ABSTRACTS EXPERIMENTAL/SPECIAL TOPICS

Selected Abstracts from the Voice of Europe Session of the 5thAnnual Congress of the EASAPS

(Editorial Coordinator Cristino Suarez Lopez de Vergara)

Kemal Findikcioglu • Radu Ionescu • Nicolae Antohi • Tiberiu Bratu •

Dana Jianu • Maria Filipescu • Doru Chirita • Jesus Benito-Ruiz •

Jose Carlos Parreira • Paul Harris • Reza Nassab • James Southwell-Keely •

Rajiv Grover • Barry Jones • Cristino Suarez Lopez de Vergara

Published online: 16 April 2013

� Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

The Hinderer Award Winner 2012

The Impact of Breast Reduction Surgery on the Vertebral Column

Kemal Findikcioglu (Gazi Universitesi Tip Fakultesi Plastik Rekonstruktif

ve Estetik Cerrahi A.D. Turkey. email: kemaldoctor@yahoo.com)

Background: Although many studies have shown that breast reduction

surgery is effective in reducing neck, back and lumbar pain; most of

these studies are subjective evaluations that usually provide data

through pain scales. This study was undertaken to objectively eval-

uate the radiologic effects of breast reduction on the vertebral column.

Methods: Thirty breast reduction patients were included in the study.

A lateral thoracolumbar radiograph was taken preoperatively and

three months postoperatively for each patient. The thoracic kyphosis,

lumbar lordosis and sacral inclination angles were measured for each

radiograph. The impact of breast reduction surgery on posture was

evaluated according to the comparison of these angles preoperatively

and postoperatively. Effect of the age, BMI and the total amount of

removed tissue was also taken into account and the relationship

between these parameters and their effects on the change in preop-

erative and postoperative angle measurements were evaluated.

Results: There was a significant decrease in all three angles after

breast reduction surgery. A significant correlation was determined

between BMI and the total amount of removed tissue on the change in

angle measurements while a definite relationship was not observed

between the angles and the patient’s age.

Conclusion: This study has shown the objective impact that breast

reduction surgery has on the vertebral column. Even though the

symtomatic relief of breast reduction surgery on the musculoskeletal

system is widely accepted, the objective assessment of this relief will

be beneficial in persuading health insurance companies and those who

think of this surgery as a purely aesthetic procedure.

Junior Section—Young Investigator Winner

Stromal Vascular Fraction Isolation Manual Protocol: A Cheap

and Easy Way of Controlling the Production of Adipose-Derived

Stem Cells

Authors: Radu Ionescu MD, Nicolae Antohi MD, Tiberiu Bratu MD

FAT!!! and the discovery of adipose-derived stem cells put the plastic

surgery in the front line of new frontiers of science, the place where

we, with our ability for public relation and safeness of good practicing

in lipotransfer, we develop a powerful marketing tool, maybe too

powerful, performing this type of surgery with a certain lack of

knowledge and scientific data, fact that can make the ADRC research

to be estompated by a increased number of questions concerning the

safety and efficacy of Adipose-Derived Stem Cells treatments.

The main objective of this work is to standard the protocol of: Fat

harvesting, SVF preparation, and Lipotransfer.

Fat harvesting have to be performed using low aspiration pressure

0.35 bar, cannula of maximum 3 mm, tumescent or super wet, buffer solution

for infiltration—with low dosage of xyline at 37 Celsius (see photo 1).

Preparation of SVF is performed in the operation room on using

GMP devices and drugs, in approx. 60 min, on a standard protocol of

9 steps (see photo 2). Collagenase is Serva NB6 a GMP approved, and

K. Findikcioglu � R. Ionescu � N. Antohi � T. Bratu � D. Jianu �M. Filipescu � D. Chirita � J. Benito-Ruiz �J. C. Parreira � P. Harris � R. Nassab � J. Southwell-Keely �R. Grover � B. Jones � C. S. L. de Vergara (&)

Santa Cruz de Tenerife, Avenida de la Asuncion, 30 2nd,

38007 Tenerife, Spain

e-mail: cristinosuarez@gmail.com

123

Aesth Plast Surg (2013) 37:602–604

DOI 10.1007/s00266-013-0106-4

inactivation of the collagenase is effectuated with Actovegin (Nik-

omed) and PRP.

The lipotrasfer is effectuated with cannula of 2 mm, no pressure

on the plunger, micro droplets, for 1 cc of fat transfer—SVF from

1 cc fat.

First the lipotransfer, after 20 min SVF with PRP, permits post-

traumatic lymphocytes and chemokine’s that induce hypoxia, which

activate the ADRC and stop them from migration.

A quantity 10 % of prp ? svf will be sent to lab to have culture

probe. SVF was cultured in DMEM medium with 20 % FBS. Cells

were analyzed by flow cytometer (FC 500-Beckman Coulter), and

found to be positive for CD31, CD34, CD90, and CD105 surface

antigens. The cells viability was 91 % when tested using 7-AAD on

the flow cytometer. Stem Cells CFU-F 1–5 % of total SVF.

Surgical Cervico—facial ‘‘AdipoLASER

Rejuvenation’’—A Personal Method

Dr Dana Jianu, Dr Maria Filipescu, Dr Doru Chirita

Hystological and Aesthetic Outcomes

Background: The authors present an innovative surgery based on 2

types of fat surgeries and 2 types of LASERS to correct aging changes of

face and neck: 1. Fat facial transplant; 2. Fine liposuction; 3. Adipo-

citolysis (DIODE LASER); and 4. Facial fractional CO2 LASER.

Due to multiple benefits, this new method could be an option for

classical rhitidectomy.

Methods and results: The study took in consideration 56 cases with all

4 techniques realized simultaneously and other 160 cases with single

or double procedures. We demonstrate that only the full combination

obtains optimum results due to their synergetic action: 1. Fat graft

leads to volumetric and skin texture’ correction of face; 2. Fat

reduction (microliposuction) for heavy jaws and neck; 3. LASER

adipocitolysis with optical fiber at dermo-hypodermic level (DIODE

LASER) for mandible line and antero-cervical line restoration. Leads

to corrective changes of the connective and adipose tissue. Hysto-

logical images from patients’ specimens; and 4. Fractional LASER

(CO2) improves skin texture and color of face and neck.

This new method is an incision less surgery using microcannulas,

needles, optical laser fiber, and light (laser) under local/general

anaesthesia (iv).

Conclusions: ‘‘Adipo LASER surgery’’ has: A. Multiple advantages

and few B. disadvantages.

• A. Wide area of surgical indications and age

• Economically convenient method for patients and private clinics

with short recovery (1 week)

• Impressive outcomes comparable with classical rhidectomy

• Long-term stable result and natural appearance

• B. Learning curve

• Equipment (LASERS) has to be available

• The surgeon needs to master LASERS.

Limb Enhancement with Implants

Dr. Jesus Benito-Ruiz (Clinica Tres Torres, Barcelona. email:

drbenito@antiaginggroupbarcelona.com)

Breast augmentation is of course the most familiar and common

indication for implants, and in some countries buttock enhancement is

another well-known indication. Enhancement of the muscular contour

in anatomic areas other than these is still rare. However, some people

are concerned about self image and come to our offices asking for

improvement in their limbs, i.e., legs, arms, and thighs.

To our knowledge the first report about using implants for this

purpose was by Hodgkinson in 2006 (1). He described the use of solid

silicone implants for reconstruction of the muscular contour after

injury (muscular rupture or nerve injury).

After our initial experience with pectoral implants (2) and but-

tocks, we started to use cohesive (non-solid) silicone implants

(Polytech, Dieburg, Germany) for muscular enhancement in other

areas. We report herein our experience so far.

Calves: Patients seeking for calves augmentation fall into two groups:

those who have a neurological sequelae due to nerve injury, polio-

myelitis, or foot surgery (echinus varus, lengthening of the Achilles

tendon); and those who want a better contoured muscle that match

with the rest of the limb (usually men who do fitness).

The implant that I generally choose for medial gastrocnemius is

the anatomic shaped, designed by Montellano. This implant has

more projection at its upper third, imitating the muscle. However, I

prefer the Glicenstein’s implant to enhance the lateral aspect of the

leg. This implant is fusiform and symmetric, with maximal pro-

jection at its middle. The medial aspect of the leg is very shaped,

with an upper convexity and a lower concavity. However, as the

lateral gastrocnemius has less volume, the leg laterally has a gentle

convexity.

Thighs: I have found that we can enhance the rectus anterior muscle

and the vastus lateralis through the same incision and placing the

implant under their fibers. They are responsible for the contoured and

well-defined thigh. We can use buttocks oval implants or calves

implants depending on the width of the muscle and the thigh. For the

inner aspect of the thigh I use fat grafting.

Deltoid: To avoid injury to the axillary nerve we approach the muscle

from its anterior side. The incision is made at the anterior edge of the

deltoid V, at the groove between the deltoid and biceps. The incision

is deepened to the bone and a pocket is made by blunt dissection. The

pocket has to be wide enough to accommodate the implant.

For this location, a smooth, oval implant can be used, and we

prefer a volume of 110 cc. This implant has a similar shape to the

muscle and the tip of the implant will be under the deltoid V.

Triceps: The incision may be made at any of the sides of the triceps

tendon and the dissection is deepened under the tendon and muscle. A

careful blunt dissection is performed proximally under the long head

of the triceps and is expanded medially and laterally. Blunt dissection

avoids inadvertent rupture of any nerve branch crossing the muscle.

We recommend that no muscular relaxants be used by the anesthe-

siologist so we can check any muscular movement in the vicinity of

the radial nerve. If this happens, this should be an endpoint for the

Aesth Plast Surg (2013) 37:602–604 603

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surgical dissection. In thin patients, we place Glicenstein implants

(symmetric silicone calf implant) and in more muscular patients, we

use the oval buttock implant (110–240 cc depending on the available

pocket).

Biceps: The incision is performed distally at the medial aspect of the

muscle, cranial to the medial septum. A tear is performed in the

muscle fibers and the pocket is made bluntly between the biceps and

the brachialis. The nerve can be seen at the junction between the

upper and middle third of the muscle. The blunt dissection should be

continued upwards while taking care not to stretch the nerve.

The best implant to place here is the oval buttock implant with a

volume of 110 or 240 cc depending on the width of the arm.

The oval implant is wide and short and its shape does not change

much with muscular contraction. The tip of the implant is placed

medially to the nerve.

Conclusion: With a good knowledge of the anatomy it is possible to

enhance some muscles of the limbs in patients who want a more-

defined contour. Even though we can use custom-made implants,

manufactured implants available behave well in many locations. To

ensure success with muscular enhancement with implants I would

suggest to follow these broad recommendations:

– Choose an implant that properly fits the pocket and muscle size.

Avoid using an oversized implant.

– Choose a microtextured or smooth implant.

– Give a thorough explanation to the patient of the pros and cons of

the procedure as well as insisting on resting during the first

postoperative weeks (5–7 weeks).

– Do not detach the muscle boundaries.

Oculoplastic Aesthetic Surgery: Evaluation

of the Patient and Direct Surgery

Jose Carlos Parreira, (Portugal. email: jcparreira@clix.pt)

Introduction: In the periorbital area we must clearly understand the

anatomic changes that occurs with age.

Although these changes are different from patient to patient, there are

some common causes of aging, including familiar characteristics, loss

of elasticity, sun exposure, descent of periorbital tissues and atrophy

of periorbital fat.

Most of these changes can be corrected, but before we must

evaluate altogether and carefully analyze the patient, before doing any

kind of surgery.

Preoperative Evaluation: We must evaluate the face as a unit. In these

units we have several Aesthetic Units and the periorbital is one of

them. In the superior third of the face, we must evaluate the skin

texture, glabelar and frontal wrinkles and eyebrow symetry.

In the upper lid, verify the skin excess, symmetry, fat pockets,

supratarsal fold, eyelid ptosis and elevator function.

In the lower eyelid, several points must be evaluated: palpebral aper-

ture, vectors, cantal tilt, tissue laxity, distraction test and ‘snap-test’,

mild lamela retraction and distance from the tissues to the bone in the

lateral canthus.

In the ‘mid-face’ evaluate the tissue atrophy and descent of the

‘mid_face’.

Surgery: According to the evaluation of the patient, we present a short

vıdeo with the surgery we must often use.

Discussion: The periorbital rejuvenation has changed a lot in the last

years and the most recent techniques are less invasive and more

straight forward. Some small procedures, like botox, fat transfer,

conservation of the orbicularis muscle, and no resection or little res-

section of fat, all had a place in the evolution of the treatment of these

patients.

Conclusions: Periorbital rejuvenation must be directed to a specific

situation and today we tend to be more conservative and with less

‘down-time’.

Cosmetic Surgery Trends and Economic Indicators—

Comparisons Across the Pond

Paul Harris, Reza Nassab (London, UK)

The aim of this study was to explore trends in cosmetic surgical

procedures in the UK and USA. These trends were then compared to

economic indicators to identify any correlation between procedures

and the macroeconomic climate of the country.

Figures from the British Association of Aesthetic Plastic Surgeons

(BAAPS) and American Society of Aesthetic Plastic Surgeons

(ASAPS) were analysed between 2002 and 2011. Only surgical pro-

cedures were included in the analysis and non-surgical procedures

such as injectables were excluded. A correlation assessment of several

economic indicators and growth rates for cosmetic surgical proce-

dures was also undertaken.

During the study period, a 286 % increase in the number of procedures

undertaken in the UK was observed, compared to only 1 % in the USA.

However, both the UK and USA saw a significant decline in growth rates

during 2008 and 2009, coinciding with the global economic recession. A

significant positive correlation was found between the UK figures and the

Gross Domestic Product (r = 0.986, p\0.01) and the Consumer Price

Index (r = 0.955, p\0.01), that was not seen for the USA.

This study has revealed major differences in the number of cos-

metic surgery procedures in the USA and UK. One reason for this

may be the relative maturity of the respective cosmetic surgery

markets. These findings offer a useful insight into the prediction of

Worldwide cosmetic surgery rates.

Post-Operative Hilotherapy in SMAS-Based Facelift

Surgery: A Prospective, Randomised Controlled Trial

Author: Nicola Petrie

Co-authors: Mr James Southwell-Keely, Mr Rajiv Grover, Mr Barry

Jones

Background: Ecchymosis, oedema, haematoma and pain are all observed

after SMAS-based facelift surgery. Our study assesses the validity of

Hilotherapy—a novel form of cryotherapy that purports to minimise

these events through single-use face-masks circulating cooled water.

Methods: 50 Consecutive patients were randomised to postoperative

Hilotherapy or standard dressings alone. 15 Subsequent patients were

randomised to cooling of one side of the face only thereby acting as

their own control. Assessment of ecchymosis, oedema, haematoma

and pain was performed independently by clinical staff and patients.

Results: Hilotherapy produced a statistically significant difference in

facial skin temperature (p = 0.01) but there was no associated dif-

ference in ecchymosis, haematoma and pain (p [ 0.10) in either limb

of the study. The second limb of the study demonstrated a statistically

significant increase in facial swelling associated with Hilotherapy

6–8 days post surgery (p = 0.05). Subjectively the majority of

patients found the cooling masks to be comforting.

Conclusion: This randomised, controlled trial of Hilotherapy dem-

onstrated significant facial skin cooling after SMAS-based facelift

surgery but an associated increase in patient who reported post-

operative swelling. No objective benefits were derived in terms of

reducing ecchymosis, haematoma or pain.

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