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MAY/JUN 2015 F VOLUME 1 F NUMBER 3

island trends & topicsW.Y. Chung, MD

4S Facelift

Modified Minimal Access Cranial Suspension

Jaime Calderon, MD

dial-a-doctor Francisco Franco, MD

HARMONY through BalanceGerry Stanley, MD Erin Stanley

PracticeWingMara Shorr, BS Jay Shorr, BA

memberspotlightRobert Bowen, MD

Aloha, My name is Dr. W.Y. Chung MD, I wanted to share with you some insights as to what it’s like for “an island practice.” I currently reside and am the founder of the Skin Center of Hawaii and InkOff. MD, located in Honolulu, Hawaii. As one of the world’s top travel and tourism destinations, the state employs thousands of people in the hospitality industry. One of the trends we’ve seen is the increased demand for services in leg and vein care. Varicose veins have become a common health issue for many hospitality workers, because this group spends a majority of time standing and working on their feet. As many of you are aware, varicose veins result from defective or dis-eased valves in the legs. When valves are damaged, they don’t close properly, causing blood to accumulate which force the vein walls to bulge. One of the top procedures in my practice is Endovenous La-ser Ablation (EVLA), and it has resonated with patients. Here’s what one patient shared after the procedure.

“I would recommend EVLA to others in my same situation. I used to be very self-conscious about the bubbling look of the broken vein in my thigh and ever since the procedure, I haven't thought about that vein even once. I don't feel any of the pain that was associated with the vein nor do I have any swelling.” (A. A.)

TATTOO REMOVAL

Tattoos play a big part in Hawaii. It goes hand in hand with the year-round comfort-able temperatures, the prev-alence of outdoor activities and the rich tattoo tradition associated with native Hawaiian and Polynesian culture.

In the last year, tattoo removal has become a huge industry, as more companies enact policies to ban visible tattoos, such as the Honolulu Police Depart-ment, whose visible tattoo-ban policy took effect in July. Last April, the United States Army also modified its tattoo policies, affecting the number and size members could have, in certain areas of the body.

At InkOff.MD, I was the first doctor in Hawaii to offer the PicoSure laser, the most effec-tive technology available today to remove tattoos.

It’s the world’s only picosecond aesthetic laser that effectively erases tattoos with fewer treat-ments and better results.

Here’s what two patients had to share about their PicoSure experience.

“The tattoos were significantly lightened after every treatment. The healing process was much quicker with PicoSure, and you see noticeable changes with each treat-ment, compared to the traditional laser where it took several treat-ments to see any results.” (Sara)

“I started treatments previously on the mainland, completing four or five of them, but the green color remained very bright.

I started going to Dr. Chung because I saw an article about the PicoSure laser that he uses to remove green ink. I’ve had three treatments with Dr. Chung and the green is now gone.” (Deanna)

At the practice, it’s all about serving the needs of our patients, and I look forward to continuing to offer the most revolutionary treatments available.”

W.Y. Chung MD

An Insight into the Effects of Geographic Location

InkOff.MD offers the latest technology in tattoo removal. I’ve been in private practice since 2007, after working as an emer-gency physician for 10 years, at several hospitals in Illinois, California and Hawaii.

For more information, please visit www.hawaiivein.com or www.inkoffhawaii.com.

island trends and topics

DidYou Know Because the

architecture and chemistry of coral is so similar to human bone, coral has been used to

replace bone grafts in helping human bone to heal quickly

and cleanly

Q: How long have you been in practice? A: I’ve been practicing Cosmetic Medicine for the past 10 years. As an Otorhinolaryngolo-gist; I always had an incredible desire to aid patients in achieving optimal breathing and overall wellness and health. I realized that via the Cosmetic Surgery I was able to enhance the quality of a patient’s life on a regular basis.

Q: What is the most rewarding part of being a Cosmetic Physician? A: Witnessing the patient’s initial reaction (post surgery) and having them thank me for their transformation is priceless. Being able to boost a patient’s life in a positive way is extremely rewarding to me. I’ve also been lucky to establish amazing friendships with colleagues along the way.

Q: What is your favorite procedure to perform and why?A: Facial Cosmetic Surgery; rhinoplasty, in particular is my most frequented procedure. My father is an otorhynolaryngologist; since I was younger I established a deep love and appreciation for this art; I embedded the visual process and grew fond of helping others as my father did. Being able to offer someone positive reinforcement via procedure in this case is most rewarding to me. Attaining “natural” results and offering short recovery periods also makes this process very much appealing.

Q: What specific technology or technique have you implemented in the last few years that have given you the best return?A: I’ve implemented the use of lasers and radiofrequency devices to my practice; I’m especially fond of the fractional laser skin treatments; the results attained are truly exceptional. The scalpel is by far worth its weight in gold as well.

Q: Do you advertise your practice using social media?A: As far as keeping up to par with all of the social media outlets. I find myself lacking time! I’ve been extremely fortunate to have patient’s voice their support in favor of my practice; I’m extremely grateful for word of mouth advertising; there’s no better feeling.

Q: When you need to get your mind off of your practice, what activities or hobbies do you participate in?A: I really enjoy playing golf and spending quality time with family and friends; creating memories is what life is all about. Through the society I’m happy to say I’ve established amazing friendships with colleagues; creating bonds that surpass barriers.

“The scalpel by far is worth it’s weight in gold”

an interview with with Dr. Francisco Franco Gonzalez

by: A

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While print advertising, e-newsletters and websites are no longer optional in the world of today’s cosmetic physicians, it all comes down to going the extra mile to give your marketing a boost.

How do you stand out in a sea of sameness?Attach call tracking phone numbers to all of your campaigns. We always say that what gets measured gets managed, and what gets managed get measured. You’ve put time, effort and hard earned dollars into your latest print advertisement, Facebook post, radio campaign, e-newsletter

and direct mail postcard… so why aren’t you attaching a unique tracking number to each piece to manage your response? You may find that an expensive magazine advertisement left you without a single phone call, saving you thousands of dollars when you realize you can safely remove it from your budget. After all, remember that appointment requests are the entire point of your marketing cam-paigns.

Each staff member should feel empowered with his or her own business card. Each and every provider, from your physician to your esthetician, should have a customized business card. In addition, make sure each of your administrative personnel, including your “Director of First

Impressions” (previously known as your receptionist), is armed with a stack as well. Whether they’re bragging about your skills to their friends and family or showcasing your amazing work to inquiring strangers at the grocery store, make it easy for all staff members to refer patients to your office.

Don’t assume you have your patients’ current email address. Even if your patient comes in regularly for treatments, continue to check all forms of contact information, including his or her email address. For example, s/he could have switched employers since the last visit, resulting in

a new email address… causing your well-crafted e-newsletter to fall on deaf ears as it bounces into oblivion.

Utilize your on-hold messaging for marketing messages. It’s always easiest (and cheapest) to go with the standard on-hold elevator music or standard “we’ll be right with you” messaging, but use the time your patient is waiting on the phone to promote your newest, strongest, or most-in-

need-of-promotion service. Do you specialize in rhinoplasty? Does your patient-base understand that you don’t just treat females? Do they know you’ve opened up a second location? Do they know you offer gift cards? Use this time to tell them!

Offer private label skincare. Make sure your logo, branding, and contact information are the first thing your patients use when they wake up in the morning, and the last product they use at the end of their day. After spending thousands of dollars to smooth out their wrinkles and tight-

en their skin, they want to invest in the products to keep them looking their best. Remind them of all that you do with a product branded with your logo, website and phone number on the front… and give them a reason to keep coming back.

ADDRESSING PRACTICE DEVELOPMENT AT THE:

TAKE YOUR PRACTICE TO THE NEXT LEVEL with Jay Shorr and Mara Shorr June 6, 2015 Marketing and Practice Management Seminar Fort Lauderdale, FL Contact ASOCP for more details (520) 574-1050 Contributing Authors: Jay Shorr, BA, MBM-C, CAC I-VI (ASOCP Faculty)Mara Shorr, BS, CAC II-VI (ASOCP Faculty)

Practice Wing ABSTRACT We recognized that most of our patients who want a cosmetic improvement, want to avoid any distortion or any complications. The main group of patients who want to develop a face lift are young and have no extreme facial ptosis. Since 1999 a strong tendency in performing a less dramatic facelift technique based on recommendations made by Dr. Siya Saylan with his technique of facelift called S Lift.

These techniques are based on the suspension of ptosis of the facial tissues based on purse string sutures suspended in hardy cranial tissues which are represented by a process that can be performed under local anesthesia; the authors have considered some modifi-cations to the previous techniques such as the incision and how to make the drawstring suture, respecting their fundamental principles, but trying to decrease scars by simplifying the process, and main-taining efficiency. We called this technique the 4 S facelift.

We make an incision only in the temporal region and into the anterior aspect of the helix of the auricle. This requires the use of long double tipped needles for carrying out the purse string sutures over hardy, deep temporal fascia. Reduced handling of needle holder requires a longer incision with sutures. The effective vertical lifting of ptotic facial features of the lateral aspect of the face is achieved.

We developed a technique that achieved this goal through a minimal incision, a suspension of the malar bag for a lifting of it with previ-ous premaxillar subperiosteal dissection using elastic sutures raising the anterior aspect of the ptotic face.

In 20 months, we had operated on 47 patients using this technique, with satisfactory results. These patients were about 48 years old, with the oldest

patient being 58 and the youngest 39. We describe step by step, each phase of the surgical technique. This demonstration and discussion of the technique is done mainly by comparing the 4S Facelift with MACS, MACS LIFT and LIFT PLUS.

INTRODUCTIONSome techniques are more invasive while others are less invasive. The invasiveness of the technique can dictate the quantity of scars, while, in each case improving various aspects of aging. Certain techniques may be less aggressive in some parts of the face and have better scar outcomes.It is considered, that with a selected technique, we can have less scars while providing long and pleasing results.We have searched for more of a facial scarless than traditional periauricular 4S Facelift to avoid attenuating even the small scars.

MACS LIFT In the history of rhytidectomy have appeared minimally invasive techniques such as spiculated sutures, vectors with sutures, poly-acrylamide sutures that have been suggested by Marlene Medical Sulamanidze with, Maximiliano Flores, and Dr. Nicolai Serdev, respectively. However, if we analyze the effectiveness of the tech-niques that achieve long term results without a convenient embod-iment of a subcutaneous dissection and tissue convenient SMAS suspension at the level of the deep temporal fascia, we find no effectiveness on these kind of techniques.On the other hand, we noticed an important effectiveness in these suggested techniques. In each case, we prepared the deep temporal fascia tissue for the SMAS, letting the resection of excess skin, ptotic, according to Dr. Dilson Luz way. Keywords: 4 s Facelifsscarless faceliftClosed rhitydectomyNo scar vertical rhytidectomyA MACS LIFT modified without preauricular incision

RESEARCH QUESTIONIs it possible to achieve effective results with a safe Vertical Rhytidectomy by a reproducible technique that decrease or avoids scars on the facial region?

Dr. Jaime Calderon OrtizDr. Marco Antonio Conde PérezDr. Sanjeev SharmaDr. Guillermo Blugerman

4S Facelift: Modified Minimal Access Cranial Suspension

This technique was taken by Drs Tonnard and Verpaele as a basis for its proposal MACS Lift

Taken up from Tonnard and Verpaele, Minimal Access Cranial Suspension Lift 2000

Tonnard & Verpaele, Minimal Access Cranial Suspension Lift 2000

S Lift

MACS Lift

Vertical vectorial facial lifting tendency

part 2 in next issue

Part 1 of 3

Each of us is aware that the ASOCP is made up of individ- uals from varying back-grounds, different medical training, diverse age rang-es, and its mem-bership covers a vast array of geograph- ic areas. While some could argue that the intrinsic diversity of the ASOCP is a potential weakness, I would argue that the diverse make-up of this organization, as well as its powerful message of inclusivity and training without boundaries makes it an organization with a sin-gular and powerful focus...education for the benefit of our patients. After spending 4 years prac-ticing rural family medicine and surgery, I found myself in a situation in which I had a skill set of a family doctor, general surgeon, OB/GYN, ENT, and orthopedist...yet it was the skill set of a dying breed of physician. In the spring of my medical career, I was surrounded by physi-cians in their late winters. After spending a year doing facial cancer surgery in a federally qualified health center, I was introduced to a group of physicians who welcomed diversity and encouraged physicians from varying backgrounds to sit down, share their knowledge, and apply their own unique techniques to

advance cosmetic medicine and surgery. After my initial introduction to the ASOCP I was amazed at the intense level of collegiality that was shared. Aware of the politics of modern health-care, the ASOCP has made the decision to put patients first by encouraging state of the art training programs in

which physicians not only learn, but share their unique medical perspectives to im-prove upon each procedure. What makes this concept so revolutionary, to me, is that it was the method by which medicine advanced itself for centuries, until the politics of the late 1900’s emerged and we stymied collegiality for the pursuit of power. The ASOCP has been able to re-estab-lish the

roots upon which med-ical thought was founded and re-introduced a generation of physicians to the concept of standing on the shoul-ders of the giants that went before them.

Apart from the training, didactics, and discussions, the ASOCP has become a place in which physicians can establish friendships to share in the evolution of modern medicine. A place in which office managers can build relationships to share programs and mar-keting ideas, where nursing staff can connect on ways to improve the patient expe-rience, and spouses can commiserate on the process

of practice evolution (never underestimate the power of an organization that includes your spouse). The sense of community that the ASOCP has established has been the guiding force in my cosmetic practice. If work to emulate the physicians that trained me, and I encourage my staff to connect with the support

staff of facilities I marveled at, all the while hoping to pay it forward and find ways in which I can share with other physicians, in search of education, in the same manner that the ASOCP has shared with me.

The American Society of Cosmetic Physicians is not just an organization of like minded physicians. It is MY

organization...it is YOUR organiza-tion...it is OUR organization. And so I would chal-lenge each of you:

share your knowledge, teach your colleagues, and build a better future for our organization and our

patients.

O W E R

“The Sense of community that the ASOCP has established has been the guiding force

in my cosmetic

practice.”

Dr. Gerry Stanley attended his residency in rural family medicine and surgery at the renowned North Colorado Medical Center where he served as the Chief Resident in his final year. After complet-

ing his initial training, Dr. Stanley served in the National Health Service Corp for 4 years doing charitable work in low-income and critically underserved areas of the Midwest. Following his service, he spent an additional year training on minimally invasive and contemporary cosmetic surgical procedures. In addition to being certified in cosmetic surgery, Dr. Stanley also became certified in bariatric or obesity/weight loss medicine.

by: Dr. Gerry Stanley

f Inclusivity

PAs office manager, we had some of the most profitable months to date. It was a position I took pride in. As we all know, running a busi-ness is stressful: there is always someone or something to worry about, and it was tough for me to “turn it off” when I got home. And while my staff is used to wife Erin, they didn’t always respond the best to work Erin’s new ideas, flows, and best practices. At times they were met with resistance by staff. That was tough for me, because our staff is like family to me, and switching “hats” was a big chal-lenge. Managing an office is difficult yet re-warding, but managing staff was not my forte. There are times that Gerry and I bring work home, and I am sure you do too! At times, it is necessary. Other times, it’s not. If it is a necessity, we try our best to make it a point to keep the conversation contained, so that it doesn’t interfere with us personally and our two boys. “OK, we are going to talk about this to-night after the kids go to bed and come up with a solution,” then we will leave it at that. Other times, we have to make it a point that we won’t talk about work tonight.

It is a case-by-case basis.

Gerry and I have recently brought on a wonder-ful office manager, who has experience running a busy practice and enjoys managing the staff. I have transitioned into a business development role, which allows me to work “on” our busi-ness, rather than “in” it. While I still manage the finances of the practice, I am able to find a balance between my professional strengths and my personal relationship. I get to support my husband, professionally, in the best way I know how: getting out in the community and getting people in the door. By no means do I consider hiring an office manager a failure on my end, but rather a learning and growing ex-perience for Gerry and I, as business owners,

and as a married couple. We are finding what makes us “tick” as a

husband-wife team.

Bottom line is that you and your spouse need to find your balance, whatever that may be. Whether it is you managing the office, whether it’s you not being a part of the office, or a small part of the office, you have to find what works best for your practice, but most importantly, your marriage. Gerry and I very much enjoy working together. It gives me no greater joy than to see him succeed, and I do my very best to help him with that endeavor, because he deserves it. I look forward to meet-ing many of the other husband-wife teams at the

upcoming ASOCP meeting in October.

O ne of my favorite things about cosmetic surgery is that we operate as a small business. Our practices are not just medical practices, they are family-owned businesses. Therefore,

we come across many husband-wife teams: my husband and I being one of them. By being associ-ated with ASOCP, I get to meet other husband-wife teams, and hear how they make it work. What makes a husband-wife team tick is different for everyone, whether you are the nurse, the office manager, a stay-at-home parent, or you have your own job. The underlying most important aspect for a successful practice and marriage is balance.

Tailoring thoughts and perspectives; a journey in achieving a perfect fit

by: Erin Stanley

nd I know firsthand managing the work-wife with home-wife comes with its challenges! I am married to Dr. Gerry Stanley. We own SCULPT Contemporary Cosmetic Surgery in Omaha, Nebraska. Since we opened in 2012,

I have played many roles in my husband’s practice. I am the mouthpiece...I drive business…I assist our staff…I scrub toilets…You name it, I’ve done it. I’ve had my own job outside the practice, I’ve been the office manager, and right now I’ve transitioned into a business development role, which we have found works best for us and our practice.Our two-and-a-half year old practice has been fortunate to experience rapid growth over the past year. We got busy enough that Gerry asked me to come on board, full-time as the office manager. We thought it was a wise decision to keep the money in the family, and who cares more about the business and the doctor than me? So I quit my job as a marketing manager and came aboard the family business. Little did I know that managing our small practice would be the toughest job of my life!

“What makes a husband-wife team tick is different for

everyone, whether you are the nurse, the office manager, a stay-at-home parent, or you

have your own job. The underlying most important aspect for a successful practice and marriage

is balance.”

A

LEMON JUICE promotes

perspiration and helps block pain. When lemon juice is heated, salicylic acid – the chemical cursor of aspirin’s

active ingredient is produced.

spotlights and

elemental facts featuring, Dr robert Bowen

COCONUT WATER is not only sterile, but it also works extremely well as a sports/hydration drink, is nearly isotonic, and in an emergency can also be used as an IV fluid.

Every issue often has a “current “of its own. For our early summer issue the main underlying

theme focuses on destination. Whether it be about reaching your educational goal or travel

site; ultimately it’s about

making the best of the journey.

We always find ourselves en

route; hopefully the exchange of

knowledge and information

fused within this issue leads the way to a prompt and

triumphant arrival of your ultimate destination. Again we thank everyone for their

support and effort in making the ASOCP a

vessel amongst the great voyage of knowledge.

Annette Estrella Editor-in-Chief

EDITOR’S NOTE

Growing up in southern Illinois in the 1960s I was inspired by the compassion, knowledge, and skill of my family’s doctor, ( there was no such thing as a "family doctor" as a specialty then ) a board-certified general surgeon who delivered babies, treated congestive heart failure, set fractures, and treated my asthma and allergies. Although things had already started to change by the time I finished my residency and fellowships in 1984, physicians were still encouraged to practice individualized/personalized medicine in the process of caring for their patients. Today, medicine has become dependent on algorithm like application of "evidence-based medicine". Standardized, evidence-based care may be an overall positive development for the majority of our patients but often “standards of care” or “clinical pathways” do not address the needs of patients who are considered "nonresponders". For this patient cohort, their welfare depends on using judgment and common sense based on knowledge of anatomy, biochemistry, pharma-cology, physiology, etc. . These skills seem to be receiving less attention in medical schools and training programs. This loss of independent, creative judgment is responsible in part for the decreasing level of satisfaction among practic-ing physicians.

For physicians who find themselves to con-strained by the “medical industrial complex”, cosmetic medicine and surgery, antiaging /regenerative medicine, and concierge medicine have become a refuge. Governmental interfer-ence may limit this sanctuary unless physicians stand up for ourselves and our patients in organization such as ASAPS, A4M, AACS and of course ASOCP.

Enough for the soapbox then. Today I would like to briefly introduce two areas of personalized non-pharmaceutical medicine which I have become especially interested.Regenerative medicine could be defined as the use of autologous cells and growth factors to treat both disease and aesthetic concerns. Platelet rich plasma (PRP) is obtained from a sample of peripheral blood then centrifuged to obtain separation of RBCs, buffy coat, and plasma. Highest concentration of platelets are found near the bottom of the plasma layer it into the top of the buffy coat. Various kits designed for the separation process are able to concentrate platelets and their growth factors such as PDGF, TGFB, FGF, and VEGF by factor of 2× to 10-12x over physiologic concentration depending on the method and the quantity of blood obtained. PRP has been shown to be use-ful for treating chronic wounds, tendinopathies, aging skin, and enhancing results and shorten-ing recovery time from laser resurfacing, among many others.

Adult stem cells are now known to be present not only bone marrow but in a perivascular location in all tissues. The process of lipoaspi-ration has been shown to be effective method of harvesting these regenerative cells from adipose tissue for point of care applications like cell assisted fat grafting and joint injections as well as experimental applications such as critical limb ischemia, COPD, cardiomyopathy, and tissue engineering. Low level light therapy (LLLT), also referred to as photobiomodulation (PBM ), offers another non-pharmaceutical approach to disease management.

Unlike cosmetic ablative lasers, which vaporize abnormal tissue and allow new more func-tional healthy tissue to replace it. LL LT helps restore normal cellular metabolism to disease or injured tissue. Power levels of these devices are typically measured in milliwatts rather than Watts and deliver fluences of around 4-8 J /cm2 over a few minutes rather than a few milliseconds. Recently, some of the mechanism of action of this LLLT have been elucidated: Injured tissues have been found to have nitric oxide binding to complex IV of cytochrome C oxidase of the electron transport chain which inhibits synthesis of ATP. Photons in the red and infrared range are capable of displacing nitric oxide and at the sub cellular level and allowing return of normal cellular metabolism as well as releasing nitric oxide into the local environment and providing vasodilation. In addition, the pho-tons are capable of upregulating the production of nuclear factor kappa beta which influences gene transcription and can increase production of growth factors such as the TGF-beta family. Like autologous cells and growth factors, light therapy has shown promise in the treatment of a variety of cosmetic and medical problems. Such as healing of chronic wounds, musculoskeletal injuries, skin reju-venation, traumatic brain injury, and even myocardial infarction. I believe that with these and other tools the cosmetic, regen-erative, antiaging physician can forge a satisfying career of caring for patients using an optimal blend of both art and science.

Member Spotlight

Robert Bowen MD

Wisdom is knowledge at its most edible

state

Courses

BREAST AUGMENTATIONJune 5-6, 2015 Location: Framingham, MA Sanjeev Sharma , MD LASER LIPOSUCTIONJune 18-19, 2015Location: Coeur d’Alene, ID Kevin Johnson, MD

INTRO TO INJECTABLESMay 22-23, 2015Location: Reston, VA Dima Ali, MD

MARKETING & PRACTICE MANAGEMENT SEMINARJune 6, 2015Location: Fort Lauderdale, FL Jay Shorr, BA Mara Shorr, BS

Many

fish can change

sex during the course of

their lives. Others, especial-

ly rare deep-sea fish, have

both male and female

sex organs.

MEMBERSHIP INFORMATIONPartner (MD, DO, DDS, DMD) $5,000 4 Has fulfilled the fee schedule for lifetime partner. 4 Holds a genuine interest in maintaining and encouraging the mission of the ASOCP. 4 Holds a current and unrestricted license. 4 Performs or is interested in cosmetic medicine. Physician (MD, DO, DDS, DMD) $500 4 Holds a genuine interest in maintaining and encouraging the mission of the ASOCP. 4 Holds a current and unrestricted license. 4 Performs or is interested in cosmetic medicine. Aesthetic Professional $250 4 Holds a genuine interest in maintaining and encouraging the mission of the ASOCP 4 Performs or is interested in offering services related to cosmetic medicine. 4 Non-physician. Resident No Cost 4 Holds a current and unrestricted license. 4 Currently practicing in a residency or fellowship program. 4 Holds a genuine interest in maintaining and encouraging the mission of the ASOCP. TO APPLY FOR MEMBERSHIP: Visit our website www.cosmeticphysicians.org and fill out the form or you can simply download form and fax/email back to ASOCP. Fax number: (520) 545-1254 Email: info@cosmeticphysicians.org Or contact us at (520) 574-1050 for more information.

ORCAS are formerly

known as killer whales. Orcinus orca are actually dolphins.

They are the largest of the

dolphin family.

LASER LIPOSUCTIONMay 21-22, 2015Location: Coeur d’Alene, ID Kevin Johnson, MD BOTOX COSMETIC & DERMAL FILLERS May 14-15, 2015Location: Port Moody, BC, CAN Haneef Alibhai, MD

10th ANNUAL ASOCP COSMETIC

CONFERENCE OCTOBER 8-11, 2015

OMNI Championsgate ResortOrlando, FL

In women undergoing breast augmentation, a technique

using transplantation of a small amount of the patient's own fat cells can produce better cosmetic outcomes, reports a study

in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

In particular, the fat grafting technique can achieve a more natural-appearing cleavage--avoid-ing the "separated breasts" appearance that can occur after breast augmentation, according to

the report by Dr. Francisco G. Bravo of Clinica Gomez Bravo, Madrid.

Dr Bravo analyzed the outcomes of breast augmentation surgery in 59 women. Thirty-eight women underwent conventional surgery using breast implants only. In the remaining 21 pa-

tients, Dr. Bravo used a combination technique using breast implants plus "selective para-sternal fat grafting."

In this approach, a small amount of the patient's own fat was harvested from elsewhere in the body--such as the thighs or abdomen. After processing, the fat cells were carefully placed along

the inner (medial) borders of the breasts. The goal was to achieve a more natural shape, and particularly to soften the "medial transition zone" between the sternum (breastbone) and the

implant edges.

Dr Bravo compared the results of women undergoing the two procedures by measuring the distance between the medial border of the breasts, or "vertical aesthetic line" (VAL).

He also had 20 observers rate the attractiveness of paired breast photographs, digitally altered to show a narrower or wider VAL distance.

Both groups of women reported high satisfaction rates. However, the results showed a more natural cleavage in patients undergoing the fat grafting technique.

As measured on postoperative photographs, the average VAL distance was 2.26 centimeters in women receiving implants only versus 0.6 centimeter with fat

grafting plus implants.On the breast attractiveness questionnaire, 95 percent of participants selected

images with a narrower distance between breasts. There were no complications related to fat grafting--likely reflecting the small amounts of fat transplanted

and the gentle "micro-grafting" technique used.

In recent years, several different fat grafting approaches have been evaluated for use in breast augmentation. Dr Bravo believes his combination technique

may be especially useful in preventing the "separated breasts" deformity sometimes seen after implant-based breast augmentation. This problem is especially common in thin women, occurring when the edge of implant is

visible on the inner side of the breast.

Careful fat grafting between the sternum and implant on both sides seems to provide a significant cosmetic advantage, producing a smoother tran-sition between the breasts and avoiding the artificial "separated breasts" appearance. The results also support the concept that the VAL distance, as a measure of the space between breasts, is a useful concept for plastic surgeons to consider in achieving a more attractive, natural appearance

after breast augmentation.

a shapely standpoint:

Fat Grafting Technique Improves

Results of Breast Augmentation

LARGE VOLUME FAT GRAFTING WORKSHOP May 2015 June 2015 Harold Bafitis, DO West Palm Beach, FL Edward Zimmerman, MD Las Vegas, NV

Bravo, Dr. Francisco G. “Fat Grafting Technique Improves Results of Breast Augmentation.” Parasternal Infiltration Composite Breast Augmentation 135.4 (2015): MNT. Web

Hors d’Oeuvres

SAVOR THE FLAVOR a CREATE THIS CULINARY DELIGHT FROM

Grace’s PANTRYVIETNAMESE FRESH SPRING ROLLS Ingredients for the spring rolls (makes 8 spring rolls): 2 ounces rice vermicelli 8 rice wrappers (8.5 inch diameter) 8 large cooked shrimp - peeled, deveined and cut in half 1 1/3 tablespoons chopped fresh Thai basil 3 tablespoons chopped fresh mint leaves 3 tablespoons chopped fresh cilantro 1 c mung bean sprouts 1 med cucumber cut into sticks 2 leaves lettuce, chopped

Ingredients for the dipping sauces: 4 teaspoons fish sauce 1/4 cup water 2 tablespoons fresh lime juice 1 clove garlic, minced 2 tablespoons white sugar 1/2 teaspoon garlic chili sauce 3 tablespoons hoisin sauce 1 teaspoon finely chopped peanuts DIRECTIONS: Bring a medium saucepan of water to boil. Boil rice vermicelli 3 to 5 minutes, or until al dente, and drain.Fill a large bowl with warm water. Dip one wrapper into the hot water for 1 second to soften. Lay wrapper flat. In a row across the center, place 2 shrimp halves, a handful of vermicelli, basil, mint, cilantro and lettuce, sprouts and cucumber leaving about 2 inches uncovered on each side. Fold uncovered sides inward, then tightly roll the wrapper, beginning at the end with the lettuce. Repeat with remaining ingredients. In a small bowl, mix the fish sauce, water, lime juice, garlic, sugar and chili sauce. In another small bowl, mix the hoisin sauce and peanuts.Serve rolled spring rolls with the fish sauce and hoisin sauce mixtures.

These light and healthy Vietnamese-influenced summer rolls are filled with cooked shrimp, rice noodles, and plenty of fresh herbs and vegetables for flavor and crunch. Once your ingredients

are prepped, the rolling fun begins as sheets of rice paper are softened in water and used for the wrappers. Dipped in a spicy peanut sauce, these rolls are a great hot-weather appetizer or light

lunch. Store the summer rolls in a dish or plastic container that’s roomy enough to hold them without their touching. Place a damp paper towel in the bottom of the container to keep the rolls

moist. Cover tightly with plastic wrap.

Game plan: Be sure to have all your ingredients ready and easily accessible when you start to roll, and give yourself plenty of time (and counter space) to make these. Also be sure to have a

few extra rice paper wrappers on hand—it may take a few tries before you’re rolling like a pro.

Answer Key:Across:3. Dermabrasion5. Tangram6. Sutures7. Abdominoplasty11. Varicoseveins12. Orlando

Down:1. Ptosis2. Botulinumtoxin4. Blepharoplasty8. Liposuction9. Rhinoplasty10. Grafting

All of the information contained here within is printed in good faith and for general information purpose only. We do not make any warranties about the completeness, reliability and accuracy of this information. Any action you take upon the information is strictly at your own risk. All of the views and opinions expressed within do not reflect those of the ASOCP.

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Foundation for the Advancement of Medical Education8000 South Kolb Road, Suite 101 Tucson, AZ 85756

P RS RT S TDUS P OS TA GE

PAIDTUCS ON A Z

P E RMI T NO. 448cosmeticphysicians.org

Gerard Stanley MD robert bowen MD w.y. chung MDerin stanley

francisco franco MDjay shorr, ba mara shorr, bs jaime calderon md

CONTRIBUTING AUTHORS IN THIS ISSUE

ASOCP

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