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Welcome Letters Meeting Information Programme Invited Speakers’ Biographies Poster Presentations Acknowledgements Notes

CONTENTS

It is my great pleasure to welcome you to our first national FPS UK meeting, here at the Royal College of Surgeons. For many years FPS UK has been an advisory body for ENT UK on matters relating to facial plastic surgery. Our committee felt however that given the increasing interest in this subspecialty, the time had come to form a Facial Plastic Surgery Society for ENT Surgeons. We have therefore established FPS UK as the ENT UK Facial Plastic Surgery Society, and I am grateful to ENT UK for their unwavering support in this process. We aim to represent all ENT Surgeons who perform the many aspects of facial plastic & reconstructive surgery in either the NHS or private sector. The society will also provide encouragement and advice to trainees keen to pursue a career in facial plastic surgery. Membership is free for ENT UK members; trainees are particularly welcome and I would encourage you all to join our society. I am confident you will find today's meeting educational because it features many of our specialties most experienced facial plastic surgeons. Knowing them as I do, I am sure we will have some interesting discussions! I am also delighted to welcome Pietro Palma from Milan to give our first society keynote lecture. Pietro is the President of the European Academy of Facial Plastic Surgery, indicating the close association FPS UK will have with our European colleagues. Enjoy the day! Tim Woolford Chair, FPS UK The ENT UK Facial Plastic Surgery Society

WELCOME MESSAGE FROM THE CHAIR OF FPS UK, TIM WOOLFORD

Date Monday, 23 February 2015 Venue The Royal College of Surgeons of England 35-43 Lincoln’s Inn Fields London WC2A 3PE Certificate of Attendance A Certificate of attendance will be emailed to all registered delegates on receipt of the completed online evaluation after the meeting. Facial Plastic Surgery UK Annual Meeting has been accredited by ENT UK with 4 CPD points. Refreshments Tea, Coffee and Lunch will be served in the Exhibition Hall (Webb Johnson Hall) during the official breaks. Exhibition An exhibition is being held in conjunction with the Meeting. The exhibition is located in the Webb Johnson Hall, Ground Floor, The Royal College of Surgeons of England. The exhibition will be available to delegates from 8:30am to 2:00pm. Mobile Phones As a courtesy to speakers and other participants, all mobile phones and pagers must be turned off before entering the Scientific Sessions. Safety and Security Please do not leave bags or suitcases unattended at anytime, whether inside or outside the Session Hall. Wifi There is complimentary wifi for all participants for the duration of the meeting Disclaimer The Organising Committee, ENT UK or The Royal College of Surgeons of England, London accept no liability for any injuries/losses incurred by participants and/or exhibitors/contractors, nor loss of, or damage to, any luggage and/or personal belongings.

MEETING INFORMATION

The ENT UK Facial Plastic Surgery Society

Annual Meeting

PROGRAMME

From 08.30 Registration – Inner Hall Coffee – Webb Johnson Hall Sessions – Lecture Theatre 2

09.55 - 10.00 Introduction & Welcome Tim Woolford, Chair FPS UK

10.00 – 10.30 Patient Selection in facial plastic surgery David Roberts

10.30 – 11.15 Form and function in naso-facial reconstruction Ullas Raghavan & Callum Faris

11.15 – 11.45 COFFEE BREAK AND POSTER VIEWING IN EXHIBITION AREA

11.45 – 12.15 Achieving Finesse in Pinnaplasty Simon Watts

12.15 – 13.00 Keynote address: Lessons learned from a career in rhinoplasty Pietro Palma, Milan, President, European Academy of Facial Plastic Surgery

13.00 – 14.15 LUNCH BREAK AND POSTER VIEWING IN EXHIBITION AREA

14.15 – 14.45 Shortening the learning curve in facelift surgery Alwyn D’Souza

14.45 – 15.45 Rhinoplasty roundtable Chair: Julian Rowe-Jones Panel: Charles East, Hesham Saleh, Paul White, Pietro Palma

15.45 – 16.15 Training, Fellowships & Examinations in Facial Plastic Surgery Santdeep Paun

16.15 FPS UK AGM Tim Woolford

Alwyn D’Souza is a Consultant ENT / Head and Neck / Facial Plastic and Reconstructive Surgeon, University Hospital Lewisham.

Mr D’Souza has a particular interest in Reconstructive and Aesthetic Plastic Surgery of the face, head and neck. He runs a combined dermatology/facial plastic surgery clinic for skin cancer, as well as offers multimodality, cosmetic and reconstructive surgery services. Having completed the FPS examination, he is certified by the International and European Facial Plastic Surgery Board. He is an invited speaker to both National and International meetings, and runs FPS courses. He is a member of CSIC and Chairs the Education committee for EAFPS. He offers a post CCT Cosmetic and Reconstructive Facial Plastic Surgery fellowship.

Invited speaker’s Biographies

Mr Charles East is a Director of Rhinoplasty London and ENT@150 Harley Street. He graduated from the University of London, Charing Cross Hospital Medical School in 1980. He was awarded the Hallett Prize by the Royal College of Surgeons of England and continued his training at Oxford, University College Hospital and the Middlesex Hospital. He was a senior clinical and research Fellow in the University of Washington Seattle for 12 months studying Facial Plastic surgery.

Charles is the lead clinician for the Rhinoplasty service at the Royal National Throat Nose and Ear Hospital, and is part of the Craniofacial surgery team at University College Hospital Foundation Trust- one of 6 national centres in the UK.

Academically he holds an Honorary Senior lecturer post at University College London and is the course director for the Plastic Surgery of the Nose and Techniques in Facial Plastic Surgery courses which attract an international audience. Charles is an active member of the European Academy of Facial Plastic Surgery, The Rhinoplasty Society of Europe and the British Association of Aesthetic Plastic Surgeons. Charles regularly lectures at national and international meetings. He has been a faculty member at the Royal College of Surgeons for minimally invasive sinus surgery courses. He has been Chairman of Facial Plastic Surgery UK, a committee at the Royal College, and is a specialty adviser to NICE Charles has written chapters in the British national textbook Scott - Brown's Otolaryngology - Head and Neck Surgery and is co-author of the extremely successful textbook, Ear Nose and Throat - Head and Neck Surgery. He has published regularly in his field of expertise and maintains clinical contacts in many countries.

www.rhinolastylondon.co.uk

www.150harleyst.com

INVITED SPEAKERS

Alwyn D'Souza Consultant ENT/ Head and Neck/Facial Plastic and Reconstructive Surgeon

Charles East Consultant Surgeon at University College London Hospitals trust

Mr Faris completed his Otolaryngology, Head and Neck training in England on the University of Southampton Wessex rotation and successfully completed the additional training of the Diploma in Facial Aesthetic Surgery from the University of London 2012. In 2013 he was awarded a 12 month funded scholarship from the European Academy of Facial Plastic and Reconstructive Surgery, and has successfully completed this in a skin cancer reconstructive fellowship in Holland and a Facial Reanimation fellowship in five further academic centres in Holland, France and North America. Mr Faris was awarded the Claus Walter Prize for 2013 for the highest score of all participants in the International Facial Plastic Reconstructive Surgery examination. In addition he has completed a Mohs fellowship and has been accredited as Mohs surgeon by the Department of Dermatology Erasmus University, Rotterdam. At present he is undertaking a Head and Neck Oncology and Microvascular Reconstructive fellowship at the University of British Columbia, Vancouver. Mr Faris currently works as Consultant Facial Plastic Reconstructive Surgeon in the Nottingham University focusing on nasal reconstruction/revision rhinoplasty, skin cancer reconstructive surgery and facial reanimation surgery. He has published a range of medical articles and is clinical lead for the tissue-engineering group for total nasal reconstruction.

INVITED SPEAKERS

Callum Faris Consultant ENT/ Head and Neck/Facial Plastic and Reconstructive Surgeon

Mr Hesham Saleh is a consultant rhinologist/facial plastic surgeon at Charing Cross and Royal Brompton Hospitalsin London and at his private practice in Harley Street since 2001. He is also an honorary senior lecturer of ENT at the Imperial College London. Mr Saleh trained in at Ninewells Hospital in Dundee, The Royal National Throat, Nose and Ear Hospital and Charing Cross Hospital in London where he learned from internationally renowned rhinoplasty and sinus surgeons. From early on in his career, he chose to specialize in treating the nose, including both its cosmetic and functional aspects. He became a Fellow of the European Academy of Facial Plastic Surgery at Amsterdam Medical Centre, the Netherlands in 2000. He was also a visiting fellow to centres of expertise in rhinoplasty and rhinology in Beverly Hills and St Louis, in the USA. In his practice he operates exclusively on the nose with a particularly large number of complex and tertiary referral cases. Mr Saleh is the president elect of the section of Laryngology &Rhinology in the Royal Society of Medicine. He is an active member of the EAFPS and is a council member of FPS-UK. He has published several peer-reviewed articles and book chapters on rhinology and rhinoplasty and is a regularly invited speaker worldwide.

Hesham Saleh Consultant Rhinologist/ Facial Plastic Surgeon

INVITED SPEAKERS

Mr Santdeep Paun is a Consultant Nasal and Facial Plastic Surgeon at St Bartholomew's and The Royal London Hospitals.

Mr Paun trained in ENT in London and was a Fellow of the European Academy of Facial Plastic Surgery (EAFPS) and spent time in Amsterdam, Toronto and Boston. He is the Inaugural and current President of the European Board for Certification in Facial Plastic and Reconstructive Surgery and was one of the first Board certified surgeons of and is the General Secretary of the International Board. Spending much of his time performing rhinoplasty and aspects of facial plastic surgery, Mr Paun is also part of the Royal London craniofacial trauma team, a unique multidisciplinary service dedicated to aesthetic reconstruction following severe facial trauma. He has an active interest in teaching and is Chairman of the credentials committee of the EAFPS. He has written numerous book chapters and peer-reviewed papers on his various clinical interests.

Santdeep Paun Consultant Nasal and Facial Plastic Surgeon

David Roberts Consultant ENT Surgeon

Mr David Roberts MBBS BSc FRCS (ORL) has been a Consultant Ear Nose and Throat surgeon for the last 14 years. Appointed to Guy’s and St Thomas’ Hospitals NHS Foundation Trust and currently Clinical Lead to the ENT and Head & Neck department. He has developed a tertiary service in rhinology, facial plastic surgery and endoscopic skull base surgery. He specialises in rhinoplasty, complex sinus surgery and endo neurosurgery in adults and children. He is a fellow of and an examiner for the Royal College of Surgeons of England and a member of the British Association of Otorhinolarygology and the European Rhinology Society. He holds the diploma of the American Association of Facial Plastic and Reconstructive Surgeons and is a past fellow the European Academy of Facial Plastic Surgeons. He lectures nationally and internationally on many aspects of nasal, sinus and skull base surgery.

INVITED SPEAKERS

Pietro Palma

Ullas Raghavan Rhinologist and Facial Plastic Surgeon

Mr Ullas Raghavan received his medical and postgraduate degree in ENT surgery from India. He became a fellow of The Royal College of Surgeons of Edinburgh and Glasgow in 1999. In the UK, Mr Raghavan received higher surgical training at University Hospitals of Nottingham, Derby and Leicester. In 2005 he received full accreditation from the Specialist Advisory Committee in Otorhinolaryngology-Head and Neck Surgery and was awarded his Certificate of Completion of Specialist Training by the Specialist Training Authority of the Medical Royal Colleges. He was awarded a Clinical Fellowship by the European Academy of Facial Plastic Surgery in 2005 and received advanced specialist training in Facial cosmetic and reconstructive surgery from renowned centres in France, Germany, Switzerland, Netherlands and the US. He passed the examination conducted by the American Board of Facial Plastic and Reconstructive Surgery in 2005 as a European candidate. Apart from Facial Plastic Surgery, he also has a special interest in Rhinology. He has gained advanced training in Rhinology, particularly in Endoscopic Sinus Surgery under Prof NS Jones, Nottingham, UK. In 2006 he was awarded a travelling Fellowship by the Royal College of Surgeons of Glasgow and received advanced training in Endoscopic sinus surgery from Prof Moriyama, Jekei University, Tokyo, Japan.

Mr Ullas Raghavan is an invited faculty and has given numerous presentations at national and international meetings on the topic of facial plastic surgery. He has published over 40 scientific papers and written book chapters on facial plastic surgery in reference books such as Scott Brown’s Text book of Otorhinolaryngolgy, Operative Head and Neck Surgery, Practical Otorhinolaryngology, Atlas of Otorhinolaryngology etc and lectured on various topics related to facial aesthetic and reconstructive surgery in various meeting nationally and internationally. He is passionate about teaching these skills and runs Advanced Facial Plastic Surgery and Basic Facial Plastic Surgery courses in the UK and National Facial Plastic Course in Bangalore, and is a faculty of various national and international workshops and courses. He is also a national committee member of Facial Plastic Surgery UK and the lead for facial plastic skills centre in the BACO meetings in the UK. In 2005, Mr. Raghavan was appointed as a Consultant in Ear, Nose & Throat surgery with special interest in Rhinology and Facial Plastic Surgery in Doncaster and Bassettlaw Hospital NHS Trust. He is the facial plastic surgery and rhinology lead for his department.

INVITED SPEAKERS

Julian Rowe-Jones is Consultant ENT / Facial Plastic Surgeon at The Royal Surrey County Hospital NHS Trust and Director of The Nose Clinic in Guildford and London. He is European and International Board certified in Facial Plastic Surgery. He is a board member of the International Federation of Facial Plastic Surgery Societies and has been Chairman of the European Rhinoplasty Society. He has authored numerous papers and book chapters on rhinoplasty.

Simon Watts trained as a registrar on the North East rotation and was

awarded the Joseph Fellowship in facial plastic surgery during that time.

Following this he was appointed as a consultant in Brighton where he has

worked for the past 11 years.

His practice is sub-specialised in rhinology and facial plastic surgery with a particular interest in the extended applications of FESS and nasal / pinna reconstruction.

Julian Rowe Jones Consultant ENT/Facial Plastic Surgeon

Simon Watts Rhinologist and Facial Plastic Surgeon

Tim Woolford Consultant ENT Surgeon.

Tim Woolford is a Consultant ENT Surgeon at the Manchester Royal Infirmary where his surgical practise is almost entirely dedicated to Facial Plastic & Reconstructive Surgery, particularly septorhinoplasty and Edge Hill University. He writes, teaches and lectures widely on this subject, and is involved in tissue engineering research. He is a Co-director of the Manchester Sinus Surgery & Nasal Plastic Surgery Course, a past Academic Chairman of the British Academic Conference in Otolaryngology and current Chairman of FPS UK, the ENT UK Facial Plastic Surgery Society.

INVITED SPEAKERS

Pietro Palma

President of the European Academy of Facial Plastic Surgery

Paul White ENT Consultant and Rhinologist

Pietro Palma is currently acting as the President of the European Academy of Facial Plastic Surgery (EAFPS) www.eafps.org. He is serving also as the President of the IFFPSS (International Federation of Facial Plastic Surgery Societies) www.iffpss.org. Pietro Palma has been founder of the “Italian ORL Society of Facial Plastic Surgery”. www.aicef-chirurgiaplasticafacciale.it serving as the President from May 2004 till May 2010.

Since December 2002 he is appointed as a consultant surgeon, ENT Dept. of the University of Insubria-Varese (Director: Prof. Paolo Castelnuovo). Since 2005 he has been appointed as a Clinical Professor. In 2006 he got the position of Clinical Professor also at the Faculty of Dentistry. Pietro Palma is a world recognized rhinoplasty surgeon and lecturer and has been invited to lecture and operate in courses and meetings in: Austria, Belgium, Brazil, China, Colombia, Croatia, Czech Republic, Denmark, Egypt, Emirates, Finland, France, Germany, Great Britain, Greece, Hungary, India, Iran, Ireland, Israel, Korea, Kuwait, Lebanon, Lithuania, Mexico, Morocco, Norway, Peru, Poland, Portugal, Romania, Russia, Serbia, Spain, Switzerland, Thailand, The Netherlands, Tunisia, Turkey, Ukraine, USA and Venezuela. In 2001 he established with prof. Paolo Castelnuovo the biennial “International Milano Masterclass” www.milanomasterclass.it The last edition was attended by more than 600 participants coming from 67 different countries. Pietro is Co-Editor of Rhinoplasty Archive www.rhinoplastyarchive.com, and former editorial member for 10 years of “JAMA Facial Plastic Surgery”.

Pietro Palma graduated at the University of Bologna, and got the specialization in Otorhinolaringology/Cervico-Facial Surgery at the University of Sienna.

After completion of surgical training with Australasian College of Surgeons Paul White moved to the UK for fellowship training and stayed specialising in Rhinology/FPS. He has been an ENT Consultant and Rhinologist at Ninewells Hospital in Dundee since 1994.

He has a special interest in surgical skills training in rhinology and facial plastic surgery and research interests in surgical technology and robotic surgery. He is Co-Director of the Dundee Open Rhinoplasty Course (in its 20th year) and has been President of the British Rhinological Society since 2013.

Ahmad Hariri, Central Manchester University Hospitals NHS Trust Objectives To describe the multi-disciplinary model of the Manchester Ear Reconstruction Centre (MERC). Methods The multi-disciplinary team (MDT) approach to patient care has been integrated into many aspects of medicine. Using our experience at the MERC we describe the considerations and advantages of an MDT microtia clinic. Results Patients with microtia present two key challenges: hearing rehabilitation and cosmesis. Addressing these problems requires a ‘joined-up thinking’ approach. The key members of a microtia MDT include: audiologist, reconstructive surgeon and implantation otologist. The MERC provides a holistic approach to care for patients with microtia. Patients undergo structured assessment for candidacy and counselling with unbiased information for the options of no surgery, autologous reconstruction and osseointegrated prosthesis. Specific considerations include adequate positioning of hearing implants to avoid interference with subsequent reconstructive surgery. We have found that the MDT approach provides better integration of patient care pathways wherein both hearing and reconstructive issues can be addressed within a single clinic setting. This is facilitated by the inclusion of an Otolaryngologist reconstructive surgeon with an integral understanding of hearing needs. This avoids the need for referral to other specialities, simplifying and streamlining the patient journey. Patient satisfaction with the service is extremely high as a result of this combined approach and single clinic setting. Conclusions An MDT approach to the management of microtia provides a holistic service and significantly improved patient satisfaction. Having a service wholly led by Otolaryngologists for both hearing and reconstruction facilitates this. We would advocate a similar approach to microtia on a national basis.

P01: A MULTI-DISCIPLINARY APPROACH TO MICROTIA: EAR RECONSTRUCTION AND HEARING

Rhydian Harris, Manchester Royal Infirmary

Objectives Objective: To report a case of neurofibroma of the nasal tip, and a case of schwanomma of the nasal tip, and to discuss the genetic implications of this diagnosis.

Methods Two case reports and review of the medical literature.

Results A 14 year old girl presented with a recurrent slow-growing lesion of her nasal tip. She had undergone 3 previous procedures to excise this lesion. Histopathological diagnosis of these lesions revealed appearances in keeping with a neurofibroma. Tehre were no other neurocutaneous stigmata but due to its association with Neurofibromatosis type 1, she was referred for a genetic assessment, which confirmed that this was an isolated neurofibroma with no genetic implications. The second case was a 24 year old woman who presented with a slow-growing cystic lesion of her nasal tip. She underwent excision of this lesion, which revealed a schwanomma of the nasal tip. In both cases the tumours were excised using an open rhinoplasty approach.

Conclusions Benign peripheral nerve sheath tumours should be considered as a differential diagnosis for nasal tip soft tissue lesions, albeit an exceedingly rare presentation. They tend to be isolated lesions, with no underlying genetic condition; however due to their association with neurofibromatosis, this must be considered and excluded. An open septorhinoplasty approach is a suitable technique to excise such nasal tip tumours.

P02: SURGICAL APPROACH FOR BENIGN PERIPHERAL NERVE TUMOURS OF THE NASAL TIP

Pavol Surda, St Georges University Hospital

Objectives The aim of this study is to introduce the image analysis measurement (IAM) of the inner valve area which seems to be simple, cheap and easily performed method.

Methods 13 adults scheduled for septorhinoplasty and septoplasty were included. Prior to surgery we assessed nasal symptoms, judged by SNOT 22 questionnaire and clinical signs of nasal blockage, determined by anterior rhinoscopy. Subsequently, we obtained one image preoperatively and one postoperatively using endoscope attached to mobile phone with adapter. To ensure that both images match, we used template-based approach with help of Overlay Camera free mobile application and anatomical landmarks. Two cross-sections of the nasal valve area were digitally processed, measured and compared (in mm2).

Results Postoperatively, all 13 patients reported subjective improvement of the nasal blockage which strongly correlated with IAM and SNOT 22.

P03: IMAGE ANALYSIS OF THE INNER NASAL VALVE AREA AS AN OBJECTIVE THERAPEUTIC EFFECT MEASUREMENT

Samantha Goh, Royal National Throat, Nose and Ear Hospital

Objectives To identify individuals at-risk of body dysmorphic disorder (BDD) in Septorhinoplasty patients. Review current management to identify areas where BDD can be screened and patients can be referred early for psychological assessment.

Methods Retrospective study on patients seen in ENT outpatients for septorhinoplasty and identify those with a diagnosis of BDD or referred for further psychological assessment to determine diagnosis. Recruit a prospective cohort referred to ENT outpatients for septorhinoplasty and patients listed for septorhinoplasty. Use of the validated screening tool, the Body Dysmorphic Disorder Questionnaire, to identify patients at-risk of BDD.

Results Results: Over 1 month, 90 patients seen for septorhinplasty in outpatients, 10% of all clinic referrals were for septoplasty. 22% were referred for psychological assessment and 50% of those referred had surgery postponed due to BDD and suicidal ideation.

Conclusions Although rare, there are a significant number of patients with BDD who are seen in ENT outpatients. A multi-disciplinary approach should be sought for their management. Surgery, such as septorhinoplasty, may not be the best first step of management. Therefore early identification, meticulous surgical planning, post-operative follow-up and support is needed to ensure that patients have a good outcome

P04: BODY DYSMORPHIC DISORDER IN SEPTORHINOPLASTY PATIENTS

Abdul Nassimizadeh, University Hospital Birmingham

Objectives A 56 year old male presented with a 4 cm parotid gland carcinoma and underwent a left parotidectomy and a neck dissection followed by radiotherapy. Following surgery he had a 20cm indented scar from his left temple down to his left neck with scar alopecia. He had a tight scar across his neck anteriorly causing a slight restriction of movement and scar contracture. The loss of soft tissue lead to a marked contour deformity of the face and neck.

Methods Case study of patient undergoing fat grafting in response to scar tissue and facial asymmetry Results He underwent 5 episodes of fat grafting from the abdomen ranging from 30cc to 80cc with riggotomies to release the scar tissue. After the last episode of fat grafting he had good facial symmetry with softening of the scar and improvement in the quality and colour of the skin. Most interestingly the hair had regrown within the scar alopecia in his temple.

Conclusions This case illustrates the potential regenerative benefits of even small volumes of fat grafting to radiotherapied facial scar in resolving the soft tissue deficits and restoring facial symmetry. From the pre and post fat transfer (pictures) results the regeneration of the overlying skin produced outstanding results as well as interestingly the regrowth of hair.

P05: FAT GRAFTING A CURE FOR ALOPECIA?

Jawed Tahery, Countess of Chester Hospital NHS Foundation Trust

Objectives We present our combined approach pinnaplasty technique with discussion of pros and cons and review of literature.

Methods Retrospective observational review of our practice of pinnaplasty performed by the main author. The main author applies various steps and measures in a combined approach fashion inspired from combined approach tympanoplasty. This includes anterior and posterior incisions and excision of cartilage and mattress suturing. Pre-operative and post- operative photos were taken by our medical illustration department .Our presentation will be supported by appropriate images / video.

Results We performed ten combined approach pinnaplasties on 5 patients in our NHS institution. The main author performed more in the private sector. There was no need for bandaging and there were no significant complications. All patients were happy with the results.

Conclusions Despite the small number of patients which could be attributed to NHS restrictions on plastic surgery. We believe this is a valuable technique which adds to the current state of art and could be favoured by many pinnaplasty surgeons.

P06: COMBINED APPROACH PINNAPLASTY

Abdul Nassimizadeh, University Hospital Birmingham

Objectives Case study illustrating the potential regenerative benefits of even small volumes of fat graft.

Methods A 40 year old female presented in Oct 2010 with a spike of cartilage eroding through a full thickness skin graft on her nose. She had a history of Basal Cell Carcinoma excised with Moh’s surgery in 1997. This was reconstructed with a full thickness graft and cartilage graft from her ear. She has had no recurrence to date. On examination she had a thin full thickness skin graft to the tip of her nose which had overlying telangiectasia and hypopigmentation. The cartilage framework was prominent and a small area of cartilage was close to eroding through the skin. Whilst shaving the spicule of cartilage would remove the immediate problem it would not improve the overall appearance of the nose. She had previously been offered a forehead flap reconstruction she had declined this on the basis that she did not want additional scars to her forehead. In February 2011 she underwent removal of the spicule of cartilage and fat grafting from the abdomen in order to disguise the framework and potentially re-vascularise the area.

Results In March 2011 and Jan 2012 she was reviewed in clinic, and was delighted with the results. The overlying skin had improved in texture and quality, the colour had normalised and the telangectasis had resolved. The cartilage framework was less obvious and the sharp contours hidden.

Conclusions This minimally invasive approach avoided the need for a complex reconstruction.

P07: FAT GRAFTING: SKIN AND SCAR REGENERATIVE PROPERTIES

Rachel Edmiston, Manchester Royal Infirmary

Objectives Presentation of a difficult nasal reconstruction case

Methods This patient required reconstruction of a sizeable full thickness post Mohs defect. Reconstruction was performed using mucosal flaps, ear cartilage and a paramedian forehead flap (PMFF).

Results One week post-operatively it became clear that the distal PMFF on left alar subunit was non-viable. At four weeks, rather than divide the PMFF in the usual manner, it was released, lengthened, and re-attached . Despite the full thickness failure of the distal PMFF, the underlying pinna cartilage was viable due to a well vascularised anteriorly based septal mucosal hinge flap. This was also not divided at this procedure. The defect healed, and both PMFF and mucosal flap were divided four weeks later.

Conclusions The PMFF is the so-called ‘workhorse flap’ for reconstruction of large nasal defects, and is generally very reliable. Failure of the distal part of the flap is a rare complication. In this case a decision was made to delay division, and lengthen the PMFF achieving a satisfactory result. This did require a third stage of surgery, however an alternative technique such as a melolabial flap was avoided. Despite the failure of the distal PMFF, the underlying cartilage graft remained viable, illustrating the importance of the underlying mucosal flap.

P08: MANAGEMENT OF PARTIAL PARAMEDIAN FOREHEAD FLAP FAILURE FOLLOWING RECONSTRUCTION OF A FULL THICKNESS NASAL TIP DEFECT

Pooja Bijoor, University Department of Otolaryngology and Head & Neck Surgery, Manchester Royal Infirmary Objectives A three layer reconstruction is of key importance in the reconstruction of full thickness nasal defects. It is vital to have a vascular mucosal lining and strong cartilaginous support of the skin layer and the techniques required to achieve this will be presented. Methods A retrospective review of the senior author’s case series of nasal reconstructions was performed and suitable cases were selected to illustrate to importance of the mucosal and cartilage layer in nasal reconstruction. Results Two main techniques were adopted to reconstruct mucosal defects. If the defect was less than 1cm a bi-pedicled mucosal advancement techniques was adopted following extensive mucosal mobilisation. For larger defects an anteriorly based septal mucosal hinge flap was adopted. Pinna cartilage was used to provide cartilage grafting of defects involving the tip of the nose. These are non-anatomical grafts to support the alar margin and this important technique will be illustrated. Cases where poor results were achieved due to a sub-optimal mucosal lining and cartilage support will also be presented to illustrate the importance of these layers in nasal reconstruction. Conclusions Achieving a satisfactory functional and aesthetic result in the reconstruction of full thickness defects is challenging. A three layer approach which includes a skin covering, a cartilaginous framework and an inner mucosal lining is essential. The design and choice of lining flaps requires experience and can be the most difficult aspect of nasal reconstruction. Non-anatomical cartilage grafting is essential for any defect involving the alar margin to prevent flap retraction.

P09: CARTILAGE AND MUCOSAL LINING IN THE RECONSTRUCTION OF FULL THICKNESS NASAL DEFECTS

P10: CHIMERIC UPPER EYELID-SUPRAORBITAL FLAP RECONSTRUCTION

Eyal Schechter, The Christie Hospital, Manchester Objectives A 79 year old patient was referred to our tertiary cancer centre for further management of a T2a malignant melanoma due to concerns regarding cosmesis, varying skin types, tension vectors and preservation of orbital function. We report the first successful use of chimeric upper eyelid-supraorbital flap to reconstruct a facial defect encompassing several facial subunits. Methods Following wide local excision, the defect involved the entire right nasal sidewall, medial 2/3 of lower eyelid anterior lamella and most of the infraorbital cheek including zygomatic muscles. Chimeric flap was raised based on both right supratrochlear and superior medial palpebral vessels. Nasal sidewall and cheek were resurfaced using the supraorbital aspect, while upper eyelid aspect resurfaced the lower eyelid defect. Both donor sites were closed directly. Prophylactic right lateral canthopexy was performed. Forehead flap was divided 4 weeks later. Results Healing was uneventful and both flaps survived completely. Excellent functional and aesthetic outcome was noted on follow up 2 and 4 month postoperatively. Additionally, closure of supraorbital crescent-shape donor site corrected the brow ptosis commonly seen in elderly patients. Conclusions Chimeric upper eyelid-supraorbital flap provides simultaneous reconstruction of lower eyelid, nasal sidewall and infraorbital areas, therefore replacing multiple facial aesthetic subunits at the same time with unparalleled tissue quality match. Unlike the well-known paramedian forehead flap, donor site can be closed directly obviating the need for delayed healing or donor site grafting. We propose this flap as the first option in reconstruction of challenging defects encompassing lower eyelid and more than one additional aesthetic facial subunit.

P11: A HIGH VELOCITY FACIAL GUN SHOT WOUND. A CASE REPORT AND REVIEW OF THE ROLE OF FACIAL PLASTICS IN THE RECONSTRUCTION FOLLOWING MASSIVE FACIAL TRAUMA.

Joseph Sinnott, Kent, Surrey, Sussex. Core Surgical Training Objectives Massive Facial Trauma requires input from a multidisciplinary surgical team where facial plastics play a key role. The objectives were to analyse the facial plastics techniques used in reconstruction following a close range high velocity facial gun wound. These techniques were then compared to those described in the literature. Methods The case was followed from first presentation in A+E through multiple trips to theatre over the following months. Medical photography was used to give an overview of the progress. A Medline search was performed to review the current literature. Results Objectively, the outcome for the patient was functionally and aesthetically good. When comparing the techniques to the literature, due to the rarity of such cases, case specific variables and advancements in technology, there was a wide range of techniques described. Reflecting on our case and the techniques used instance we decided on some pertinent learning points.

Anastasia Rachmanidou, University Hospital Lewisham, Lewisham and Greenwich NHS Trust Objectives Low-heat driven Coblation technology has been used for tissue reduction and dissection for the last 15 years in ENT surgery. It utilises radiofrequency energy to create precise focused plasma to allow for accurate dissection. The application of Coblation in rhinology and in turbinate reduction surgery is not as widely described. In our department we utilise the Coblator to perform Coblation turbinoplasty in the post-rhinoplasty narrow nose. This allows us to create an increased nasal cavity volume available for airflow, decreasing obstruction and reducing the incidence of nasal valve collapse by creating space mainly at the anterior part of the nasal turbinate. Methods In this paper, we describe our experience in the use of Coblation turbinoplasty. We provide a step-wise approach to this technique. Our post-operative protocol is explained and we identify the appropriate indications as well as the surgical pitfalls that we have highlighted from our experience. Results We achieved very good outcomes using Coblation turbinoplasty with marked reduction in nasal obstructive symptoms in patients with post-rhinoplasty decreased nasal airway. We identified many advantages for this technique in comparison to alternate approaches to turbinate reduction including the lack of post-operative bleeding and therefore no need for nasal packing allowing for enhanced surgical recovery and a shorter hospital stay post-operatively. The very good outcomes and lack of post-operative bleeding/need for packing makes this method favourable when compared with other methods.

P12: THE USE OF COBLATION TURBINOPLASTY IN THE POST RHINOPLASTY 'NARROW NOSE'

Anastasia Rachmanidou, University Hospital Lewisham, Lewisham and Greenwich NHS Trust Objectives Protruding ears are a potential source of psychological distress in children. Pinnaplasty is a surgical procedure that can address the cosmetic and psychological aspect of prominent ears in children as well as adults. Funding policies for cosmetic surgery in the NHS is variable and growing financial strains in recent years has resulted in funding approval being required from local commissioning groups for paediatric pinnaplasties. These pressures have further stressed the importance of avoiding revision surgery and aiming for an optimal outcome in the first procedure. Methods Several techniques are extensively described in the literature for pinnaplasties. One of the most commonly used is the Mustarde technique however other methods such as the Converse, Stenstrom and Pitanguy technique are favoured in different surgical hands. We describe our method undertaken by one consultant ENT surgeon with special interest in facial plastic surgery over 10 years. Our method is tailored around the needs of children/adults with very strong cartilage and prominent conchal bowl. A combination of anterior cartilage scoring with excision of conchal bowl and post auricular skin where required has led to optimal to aesthetic outcomes. The technique is clearly described in a step-wise manner. We stress the importance of meticulous post-operative care and dressing application. Results We present the results of a case series of paediatric patients who have undergone this procedure with very good cosmetic results and patient reported outcomes. Pre and postoperative photographs are provided.

P13: CARTILAGE SCORING AND EXCISION IN PAEDIATRIC PINNAPLASTY: OUR EXPERIENCE

P14: EARFOLD„¢: A SIMPLE, QUICK AND EFFECTIVE TREATMENT FOR CORRECTION OF PROMINENT EARS

Mr. S. Alam Hannan, FRCS(ORL-HNS), Royal Free London NHS Foundation Trust Objectives OBJECTIVES: The earFold™ implantable clip system is a new treatment for prominent ears, ideally those secondary due to poor development or absence of the antihelical fold. earFold™ is a permanent implant made from a nickel-titanium alloy with a pre-determined shape. The implant is fixed to the cartilage then released, allowing it to return to its pre-determined shape, thereby folding the underlying cartilage and correcting any prominence of the ear. We present our early experience with the use of the implant. Methods METHODS: Over 21 months, we have used 1200 implants to treat 403 patients with prominent ears. Outcomes were recorded with videos, photography and case records. Results RESULTS: Most patients needed 2 implants per ear, but some patients had unilateral prominence while others needed 3 implants per ear. If an adverse outcome occurred, the problem was invariably only due to a single implant. Problems included infection (1.8%), extrusion (3.0%), repositioning (3.7%). There were no reports of haematomas, adverse scarring, skin problems or recurrence of prominence.

Peter Andrews, Royal National Throat, Nose and Ear Hospital Objectives The management of long-standing facial palsy, of any severity, is fragmented and variable and many patients languish without a structured holistic management plan with few treatment options. Our facial function clinic includes the expertise of a lateral skull base surgeon, a facial plastic surgeon and allied professionals. We provide a full range of static and dynamic reanimation procedures, including nerve anastomosis and the minimally invasive temporalis tendon transfer technique (MIT3). This involves a nasolabial fold incision and attachment of the temporalis muscle tendon to the modiolus of orbicularis oris. These techniques can all be used simultaneously with our available expertise. Methods Clinical photographs were taken pre and postoperatively. These were analysed using the objective scaled measurement of improvement in lip excursion (SMILE) and the subjective FACE instrument questionnaire. Results 10 patients underwent the MIT3 procedure, 4 of whom also had concurrent facial nerve surgery. 1 patient had facial nerve reanastomosis along with static reanimation procedures. The SMILE score showed significant improvement in lip excursion and facial symmetry post-operatively. The subjective FACE score was also significantly improved Conclusions The MIT3 technique, combined with other facial reanimation techniques is effective in improving outcomes following facial nerve paralysis.

P15: A REVIEW OF OUTCOMES FOLLOWING DYNAMIC FACIAL REANIMATION IN FACIAL PARALYSED PATIENTS, FOCUSSING ON THE MINIMALLY INVASIVE TEMPORALIS TENDON TRANSFER TECHNIQUE

P16: HOW DOES QUALITY OF LIFE CORRELATE WITH APPEARANCE IN RHINOPLASTY PATIENTS? AND WHAT

DO RHINOPLASTY PATIENTS DISLIKE ABOUT THEIR NOSE?

Charles East FRCS, Rhinoplasty London, The London Clinic Objectives To measure quality of life and appearance in rhinoplasty patients, and what do rhinoplasty patients dislike about their nose? Methods PROM questionnaire FACE-Q Results

Satisfaction with the nose associates with satisfaction with the face

Distress and expectation correlate strongly, expectations and stress correlate (patients with higher BDD

symptoms expect surgery will transform them, but cannot identify these from appearance score)

Psychological wellbeing correlates with nose appearance, face, expectations and stress (later 2 both

negatively)

The three main issues about appearance relate to 1.how the tip of the nose looks, 2.how the nose looks

smiling .3.how the nose looks laughing

FPS UK KINDLY ACKNOWLEDGES THE GENEROUS SUPPORT FROM THE FOLLOWING COMPANIES

Avita Medical Beech House, Melbourne Science Park, Melbourn, Royston. Herts. SG8 6HB, UK Tel : +44 (0) 1763 269770 Fax : +44 (0) 1763 269780 Mobile : +44 (0) 7769 705 799 Email: kali@avitamedical.com Website : www.avitamedical.com Contact : Kulsuma Ali DP Medical Systems Ltd 15a, Oakcroft Road Chessington Surrey KT9 1RH Tel : +44 (0) 208 391 9553 Fax : +44 (0) 208 397 1262 Email : julietteprice@dpmedicalsys.com Website : www.dpmedicalsys.com Contact : Juliette Price

Karl Storz Endoscopy (UK) Ltd 415 Perth Avenue Slough Berkshire SL1 4TQ Tel : +44 (0) 1753 503500 Fax : +44 (0)1753 578124 E-mail: customerservice@karlstorz-uk.com Website: www.karlstorz.com Contact: Ben Pattinson KARL STORZ Endoscopy is a manufacturer and supplier of the highest quality endoscopes, endoscopic instrumentation and HD imaging solutions. The new rhinoplasty instrument set designed by Professor G. J. Nolste Trenité enables surgeons to achieve superior results. This high-quality set consists of a wide range of instruments with the exclusive KARL STORZ gold-brown finish.

Smith & Nephew Unit 5-6 Cardinal Park Cardinal Way Huntingdon PE29 2SN Mobile : +44 (0) 7971 154709 Email : Laura.fisher@smith-nephew.com

Smith & Nephew, a global medical technology business, dedicated to helping improve people's lives.

Smith & Nephew has leadership positions in Orthopaedic Reconstruction, Advanced Wound

Management, Sports Medicine, Trauma and ENT Coblation.

Coblation technology has treated more than 6 million patients over the past 16 years in ENT surgery with

particular procedural focus in Tonsils, Adenoids, Sinus and Sleep related conditions from a wide range

anatomically designed solutions (brands include- EVAC, REFLEX and PROCISE).

Supporting the procedural solutions, Smith & Nephew ENT also provides post operative sinus and

epistaxis trauma nasal haemostasis, closure and packing solutions enhancing the pre, procedural and

post operative portfolio of products (brands include- RAPID RHINO, STAMMBERGER and ENTACT).

Smith & Nephew will continue to provide both surgeons and patients with innovative cost effective

solutions in ENT through 2015/ 2016 from the launch of new minimally invasive, cost and time saving

Sinus Solutions.

Smith & Nephew is also committed to providing high quality training and education for our customers, and throughout, 2015 provide ENT surgeons with easier access to Coblation training courses, clinical symposiums and educational materials to enhance the surgical experience of ENT Coblation. Wescott Medical Ltd Unit 3B Drum Industrial Estate Chester le Street Co Durham DH2 1AG Tel: +44 (0)191 492 0777 FaX : +44 (0)191 492 1770 Mobile: +44 (0)7739 261432 Email: ajohnston@wescott-medical.com Contact: Alex Johnston

NOTES

NOTES

FPS UK at The Royal College of Surgeons of England 35-43 Lincoln’s Inn Fields | London WC2A 3PE, UK

Tel: +44 (0)207 404 8373 | www.entuk.org