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The Ongoing Debates in Plastic Surgery

Op-Med is a collection of original articles contributed by Doximity members.

The Aesthetic Meeting 2018, hosted by the American Society of Aesthetic Plastic Surgery (ASAPS) and the Aesthetic Surgery Education and Research Foundation (ASERF), was one the most innovative and cutting edge global gathering of aesthetic experts of its kind. The meeting included lively debates on trending topics from world experts in areas such as body contouring, rhinoplasty, facial rejuvenation, and aesthetic medicine.

Body contouring, and specifically high definition liposculpture, is a relatively new technique that has gained much attention as surgeons are becoming more attune to body surface anatomy features of males and females. Using advanced techniques of liposuction in conjunction with fat transfer, aesthetic surgeons have been able to reliably achieve the appearance of muscles such as the rectus abdominus, deltoid, pectoralis, and triceps. Impressive results were showcased at the meeting, including long term postoperative outcomes demonstrating the durability of this technique and high patient satisfaction. Patient candidacy, preoperative considerations, and technical execution were also discussed.

Colombian plastic surgeon Dr. Alfredo Hoyos, for instance, presented his approach of avoiding periumbilical abdominoplasty scars by eliminating the umbilicus with the abdominoplasty specimen and re-creating the umbilicus using a four-triangle flap technique, either at the time of surgery or in a delayed fashion. The approach provides the patient with a more ideal result, avoiding the circular umbilical scar that is often a tell-tale sign of abdominoplasty.

Buttock fat grafting, commonly known as the “brazilian buttock lift,” was another hotly debated topic at the meeting. This procedure is among the most controversial in aesthetic surgery, due to the cited mortality rate of 1 in 3,000. Recent cadaveric studies by DelVecchio et al. provided evidence of the mechanism leading to fat embolism and provide strong rationale for avoiding this dreaded complication by only transplanting fat in the subcutaneous plane rather than intramuscular. These studies demonstrated that there is a fascial layer overlaying the gluteal musculature that serves as a barrier between the subcutaneous plane and large gluteal veins presumed to contribute to fatal fat emboli when injured. When fat was injected in the intramuscular plane, the pressure gradient was large enough to tear the veins and presumably lead to embolic events. Outcomes were discussed and numerous technical details were elucidated to improve safety and efficacy of this highly sought after procedure.

Rhinoplasty, known as “the surgery of millimeters,” is among the most technically challenging procedures in aesthetic surgery. Global experts including Drs. Rod Rohrich, Bahman Guyron, Nazim Cerkes, and others presented their approach to rhinoplasty and how to avoid common pitfalls. The vast collective experience of these experts shed light on intricacies of rhinoplasty and how to best approach nasal analysis and operative technique to ensure optimal long term results.

Notably, Dr. Rohrich presented pearls of his approach including numerous techniques and grafts that he has adapted in his extensive rhinoplasty experience to avoid long-term pitfalls. For example, he discussed the frequent use of alar contour grafts to prevent alar retraction as well as the use the “butterfly graft,” which is of the cartilage removed during cephalic trim that perfectly blends the transition from the tip lobule to the alar lobule. Many impressive cases were presented by these international experts with long-term follow-up results.

Beyond the vast surgical education at the meeting, were many opportunities to learn more about the business side of optimal practice management and marketing. Popular sessions included tips for building a social media presence and how to best stay true to one’s mission and practice brand. Social media experts such as Drs. Sheila Nazarian and Karen Horton were among those teaching how to build a loyal following and maintaining ethical practices in social media.

Dr. Erez Dayan is a plastics and surgeon at Harvard who focuses on reconstructive and aesthetic surgery.

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