Day 1 :
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
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.
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
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
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.
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
NMCS Hospital, UAE
Time : 10:20-10:45
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.
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.
Clinica Milenio, Portugal
Time : 10:45-11:10
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.
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.