warsAfter peace was declared in November 1918, American,Canadian, Australian and New Zealand surgeons returnedto their home countries to develop Plastic Surgery and toestablish new units.Most of England was covered by four Plastic Surgeonsin the 1930’s – Gillies, Kilner, McIndoe and Mowlem.In 1936, Richard Battle was told “there are four PlasticSurgeons in the country and there is no room for anymore”, but fortunately he was not put off. The onlyother surgeon in formal Plastic Surgery training at thattime was David Matthews, later joined by Eric Peet andJ P Reidy.The Royal Air Force was to recognise the importanceof the new specialty of Plastic Surgery, setting upPlastic, Maxillofacial and Burns centres, including EastGrinstead and Halton. At the Queen Victoria Hospital,East Grinstead, the Guinea Pig club was founded bysurviving burnt RAF crew members. The Royal Navyand the Army also developed Plastic Surgery facilities.From 1939, the period of the “phoney war” mass casualtiesthat had initially been expected did not materialise, butthe specialty developed by accepting civilian casualtiesresulting from the blackouts, which increased the roadand domestic accident rate, and from those injured infactories, which were depending on unskilled labour todevelop munitions (for example, women whose long hairwas caught in conveyor belts causing scalping injuries).The British Association of Plastic Surgeons stimulatedthe development of the specialty in many countriesaround the world. At the outbreak of the Second WorldWar, medical officers from Australia, Canada, India,Ireland, New Zealand and South Africa were allocatedto the four newly established Plastic Surgery units in theUnited Kingdom for training.The Second World War and afterwardsOn December 7, 1941 the Japanese bombed Pearl Harbourand the next year large numbers of American forces beganto appear in Britain, together with their surgical hospitalsand field units. They brought with them specialisedMaxillofacial and Plastic Surgery teams, including pioneerssuch as Aufricht, Converse, Ivy, Kazanjian and Webster.The friendly co-operation during that time led to strongtrans-Atlantic friendships, including the collaboration ofRalph Millard of Miami with Sir Harold Gillies, with whomhe became co-author of “The Principles and Art of PlasticSurgery” (1957) being awarded an honorary FRCS(Ed).After the end of the war, Loenneken (Oslo), Olsen(Copenhagen), Ragnell (Stockholm), and Schjelderup(Bergen) were amongst those who came to Britain totrain in the new specialty of Plastic Surgery, encouragedby the inauguration of the Association in 1946 and of theBritish Journal of Plastic Surgery in 1948.Distinguished Visitors to BritainMany pioneers of Plastic Surgery in Europe came to trainin Britain, including:Holland: C Koch, C HonigBelgium: J Polus, A de ConinckFrance: D Morel-Fatio, C Dufourmentel,R TubianaSpain: B Vilar-Sancho, J Planas, L Mir y Mir,P GabarroPortugal: J Conde, A M FernandesItaly: S Rosselli, S Teich-Alasia, G DogoAustria: R Trauner, P WilflingsederSwitzerland: H U Buff, H L ObwegeserYugoslavia: V Arneri, I Cupar, H Klemencic,M Derganc, F ZdravicCzechoslovakia: F Burian, S DemjenPoland: J SzlazakDenmark: P Fogh-AndersenSweden: T Skoog, B JohansonInternational Meetings in Plastic SurgerySurgeons from France, American and Britain, who hadbeen engaged in treating the wounded of the First WorldWar, attended a meeting held in Paris in June 1925.Meetings were then held in Brussels in 1936 (“Le PremierCongrès de Chirurgie Structive”) and this was followedby the “Second European Congress of Structive Surgery”in London, in October 1937. An international meeting78 IPRAS Journal www.ipras.org Issue 7

was planned under the presidency of Professor SanveneroRosselli in Milan, in September 1938 and this had to beabandoned midway, because of the Munich crisis. Dr TordSkoog was the Organising Secretary of the ScandinavianAssociation of Plastic Surgeons International Congress,which was held in Stockholm in August 1955, under thepresidency of Professor Erik Aschan of Finland, with SirHarold Gillies as its Honorary President.The London International Congress was held at theRoyal College of Surgeons of England, on July 13th,1959, under Mr Rainsford Mowlem, President of theBritish Association of Plastic Surgeons and ProfessorT P Kilner, Vice-President of the Association and of theCongress. Appointed delegates of 29 national societiesof Plastic Surgery attended, each seated below theirnational flag and receiving an address from His RoyalHighness, Prince Philip, Duke of Edinburgh, who hadconsented to being the Patron of the Congress (and whoin November 1964 agreed to become the first patron ofthe British Association of Plastic Surgeons), a role whichhe continues to the present day.BAPS Becomes BAPRASIn 2004 the majority of the members of the BritishAssociation of Plastic Surgeons (BAPS) voted to changethe name of the Association to the British Associationof Plastic, Reconstructive and Aesthetic Surgeons(BAPRAS), in line with many European associations ofPlastic Surgery. http://www.bapras.org.ukThe Association’s new look and name came into being inJuly 2006. This was associated with a change of brandidentity,moving from the previous heraldic crest to anew, contemporary logo, retaining one of the key motifs,the salamander.The salamander possesses natural powers of regenerationand is able to restore lost or damaged tissue or limbs. Inmythology, the salamander was believed to be capableof withstanding fire and was often depicted walkingunharmed through flames. Thus, this simple amphibianis an enduring symbol of reconstruction, protection andrepair. Over the years, the salamander has also beenvaluable in scientific research and this new emblemprovided a vital link with history as, moving forwardBAPS became BAPRAS and a new era began.The British Association of Plastic, Reconstructiveand Aesthetic Surgeons is now “the voice of PlasticSurgery” in the UK, advancing education in all aspectsof the specialty and promoting contemporary practice.BAPRAS sees its role as increasing understanding of thescope of the specialty of Plastic Surgery. It aims to raisethe profile of Plastic Surgeons, who are a crucial elementof surgical care teams which provide specialist care topatients over a wide range of conditions. Continuingthe core objective of advancing education, BAPRASis always looking to promote innovation within thespeciality of Plastic Surgery.The President in 2011, Tim Goodacre, set out ways inwhich the Association looks to develop: enhancing itsresearch profile; increasing its presence in the regionsin support of its members; and collating accurate datarelating to the numbers of Plastic Surgeons, the focus oftheir work and the impact created.Members and Plastic Surgery UnitsThere are currently Plastic Surgery units in 56 centresin the United Kingdom and 6 units in the Republic ofIreland. Plastic Surgery clinics, however, are held inmany other hospitals throughout the country, each onelinked to a regional unit. There are 892 members ofthe Association including honorary members, seniormembers, full members, trainee and junior members, andother categories of associated and overseas members.Current Meetings, Courses, and ResearchThe Association, together with the Royal Colleges,has appointed Plastic Surgery and Cosmetic Surgerytutors. Each year, BAPRAS holds two 3- day ScientificMeetings, and two 2-day Advanced Courses, covering thespectrum of Plastic Surgery, which are open to colleaguesfrom the UK and abroad. In addition, there are two 1-day meetings for medical students interested in PlasticSurgery, and a 1-day breast care nurses’ course. There isan active Education and Research subcommittee.The Next BAPRAS instructional Course will be heldin Manchester on 18th and 19th April, 2012. Deliveredby renowned international experts, this course is aimedat specialist trainees and established surgeons in PlasticSurgery, breast oncology, and applied disciplines fromthe UK and the wider international community and willcover the latest innovations and techniques.Examinations and AssessmentMembers of BAPRAS have also been heavily involvedin mainstream teaching, training, and examinations. TheIntercollegiate Board in Plastic Surgery brings together thefour Royal Colleges and the examination structure, whichstarted with the FRCS (Plastic Surgery) in 1986 at theinstigation of Mr Ian McGregor, which includes written, oraland clinical examinations. The FRCS (Plast) examinationis held in different centres throughout the UK.The evolving structure of the Intercollegiate Examinationhas helped to shape the course of other examinationsabroad, including those of the European Board, first heldin Brussels in 1994 under the encouragement of Mr MagdySaad, then President-Elect of BAPS, and Professor JohnIoannovich of Athens. The EBOPRAS European BoardExamination in Plastic Surgery currently has a BritishChairman, Mr John Boorman FRCS.Issue 7 www.ipras.org IPRAS Journal 79

BAPRAS and the Developing WorldBritish Plastic Surgery has a long tradition of links withthe developing world. Through its Overseas Service andTraining Committee, BAPRAS continues to offer supportto developing countries, recognising the importance ofReconstructive Plastic Surgery in the treatment of injuryand disease and helping to develop Plastic Surgery skillsin these environments.BAPRAS is keen to provide sustained and effective help tocolleagues abroad. Some UK Plastic Surgery units alreadyhave twinning arrangements with overseas hospitals anddepartments and more links can be set up through theBAPRAS Overseas Service and Training Subcommittee.BAPRAS also has links with non-governmentalorganisations, as well as the UK government, to provideacute help, for example following natural disasters abroad,such as earthquakes. Overseas activities include:• Funding short visits for Surgeons to learn newtechniques in the UK• Supporting Surgeons in countries as diverse asBangladesh, Ghana, India, Nepal, Pakistan, Sri Lankaand Uganda• Enabling BAPRAS members to visit many of thesecountries to participate in meetings and to work incollaboration with overseas colleagues• Conducting teaching and training and workshops incountries with limited plastic surgical infrastructure.The Journal of Plastic, Reconstructiveand Aesthetic SurgeryAn early proposal, after the foundation of the Associationin 1946, was to start a regular scientific communication onPlastic Surgery and the British Journal of Plastic Surgerywas launched in March 1948, under the editorship of MrA B Wallace.LecturesTHE GILLIES LECTUREIn 1961 the Council of the British Association of PlasticSurgeons instituted the Gillies Lecture as a memorialto Sir Harold Gillies. Distinguished Plastic Surgeonsfrom within the UK and abroad, are invited to lectureto the Association and receive the Medal. The mostrecent Gillies Lecture was given at the BAPRASWinter Scientific Meeting in December 2011 by Dr SamNoordhoff, a world leader in the field of cleft lip andpalate and Craniofacial Surgery, who practised for over40 years in Taiwan and was instrumental in establishingseveral hospitals and Plastic Surgery Departments inTaipei, which have an international reputation.THE McINDOE LECTUREIn 1962, the Royal College of Surgeons of Englandreceived a donation from the Royal Air Forces Associationwhich was to cover a Lectureship, awarded by the Councilof the College, on the recommendation of the President ofthe College and the President and Honorary Secretary ofthe BAPRAS, devoted to Plastic Surgery or another alliedsubject, in the name of Sir Archibald McIndoe, the ThirdPresident of the British Association of Plastic Surgeons.HUNTERIAN LECTURESMany Plastic Surgeons, and members of the Association,have been awarded Hunterian Professorships by the RoyalCollege of Surgeons, at the invitation of the Council. Themost recent Hunterian lecture was given at the BAPRASWinter Scientific Meeting in December 2011 by Mr MSchaverien whose ground-breaking work in the UK,Australia and the USA was the basis of his lecture on “Theuse of three-dimensional imaging for the investigationof the microvascular arterial and venous anatomies andperfusion of surgical flaps and the integument”.The Organisation of BAPRASThe Officers of BAPRAS are its President, Vice-President, Honorary Secretary and Honorary Treasurer.The other elected members of Council and the officersare the Trustees of the Association and there has been astrong move recently towards regional representation onthe Council.A number of other colleagues are invited to attendBAPRAS Council meetings, including the Presidentof the Irish Association of Plastic Surgeons, a patientliaison representative, the editor of JPRAS, the Chairmanof the Overseas Service and Training Committee, theChairman of the Professional Standards Committee, theCommunications Officer, the chairman of the SpecialistAdvisory Committee in Plastic Surgery, the President ofthe British Association of Aesthetic Plastic Surgeons, andthe Chairman of the Education and Research Committee.From 2012 the presidency will be extended to a two yearterm of office. Recent Presidents:• Mr Timothy Goodacre (Oxford) 2011• Mr Richard Milner (Newcastle) 2012• Mr Graeme Perks (Nottingham) 2013/2014European and InternationalRepresentationBAPRAS is proud to be represented on the EuropeanBoard of Plastic, Reconstructive and Aesthetic Surgery,and the Union Européenne des Médecins Spécialistes.BAPRAS is represented on the International Confederationfor Plastic, Reconstructive and Aesthetic Surgery by itsPresident.80 IPRAS Journal www.ipras.org Issue 7

ESPRAS, Edinburgh, 2014BAPRAS is pleased to be able to host the 12th Quadrennialmeeting of ESPRAS in Edinburgh, in 2014. Earlier thisyear, Mr Tim Goodacre, President of BAPRAS in 2011,issued a warm invitation to colleagues throughout theworld to join their BAPRAS colleagues in Scotland in thesummer of 2014.(from “The History of the British Association of Plastic SurgeonsTHE FIRST FORTY YEARS” Churchill Livingstone 1987, andother sources)Chris KhooPrevious President, BAPRASMember, Executive Committee of the European Board,IPRAS Regional RepresentativeA.B. Wallace, M.C. Oldfield, W. Hynes, J.S. ToughR.Mowlem, J.N. Barron, Prof. T.P. Kilner, R.P. Osbourne, Sir Harold GilliesGiven by I.A. McGregorSir Harold Gillies in uniform and when kligthedGiven by Lady GilliesIssue 7 www.ipras.org IPRAS Journal 81

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Çistory of Plastic Surgery in the Republic of ArmeniaThe history of Plastic Surgery in the Republic of Armeniabegins in 1982. Since 1982, the “Initiative Group”, ateam of young surgeons, started experimental operations.They derived from the ranks of a microsurgery fellowshipin Moscow. They worked in the Armenian branch ofthe All-Union Scientific Center of Surgery. The firstsuccessful clinical operation, was the replantation ofthumb in 1984.In 1984 a division of microsurgery in the Armenianbranch of the All-Union Scientific Center of Surgerywas created by the initiative group. The first operationswere muscle, tendon, vessel and nerve reconstructions ofextremities.In 1985 the first department of Microsurgery wascreated and headed by Artavazd Sahakyan. Later in1992, a second department, the Center of Plastic andReconstructive Surgery was organized and headedby Gagik Stamboltsyan. All surgeons of the seconddepartment completed their specialization period in YaleUniversity.Since 1990 many aesthetic operations take place in theRepublic of Armenia.In 1996 in Yerevan State Medical University andNational Health Institute, two new departments ofPlastic Surgery were organized. They also manage apostgraduate education program. After graduating froma 4 year residency in one of these departments you canget a Plastic Surgeon’s diploma.The Armenian Association of Plastic Reconstructive andAesthetic Surgeons (AAPRAS) was founded in 2005 bythe main Committee (The First RPesident was ArmenHovhannisyan). The greatest part of the Armenian PlasticSurgeons have decided to create this Society, givingpriority to issues like:- coordination of the surgeons’ practicaland scientific work,- promotion of postgraduate education,- unification of educational programs,- organization of International Congresses.During the last period the Association organized fourInternational Congresses, the last of which took placeunder the endorsement of IPRAS and ESPRAS. OurAssociation is in close relationship with the Russian andGeorgian Societies. Our relationship with IPRAS andESPRAS is very productive and highly influential to ouryoung Plastic Surgeons’ education and training in famousEuropean clinics.Nowadays, many Member Surgeons of our Associationwork in aesthetic and reconstructive Surgery Unitsworldwide.In 2013 we are planning an International MultidisciplinaryCongress on Antiaging Medicine and we invite all ourcolleagues to participate in it.Dr. Armen HovhannisyanPresident of AAPRASArmenian Associationof Plastic Reconstructiveand Aesthetic Surgeons(ÁÁPRAS)Issue 7 www.ipras.org IPRAS Journal 83

World Health OrganizationDear colleagues,WHO Patient Safety is pleased to share with you the results of the Latin American Studyof Adverse Events (IBEAS): on a given day, 1 in 10 patients admitted to the participatinghospitals were suffering from, or undergoing treatment for, a health care -related adverseevent. The risk of suffering adverse events doubled if the entire hospital stay was considered.This evidence is a reflection of the reality of many other hospitals in transitional countriesacross the globe and it highlights the importance of addressing patient safety globally.The result of a collaborative effort between the governments of Argentina, Colombia,Costa Rica, Mexico and Peru, as well as the Spanish Agency for Quality of the Ministryof Health, Social Policy and Equality, the Pan-American Health Organization and WHOPatient Safety, the IBEAS study is the first large scale study of this kind in Latin America.For more information, click herehttp://www.who.int/patientsafety/research/country_studies/en/index.htmlTo download the study results in English, click herehttp://www.who.int/patientsafety/research/ibeas_report_en.pdfTo download the study results in Spanish, click herehttp://www.who.int/patientsafety/research/ibeas_report_es.pdfThe WHO Patient Safety team84 IPRAS Journal www.ipras.org Issue 7

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Dear colleagues,The IPRAS International Committee for Quality Assurance and Medical Devices in PlasticSurgery (IQUAM) celebrates the 20-year anniversary from its foundation, in 1992. Thiscelebration will take place during the 10th Congress and Consensus Conference to be heldin Athens on Nov 1st – 4th, 2012.The organization was founded as EQUAM by a group of Plastic Surgeons from variousEuropean, Central and South American, African, Southeast Asian and Middle-Easterncountries. Representatives participating in meetings are Plastic Surgeons, scientists,manufacturers and delegates from governmental bodies involved in the development andsurveillance of advanced technologies, devices and techniques in the field of Plastic Surgery.Consensus Conferences are held biennially. At the close of meetings, a Position Statementis drawn up, summarizing the conclusions of the meeting. This statement is presented to thehealth ministry and Plastic Surgery society of each member country, the industry and anyother interested party. Over the years, these statements acquired an important significancein the practice of the Specialty and proved helpful for all.No doubt, this type of meeting is unique in its purpose and, besides clinical practice, it alsofocuses on evaluating technology and methodology. Among others, topics like Fat Grafting,Stem cells and Growth Factors will be addressed, as well as results from recent and olderprocedures like breast augmentation and ALCL, quality of silicone implants, injectablefillers, Botulinum toxin A, suturing materials, wound dressings, medical equipment,instruments, LASER apparatuses and so many others. The recent issue regarding PIP,which alarmed Plastic Surgeons and the public worldwide, will be particularly discussedin detail.Besides science, a rich social program is planned, including a guided evening tour at theilluminated Acropolis. Most of all please be assured that the organizing committee shallspare no effort in putting together a successful congress.A cordial invitation to all,C. Neuhann-LorenzIQUAM PresidentJan PoëllCongress PresidentDaniel MarchacChair Organizing Co.Andreas YiacoumettisChair Scientific Co.108 IPRAS Journal www.ipras.org Issue 7

For the FIRST time…The 1st IPRASINTERNATIONAL TRAINEES’MEETINGwill take place in Athens on November 1st, 2012.This meeting will make history as the first of its kind in the world. It is expected thatTrainees from many countries will participate, as well as representatives from Trainees’organizations.The program will include the following:1. Scientific Presentations2. Training and accreditation3. International co-operation4. Official participation of trainees in IPRASThe Faculty of this meeting will include respected and well known teachers, Heads oftraining programs, Trainees and members from the IPRAS leadership.More information will soon be uploaded on the IPRAS website www.ipras.orgIssue 7 www.ipras.org IPRAS Journal 109

SUPPORT LETTER FROM BOARD OF TRUSTEES MEMBERDear colleagues and friends of IPRAS,I have always been certain that the only way forward is to have our eyes looking to thefuture, confident that plastic surgery will carry on thriving, absorbing new technologies andtechniques. I have accompanied our society since its first steps, and I am glad to see visionstransformed to reality! It has been my hope that IPRAS and its national societies willcontinue to be the forums where innovation will be presented, where the inquisitive mindwill find others equally curious, so that plastic surgery may evolve within the framework oftwo principal objectives: to generously pass on knowledge to the next generation, and toassure safety to our patients.I am particularly happy that the upcoming IPRAS World Congress is to be held in beautifulChile, in our continent of South America, where plastic surgery has made giant steps ofdevelopment. I invite you all to add this important event to your plans for 2013 and to takeadvantage of the opportunity to attend one of the most important scientific gatherings forplastic surgery.Ivo PITANGUYHead-Professor of the Plastic Surgery Departments of the Pontifical Catholic Universityof Rio de Janeiro and the Carlos Chagas Institute of Post-Graduate Medical StudiesMember (and patron) of the Brazilian Society of Plastic Surgery, the National Academyof Medicine, and the Brazilian Academy of LettersVisiting Professor, I.S.A.P.S. FICS, FACS110 IPRAS Journal www.ipras.org Issue 7

NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS17 - 19 February 201217th Annual Pakistan Association Of Plastic Surgeon MeetingLocation: Bahawalpur, Pakistan - Venue: Quaid-e-Azam Medical College - Contact: Dr M. Mughese AminE-mail: mughese@yahoo.com - URL: http://www.papscon2012.com06 - 11 March 2012XLIII National Congress of Plastic, Aesthetic and Reconstructive SurgeryLocation: Merida, Yucatan, Mexico - Venue: Convention Center MeridaURL: http://www.cirugiaplastuca.org.mx09 - 11 March 20121st Congress of the International Society of Plastic Regenerative Surgery (ISPRES)Location: Rome, Italy - Venue: Hotel Columbus - Contact: Chrysa KontololiTelephone: +30 2111001783 - Fax: +30 2106642116E-mail: chrysa.kontololi@zita-congress.gr - URL: http://www.ispresrome2012.com11 - 14 March 201216th ASEAN Congress of Plastic SurgeryLocation: Boracay Island, Aklan, Philippines - Venue: Boracay Regency Beach Resort & Convention CenterURL: http://www.papras.org/17- 20 April 201242º Argentine Congress of Plastic SurgeryLocation: Buenos Aires, Argentina - Venue: Sheraton Hotel - Telephone: (54) 114811-9103E-mail: info@42congresoargentino.com - URL: http://www.42congresoargentino.com03 - 05 May 20123rd Central Asian Plastic Surgery ConferenceLocation: Tashkent, Uzbekistan - Contact: George KoliopoulosE-mail: george.koliopoulos@zita-congress.gr - URL: http://www.caps2012.com/15 - 18 May 201211th SRBPRAS CongressLocation: Belgrade, Serbia - Venue: HYATT Regency BelgradeE-mail: info@srbpras.rs - URL: http://www.srbpras2012.org18 – 20 May 2012Controversies, Art and Technology in Breast and Bodycontouring Aesthetic Surgery, CATBBAS ILocation: Ghen, Belgium - URL: www.coupureseminars.com - E-mail: seminars@coupurecentrum.be22 - 26 May 2012XIX International Meeting of FILACPLocation: Medellín (Colombia) - URL: http://www.filacp2012.com29 - 31 May 20123rd European Congress on preventive, Regenerative & Aesthetic Medicine (ECOPRAM)Location: Istanbul, Turkey - Venue: Harbyie Military Museum - Contact: Chrysa KontololiTelephone: +302111001783 - Fax: +302106642116E-mail: chrysa.kontololi@zita-congress.gr - URL: http://www.ecopram2012.com/

NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS05 - 07 June 201217th Meeting of the Euro-Mediterranean Councilfor Burns and Fire Disasters (MBC) & 25th Anniversary Commemorative MeetingLocation: Palermo, Italy - Contact: Prof. Bishara Athiyeh - E-mail: batiyeh@terra.net.lb16 - 17 June 20121st Seoul Rhinoplasty ForumLocation: Seoul, Korea - Venue: Seoul St. Mary’s HospitalE-mail: psyskim@gmail.com - URL: http://www.srf2012.or.kr/conference/1st_html/11-12 September 2012The XIIth Congress of the Romanian Association of Plastic Surgeons with Participation ofHungarian Association of Plastic, Reconstructive and Aesthetic SurgeryLocation: Sinaia, Romania - Contact: Lefteris Aivaliotis - E-mail: e.ai@zita-congress.gr12 – 15 September 2012LaserInnsbruck 2012Location: Innsbruck, Austria - Venue: Faculty of Catholic Theology of the University of InnsbruckContact: Ms Chrysa KontololiE-mail: congress@laserinnsbruck.com - URL: http://laserinnsbruck.com/13 - 15 September 201243. Jahrestagung der DGPRÄC / 17. Jahrestagung der VDÄPCLocation: Bremen, Germany - URL: http://www.dgpraec2012.de10 - 13 October 20122nd World Congress of Plastic Surgeons of Lebanese DescentLocation: Cancun, Mexico - Venue: Convention Center CancunURL: http://www.congressmexico.com/LSPRAS201226 – 30 October 2012Plastic Surgery THE MEETINGLocation: New Orleans, USA - E-mail: registration@plasticsurgery.orgURL: http://www.plasticsurgerythemeeting.com/1st November 2012The 1st IPRAS International Trainees’ MeetingLocation: Athens, Greece - Venue: Royal Olympic HotelContact: Mr Nikos Antonopoulos - E-mail: n.an@zita-congress.gr01 - 04 November 201210th IQUAM CONSENSUS CONFERENCELocation: Athens, Greece - Venue: Royal Olympic Hotel - Contact: Nikos AntonopoulosTelephone: +302111001782 - Fax: +302106642116E-mail: nikos.antonopoulos@zita-congress.gr - URL: www.iquam2012.com14 – 18 November 201349th Brazilian Congress of Plastic SurgeryLocation: Porto Alegre - URL: http://www.cirurgiaplastica.org.br/

I P R A S W E B S I T EJOIN YOUR COLLEAGUESThe first website that gives you the opportunityto upload your scientific profile for free!!www.ipras.orgNow it is very simple to upload your scientificprofile and gain the benefits of being under theIPRAS umbrella.Try it…!!Sign up on www.ipras.org and follow the followingsteps:1. Create an account by clicking “Member’slogin” on the top right-hand corner and thenselect the “Create new account” tab.2. Fill out your “Username”, “Email” and“Password”, as required.3. Select the option “Doctor” and your country,under the section “If you are a doctor, completethe following”.4. Once all account details have been added, clickon “Create new account” button.Then you click on “EDIT” and then on “DOCTORPROFILE”.This is the section where all the information ofyour scientific profile can be uploaded.You may complete the fields with the informationthat you prefer such us: Personal Picture, HospitalPosition, Affiliation, Special Field of Interest,Contact Details, Memberships, Topics of SpecialInterest, Publications etc.At the “EDIT” section you may proceed to theappropriate corrections at your account such usto change your password or to update personalinformation.When you complete the aforementioned stepsthere will be one last step remaining for yourdetails to be uploaded on the IPRAS website. Theapplication must be approved by the NationalAssociation you are a member. The application willbe sent at the Association of the country that youhave declared, ensuring that only IPRAS membersof good standing and high ethical principles areable to upload their personal details.As soon as your Association verifies you asa member, your profile will automatically beuploaded at the website’s, “Find a doctor” optionin the “Members”section.It is also up to you to decide whether your profilewill be classified as “private” or visible to allvisitors of the IPRAS webpage. Our aim, besidesfacilitating communication among colleagues,expands to allowing patients to verify the goodstanding and high ethical principles of the doctors’profiles hosted, allowing them to choose qualifiedIPRAS members for needed procedures.In conclusion, I want to emphasize the usefulnessof the IPRAS website FORUM. A section youwill gain access to, as soon as your profile hasbeen accepted and uploaded. Only verifiedplastic surgeons can use it and read its contents.Therefore, you will have the opportunity toexchange ideas, news regarding plastic surgerytechniques, news from your National Association,alerts and all other information you would like toshare with your peers.Don’t miss the opportunity to make the IPRASwebsite twice as useful to you!If you face any difficulties please do not hesitateto contact me at: maria.petsa@iprasmanagement.com .Always at your disposal!Maria PetsaIPRAS Assistant Executive Director116 IPRAS Journal www.ipras.org Issue 7

e-Stetix 3D2011 has been the result of several important achievements,among them:- e-Stetix 3D progressed through versions 1 to 5, with a longlist of improvements and new functionalities. All updateswere provided for free to registered users, and the servicewas continuously updated with the latest technologyfollowing users’ feedback.- e-Stetix was selected by IBM for its “Smarter Planet”I N D U S T R Y N E W SCrisalix 3D simulations are now usedin more than 70 countries“Special offer for all IPRAS members and readers.See end of the article for more details.”answering the most common question from patients.Dr. Serge Lê Huu (LaClinic, Montreux) has been using e-Stetixsince its first commercial release and recently announced thatin only 18 months, e-Stetix had contributed to increasing hisconversion rate from 57% to over 92%.Aside from generating these impressive results, Dr Lê Huu alsonoted that e-Stetix has been invaluable in optimizing the relationshipwith patients, through educating them about their bodies, helpingthem to select the desired implants, and helping to understand andmanage the patients’ expectations and aspirations.Some new developments available in version 5.2: complete setof linear and surface measurements, 3D planning for implantpositioning and nipple orientation, and much more.program due to its innovative cloud computing approach.- A 24/7 support desk was implemented, to train and supportevery e-Stetix user whenever necessary.- A second research & development project was commissionedby the Swiss National Fund of Research - CTI (Commissionof Innovation and Technology) in Switzerland, due to thevalue e-Stetix unique technology brings to the field of plasticsurgery.- e-Stetix reached the milestone of more than 1,500 activeusers in more than 70 countries (see map below).- The launch of its consumer website www.sublimma.com,which today is already generating more than 30 enquiriesper day in 10 different languages from people interested inplastic surgery with certified surgeons.- Endorsements by the International confederation of PlasticReconstructive Aesthetic Surgery (IPRAS) and the SociedadEspañola de Cirugía Plástica Reconstructiva y Estética(SECPRE). Both organizations support and share the sameobjective as Crisalix; increasing patient satisfaction bySHOWCASE – Serge Lê Huu – Switzerland“e-Stetix for Patient Education“Dr Lê Huu specifically refers to using e-Stetix in order tohighlight asymmetries and distance between the breasts, aswell as to show how implant shapes and volumes can producevarying results on different patients’ bodies. He maintainsthat having this discussion prior to surgery has significantlyminimized potential disappointment, and even surgeryrevisions, to the extent that he has not encountered a singleunsatisfied patient during these 18 months.IPRAS members and readers have a special 10% discounton e-Stetix annual subscriptions until March 15th 2011. Tobenefit from this offer, please visit http://www.crisalix.com/en/pricing and proceed to “sign up”. Use the following code in the“Promotional Code” field: 41f282e1d8CrisalixPSE-A1015 LausanneSwitzerlandinfo@crisalix.comIssue 7 www.ipras.org IPRAS Journal 117

I P R A S P A S T G E N E R A L S E C R E T A R I E STord Skoog (Sweden)1955 - 1959David N. Matthews (U.K.)1959 - 1963Thomas Ray Broadbent (USA)1963 - 1967William M. Manchester (N. Zealand)1967 - 1971John Watson (U.K.)1971 - 1975Roger Mouly (France)1975 - 1983Jean-Paul Bossé (Canada)1983 - 1992Ulrich T. Hinderer (Spain)1992 - 1999James G. Hoehn (USA)1999 - 2006118 IPRAS Journal www.ipras.org Issue 7

International Confederationfor Plastic Reconstuctiveand Aesthetic SurgeryInternational Confederationfor Plastic Reconstuctiveand Aesthetic SurgeryIPRAS BENEFITSFOR INDIVIDUAL MEMBERS• Immediate information about safetywarnings on devices, drugs and procedures• Information regarding the proper use ofall materials, substances and techniquesrelated to Plastic, Reconstructive andAesthetic Surgery through IQUAM(the International Committee of QualityAssurance and Medical Devices in PlasticSurgery) General Consensus statement,with an update every 2 years• Free electronic receipt of the IPRASJOURNAL• Information regarding harmonization oftraining• Information regarding accreditation ofPlastic Surgery Units• Promotion of Patient Safety and QualityManagement (in cooperation with WHO)• Protection of the Specialty and Promotionof its image world-wide• Promotion of Individual Members ofNational Associations by uploading theirscientific profile on the IPRAS website• Exchange of ideas, views, thoughts andproposals though the IPRAS website andits FORUM section• Certificate for Individual Members todisplay their IPRAS Membership• Regular updates on necessary informationand the right to participate in all eventsorganized by National Societies andIPRAS• Strengthening ties of professionalcooperation and friendship with colleaguesbeyond national borders all over the world• Information regarding the developments ofplastic surgery worldwideIPRAS BENEFITSFOR NATIONAL ASSOCIATIONS• Association support for educational andresearch purposes• Association legal & ethical adviceaccording to international law andpractices and assistance with crisismanagement• Promotion of local or regional eventsthrough the official IPRAS managementoffice• Promotion of local or regional news anda Historical Account for the Associationthrough the IPRAS Journal• Free shipment of copies and electronicreceipt of the IPRAS Journal• Immediate information and advice aboutsafety warnings on devices, drugs andprocedures• Information regarding the proper use ofall materials, substances and techniquesrelated to Plastic, Reconstructive andAesthetic Surgery through IQUAM(the International Committee of QualityAssurance and Medical Devices in PlasticSurgery) General Consensus statement,with an update every 2 years• Promotion of Patient Safety and QualityManagement (in cooperation with theWorld Health Organization - WHO)• Information regarding harmonization oftraining• Information regarding accreditation ofPlastic Surgery Units• Protection of the Specialty and Promotionof its image world-wide• Information and reports about eventsorganized by other National Societies andIPRAS

7th Issue December 2011IPRAS Journal ManagementEditor:Editor-in-Chief:Editorial Board:Page Layout:E-mail:Post Editing:Photographer:IPRASThomas Biggs, MDMarita Eisenmann - Klein, MDAndreas Yiacoumettis, MDChristian Echinard, MDConstance Neuhann-Lorenz, MDZacharias Kaplanidis, Economist“In Tempo” Athens Greecepanos@intempo.grAthena Spanou, MDJulian KleinIPRAS Management OfficeZITA CONGRESS SA1st km Peanias Markopoulou AveP.O BOX 155, 190 02Peania Attica, GreeceTel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216URL: www.ipras.org • E-mail: zita@iprasmanagement.comExecutive Director: Zacharias KaplanidisE-mail: zacharias.kaplanidis@iprasmanagement.comAssistant Executive Director: Maria PetsaE-mail: maria.petsa@iprasmanagement.comAccounting Director: George PanagiotouE-mail: george.panagiotou@zita-congress.grAssociations Management Director: Dimitris SynodinosE-mail: dimitris.synodinos@zita-congress.grCommercial Director: Gerasimos KouloumpisE-mail: gerasimos.kouloumpis@zita-congress.grNext issue: April 2012DISCLAIMER:IPRAS journal is published by IPRAS. IPRAS and IPRASManagement Office, its staff, editors authors and contributors donot recommend, endorse or make any representation about theefficacy, appropriateness or suitability of any specific tests, products,procedures, treatments, services, opinions, health care providers orother information that may be contained on or available through thisjournal. The information provided on the IPRAS JOURNAL is notintended or implied to be a substitute for professional medical advice,diagnosis or treatment. All content, including text, graphics, imagesand information, contained on this journal is for general informationpurposes only. IPRAS, IPRAS Management Office and its staff,editors, contributors and authors ARE NOT RESPONSIBLE NORLIABLE FOR ANY ADVICE, COURSE OF TREATMENT,DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES ORPRODUCTS THAT YOU OBTAIN THROUGH THIS JOURNAL.NEVER DISREGARD PROFESSIONAL MEDICAL ADVICEOR DELAY SEEKING MEDICAL TREATMENT BECAUSEOF SOMETHING YOU HAVE READ ON OR ACCESSEDTHROUGH THIS JOURNAL.While every effort has been made to ensure accuracy, neither thepublisher, IPRAS, IPRAS Management Office and its staff, editors,authors and or contributors shall have any liability for errors and/oromissions. Readers should always consult with their doctors beforeany course of treatment.©Copywright 2010 by the International Confederation of Plastic,Reconstructive and Aesthetic Surgery. All rights reserved. Contentsmay not be reproduced in whole or in part without written permissionof IPRAS.