Newsletter EAFPS December2009 - European Academy of Facial

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www.eafps.org
The European Academy of Facial Plastic Surgery
Dear Colleagues and Friends,
come.
The conference witnessed the migration of the presidency of EAFPS from the Dutch rhinoplasty maestro Professor
In the year 2008 and 2009, there have been 14 meetings and
Nolst Trenité to the Italian endonasal rhinoplasty supremo’ Proevents held under the auspices of the EAFPS, which represents
fessor Pietro Palma. We must all thank Professor Nolst Trenité
a new record. While undoubtedly all of them were interesting,
for his relentless efforts and commitment to the EAFPS, which I
in the following you will find those meeting reports that were
sure will continue to guide us.
made available to the newsletter committee. The change in the
The congress programme contained substantial social
newsletter team is a good occasion to express our gratitude to
and
scientific
components. The scientific section included topAbel-Jan Tasman, who did a great job in editing and chairing
ics on art in surgery, rhinoplasty, rhytidectomy, blepharoplasty
the newsletter Committee in the last years.
and periorbital rejuvenation, comprehensive surgical rejuvenaI would like to whish all of you a happy new year 2010.
tion of the ageing face, cleft lip and palate surgery, surgical
It will be a great pleasure to meet many of you in the oncoming
reanimation procedures as well as non-surgical rejuvenation
annual meeting in Antalya in 2010.
with botulinum toxin, fillers and lasers.
Specific aspects relating to rhinoplasty included art and
Sincerely, Wolfgang Wagner, Tübingen
science of Chinese face reading, Asian aesthetic perception of
the nose and chin, Mediterranean
rhinoplasty, gender issues in modern
rhinoplasty, role of computer imaging
and aspects relating to functional
The Annual Meeting of
rhinoplasty such as management of the
the EAFPS,
nasal valve and septal perforation. Debate marched on regarding open versus
Porto, September 3-5
closed approach in addition to cover2009
ing a vast number of other rhinoplasty
topics – augmentation, reduction, tip
The 32nd annual Meeting of the Euromodification techniques, alar base
pean Academy of Facial Plastic Surmanagement, cocaine nose, grafts and
gery this year was held in the historic,
variations in usage, complications of
welcoming city of Porto, Portugal.
rhinoplasty and prevention etc. AllThis was the first venture of the Acadimportant “physician patient relationemy in Portugal. The academic bar
ship and patient psychology” was also
was set high, covering all aspects of
covered.
both Cosmetic non-invasive, invasive,
Concepts pertaining to science
and Reconstructive facial plastic surof
beauty,
facial sculpting, were disgery, for the first time in the history of
cussed
supplemented
with fine lectures
the EAFPS meetings. My hearty conon
facial
anatomy,
safety
facelift, deep
gratulations go to the congress presiplane
facelift,
midface
techniques,
dent Professor Antonio Sousa Vieira
brow
and
forehead
lift
and
hybrid
faceand the distinguished members of the
lift techniques. Holistic approach to
local and scientific committees.
facial rejuvenation continued with secThe opening ceremony was
tions on management of baldness as
marked with the intriguing Joseph lecwell as upper and lower lid blepharoture by Professor Adamson. Peter
plasty procedures including transconAdamson walked the audience through the past, the present and
junctival technique, tips and pearls for periocular rejuvenation.
the future for facial plastic surgery emphasizing the imDr. Fritsch ran pioneering incision-less otoplasty techportance of looking at the future development of our
nique workshop while other faculty covered other tech1
specialty carefully in order to protect our as well as the
niques of cosmetic otoplasty and auricular reconstrucfuture of the generations of facial plastic surgeons to
tion.
Editor: Wolfgang Wagner
For those who dedicate their time to cancer reconstructive
surgery, there were plenty of topics encompassing all aspects of
facial cancer and regional reconstruction. Reconstruction of simple to complicated defects of the nose, lips, periocular areas,
cheeks, pinna, forehead, scalp etc were discussed with emphasis
on oncologic clearance including role of Mohs micrographic surgery and achieving a pleasing aesthetic outcome.
In the current economic climate many of our patients are
looking for non-invasive yet effective facial rejuvenation and this
is reflected by the explosive increase of such treatments. The
non-surgical rejuvenation panel discussed this very aspect with
practical tips and pearls on the use botulinum toxins, fillers, nonablative lasers and setting up such services within the realm of
ENT/facial plastic surgery.
The social events obviously reflected exceptional Portuguese hospitality. The golf journey, welcome reception at “Casa
da Musica”, educational visit to the Port Wine Cellars followed
by Gala dinner with mature mouth watering port wine being
poured relentlessly into your glass made it an overwhelming experience. All this was topped up by the Douro River Cruise,
which sailed after the closing ceremony, yes perfect for those
with the resilience to stick to the very end.
In a nutshell the meeting was comprehensive, with speakers from North and South America, Africa, Asia and of course
Europe. May I take this opportunity to invite all readers, members of the academy and others to attend our future meetings,
learn and enjoy the experience and support our academy to grow
and become powerful under our new leader Pietro.
Alwyn D´Souza, London
1st EAFPS session at a Nordic ORL
Head & Neck Congress,
Trondheim, Norway
The Nordic countries have a poor representation in the EAFPS.
Unlike in Germany, GB, Holland and France there is no tradition of facial plastic surgery among ENT H&N surgeons. On
the contrary there
has been a resistance to it; aesthetic surgery is
considered to be
in the shadow
lands and Head &
Neck
surgeons
should only deal
with functional
problems. However, there is a
change going on
Jarl Bunaes and P-O Haraldson
mainly due to the
fact that Facial plastic surgery has increased immensely during
the past 20 years, and an increased number of patients with severe postoperative nasal deformities are getting referred to the
ENT departments for complex functional and aesthetic problems. This has to be dealt with. As a result of that an EAFPS
session was introduced at the Nordic ENT meeting in
Trondheim, Norway, 12-14 June 2008. It was conducted
by the National
2 Delegates of the EAFPS in Norway and
Sweden - Jarl Bunaes and P-O Haraldsson. The lectures on nasal trauma and on approaches to the difficult nose attracted a big
audience and new EAFPS members were recruited.
P-O Haraldsson, Stockholm
12th EAFPS Wintermeeting and
1st EAFPS Winterschool, St. Gallen
and Flims-Laax, March 7-14 2009
The
biannual
EAFPS Wintermeeting 2009 was preceded by the one day
1st Winterschool at
the ENT Department
of the Kantonsspital
St. Gallen. Werner
Heppt and Abel-Jan
Tasman aimed at
teaching the basics
of septorhinoplasty
and
endo scopic
brow-lift through 4
live surgery cases.
Lectures were replaced by short comments and illustrations by the moderator during surgery.
Thirty six participants made ample
use of the microphone that was with
them at all times for
many detailed questions to the surgeons,
Werner
Heppt and Abel-Jan
Tasman.
The Wintermeeting was held at the Laaxerhof in Flims
Laax, Switzerland, in honour of our past-President Gilbert Nolst
Trenité. The Meeting attracted more that 50 participants from
Europe and overseas. The programme offered an update in Facial
Plastic Surgery, including dermatologic and maxillofacial procedures, the management of midfacial trauma and patient psychology. Among the speakers were Petra Becker-Wegerich, Marc
Bloching, Jarl Bunaes, Petros Economou, Callum Farris, Holger
Gassner, Godber Sönke Godbersen, Norbert Gorski, Wolfgang
Gubisch, Eckart Haneke, Thomas Hundt, Kurt Lädrach, Ralph
Litschel, Frank Muggenthaler, Gilbert Nolst Trenité, Welf Prager, Katja Schwenzer-Zimmerer, Jonathan Sykes, Hade Vuyk,
Myriam Wyss, Stefan Zachow and Max Zinser. The traditionally
relaxed atmosphere with plenty time reserved for discussion, the
ski lifts in walking distance and excellent snow conditions helped
to make feedback from this Wintermeeting once more very positive.
Werner Heppt and Abel-Jan Tasman, Karlsruhe and
St.Gallen
9th International Course “Aesthetic
and Reconstructive Rhinoplasty and
Otoplasty, Blepharoplasty and Face
lift”, Erlangen, March 24-27 2009
The ninth International Course “Aesthetic and Reconstructive
Rhinoplasty and Otoplasty, Blepharoplasty and Face lift” was
attended by over 60 participants representing the multidisciplinary nature of this meeting as it embraced ENT Surgeons, General Plastic Surgeons and Maxillofacial Surgeons.
Traditionally functional and aesthetic rhinoplasties represent one emphasis of the Erlangen Course. Almost all aspects of
modern septal surgery, dorsum reduction, nasal valve and nasal
tip surgery including the use of grafts and suture techniques were
demonstrated to the audience. The internal faculty shared their
knowledge both in numerous lectures and live operations. Prof.
Walter introduced a new technique in nasal tip surgery using a
bone graft harvested from the mastoid region. All faculty members emphasized the importance to preserve the structural support
of the nose and demonstrated various techniques to stabilize or to
reconstruct the nasal framework.
Since 2003
the aesthetic surgery
of the face marks
another focus point
of the scientific program. Basic as well
as advanced techniques in face lift
surgery, endoscopic
brow lift surgery
and blepharoplasty
were deepened during the meeting.
Live
operations
included two otoplasties, five rhinoplasties, face lift and
endoscopic brow lift
procedures as well
as two blepharoplasties.
These topics were
amended by hands
Logo of the Erlangen Course
on experiences in
facial implant surgery and last but not least by a tutorial teaching different applications of botulinum toxin in the face.
Since 2008 the fourth day of the Erlangen Course is designed as a full day cadaver dissection course. 50 participants
took advantage of the opportunity to perform all desired procedures and surgical techniques on fresh frozen specimen. Both the
personal teaching by the faculty members and the dissection
manual assisted the participants in order to increase their experiences.
All these circumstances in addition to the congress dinner
at the beautiful “Atzelsberg Castle” contributed to the remarkably
friendly and familiar atmosphere throughout the course providing
a setting for both the exchange and development of ideas.
Jochen Wurm, Erlangen, Germany
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Milano Masterclass 2009
March 27-31 2009
This biennial course of essential surgical rhinology was arranged
for the 5th time with again a growing number of participants
(around 300 people attended each segment) and participating
countries (49) in the beautiful 5-stars Melia Milan hotel. The
international faculties of the two segments represented hardcore
clinical knowhow from different continents in the field of sinunasal surgery and rhinoplasty. The setting was warm and intimate,
'Italian', and all practical issues were very smoothly organized.
There was no one and only truth as may be the case in
many courses but the Masterclass was a stage for several experts
listening carefully each others presentations leading to conversations and even debates that were fruitful for the audience. However the strict time-table and the almost exhausting day-program
from 7.45 to 19.00+ did not allow many questions from the audience. The presentations were straightforward clinically oriented
and detailed and concentrated to solutions of clinical problems.
Faculty Milano Masterclass (left to right): Dirk-Jan Menger, Rollin K.
Daniel, Stephen Perkins, Pietro Palma, Roxana Cobo, Gilbert Nolst Trenité, Abel-Jan Tasman, Julian Rowe-Jones
The obvious aim was to help the clinician in the audience by experienced surgeons who had lived through their learning curves
and who sincerely wanted to help colleagues to make their curves
steeper and to avoid mistakes. This sincerity and commitment by
the faculty may be one of the secrets of the Masterclass. The
teachers were committed to share real knowledge from real
working life, as was stated by Paolo Castelnuovo, the copresident. The seats of the auditorium were filled very quickly in
the morning and remained occupied until the evening.
The rhinoplasty segment was hosted by Pietro Palma
whose presentatios as themselves were like little pieces of art as
was commented by Gilbert Nolst Trenité. Their main message
was not in techniques but in the focused analysis of the patient so
that the treatment can be targeted by selecting appropriate techniques from many. Differences between male and female desires,
identification of problematic patients, exploiting endonasal approaches and using struts and structural grafts sparingly, and understanding that almost all cosmetic patients want a smaller nose.
From the USA Rollin K. Daniel was an expected guest. How to
achieve a naturally cute Californian nose? Suturing and grafting
techniques, tricks with fascia and diced cartilage, integrated tip
grafts, a composite structure in saddle nose reconstruction, tricks
for a boxy tip, warnings from a nose with an alar malposition
and so on. Just what the auditorium expected: real tested knowledge from real working life. Gilbert Nolst Trenité showed how to
use composite grafts in alar reconstruction, Stephen Perkins
shared his wide experience in cosmetic rhinoplasty and challenged the faculty to discuss if spreader grafts improve the airway and Roxanna Cobo and Daniel pointed out that big or
extended spreaders may even narrow the airway. Extension grafts were reviewed in detail by Cobo and Daniel
showed how columella strut and tip graft may be added to
the reconstructed L-strut to form a composite structure. Julian
Rowe-Jones discussed important issues in cosmetic rhinoplasty
from practical points of view and honestly added 'luck' as one possible component for a succesful outcome in rhinoplasty. Yong Ju Jang
proved to be a specialist in twisted noses and Abel-Jan Tasman presented among others tricks how to avoid bruises in rhinoplasty, how
a hump is a friend in correction of a twisted nose and if there is a
risk for overselling rhinoplasty if computer imaging techniques are
exploited. These and many other issues were dealt with in the many
lectures that were short enough so that the speakers had to go
straight to the essential questions.
The Masterclass 2009 was undoubtedly a significant learning
experience, the emphasis being on essential, more advanced than
basic issues. It was some challenge to survive the both segments as
a 5-day learning marathon, but fortunately the luxorius refreshments
during breaks and the two gala dinners that were included in the
course fee gave moments of relaxation in fascinating surroundings,
especially when 'Nel blu dipinto di blu' from 'Volare' was sung
together with sincere devotion by the colleagues in the last gala.
The 6th edition of the Milano Masterclass will take place in March
25-29, 2011 and again it will completely re-designed with the new
topics and new speakers!
chin augmentation with mentoplasty and sliding genioplasty and
other aspects of facial surgery. The day ended with an in depth discussion of the management of chronic facial paralysis a topic that
lives on the back burner many a times.
Live surgery marked the early start to the second and third
days. Among the eight procedures demonstrated were rhinoplasties,
demonstrating both endonasal and open structure techniques,
blepharoplasty, endoscopic brow lift and mid face lift, as well as
deep plane face lift. Use of endotine devices was also demonstrated.
Impeccable audiovisual transmission across to the operating surgeons and audience allowed for stimulating interactive and interesting
sessions during which nuances and pearls of wisdom were explored
in addition to focussing on basic surgical principles. Management of
facial trauma did not go uncovered, along with a scintillating overview of the application of transorbital neuroendoscopic surgery
(TONES) by Kris Moe highlighting the versatile nature of endoscopic surgery.
The nonsurgical facial rejuvenation with laser, neuromodulators as well as facial fillers was addressed in detail. Jonathan Sykes’
live demonstration of botulinum toxin and filler injections was well
received by the attendees, triggering off intricate discussion on various aspects of non-surgical rejuvenation. He also highlighted techniques and value of local anaesthetics in facial surgery and nonTapio Pirilä, Oulu, Finland surgical rejuvenation.
Final day was spent in the anatomy laboratory working on
The Regensburg Course in Facial Plastic Surgery, April 29 -May 2 2009
The First Regensburg Course in Facial Plastic Surgery was held at
Regensburg University ORL Hospital, Germany. This was an international, truly multidisciplinary event with representation from both
the East and West bringing over 100 experienced and trainee surgeons in ENT, maxillofacial surgery, plastic surgery, oculoplastic surgery, and dermatology together in quest of furthering their knowledge in facial plastic surgery. The event proved to be an extraordinary
learning experience and a major step forward for both cosmetic and
reconstructive arms of European Facial Plastic Surgery. Thanks to
Course Director Holger Gassner and Thomas Kühnel and their organising committee of the University of Regensburg who provided an
exceptional programme in collaboration with Mayo Clinic and under the auspices of EAFPS. The organisers paid detailed attention to
all aspects of the course, including travel and boarding both for delegates and faculty, social programme, and above all course content.
The course was delivered in three distinct segments - didactic lectures, live-surgery and live demonstration of botulinum toxin
and filler injections and laboratory based fresh frozen cadaveric
dissections, which also included a dedicated auricular reconstruction
workshop.
Department chairman Jürgen Strutz delivered the welcome
note, followed by a brief overview of the vision of EAFPS by Pietro
Palma as well as its fellowship programme by Julian Rowe-Jones.
The subsequent didactic session focussed on basic and finesse facial
reconstruction with excellent, practically oriented lectures from
David Sherris and Kris Moe from the USA. This was followed by
advanced lectures on anatomy, assessment, indications, techniques
and nuances of otoplasty, blepharoplasty, as well as face lift surgery. Of note was Wayne Larrabee’s superb account of ‘SMAS and
deep plane face lift – lessons from 5000 cases’ laying out
some pearls of wisdom regarding face lift surgery. The
4
focus then turned
to maxillofacial surgery encompassing
Faculty Regensburg Course (left to right) Torsten Reichert, Camilo Roldán, Pietro Palma, Jürgen Strutz, Thomas Kühnel, Wayne Larrabee Jr,
Jonathan Sykes, David Sherris, Wolfgang Wagner, Holger Gassner, Kris
Moe, Uwe Müller-Vogt, Hermann Hilber, Alwyn D‘Souza
fresh frozen cadaveric heads with the luxury of endocopes and high
quality surgical instruments courtesy of Karl Storz. The delegates
had ample opportunity to get to grips with the surgical anatomy and
perform various procedures including face lift, blepharoplasty as
well as endoscopic facial rejuvenation techniques such as mid face
lift. Some used this opportunity to familiarise with other aspects of
facial surgery such transorbital techniques. The auricular reconstruction workshop headed by Ralph Magritz ran parallel and
provided hands on experience of auricular sculpturing techniques.
My sympathies are with those who could not capitalise on this experience because of limited availability of places – “Book early next
time!”
No course is complete without the social programme, the
icing on the cake. The gala dinner encompassing a blend of perfect food, drink and on-stage act where local maestros
inspired the delegates to take to stage unleashing their
hidden talent suitably complemented this global learning experience.
In summary the course offers an unparalleled learning
experience and excellent value for money. I think this is a
must course to all surgeons interested in facial plastic surgery
and I am sure it will augment the knowledge and clinical practice in Facial Plastic Surgery to the highest level. I would
strongly urge you to mark your diaries for the next course,
which will be held June 10 – 13th, 2010..
Alwyn D´Souza, London
A one day Course in Neuromodulation and Fillers, London,
August 1 2009
This course was held on 1st August 2009 in London (Course
Director Alwyn D´Souza). The aims of the course were to
provide physicians with both theoretical and practical knowledge in facial aesthetics and rejuvenation techniques with emphasis on the use of botulinum toxins and hyaluronic acid
based fillers. Our cohort included both generalists and specialists, who wished to incorporate these techniques into their
individual practices. The course provided lectures, an in depth
course manual
(written specifically for this
course)
and
extensive hands
on experience
in the use of
botulinum toxin
and
d er mal
fillers, on live
models. Each
www.londonfacialsurgery.org
delegate was
www.essentialguides.org.uk
clo sely
ob served,
and
allowed the opportunity to both consult, and implement an
individual treatment plan for each of their models. Post course
feedback was very positive, confirming that the course met the
expectations and needs of the delegates. Amongst the feedback comments for future courses, delegates asked if we could
develop a course into the advanced techniques of neuromodulation and dermal fillers, and we are in the process of developing the advanced course.
Alwyn D’Souza, London
16th Course in Modern Rhinoplasty
Techniques, Amsterdam,
October 28-30 2009
This year, the Amsterdam International Course in Modern Rhinoplasty Techniques was organized aleady for the 16th time. The
participants came from 26 different countries from all over the
world. They enjoyed excellent lectures by the international board of teachers, this year including both Daniel
5
Becker (Pennsylvania,
USA) who was invited as teacher
of honour and Eugene Tardy (Chicago, USA).
During the first two days there were many interesting lectures. For example, René Middelweerd (Hilversum, The Netherlands) talked about tip rotation and projection techniques and
Floris Otten (Leiden, The Netherlands) discussed diagnosis and
management of internal and external nasal valve pathology. Gilbert Nolst Trenité and Daniel performed outstanding live surgery
and the participants could practice cadaver dissection on fresh
frozen cadavers in our entirely new dissection lab.
The symposium “revision rhinoplasty, analyses and surgical solutions” was held on the last day. During this day Eugene
Tardy spoke about pitfalls in rhinoplasty and how to prevent revision surgery. Daniel Becker talked about the importance of
computer analysis in order to avoid a surgical outcome that is not
in line with the expectations of the patient. Peter Hellings
(Leuven, Belgium) showed us some hints to improve the outcomes in rhinoplasty while Roxana Cobo (Cali, Colombia) focused on pitfalls in the ethnic nose. Gilbert showed how to use
composite grafts in patients with over-resection of the lower laterals or vestibular stenosis with shortage of inner lining. Forty
years of experience in how to alter a boxy nasal tip into a refined
tip with the use of the endonasal dome division technique, was
demonstrated by Mr. Tony Bull (London, UK). I talked about
techniques to reconstruct the nasal septum in children and adults
with complete destruction of septal cartilage, for example, due to
Faculty and participants of 16th Amsterdam Course
a septal hematoma or abscess or after previous surgery. Peter
Lohuis (Zeist, NL) talked about reconstructive nasal surgery and
showed us different techniques how to restore the soft tissue envelope, the nasal skeleton and inner lining. René Poublon
(Rotterdam, NL), who has been a member of our board of teachers since the beginning of the course 16 years ago, was the last
speaker of the day and discussed diagnosis and management of
different features after facial trauma. We ended this interesting
day with a panel discussion about analysis and surgical solutions
in rhinoplasty. This 16th course was a great success again!
Unfortunately, due to his retirement, this was the last
course that Gilbert organized as a member of our staff at the Academic Medical Centre in Amsterdam. The course will continue,
and I am very happy that Gilbert will be guest of honour in the
17th course and a very special guest in the years to come. Next
year the 17th course will be organized on October 27, 28 and 29,
of course including interactive lectures, live surgery and fresh
frozen cadaver dissection. For information or registration please
email
to
Ms.
Margalith
van
Huiden
(m.b.vanhuiden@amc.uva.nl).
Dirk Jan Menger
Looking forward to seeing You in Antalya 2010!
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