Day 1 :
Banff Plastic surgery, Canada
Dr Genevieve FCaron is a Canadian Board certified Plastic Surgeon. She completed her medical degree and Plastic surgery training in Quebec, Canada then two fellowships in Western Canada focusing on scar management and cosmetic surgery. She now practices in Montreal, Canada in a private clinic and teaching at the University hospital.
Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but offers the potential to overcome the long-term limitations of simpler options. We present, our experience with microvascular free flap for release of burn scar contractures of the neck as a potential high quality permanent solution.
Methods: Between 2005 and 2016, 9 free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFF) and one ulnar forearm flap were used to release neck contractures.
Results: All 9 flaps were completed successfully with significant improvement of neck range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, 5 of 9 cases required at least one secondary procedure for flap defatting to reach optimal results.
Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.
Consultant Plastic Surgeon,Lecturer of Surgery, Beni-Suef Faculty of Medicine, EGYPT.
Dr. Rimon Boshra Rizk is Consultant Plastic Surgeon and Lecturer of Surgery in Beni-Suef Faculty of Medicine, EGYPT.
BACKGROUND: Brachioplasty is a great way to achieve improved contour in the arm with a growing number of patients undergoing this procedure. (Shermak, 2011) Aim: The authors analyzed data from a retrospective and prospective study to compare the results of different techniques of brachioplasty in treatment of stage III and IV of brachial dermolipodystrophy according to El Khatib(2007)
METHODS: Twenty patients underwent brachioplasty with different techniques and assessment was done for selection of technique, hospital stay, complications, nerve injury, circumferential measurements improvement, skin quality, scar and finally patient’s satisfaction.
RESULTS: Twenty female patients (fourteen stage III & six stage IV) with mean age of 34.5 years underwent brachioplasty. Techniques used and the mean percentages of circumference reduction in proximal, middle and distal arm thirds are as follows: for stage III a)Minibrachioplasty plus liposuction (2 pts) ( 15.1 - 17.9 - 10.2%), b)Bicipital-groove brachioplasty plus liposuction (2 pts) (18.6 – 21 – 13.8%), c)L-brachioplasty (2 pts) ( 22.9 – 19.7 – 14.2%), d)L-brachioplasty plus liposuction (2 pts) (21.9 – 19.3 – 12.9%), e)Fish-incision brachioplasty plus liposuction (1 pt) (21.1 – 19.8 – 8.1%), f)Liposuction only (5 pts) (15.2 – 13.2 – 16.4%) while for stage IV are g)Bicipital-groove brachioplasty (3 pts) (21.3 – 21.2 – 15.1%) and h)Double-ellipse brachioplasty (3 pts) (32.2 – 36 – 25.8%). All patients spent 1 night at hospital. Complications occurred are oedema (20), cellulitis(1), delayed healing (3), superficial wound infection (2), allergic skin maceration (5) and mild contour irregularity (5). No nerve injury occured. For stage III patients, scar is rated as Excellent in 3 patients (21.4%), Good in 7 patients (50%), fair in 3 patients (21.4%) and poor in 1 patient (7.2%). For stage IV patients, scar is rated as Excellent in 1 patient (16.7%), Good in 3 patients (50%), fair in 1 patient (16.7%) and Poor in 1 patient (16.7%).Mean satisfaction for contour, symptoms, scar and overall satisfaction for stage III patients is (3.8 – 4 - 3.65 - 3.8) and for stage IV patients is (4.5 – 4.5 – 3.7 – 4.25)
CONCLUSION: In a brachioplasty for a fatty arm, liposuction may be performed in a separate stage months before excisional procedure or may be done simultaneously at the same session. Performing the procedure on an arm with less fat gives better results in contour improvement, symptomatic relief, but with longer scars which may annoy the patient. The overall procedures were tolerated well by the patients with acceptable complications.
Neo Skin and Cosmetic Clinic, India
Keynote: Non-surgical facial rejuvenation
Dr. Narmada Matang completed her medical education from M. P. Shah Medical College Jamnagar Gujarat in India. She pursued her interest in cosmetic dermatology and underwent trainings in the US. She is a certified international trainer in minimally invasive techniques for aesthetics and follicular hair transplant. She is a trainer and on the Panel of National consensus for Botox and Fillers for Allergan
Introduction: In the ever advancing world of aesthetics patients seek more from physicians and have been opting for non-surgical treatments. As a physician there couldn't be a better time than now to enjoy the variety of technologies Laser and energy based devices, topical therapies and minimally invasive volumetric enhancement modalities to give the best to our patients.
Theoretical Orientation: Subtle enhancements in facial aesthetics preserving the natural appearance continues to be the trend. A three dimensional view of facial aging indicates the progressive depletion of different fat compartments resulting in dynamic changes in facial appearance. Global volumetric correction with HA fillers and energy based devices for treatment of skin laxity along with textural skin enhancement are need of the hour for facial rejuvenation. The no or low downtime, comfort during the treatment and safety adds to the popularity of these treatments.
Conclusion and significance: A defined approach to patient concern along with combination of various nonsurgical treatments can help give fairly long lasting satisfying results for facial rejuvenation. I discuss the global approach with various minimally invasive techniques in patients of varied skin type and how combination of treatments is the solution for best outcome.
- Aesthetic Surgical Procedures |Aesthetic Non-Surgical Procedures| Blepharoplasty | Skin Rejuvenation and Resurfacing| Managing Hair Loss | Cosmetic Dermatology| Advances in Cosmetology and trichology
Root Hair Transplantation Center, South Korea
Follicular unit extraction has many advantages which is minimal scar, quicker recovery time but definitely have disadvantages as well. One of them include potential for high hair follicle
transection rate. The disadvantage is mostly due to blind harvesting technique. Thus we had been looking for imaging methods which make visible technique possible. One of them is the ultrasound scanner which is 22MHz in frequency and shows structures within the dermis. Through it we found out that there were angle differences between hair shaft out of the skin and hair follicle in the occipital scalp. The results were in 20.8-40.3 degree range and 12.8 degree of average. In addition there were significant differences in the average follicle angle depending on the area of occipital region. Therefore we employed its data in order to reduce transection rate for graft. But despite ultrasound’s great ability, we was not able to harvest the grafts simultaneously while seeing the hair follicle. So we were searching for something to be capable of resolving the problem and lights gave us good idea. We made the first attempt with the NIR(one kind of lights which is 700-2500nm in wavelength). We were able to identify the hair follicles, but felt a need for further improvement. The most suitable amount of melanin to be observed in hair follicles was 640 nm red visible. We were able to identify hair follicles using 640nm red visible light with PL filter. As a result, we can harvest the grafts while looking at the hair follicles through the monitor simultaneously.
Conclusion: While harvesting the hair follicle, we always have potential for transection of it when just depend on blind technique. We have been making much effort to lower transection rate of the follicle and at last we found out Follicoscope and ultrasound scanner. They consequently make visible technique possible.
Associate chief surgeon, Plastic Surgery Hospital, China
Xiaolei Jin, 45 years old male. Renowned plastic surgeon in china. He has a firm commitment to safety, patient education, and surgical excellence. He has over 20 years of surgical experience to include reconstruction, microsurgery and the entire spectrum of cosmetic surgery. He specializes in blepharoplasty, orthognathic surgeries, face lifting, rhinoplasty and so on. He has performed more than 5000 cases of Asian double eyelid blepharoplasty. Except for cosmetic plastic surgeries, he also performed many reconstructive surgeries, for example the reconstruction of facial contour deformity with anterolateral thigh flaps. He is also a tutor for post-graduate students. He has published 9 articles in English and 12 articles in Chinese as the first author or corresponding author.
The epicanthus can weaken the effect of blepharoplasty, which makes it difficult to form the outfold type double eyelids preferred by Asian women. The
integration of blepharoplasty and Z-epicanthoplasty has become increasingly popular. Although many techniques have been introduced to remove the epicanthus during
blepharoplasty, there are still some surgical complications.
Method This study aimed to evaluate the practicability and effectiveness of combining Z-epicanthoplasty and blepharoplasty. Removing a slice of skin from the upper eyelid to the inner canthus makes the epicanthus crease along the vertical axis of Z-plasty. The up-outward triangular flap points to the lower eyelid margin instead of the inner canthus. By cutting off the fibrous tissue and orbicularis oculi muscle, the tension that causes epicanthus is completely released; therefore, the inner canthus ligament anchor is unnecessary and avoids damage to the inner canthus.
Result From January 2008 to June 2014, this modified surgical method was carried out on 1108 patients. One hundred and twelve patients were evaluated at a follow-up visit ranging from 6 to 72 months. In 2 cases, the double eyelid fold developed into an in-fold type, while, in 110 cases, it developed into an out-fold type. The outlines of the upper eyelids were natural and symmetric, and the inner canthus and lacrimal caruncle were fully exposed with no visible scar.
Conclusion This modified method is simple in design and practice. The inner canthus and lacrimal caruncle can be fully exposed, giving a natural, smooth, Westernized, appealing look. This technique is suitable for all types of epicanthus in Asian women.
Associate Professor of Plastic and Aesthetic Surgery, Plastic Surgery Hospital, PUMC, CAME, Beijing, China
Yang Xiaonan, M.D., Ph.D., Associate Professor of Plastic and Aesthetic Surgery, Plastic Surgery Hospital, PUMC, CAME, Beijing, China. Dr. Yang is an experienced Plastic Surgeon with a demonstrated history of working in the hospital & health care industry. Skilled in Clinical Research, Medical Education, Facial Plastic & Reconstructive Surgery, Botox Cosmetic, filler injection, liposuction, fat grafting and Breast Surgery. Strong healthcare services professional with a Doctor of Philosophy (Ph.D.) focused in Plastic surgery from Shanghai Jiao Tong University. Visiting experience at Harvard University, USA, in 2014.
Objective: To discuss the effect of one-stage vermilion reconstruction with axial pattern composite tissue flap.
Methods: According to the size of vermilion defect, the axial pattern composite tissue flap with pedicle in oral commissure was designed and transposed to reconstruct simple lip defect. The defect at the donor site was closed directly.
Results: 9 patients were treated with satisfactory aesthetic results. All the flaps survived completely. The characters and color of repaired lips were similar to normal ones. The oral commissure kept normal with no obvious scar at the donor sites.
Conclusions: The method of vermilion repair with axial pattern composite flap has the advantages of avoiding inconvenience in feeding, speaking and cleaning. The procedure is simple with available blood supply and shortens the treatment. Both aesthetic and functional results are satisfactory.
Maxillofacial & Facial Cosmetic Surgeon, India
Dr. Athreya Rajagopal Trained in all aspects of Oral and Maxillofacial surgery, along with a Fellowship in Facial Cosmetology & Facial cosmetic surgery, cleft and craniofacial surgery. He is certified Implantologist and has loads of experience in conventional & basal implantology. he was awarded as the best student in Oral & Maxillofacial Surgery by the International College of Dentists. Dr. Athreya has routinely been training dental practitioners the Art & Science of Facial Cosmetology.
Minimally invasive techniques are the need of the hour to achieve the best results in facial rejuvenation.The ageing face shows poor definition of the mandibular margin, wrinkles of the forehead, vertical wrinkles in the glabellar area, drooping of the zygomatic malar region, and deepening of the naso-buccal fold. Another main factor in the effect of aging on appearance is gravity,due to the resorption & atrophy of fat and muscle specially in the middle third of the face & hence increased skin laxity in the lower third of the face.
To counteract the volume loss in the middle third & increased skin laxity in the lower third a combination technique proved to be an accurate method to treat the ageing face.The twilight lifting techniques lays emphasis on the use of PDO threads with Growth factors derived from the patients blood.Activated growth factors with PDO helps collagen synthesis & activates a series of events that help in collagen re-modelling and increase in lymph circulation which in turn causes the firmness and acts as an asset in facial rejuvination.
PSH, CAMS, PUMC, Beijing, China.
Panxi Yu is an outstanding student from Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), which is the best medical college in China. She works in Plastic Surgery Hospital affiliated to CAMS and PUMC, and specializes in craniomaxillofacial surgery and cosmetic surgeries.
Statement of the Problem: Unaesthetic scarring is associated with physical and psychosocial consequences, and nowhere is this truer than large ones in the face. Revision of large facial scars is difficult, yet the superficial ones might be relatively more curable since their therapeutic goal is basically to improve the appearance instead of function. Methodology: According to the etiology, target scars were divided into post-burning group, post-traumatic group and post-acne group and treated by the same surgeon with dermabrasion and ReCell®. By analyzing healing time, complication rate as well as the pre-op and 18-month-post-op Patient Satisfaction Score, Vancouver Scar Scale, and Patient and Observer Scar Assessment Scale, the effect of the combined therapy on different groups were compared and analyzed. Findings: The healing time of post-burning group (19.6±4.0 days), post-traumatic group (15.8±2.6 days), and post-acne group (11.4±3.1 days) varied remarkably (P≤0.01). The complication rate (60%, 20% and 0% respectively) did not reveal significant difference (P>0.05). The post-op Patient and Observer Scar Assessment Scale improved significantly in all groups (P≤0.05), but its improvement in post-acne group was more significant than that in other groups (P≤0.05). The post-op Patient Satisfaction Score and Vancouver Scar Scale promoted only in post-traumatic group and post-acne group (P≤0.05), and they promoted more significantly in post-acne group than they did in other groups (P≤0.05). Conclusions: The combined treatment of dermabrasion and ReCell® is effective for acne scars, moderate for traumatic scars and not suggested for burn scars. To assess the therapeutic effects of treatments for large irregular scars, the application of Patient and Observer Scar Assessment Scale could be applied
Dr. Atul Kathed has trained in Clinical Dermatology & Cosmetology and over the last 15 years has dedicated his focus to Cosmetic Medicine working full time in same. He is passionate about his work and believes that everyone has natural beauty potential, and that it is the duty of the treating physician to release this potential and ‘hyper beautify’ everyone within the process of facial rejuvenation. This can be achieved non-surgically using a combination of therapies in a comprehensive ‘pan facial’ approach.
Acne scars are one of the most difficult disorders to treat in aesthetic dermatology. The most common treatments used are dermabrasion systems, deep laser, chemical peels and microsurgery. These treatments are frequently associated with prolonged downtime, discomfort, pain and considerable side effects.
Changes in skin texture, appearance of wrinkles, decrease in skin laxity and color changes are the main characteristics of aging skin.
Dermatologists and plastic surgeons look for treatments that provide both epidermal resurfacing for the improvement of skin texture and collagen remodeling in the dermis to reduce wrinkles and skin laxity.
Radiofrequency (RF) is non-ionizing electromagnetic radiation used in medicine for nearly 100 years. In contrast to most lasers that target specific chromophores, RF is chromophore-independent and has deeper penetration to the dermis and hypodermis as compared to light based technologies. The use of RF devices for skin resurfacing has similar efficacy however with less downtime, pain and adverse effects, especially when treating dark skin types.
The latest generation of multisource RF systems which use six independent RF generators simultaneously, have been shown to provide deeper penetration with less surface heating and discomfort.
The Fractional Skin Resurfacing (FSR) technology provides unique ability to treat the epidermis and dermis simultaneously; fractional micro-ablation for skin texture at the epidermal layer and significant volumetric heating up to 2.9mm for collagen remodeling at the dermal layer.
Study Design & Methods
20 patients enrolled in this study. All subjects were treated with the Fractional Skin Resurfacing handpiece (FSR Handpiece, Endymed PRO, ENDYMED Medical Ltd, Caesarea, Israel). Treatment areas were cheeks, forehead, thighs, chest and upper arms. Treatment protocol includes 4-5 treatments with one moth interval. All patients were photographed before the first treatment and after the last treatment at a standard distance and illumination.
None of the patients had reported any pain during the treatments. No adverse events were reported during and after the treatments. B&A photos show improvement in acne scars, stretch marks and skin texture. Subjective and objective questionnaires showed high treatment satisfaction.
The current study evaluates the efficacy and safety of a Fractional Skin Resurfacing handpiece. The evaluated indications were acne scars, stretch marks and skin texture. The findings show that the treatments are safe and effective with high satisfaction rate.
Dr.Faruk got the scholarship from Japan dermatological association for post graduate Diploma in Dermatology and Dermatosurgery . Mr.Faruk has completed his diploma in dermatology in 2015 which was a combined course of Juntendo University , Japan and Ministry of Health , Thailand at Institute of Dermatology , Bangkok . Mr.Faruk joined as consultant of dermatology at National Skin Centre , Dhaka , April 2015. Now he is working as a Senior Consultant . As a young and energetic dermatologist he has many national and international publications. He has recently published a research article on psoriasis
Everyone loses hair , no matter what their age , most people part with 25 – 100 strands per day but some lose faster than they can re grow . Both male or female are affected by hereditary hair loss , female tend to see a widening part an overall thinning of the hair , Hair transplantation ,PRP therapy is surgical intervention for hair loss . Another option is minoxidil, an over-the-counter foam or liquid that’s applied to the scalp. The prescription pill finasteride, which decreases the levels of dihydrotestosterone (a hormone linked with male-pattern baldness) so baldness is decreased. Lifestyle and health can affect the pace and progress of genetic hair loss. It can be accelerated by stress, smoking , being overweight, thyroid problem. Other reasons why people lose hair include poor nutrition, heavy hair extensions, straightening -tightening - highlighting, hormonal changes during menopause or after childbirth, medications. Carbohydrate , Protein , Fat is necessary for hair building and regrowth,found in balanced diet.Vitamin B,C, D, A is necessary for hair generation and synthesis. Vitamin A from vegetable source is better than animal source . Ascorbic acid 2 phosphate promotes elongation of hair shafts via secretion of insulin like growth factor 1 from dermal papilla cells. Vitamin D is necessary for anagen initiation. Low serum ferritin and vitamin D2 are associated with hair loss in female with telogen effluvium and female pattern hair loss. Silicon is necessary for hair shine. Cobalamin (B12) may have connection to excess hair loss in woman with anemia depression. Zinc, Iron , Copper , Selenium , Silicon , Magnesium , Calcium play important role for hair growth. Balanced diet , RDA nutritional supplementation can be taken for personal imbalance diet. Oral nutritional supplementation is to be rejected , unless proved by serum level measurement .