Day 1 :
Keynote Forum
Barry Lycka
Barry Lycka Professional Corp. Canada
Keynote: Use of a novel agent to decrease bleeding and bruising associated with dermatologic surgery
Time : 09:30-09:55
Biography:
Barry Lycka is one of North America’s foremost authorities on cosmetic surgery, skin cancer surgery, reconstructive surgery and laser surgery of the skin. He graduated from the University of Alberta in Medicine, in 1983. He completed his internship at the Misericordia hospital in Edmonton, and then did his residency in Internal Medicine at University of Alberta. He completed a 2nd Residency interning in Dermatology at the University of Minnesota in 1989.
He is recognized by the College of Physicians and Surgeons of Alberta as a specialist in Dermatology. Dr. Lycka founded the Canadian Skin Cancer Foundation and Co-developed a telephone app for Dr.’s called “Dermatologist in your pocket”. He is a proud member of the Doctors for the Practice of Safe and Ethical Aesthetic Medicine, The Rotary Club, and volunteers with many organizations; as he believes it is very important to give back to the community and those less fortunate.
Dr. Lycka has traveled to many countries speaking with and teaching other Dr.’s the latest methods in scar correction; as he takes great pride in teaching the next generation of cosmetic surgeons, as well teaching about the importance of skin protection.
Abstract:
Introduction: Bleeding represents a significant complication of dermatologic surgery, affecting 42% of patients greater than 80 years of age and 26% of patients under the age of 80 after excision of non-melanoma skin cancer in a recent study (1) It is a common occurrence after botulinum and filler injection as well as laser surgery. In 2007, Haines Ely proposed a solution. It was based on an observation initially made when he wasrna phlebotomist as a college freshman working in the lab of Colonel James Ash (founder of the Armed Forces Institute of Pathology [AFIP]). He noted that patients who had eaten ice cream were noted to have a milky serum and did not bleed when blood was drawn. Later, when Ely had undergone a surgical procedure and suffered a hemorrhagic complication, he used this principle to stop the bleeding. This study looks at this method in clinical settings.
Discussion: Bleeding after surgery can be a devastating event. It occurs frequently in dermatology and is closely related to anticoagulation use. What is needed is an easy, cost-effective way to administer an application that reverses bleeding at the time of surgery and is readily reversible. The observations by Ely provided the answer for this simple and elegant study. Feeding patients ice cream 10 minutes prior to surgical intervention (Mohs Micrographic Surgery, botulinum and filler injection) resulted in a huge diminution in the numbers having the complication of bleeding. Why do foods high in fat content affect the hemostatic mechanism? Triglycerides from dietary fat are absorbed across the small intestinal lining where chylomicrons are formed. Chylomicrons are released by the intestinal cells and enter the lymph system. Chylomicrons then travel for a short distance and enter the blood stream. Along with chylomicrons, chylomicron remnants, and VLDL, changes in blood coagulation (clotting) occur in the postprandial period. Directly, clotting factor VII is activated, as well as plasminogen activator inhibitor-I, both of which encourage blood clot formation.Indirectly, recent work has shown that a high fat, high sugar meal causes an immediate increase in absorption of bacterial endotoxin from the gut. (4) Endotoxin directly activates platelet aggregation. Emulsified fats increase this absorption even more. (5) Commonly used emulsifiers in ice cream such as carboxymethylcellulose and polysorbate 80 further increase plasma endotoxin levels above those seen with simple emulsification.(5) IL-6 and endotoxin receptor sCD14 are increased in human plasma after a high fat ice cream meal and these also contribute to platelet activation.(5) High fat ice cream delivers the triple whammy of chylomicrons, increased circulating chylomicron remnants, and endotoxin absorption with subsequent platelet activation. In summary, the current paper compared bleeding in patients undergoing a dermatologic surgical procedure including Mohs micrographic surgery, injection of botulinum and filler injections, and laser surgery, before and after ingestion of material with a high fat content (from Marble Slab Creamery, Calgary, Alberta, Canada). This resulted in the incidence of hemorrhagic sequelae decreasing from 7% to less than 1%. The author is deeply indepted to Haines Ely, Professor of Dermatology, University at California Davis, Sacramento for his contributions to this poster.
Results:From 2007 to 2015, 1011 patients were pretreated with ice cream prior to Mohs Micrographic surgery, 1357 prior to botulinum injections, 1153 prior to filler injections, and 1107 prior to laser treatments. This resulted in a decrease in bleeding complications from 7% to less than 1%. (chi square d – 3 df -93.5 p <0.001)rnrn
Keynote Forum
Alain Tenenbaum
Swiss Academy of Cosmetic Dermatology and Aesthetic Medicine, Switzerland
Keynote: Tissular repositioning and rejuvenation of the face and neck by combination of the chemical myoplasty and peeling
Time : 09:55-10:20
Biography:
Alain Tenenbaum (MD, PhD and DSc). His Specialties are ENT and Facial Plastic Surgery- Paris, Aeronautic and Cosmonautic Medicine-Paris, Human Biology-Paris, Biological Physico Chemistry-Paris and Ex-Associated Prof. of Informatics-Nancy.
Abstract:
Introduction: Until now, the concept of facial rejuvenation was based only on volume augmentation concept (fillers) as myorelaxation with myoatrophy (Botulinum toxin), from now and thanks to the Endopeel techniques one acts not only on the myotension by preserving the muscular mass and without affecting the muscular contraction but also on the myoplasty and the myopexyrnrnMaterial & Methods: The techniques are so called Endopeel, a mixture of carbolic acid and peanut oil acid (arachidonic acid). The basic technique consists in injecting perpendicular to the plan of the muscle 0.05 ml of oily carbolic acid each cm and same in the perpendicular plan to the precedent following the direction and the sense to obtain the wished deformation of the muscle using criss cross-technique. The mechanisms of action are the chemical myoplasty or reshaping and tightening the facial muscles, the chemical myopexy by lifting facial muscles, the chemical myotension giving back the tension of facial muscles lost during the past years and a younger aspect of the face and also regeneration of the skin and dermis. Intramuscular trivectorial injections using the surgical logic of a facelift will be exposed requiring a basic anatomy physiological knowledge to realize a nasal labial furrow lifting on one side and to lift the sadly baggy low jowls on another side as to make a re-contouring of the mandible.rnrnResults: The face lift effect is immediate and is perfectly visible 30 minutes after the end of the treatment with a maximum result 2 to 3 days after the procedure. The face lift effect is early and will be relayed by the late peeling effect, specific to the techniques Endopeel. The effectiveness of this treatment increases with the number or the repetition of the procedures because the basic muscular tone will be thus increasingly high on the scale of the tension of this last. The treatment can be ineffective in 8% of the cases (bad technique). The only complications met are only transitory, like edema ecchymosis which never exceeds 10 days in worst cases without medicationsrnrnConclusion: With Endopeel we observed a slowdown in the natural biological time of the cells. rnThe advantages of these techniques are important for the patients: the immediate effect, the absence of scars, the absence of down time and the absence of social eviction. All treatments performed with Endopeel have given an improvement in terms of cellular rejuvenation so that the appearance it is more healthy and steady regarding the recovery in timing of biological ageing. The techniques of Endopeel are thus a new strategic weapon for the facial plastic surgeons enabling them to complete and/or maintain a face lift and to propose an alternative to the surgery.rn
Keynote Forum
B Venkata Ratnam
NMCS Hospital, UAE
Keynote: A new classification and treatment protocol for gynecomastia
Time : 10:20-10:45
Biography:
B Venkata Ratnam is the Head of the Department of Plastic Surgery, NMCS Hospital, Abu Dhabi, UAE and Vice President of the Emirates Plastic Surgery Society. He got qualified in MS (Orthopedic surgery) and M Ch (Plastic Surgery) from India. His works were published in several peer reviewed, indexed, scientific journals. He is an editor for the Breast Section, Aesthetic Plastic Surgery (official Journal of the ISAPS), and the International Editor for the Journal of Society for Wound Care and Research. He is the recipient of several academic distinctions.
Abstract:
Patients with gynecomastia seek flat chests, no scars on chest wall and no evidence of the condition after surgery. Despite the availability of a large amount of literature on the subject, gynecomastia continues to be a neglected subject. And, a concerted effort on the part of medical fraternity to standardize treatment guidelines for this condition is lacking. The result is that some of the patients who underwent surgery for gynecomastia are not fully satisfied with the outcomes of surgery. The causes for such dissatisfaction, as observed by the author, are:
1) Residual gynecomastia,
2) Redundant skin sleeves,
3) Persistent infra-mammary folds &
4) Unsightly scars on chest wall.
After carefully analyzing the outcomes over a period of seven years, the author had found that the presence of infra-mammary folds and the skin redundancies are the main causes of such unsatisfactory results. Based on these two simple clinical features, the author has categorized gynecomastia into three types and identified treatment techniques to treat each category. Application of this new classification and treatment protocol over a period of eight years was found to eliminate those unsatisfactory outcomes and to yield uniformly satisfactory results. Details of the classification, the treatment protocol and the results are included in the presentation.
Keynote Forum
Angelo Rebelo
Clinica Milenio, Portugal
Keynote: Blepharoplasty with external mini-incisions
Time : 10:45-11:10
Biography:
Angelo Rebelo has concluded his medicine studies in the Faculty of Medicine of the University of Lisbon, Portugal in 1980 and he became a specialized in Plastic, Reconstructive and Aesthetic Surgery in 1990. Since 1997 he opened his own outpatient private clinic for aesthetic-plastic surgery in Lisbon, Portugal, in the last 18 years, he’s in exclusivity at Clinica Milenio in Lisbon - Portugal, as Clinic Director and Cosmetic Surgeon. He is precursor in several techniques of Cosmetic Surgery performed under Local Tumescent Anesthesia and outpatient. Internationally, he has been invited to teach and perform several surgical demonstrations in many countries. He is frequently sought out by the media as an authority in his field. His surgical techniques and advancements have been the subjects of interviews in Portuguese and international media, he’s also author of numerous videos, lectures and articles presented at congresses and scientific journals. He is also an active member of several Professional Societies and Associations through the world.
Abstract:
The author presents an efficient technique to improve the appearance of people with herniation of fat pad bags of the lower lids. Compared to the unsatisfactory results of the classical blepharoplasty with “sclera-show”, “round eye” and ectropion and given the retractile skin capacity of the eyelid region, the author has for several years used this technique, abandoning the classical blepharoplasty with the resultant 4 cm scar. It was Fontana, Spain, who described this technique to remove the fat pad bags of the lower lids through minimal transcutaneous incisions of 2-3 mm. It’s a very simple technique, easy to perform, with indication in cases with excess or herniation of the fat pad bags but the author also performs this procedure in patients with skin excess and/or wrinkles, with satisfactory results. It’s a good alternative to the conjuntival approach because of fewer risks to the patient. The author verified that the removal of the simple fat pad gives a much better appearance to patients with a good skin retraction and if necessary can be complemented with peeling or laser procedures. Performed under local anaesthesia, through a small 2-3 mm incision with a 11 blade, in the lower lid at pupil level, cutting at once skin and muscle until the central bag, at the same time putting pressure on the eye to facilitate the extrusion of the fat with the removal of the blade. With the help of a forceps the fat is gently pushed and cut with a thermocauter (or electrocautery using low intensity, radiobisturi or laser). Through the same incision we have access to the internal and external fat pad bags always with gentle and directioned movements. Sufficient fat, not excess should be removed. Incision closure is carried out with a 6/0 nylon that is removed after 3 days. No dressing is used. Swelling is much less evident and recuperation is quicker. The author has also performed a similar procedure on the upper lid, but with very specific indications of herniation of the medial and internal fat pad bags, through a 2-3 mm incision in the inner portion of the upper lid, in a wrinkle near the naso-frontal field with the same steps as for the lower lid. In all cases there are neither problems nor complications and there is no risk of eye deformation as the “sclera-show”, ”round eye ” and ectropion. It’s a simple quick technique, with very good results, scars are almost invisible, recovery is quick, risks and complications are very few.
- Breast Surgery Symposium
Location: Dubai, United Arab Emirates
Session Introduction
Barry A. S. Lycka
Barry Lycka Professional Corp, Canada
Title: SVELT-Serial Small Volume Elective Lipo Transfer- A new means of breast augmentation
Time : 11:25-11:50
Biography:
Barry Lycka is one of North America’s foremost authorities on cosmetic surgery, skin cancer surgery, reconstructive surgery and laser surgery of the skin. He graduated from the University of Alberta in Medicine, in 1983. He completed his internship at the Misericordia hospital in Edmonton, and then did his residency in Internal Medicine at University of Alberta. He completed a 2nd Residency interning in Dermatology at the University of Minnesota in 1989.
He is recognized by the College of Physicians and Surgeons of Alberta as a specialist in Dermatology. Dr. Lycka founded the Canadian Skin Cancer Foundation and Co-developed a telephone app for Dr.’s called “Dermatologist in your pocket”. He is a proud member of the Doctors for the Practice of Safe and Ethical Aesthetic Medicine, The Rotary Club, and volunteers with many organizations; as he believes it is very important to give back to the community and those less fortunate.
Dr. Lycka has traveled to many countries speaking with and teaching other Dr.’s the latest methods in scar correction; as he takes great pride in teaching the next generation of cosmetic surgeons, as well teaching about the importance of skin protection.
Abstract:
Introduction: Breast augmentation has been the number one cosmetic procedure in the world for a number of years (ASPS). The modern era of silicone prostheses commenced with Frank Gerow’s implantation of the patient Timmie Jean Lindsey in 1962. Despite its ubiquity and generally inert nature, silicone-based implants generated intense debate, and litigation, particularly in America. Still, it is not without complications as they occur in 5-7% in their immediate postoperative course. The worst of these include infections and capsular contracture. What is needed is a more natural augmentation process. Fat has been used as a natural reconstructive substance. Coleman recently reported impressive results in primary BA grafting a remarkable mean of 277 cc fat per breast. However, fat poses several problems – it can become necrotic, calcify and can mimic or hide breast cancer (2). That is why the American plastic surgery associations have been hesitant to recommend it. As a result, the authors of this paper have developed a technique of fat augmentation they have named SVELT that minimizes these complications. It utilizes small volume lipo transfer, serially, injected into the dermal plane above the breast tissue to produce results previously only attainable by augmentation mammoplasty with silicone or saline implants. Study: From 2013 to 2015 Daryl K. Hoffman and Barry A. S. Lycka performed the SVELT procedure in their respective offices in Stanford, California, USA and Edmonton, Alberta, Canada. During those dates 130 patients were treated. Methods and Procedure 100 cc’s or less) are harvested from abdomen, flanks or thighs under sterile tumescent anesthesia, purified and transferred to breasts. Discussion - Breast augmentation by fat injection has been a controversial topic. It was criticized by the American Society of Plastic and Reconstructive Surgeons in 1987 for potentially obscuring carcinoma of the breast upon subsequent mammographic examination, necessitating repeat biopsies to assess the numerous false positives that may arise. (2) In 2007, the American Societies of Plastic and Aesthetic Plastic Surgeons issued a joint caution against fat injection of the breast, stating that its radiological sequelae would compromise the detection of breast cancer on subsequent mammography. Despite this, both societies “strongly support the ongoing research efforts that will establish the safety and efficacy of the procedure.” (2) The main complication of fat augmentation is fat necrosis and fat absorption. Both are dependent on amounts transferred, trauma to the harvested and transferred cells and placement of the material. Small amounts of fat, harvested a-traumatically, administered into the dermal plane of breast tissue augmentation where blood supply is rich, was posited by Hoffman to solve this problem. Since small volumes do not solve the aesthetic need for fullness of this appendage, the thinking progressed to repeating the procedure serially to solve aesthetic need. As discussed, 130 procedures have been completed. There has been minimal resorption and pleasing volumes achieved. It is safe, economical, and with extremely low risk when done as a carefully controlled surgical procedure on well selected patients. Based on the results of this clinical study, SVELT (Serial Small Volume Elective Lipo Transfer) is a new augmentation procedure with minimal complications and a high degree of patient satisfaction.
Horia Remus Siclovan
MedLife- Genesys Hospital, Romania
Title: Muscle splitting biplane breast augmentation: Advantages and outcomes - A five year review of experience
Time : 11:50-12:15
Biography:
Horia Remus Siclovan is a Specialist Plastic Surgeon certified by the Romanian Ministry of Health (2004) and by The Ministry of Health, United Arab Emirates (2008). He completed his Fellowship in Aesthetic - Cosmetic Surgery and Facial Palsy Surgery at the Clinic of Plastic Surgery “Prof. Dr. Fausto Viterbo†under the supervision of Professor Fausto Viterbo, Head of the Division of Plastic Surgery, Botucatu Medical School, Sao Paulo State University, Brazil (2006 and 2013). Currently, he is a Specialist Plastic Surgeon at MedArt Clinics, Riyadh, Saudi Arabia (2007–2008) and MedLife – Genesys Hospital, Arad, Romania (since 2009). He is the first Romanian Plastic Surgeon whose scientific articles were published in Aesthetic Plastic Surgery Journal (Official Journal of the International Society of Aesthetic Plastic Surgery). He is also a renowned Member of International Society of Aesthetic Plastic Surgery (ISAPS) and American Society of Plastic Surgeons (ASPS). He attends and presents his work at various conferences around the world. These include conferences in Rio de Janeiro (Brazil), Paris (France), Santiago de Chile (Chile), Geneva (Switzerland), Prague (Czech Republic), Dubai (United Arad Emirates), Riyadh (Saudi Arabia), Botucatu (Brazil), Szeged (Hungary), Doha (Qatar), and Budapest (Hungary).
Abstract:
Background: For an optimal result in augmentation mammaplasty, the implant must have adequate soft tissue coverage. One of the most important factors in the dynamics established between the implants and the soft tissues after breast augmentation is the pocket plane. The implant placed in the retroglandular space may have significant disadvantages if the soft tissue coverage is inadequate (implant palpability, visibility and capsular contracture). To correct these problems, use of the retropectoral space has become common place. Although this provides adequate soft tissue coverage, the problem of implant displacement with contraction has resulted. A reasonable solution to the problem of acquiring adequate soft tissue coverage without displacement of the implant through pectoralis muscle contracture has been to use the muscle splitting biplane breast augmentation. The use of the muscle splitting biplane technique seems to yield the benefits of both planes without the deficits. Methods: Since 2010, 300 patients with hypomastia have undergone muscle splitting biplane breast augmentation. Results: Pleasing long-term results have been obtained, with maintenance of a natural breast shape and cleavage, a smooth transition between the soft tissues and implant in the upper pole, and low morbidity. There were no capsular contracture and no displacement of the implants. Conclusions: The muscle splitting biplane breast augmentation offers improved long-term aesthetic results due to the creation of a stronger supporting system for the implant’s superior pole. The trade-offs of the classic subpectoral approach have been significantly reduced and factors such as morbidity and postoperative recovery are acceptable.
Horia Remus Siclovan
MedLife – Genesys Hospital, Romania
Title: Correction of breast asymmetry and minor ptosis with internal mastopexy and muscle splitting biplane breast augmentation
Time : 12:15-12:40
Biography:
Horia Remus Siclovan is a Specialist Plastic Surgeon certified by the Romanian Ministry of Health (2004) and by The Ministry of Health, United Arab Emirates (2008). He completed his Fellowship in Aesthetic - Cosmetic Surgery and Facial Palsy Surgery at the Clinic of Plastic Surgery “Prof. Dr. Fausto Viterbo” under the supervision of Professor Fausto Viterbo, Head of the Division of Plastic Surgery, Botucatu Medical School, Sao Paulo State University, Brazil (2006 and 2013). Currently, he is a Specialist Plastic Surgeon at MedArt Clinics, Riyadh, Saudi Arabia (2007 – 2008) and MedLife – Genesys Hospital, Arad, Romania (since 2009). He is the first Romanian Plastic Surgeon whose scientific articles were published in Aesthetic Plastic Surgery Journal (Official Journal of the International Society of Aesthetic Plastic Surgery). He is also a renowned Member of International Society of Aesthetic Plastic Surgery (ISAPS) and American Society of Plastic Surgeons (ASPS). He attends and presents his work at various conferences around the world. These include conferences in Rio de Janeiro (Brazil), Paris (France), Santiago de Chile (Chile), Geneva (Switzerland), Prague (Czech Republic), Dubai (United Arad Emirates), Riyadh (Saudi Arabia), Botucatu (Brazil), Szeged (Hungary), Doha (Qatar), and Budapest (Hungary).
Abstract:
Background: Current techniques for correction of breast asymmetry and minor ptosis requires incisions on the breast but often the patients are dissatisfied with scars. Objectives and methods: A technique combining muscle splitting biplane breast augmentation with internal suture mastopexy that consist of sutures placed in the deep surface of the gland from the upper part of the splitted pectoralis muscle is presented. This technique leaves no scar on the breast. Results: This procedure was performed on 50 patients, with a mean follow-up of three years. Pleasing results have been obtained and the patients and the surgeon have expressed satisfaction with the procedure. Conclusions: The internal mastopexy combined with muscle splitting biplane breast augmentation is an effective alternative in selected patients.
Afschin Ghofrani
Aestheticon®- Plastic and Aesthetic Surgery Centre, United Arab Emirates
Title: Augmentation: Access, plane, types of implants and pitfalls
Time : 12:40-13:05
Biography:
Afschin Ghofrani’s current position as the Medical Director and owner of Aestheticon® has been the path of an ever increasing level of specialization with a constant focus on Plastic Surgery and Hand Surgery since 1992 and further concentration on Aesthetic Surgery since 1997.
At Europe's largest clinic, the RWTH Aachen in Germany, he studied human medicine and graduated with final marks amongst the top 2% of students. In 1992 he started his medical career at the Clinic of Burns and Plastic-Reconstructive Surgery in Aachen. In the following 5 years he got educated in the treatment of severe burned patient, intensive care, management of hand trauma, reconstructive and plastic surgery. During this period he also completed his doctoral thesis.
From 1997 to 2002 he worked as an assistant medical director and consultant representative at hospitals in Cologne and Dortmund in departments of Plastic Surgery and Hand Surgery.
In 1998 he received the certificate ‘Specialist of Plastic Surgery’ from the medical chamber in Nordrhein-Westfalen/ Germany and in 2001 the additional certificate ‘Specialist of Hand Surgery’. Furthermore he is a trained and certified emergency doctor with many years of experience in intensive care medicine.
From January 2003 until August 2010 Dr. Afschin has been the Head Physician at the Evangelische Hospital Giessen/ Germany and additionally the Medical Director of his private practice of Plastic/Aesthetic Surgery and Hand Surgery. During this period he focused besides his other specializations mainly on aesthetic surgery of face and body.
In September 2010, Dr. Afschin moved to Dubai to establish his concept of a plastic and aesthetic surgery center. After working as a specialist consultant at two different clinics in Dubai during the setup of his own clinic, Aestheticon ® opened in May 2012.
Regarding Dr. Afschin’s scientific career, he was the initiator and leader of various research projects and has published diverse articles in national and international specialists’ journals and books. Consistently he is invited to give lectures at scientific conferences and workshops.
Abstract:
Introduction: Breast enlargements remain one of the most popular plastic surgical procedures worldwide. Many different implant types, shapes and consistencies are available, as well as different pocket planes. However, given the choice, one need to truly understand how to utilize the variables of access, pocket plane and implant shape in order to achieve the best result from case to case. Methods: We routinely utilize inframmary and peri-areolar approaches. The implant pocket can be sub-glandular, sub-muscular or dual plane depending on the requirements. Anatomical or round implants are used of different gel types and projections. If needed, a lifting procedure can be performed simultaneously. In this lecture we will show how to access and plan the right combination of above mentioned variables for different preoperative findings. Potential pitfalls and how to avoid them will also be discussed. Results/ Discussion: The breast augmentation has two aspects. On the one hand it seems to be an easy to medium level surgery regarding the difficulty, on the other hand one needs expert skills to achieve superior results consistently. Each patient requires an individualized approach, a clear understanding of the possibilities and boundaries, as well as the limits. A one-technique-for-all approach is an anachronism which rarely leads to the desired outcome.
Punam Bijlani
Lifeline Health Care Group, United Arab Emirates
Title: Breast implant salvage- A working algorithm
Time : 13:05-13:30
Biography:
Punam Bijlani has completed her basic medical qualifications and super-specialisation in Plastic Surgery from the prestigous Grant Medical College, Mumbai, India in 1998. She returned as Assistant Professor for Plastic Surgery. She now heads the Plastic Surgery Department at Lifeline Health Care Group, in Dubai. She has presented extensively in the UAE and UK on various topics in Aeshtetic Surgery and has also been a Reviewer for abstracts for conferences and has chaired sessions in aesthetic surgery in India and overseas. She is the recepient of the Award for Meritorious Service to the Emirates Plastic Surgery Society.
Abstract:
This study develops on the author’s experience and includes a review of other studies that pinpoint to threats to unsuccessful breast device salvage and recurrent infection/exposure while developing an effective management guideline. Amongst the conceivable complications accompanying the usage of breast implants are peri-prosthetic infection and device extrusion. While there are several recommendations, there is no firm effective algorithm for the management of these situations. A retrospective review of 21 patients with peri-prosthetic infection or threatened or actual device exposure treated by the author along with a review of 110 articles by a PubMed search were included in this study. A retrospective analysis of multi-surgeon breast implant usage from 2004 to 2015 was performed. The author’s studies were comparable with a large number of reviewed studies where over 75% with no infection were salvaged with aggressive surgical and conservative therapy, whereas less than 25% are salvageable when infection or lack of soft tissue cover availability is demonstrated. Based on the author’s experience and those of the reviewed articles, a working algorithm to salvage breast prosthesis has been formulated.
Biography:
Angelo Rebelo has concluded his medicine studies in the Faculty of Medicine of the University of Lisbon, Portugal in 1980 and he became a specialized in Plastic, Reconstructive and Aesthetic Surgery in 1990. Since 1997 he opened his own outpatient private clinic for aesthetic-plastic surgery in Lisbon, Portugal, in the last 18 years, he’s in exclusivity at Clinica Milenio in Lisbon - Portugal, as Clinic Director and Cosmetic Surgeon. He is precursor in several techniques of Cosmetic Surgery performed under Local Tumescent Anesthesia and outpatient. Internationally, he has been invited to teach and perform several surgical demonstrations in many countries. He is frequently sought out by the media as an authority in his field. His surgical techniques and advancements have been the subjects of interviews in Portuguese and international media, he’s also author of numerous videos, lectures and articles presented at congresses and scientific journals. He is also an active member of several Professional Societies and Associations through the world.
Abstract:
Inverted nipple is not a rare situation that causes dissatisfaction and discomfort to many women in any age. In the majority of the situations, it is consequent to congenital conditions. Also, it can occur after breast surgeries. There are many techniques to correct this situation and many of them with a significant percentage of recidives. The author learned from Sakai, a Japanese Plastic Surgeon, one technique that was found very efficient, with good results and very low or no recidives. The main indication for Sakai technique are inverted nipples and the cause doesn’t matter, occurring on one or both sides in varying degrees and also dissatisfaction with previous surgery. Age is not important to decide to do the surgery. The surgery is performed upon a patient under local anesthesia with sedation as an out-patient. The operating time varies between 30 to 60 minutes. The technique is based in two small triangle flaps. The retention sutures (Nylon 4/0) are placed deeper to remake the nipple shape and closed superficial with Vicryl Rapid 5/0. Small molding dressing was done. The patients are advised that they cannot breast feeding anymore. Antibiotic per os during one week was prescribed. The percentage of recidives is very low or zero with this technique.
Allen Rezai
Elite Plastic & Cosmetic Surgery Group, UAE
Title: Multidisciplinary approach to breast reconstruction
Time : 14:30-14:55
Biography:
Allen Rezai MD is a Lead Consultant of Elite Plastic & Cosmetic Surgery Group in Dubai Healthcare City. He is a Senior Consultant Plastic & Reconstructive Surgeon in Harley street London, UK. He attained his medical degree at the Lund University in Sweden, completed his Cosmetic, Plastic and Reconstructive Surgery training at major plastic surgery centers in Sweden and United Kingdom. He attained his fellowships in Microsurgery at the renowned Chang Gung Memorial Hospital, in Taipei, Taiwan and the Micro-surgical training center at Christus St. Joseph Hospital of Houston Texas, USA. He specializes in the advanced microsurgical techniques used in breast reconstruction and head and neck reconstruction. In addition, he has an enormous breadth of surgical experience in aesthetic breast and facial surgeries. He is a member of renowned affiliations such as EPSS (13-0186.)- Emirates Plastic Surgery Society, Associate Member of British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), The Royal Society of Medicine, UK, GMC (UK, 4228875) Specialist Register for Plastic Surgery, World Society for Reconstructive Microsurgery, American Academy of Cosmetic Surgery, World Academy of Cosmetic Surgery (WAOCS), European Society of Plastic, Reconstructive and Aesthetic Surgery, International Society of Aesthetic Plastic Surgery (ISAPS) etc.
Abstract:
Among various types of autologous breast reconstruction, perforator flap reconstructions are the most advanced surgical technique applied in breast reconstruction. Abdominal flaps such as deep inferior epigastric perforator (DIEP) flap and superficial inferior epigastric perforator (SIEP) flap are generally the first choice for Perforator flaps. Perforator flaps are “free” flaps consisting of, skin, fatty tissue and tiny blood vessels (perforators) which are micro-surgically removed from the donor site and transferred to the chest for reconstruction of the new breast. With experience in microsurgical techniques and perforator selection, the DIEP flap offers distinct advantages to patients, in terms of decreased donor-site morbidity and shorter recovery periods. Mastery of this flap provides reconstructive surgeons with more extensive options for the treatment of post-mastectomy patients.
- Track 1: Aesthetic Surgical Procedures Track 3: Reconstructive Surgery
Location: Dubai, United Arab Emirates
Session Introduction
Kamal T Sawan
Sawan Surgical Aesthetics, USA
Title: Workshop on,
Time : 14:55-15:20
Biography:
Kamal T Sawan completed medical education at the Royal College of Surgeons in Ireland in 1993. His training in Plastic Surgery was completed at Johns Hopkins Hospital in the USA. He worked at the University of Oklahoma and was the Chief of Plastic Surgery and Program Director for 10 years. He is a respected member in the field of Plastic Surgery and the American Society for Aesthetic Plastic Surgery with many publications. Having a passion for innovation and best results, he launched Sawan Surgical Aesthetics in Oklahoma in 2015. His focuses in practice are facial rejuvenation and body contouring after weight loss surgery.
Abstract:
Lip augmentation with fillers is one of the most common uses of fillers in the ME region. The lip has a 3-Dimensional structure with the only framework being the relation of the muscle attachments to the skin. Attention to the anatomy and the desired lip look is key for best results. In this presentation we will review the normal lip anatomy, classification of lip shapes, lip measurements based on PHI or the golden ratio and what filler to use based on fillers characteristics and desired look.
Jamal Jomah
Med Art Clinics, KSA
Title: The value of 3D imaging and modeling in aesthetic surgery
Time : 15:20-15:40
Biography:
Jamal Jomah, MD graduated with Honors from King Faisal University, Saudi Arabia. He pursued specialty training in Canada where he completed his residency training in plastic surgery and sub-specialized in cosmetic surgery, craniofacial rehabilitation and medical education. He is certified by the Royal College of Surgeons of Canada and the Canadian Medical Council. He also obtained an honorary fellowship from the Royal College of Surgeons of Edinburgh. In addition, he is a diplomat of the American Board in Hair Restoration Surgery and a Board Examiner. He is also a fellow of the American College of Surgeons. He holds the title of Consultant Plastic Surgeon in Dubai and also has been newly elected as the General Secretary of the Emirates Plastic Surgery Society.
Abstract:
Introduction: Three D surface technology is used to demonstrate to the patients the expected changes possible with a particular procedure. This technology has allowed the patient and surgeon to both see the expected result at the same time on the same screen. This will help the surgeon identify the patient’s expectations and be cautious about patients who have unrealistic expectations. The Surgeon can also define the steps of surgery and plan it more accurately. The goal is to improve the patient’s satisfaction with this technology and minimize the revision. Three-dimensional Surface Imaging (3DSI) represents a revolution providing objective information on changes in volume or shape before and after treatment. The introduction of Three Dimensional Surface Modeling (3DSM) represents a paradigm shift towards more realistic results that the patients can see and feel and appreciate from all dimensions. The aim of this paper is to describe the author’s experience with 3DSI and 3DSM. Method: The 3D images are normally taken with digital camera with adequate lightning and then stored in a computer and images then manipulated using Software. The image can be captured with a camera or the surface can be scanned with a scanner but the latter would require the subject to be motionless for a longer time. The author used the Vectra H1 camera for the face and the Vectra XT for the body with the mirror image software for manipulation. A single camera is usually adequate (H1) but the 3D camera system (Vectra XT) is more precise and will acquire better and larger images. Once the images are taken, they are transferred to a computer where software stitches the images together. The problems of this system are the cost, limited availability and resolving the shiny of transparent areas and imaging hair. With the expansion of 3D printing, the cost has substantially decreased and becoming more readily available for personal or central use. This is going to be helpful for patients’ education and archiving of pre-operative and post-operative results. The technology is evolving and probably revolutionized the way we plan and document our procedures. 3D printing uses a composite powder printing process on a printer. This produces a 3 dimensional object by successively laying down the infiltrant to build a model slice by slice based on the image. This produces physical object that can be manipulated and it allows to understand the individual anatomy, can be physically held and viewed from multiple planes which is useful to teaching purposes and to better explain the proposed surgery to the patients using their own anatomy. The main limitation of the process is the cost associated with the products and with the images capturing. Results & Discussions: Currently, 2D photography is used to document, analyze and plan surgical procedures in Plastic Surgery. This tool does not represent 3 dimensional figures accurately. It lacks shaped and topographic depth. 3 D imaging measures XY and its coordinates and uses a triangulation concept. It is better than MRI and CT Scans which do not reflect the surfaces and surface topography and also it is less expensive and less invasive to the patient. It overlays multiple images from different planes, over the same object to create a 3D image. The use of Magnetic Resonance Imaging (MRI) is more accurate and more scientifically helpful in exact measurements however it uses screening tool that is not practical especially in cosmetic practice as MRI scans are costly and are not readily accepted by the patients. Therefore, its uses are still not foreseen in the near future. The 3Dimensional Surface Modeling (3DSM) was introduced in our clinic in the year 2014 and a comparison was conducted between the # of cases prior to that and after that to see if it had influenced patients’ decision to undergo the surgery. Subjectively, there are patients who had seen their images in 3D were more precise in their requirements and in their understanding of the outcome of the procedure. This also has modified the surgical planning and enables the surgeon to target the key areas that the patients are seeking correction. Conclusion: Three-Dimensional Surface Modeling (3DSM) is a useful tool in: 1. For the surgeon to understand the exact concerns of the patients and to have more precise planning of the procedure. 2. For the patients to see the expected changes. 3. It is important to emphasize that this is only digital morphing which may not reflect the actual outcome.
Martain P.J. Loonen
ZorgSaam Hospitals, The Netherlands
Title: Dermabond Protape (Prineo) for Wound Closure in Plastic Surgery
Time : 15:40-16:00
Biography:
Martain Pierre Jean Loonen is a specialist of plastic surgery with extensive experience and interest in plastic, reconstructive, cosmetic and hand and wrist surgery. He is a recognized fellow of the Collegium Chirurgicum Plasticum of the Board of Plastic Surgeons of Belgium, and holds recognized membership of the Dutch Society of Plastic surgeons. He holds a Doctoral Degree in Plastic Surgery and has achieved his degree with outstanding honors as the youngest PhD candidate to have attained that distinction at his Alma Mater, the University of Utrecht in the Netherlands.
Abstract:
Dermabond Protape (2-octyl-cyanoacrylate and pressure sensitive adhesive mesh; Prineo, Closure Medical Corporation) is a topical mesh and skin adhesive that forms a strong polymeric bond across opposed wound edges allowing the normal healing process to occur. No published studies have already compared the use of a topical meshen skin adhesive in wound closure. This study evaluated the possible applications of a combined mesh-adhesive system in 100 plastic surgery operations (14 different surgical procedures) with a mean follow-up of 85.5 days. The rate of allergic reaction, infection, wound dehiscence and hypertrophic scar formation were recorded in relation to patient co-morbidities, medication and tobacco consumption. No technical restrictions were found during the Derma-bond Pro-tape application. The average time for the topical mesh and skin adhesive application was 2 minutes. The Derma-bond pro-tape was removed 7 through 10 days after the operation. Three patients (3/100 or 3%) reported an allergic reaction without increased scar formation. Hyper-inflammation in one or more wound areas with a micro-abscess were noted in 11 different patients probably due to polyglactin 910 (vicryl) sutures at their scheduled follow-up visit 1 week after their operation. In-creased tissue inflammation and scar formation were found in these patients with hypertrophic scars in 1 patient (1/11 or 9.1%). One upper leg wound dehiscence was seen in a diabetes mellitus patient using corticosteroids. Two patients (2/100 or 2%) with a history of tobacco abuse showed a partial wound dehiscence after an abdominoplasty and a partial areola dehiscence after mamma reduction respectively.
Allen Rezai
Elite Plastic & Cosmetic Surgery Group, Dubai
Title: Patient selection, technique and implants placements in breast augmentation
Time : 16:15-16:35
Biography:
Allen Rezai MD is a Lead Consultant of Elite Plastic & Cosmetic Surgery Group in Dubai Healthcare City. He is a Senior Consultant Plastic & Reconstructive Surgeon in Harley street London, UK. He attained his medical degree at the Lund University in Sweden, completed his Cosmetic, Plastic and Reconstructive Surgery training at major plastic surgery centers in Sweden and United Kingdom. He attained his fellowships in Microsurgery at the renowned Chang Gung Memorial Hospital, in Taipei, Taiwan and the Micro-surgical training center at Christus St. Joseph Hospital of Houston Texas, USA. He specializes in the advanced microsurgical techniques used in breast reconstruction and head and neck reconstruction. In addition, he has an enormous breadth of surgical experience in aesthetic breast and facial surgeries. He is a member of renowned affiliations such as EPSS (13-0186.)- Emirates Plastic Surgery Society, Associate Member of British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), The Royal Society of Medicine, UK, GMC (UK, 4228875) Specialist Register for Plastic Surgery, World Society for Reconstructive Microsurgery, American Academy of Cosmetic Surgery, World Academy of Cosmetic Surgery (WAOCS), European Society of Plastic, Reconstructive and Aesthetic Surgery, International Society of Aesthetic Plastic Surgery (ISAPS) etc.
Abstract:
In order to achieve the best possible outcome, choosing the right augmentation technique and implant placement for a patient is of outmost importance. This presentation describes the various implant augmentation techniques and Implant placements and how to select the right option for a patient. The indications for each technique and placement including advantages, disadvantages as well as implant types are also presented.
Stéphane Smarrito
Riviera Clinic, Switzerland
Title: Surgical Classification of Labia Minora Hypertrophy: A retrospective study of 100 patient cases
Time : 16:35-16:55
Biography:
Smarrito Stéphane is an experienced Aesthetic Surgeon (Switzerland and France). He had performed over 400 laser nymphoplasty and combined labiaplasty procedures. He had articles, about intimate surgery, published and submitted in the “Plastic and Reconstructive Surgery” medical journal. He is the member of the GRIRG.
Abstract:
The purpose of this study is to establish a new surgical classification system for labial hypertrophy based on shape and clinical symptomatology, rather than measuring the length in centimeters. The goal of this classification system is to be able to select surgical strategies based on the type of labial hypertrophy. From 2005 to 2014, we undertook a retrospective study analyzing 100 patient files, chosen randomly from our database of 400 patient cases and preoperational photographs to reduce the labia minora, also known as nymphoplasty. The author analyzed data from each individual patient file concerning the shape of the labia minora, patients’ symptomatology and the chosen operational technique. We found 3 types of labial hypertrophy, constituting a new system of classification: TYPE I: a high form, called “flag”. 11 patient cases were observed (11%). TYPE II: a median form, called “oblique”. 29 patient cases were observed (29%). TYPE III: a low form, called “complete”. 60 patient cases were observed (60%). Concerning symptomatology, Type I was characterized by an undesirable aesthetic appearance and discomfort in the crotch area caused by wearing tight clothing, but not by dyspareunia. Type II showed an overall fuller appearance. Type III presented frequent dyspareunia more often than Type I and Type II. For Type I, the surgical technique selected was a superior pedicule flap, with only a moderate labial resection, which follows the edge of the labia minora. For Type II and Type III, the lambda laser technique was systematically proposed. The proposed system of classification seems to correspond better to patient’s symptomatology in comparison to a system based on simply measuring the length in centimeters. The proposed system of classification makes it possible to adjust the surgical strategy to fit patients’ expectations.
Afschin Ghofrani
Aestheticon®, Plastic and Aesthetic Surgery Centre, United Arab Emirates
Title: Mammareduction with central pedicle
Time : 16:55-17:15
Biography:
Afschin Ghofrani’s current position as the Medical Director and owner of Aestheticon® has been the path of an ever increasing level of specialization with a constant focus on Plastic Surgery and Hand Surgery since 1992 and further concentration on Aesthetic Surgery since 1997. He studied human medicine and graduated at Europe's largest clinic, the RWTH. In 1992 he started his medical career at the Clinic of Burns and Plastic-Reconstructive Surgery in Aachen. In 1998 he received the certificate ‘Specialist of Plastic Surgery’ from the medical chamber in Nordrhein-Westfalen/ Germany and in 2001 the additional certificate ‘Specialist of Hand Surgery’. From January 2003 until August 2010 Dr. Afschin has been the Head Physician at the Evangelische Hospital Giessen/ Germany and additionally the Medical Director of his private practice of Plastic/Aesthetic Surgery and Hand Surgery. Regarding Dr. Afschin’s scientific career, he was the initiator and leader of various research projects and has published diverse articles in national and international specialists’ journals and books. Consistently he is invited to give lectures at scientific conferences and workshops.
Abstract:
Introduction: There is possibly no other surgical technique in plastic surgery that has been modified more often than the mammaplasty. Numerous publications have focussed on this issue. Regarding the visible scars there are mainly three approaches 1) Periareolar scar, 2) I-scar, and 3) T-scar. Another variable is the pedicle. Since 1996 we use a central pedicle combined with a T-scar with short sub mammary part for most of the cases. Methods: The “inferior pedicle technique” was modified by Dr. Serdar Erenin in 1990. This modified approach is described by a detaching of the inferior part of the pedicle leaving only the central pectoral fascia attached. The blood supply is guaranteed by the intercostal perforators. The main sensory branch to the areola is routinely preserved thus maintaining a sensitive nipple in most cases. Because no dissection from the Nipple-Areola-Complex (NAC) from the gland is necessary, breast feeding after surgery is usually preserved. This pedicle gives a maximum degree of freedom regarding resection and positioning of the gland. Especially the hypertrophic lateral gland parts can be resected extensively down to the pectoral fascia. Results/ Discussion: We overlook more than 1000 mammoplasties performed with this pedicle-technique in the recent 20 years. This technique is not recommended for an inexperienced surgeon due to potential pitfalls in the preparation of the gland. Provided sufficient familiarisation with the procedure, however, this technique can be regarded as a safe method for almost all type of breast with excellent results in terms of shape and projection. Generally, breast feeding property and sensation of the NAC are preserved.
Cynthia I Legorreta Chew
Consejo Mexicano de Cirugia Plastica Estetica y Reconstructiva AC., Mexico
Title: Minimally invasive rhinoplasty
Time : 17:15-17:35
Biography:
Cynthia I Legorreta Chew is a Plastic and Reconstructive Surgeon InCorporativo Hospital Satelite and StarMedica Lomas Verdes in Naucalpan, State of Mexico. She is an active Member of International Society of Aesthetic Plastic Surgeons, FederacionIbero-Latinoamericana de CirugíaPlástica, Asociacion Mexicana de Quemaduras and College of Plastic Surgeons of State of Mexico.
Abstract:
Background: There are several approaches for performing both functional and aesthetic rhinoplasty, is made of open or closed shape, when opened, the approach is through the columella, when closed, it is through the alar cartilages. There are several ways to turn addressing the wing, marginal and trascartiloginosa cartilage. The trascartilaginoso approach is our preference to avoid scars. Objective: We propose to conduct any closed rhinoplasty technique for both primary and secondary. Methods: A retrospective review of our cases in 4 consecutive years with the same approach, in which 240 patients from 2011 to 2015, which were performed rhinoplasty primary, secondary, tertiary, quaternary and to include number is performed 5, in all closed rhinoplasty was performed with transcartilaginoso approach. Results: It is considered a proper result, the patient who is comfortable with his aesthetic results and has proper function. Only two patients showed a minimal septal perforation, February 1 mm and the other of 5 mm, 5 patients with persistent osteocartilaginous hump of the nasal dorsum, 3 lack of projection of the nasal tip. Followed for 6 months to 2 years postoperatively. Conclusion: The closed technique can be used for any type of rhinoplasty, even in patients with more than one surgery.
Dammika Dissanayake
National Hospital of Sri Lanka, Sri Lanka
Title: Avoiding scars and treating scars- Two sides of the coin
Time : 17:35-17:55
Biography:
Dammika Dissanayake obtained his MD in year 2000. He initially had training in General Surgery that was followed by Plastic Surgery which included special training in Hand Surgery. His special interests include aesthetic surgery and micro surgery. He was trained in Sri Lanka, India, Australia and Singapore. He has several publications in indexed journals to his credit. He also has delivered many lectures/presentations in international forums. He has been instrumental in conducting several free reconstructive surgery sessions for the underprivileged patients amounting to hundreds of operations over the years.
Abstract:
Scarless surgery is every patient’s wish. Plastic surgeons know that it is not a goal that is achievable. However, it is within the capacity of Plastic Surgeon to minimize scarring – and treat them quite satisfactorily when bad scars do occur. A systematic approach to ensuring minimal scars following open surgery is not easy to find in the literature. Even more difficult to find is a systematic approach to surgical management of existing scars. In this presentation, I will put forward a systematic approach to avoidance of unacceptable scars at surgery. This includes proper tissue handling, meticulous wound debridement, judicious use of suture materials and suture techniques etc, the details of which will be duly mentioned. More importantly, a systematic approach to scar revision is proposed. Numerous types of unacceptable scars including anti-tension line scars, stretched scars, depressed scars, bridle scars, trap door scars, hypertrophic scars, keloid scars etc will be outlined and surgical and ancillary treatment will be described. These include various types of plasties including variants of Z plasty and variants of W plasty.
Hiroshi Ikeno,
Ikeno Clinic of Dermatology & Dermatological Surgery, Japan
Title: Long maintenance therapy, more than 2 years of sodium L-ascorbyl-2-phosphate, for moderate to severe acne in comparison with 0.1% adapalene gel
Time : 17:55-18:15
Biography:
Hiroshi Ikeno has completed his MD from School of Medicine, Mie University and Post-doctoral studies from Osaka University School of Medicine in Japan. He is the Director of Ikeno Clinic, a dermatology & dermatological Surgery. He has published more than 10 papers in reputed journals.
Abstract:
Background: We have reported the efficacy of sodium 5% L-ascorbyl-2-phosphate lotion (5% APL) in the treatment of acne since 2003. APL shows the excellent effect for the prevention of oxidation of squalene, which was reported as a possible role of acne etiology and as a trigger of micro-comedo. While many effective treatments for acne have been reported recently, there are few reports regarding effective long maintenance therapy, more than 2 years, of acne. This time, we studied the efficacy and safety of 5% APL as maintenance therapy for moderate to severe acne in comparison with 0.1% adapalene gel (ADG). Methods: In a randomized, multi-center, open label, parallel study, 45 patients of moderate to severe acne, successfully treated in a previous 12-week study of the combination therapy with 5%APL plus 0.1%ADG, were enrolled. They were assigned to receive 5% APL (n=41) or 0.1%ADG (n =35) topically once or twice daily. This study was carried out in accordance with the method of D. Thiboutot et al. Efficacy was assessed in 5 grades at the beginning and at 2, 6, 12, 18 and 24 months of treatment based on the skinanalysis device (VISIA). Patients were instructed to refrain from receiving any other treatment for 16 weeks prior to enrolment in the study. Results: The number of patients who complied with the treatment protocol was 16 on APL, 12 on ADG. The number of patients of who maintained at least 50% improvement from baseline in lesion counts at 6 months of treatment was 14 on APL and 9 on ADG, at 12 months of treatment, 15 on APL and 7 on ADG and at 24 months of treatment was 14 on APL and 4 on ADG. Both agents were well tolerable and showed no remarkable adverse effects. Conclusion: The maintenance rate at 12 months for APL was 93.8% compared with 58.3% in the ADG treatment group. The maintenance rate at 24 months for APL was 87.55% compared with 33.3% in the ADG treatment group. The efficacy of the maintenance therapy of APL was remarkably superior to ADG. This data showed the efficacy and safety of 5% APL as maintenance therapy for moderate to severe acne in comparison with 0.1% adapalene gel (ADG).
Carlos Mercado
Stem Cells MD, United States
Title: Stem cells for erectile dysfunction Erectus Shot
Time : 17:45-18:05
Biography:
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Abstract:
ED (Erectile Dysfunction) affects 10 percent of the population worldwide. In 1995 it was estimated that 152 million affected by ED. It is estimated that by 2025, 352 million of population worldwide will be affected. Currently there is not available treatment that can restore or regenerate the tissues in the corpus cavernosum or arterial system that will cure the ED. A 20 percent failure rate with present therapies and high rate of drop out in patients with ED is due to Radical Prostatectomy and Post Radiation. Testosterone Replacement is the only independent risk factor that might help endothelial dysfunction and consequently ED. Adipose tissue is abundant and easy to collect from a mini-liposuction. The procedure consists in collecting a lipo-aspirate of 60 ml. No general anesthesia is required. It is an outpatient procedure. Adipose Tissue is processed using collagenase enzyme. SVF (Stromal Vascular Fraction) is isolated. Blood is obtained through a venipuncture. PRP (Platelet Rich-Plasma) is obtained. The SVF is suspended is PRP. The mixture is injected into the Corpus Cavernosum using our designed protocol for injection into the corpus Cavernosum. Two types of patients: 1- DM 2- ED due to Prostatectomy and Radiation. Patients filled out the Intensity score Questionnaire before and after procedure. Both reported better erections in the morning, firmer, with better response to PDI5 inhibitors for which they were not responders prior to the treatment. This might be due to Stem cells to regenerate Corpus Nerve and Endothelial cells enhancing the Nitric Oxide production and then have the PDI5 inhibitors to work. The IC injection of a suspension of SVF in PRP appears promising in ED patients due to DM and Prostatectomy and Radiation in which at present there is no a CURE and they have a high rate of Failure to PDI5 inhibitors. The Procedure is done as outpatient and requires no general anesthesia. The potential to treat diabetes as early as diagnosed might be a possibility since lower fasting glucose levels and improvement in HbA1C were noticed. More studies are in need.