Day 2 :
Keynote Forum
Kris Conrad
Nasal and Facial Plastic Surgery Institute, Canada
Keynote: The use of goretex nasal implant technique, indications and complications
Biography:
Dr Kris Conrad is Associate Professor at the University of Toronto, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery. Director of Facial Cosmetic Surgery Clinic, Mount Sinai Hospital, Toronto. Past President of the Canadian Academy of Facial Plastic and Reconstructive Surgery and past Canadian Director of the Board of the American Academy of Facial Plastic and Reconstructive Surgery. An author of numerous peer-reviewed, scientific papers and book chapters pertaining to Facial Plastic Surgery. Director of Continuing Medical Education courses in Facial Plastic Surgery, University of Toronto. Dr Conrad has lectured worldwide as a visiting professor and a guest speaker and he is also a consultant in Facial Plastic and Reconstructive Surgery for Canada International Scientific Exchange Program
Abstract:
Statement of the problem: The choice of augmentation material has been a significant challenge associated with rhinoplasty. The thin skin-soft tissue envelope of the nose renders it a high-risk area particularly for implant materials but also in some way even for autografts with regard to the incidence of complications of biological and esthetic nature. The universally accepted technique relies on the use of autografts for the purpose of adding volume or giving structural support to improve the symmetry, tip projection, the dorsal length or strengthen the external nasal valve.
Orientation: Over many decades surgeons tempted by easy availability, the absence of donor site morbidity and shorter operating time have persevered in the search for an alloplast which would pass the test of acceptance by the recipient tissue. Many materials have been tried and rejected mainly by the unacceptably high incidence of extrusion if used in the nose. I used the first nasal implant of Gore-tex to the lateral nasal wall in a secondary rhinoplasty in the 1980’s without any complications.
Significance: The availability of Gore-tex membrane as a safe method of nasal augmentation has been now documented by more than a thousand implants followed up for up to 25 years or longer in my practice and recently published by other authors claiming its superiority even over autografts in nasal augmentation. As with any surgical method, the use of nasal grafts or implants demands a thorough knowledge of physical characteristics of the material, meticulous technique and requires a proper choice of patients for achieving most rewarding permanent results. The objective of this presentation is to outline clinical indications for the use of ePTFE (Gore-tex), its physical properties as well as the detailed surgical technique. Examples of results justifying the choice of this method over the available methods for properly selected patients will be shown.
- Facial Surgery | Rhinoplasty| Cosmetology & Skin Care
Session Introduction
Sherine Raveendran
Toronto Medical Aesthetics, Canada
Title: Classification and morphological variation of the frontalis muscle and implications on the clinical practice
Biography:
Ms. Raveendran is a Plastic, Reconstructive and Aesthetic surgeon with a special interest in burns and clefts. She was board certified as a specialist in Sri Lanka, continued her training in Plastic & Reconstructive surgery in the United Kingdom, and was successful in the Fellowship examination by the Royal College of Surgeons of Edinburgh and the European Board of Plastic surgical examination. She worked in many of the prestigious hospitals in the United Kingdom. She received her Masters degree in Aesthetic Surgery from Queen Mary University, London and was trained in cosmetic surgery in the UK.
Ms. Raveendran had an excellent academic record and won awards and medals during her training. She has published many scientific articles and authored book chapters in the field of Plastic and Aesthetic surgery. She has presented at several international meetings and is an invited reviewer for scientific journals. After practicing in the surgical field for more than a decade, Ms. Raveendran established Toronto Medical Aesthetics, an institute that provides advanced medical aesthetic procedures in the province of Ontario.
Abstract:
Forehead aesthetics is an imperative element in the rejuvenation process of the face. Restoration of the upper facial aesthetics facilitates to counteract the changes related to the aging process. The interaction between the frontalis and its antagonist's muscles contribute to the overall aesthetic balance of the forehead. In this study, we evaluated the gross anatomy of the frontalis and classified the muscle according to the morphological appearance. Twenty-six cadavers of Caucasian and South East Asian origin were dissected. The frontalis muscle was dissected without mobilization and the gross anatomy and variations were analyzed on the backdrop of gender and ethnicity. Our dissection studies revealed three main variations of the muscle based on the extent of interdigitation between the two bellies in the midline. The average length of the muscle is 10.9 cm in males and 9.1cm in females. The width of the muscle in females was 6.5 cm at the base and 4 cm at the insertion and 5.8cm at the base and 4.4cm at the insertion in males. In six specimens, the muscle attached only up to the medial two-thirds of the eyebrows. This was predominantly observed in the Caucasians cadavers and may contribute the constitutional downward slanting eyebrows in some individuals. This study provides a comprehensive analysis and classification of the frontalis muscle. Understanding the morphological variation of the muscle helps to amend the clinical application accordingly. Clinical evaluation of the patterns of decussation of the frontalis muscle may assist with non-surgical interventions using botulinum toxin.
Leila Freire Rego Lima
Jurado's Institute of Education and Research, Brazil
Title: Update in alar base reduction in rhinoplasty
Biography:
Leila Freire Rego Lima, ENT doctor, Facial Plastic Surgeon, Chief preceptor of the Jurado Institute of Post graduation in Facial Plastic Surgery-São Paulo/Brazil.
Abstract:
Purpose of review: The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format.
Recent findings: Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching sutures to pull in the alae together; or to use alar base excisions that remove tissue from the alar lobule to decrease flare and from inside the nostril to decrease width; and flap advancement.
Summary: Surgical modification of the nasal base is not a routine part of rhinoplasty and should be performed in a conservative manner to prevent complications like nasal stenosis. Moreover, this maneuver should always be the last one in rhinoplasty, as alar base modifications cannot be properly assessed until all other steps have been carried out.
Guillermina RamÃrez Orozco
Benemérita Universidad Autónoma de Puebla, Mexico
Title: Strategies for a successful rhinoplasty
Biography:
Guillermina Ramirez Orozco has her expertise and experience in complete evaluation of the nose; and bases her medical practice taking a holistic view of the patient. She sees the nose not only as a part of the respiratory tract, but also as the center of the facial beauty; her surgical techniques ensure the patient adequate respiratory function in addition to seek a permanent aesthetic harmony. Never sacrifices the function by the beauty. Guillermina has been professor of Otolaryngology and Rhinology in Benemérita Universidad Autónoma de Puebla and in the Universidad Popular Autónoma de Puebla for several years. Has worked for public and private institutions for over 15 years; and has collaborated with the “Manual para el Examen Nacional de Residencias Médicas” a book edited by Benemérita Universidad Autónoma de Puebla. Her interests include teaching, Neurolinguistic Programming, emotional intelligence, as well as accelerated learning techniques for all ages
Abstract:
Rhinoplasty is one of the most common procedures in facial surgery, and due to the delicate and complicated structure of the nose, it is also among the most difficult to carry out successfully. It involves a precise balance between shaping cartilage, bone, and soft tissue. However, those are not the only factors that affect the final result and even the convalescence of a patient.
The surgical team organization, anesthesia and the methods used to handle all the tissues involved during the procedure are critical to the outcome. Post-surgery, the healing and tissue contracture may persist for up to a year (some authors would even say two years).
Since the nose is the most prominent feature of the face, the skills and experience of the surgeon are extremely important in achieving success. Both the novice surgeon as well as the more experienced one, must take care of key aspects of the surgery to successfully achieve both the functional and aesthetic objectives for the patient.
Each case has its own challenges and requires a careful evaluation of the deformity preoperatively, and a clear understanding of the techniques available and most appropriate for correction. Every surgical operation is prone to complications. The only way to avoid the risk of such complications would be to not operate in the first place. A successful surgery requires a sequenced plan of action, together with a meticulous, uncompromising execution of the whole surgical event that gives protection to the surgical event.