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4 Letter from the AAFPRS President 6 Letter from the OFPSA President 8 Global:
22
Kuwait:
24
USA:
12
UK:
28
Canada:
14
Turkey:
30
Croatia:
16
Italy:
32
Germany:
18
Egypt:
34
Poland:
20
Iran:
36
Latin America:
Putting Passion To Use
Keeping It Close To Their Chest An Educational Approach to Beauty Beauty & Aesthetic Values in the 21st Century Beauty That Transcends Time The Rhinoplasty Capital
Enhancing the Already Beautiful Patient Thinking is Inefficient Facial Beauty in the 21st Century & Beyond Paradise on Earth Undeniable Trends Aesthetic + Function Facial Plastic Surgery 3
On behalf of Ms. Tracy Drumm, President of the OFPSA, and me, we would like to invite you to join us in September in Washington, D.C. for the AAFPRS annual Fall meeting. Ms. Drumm and her organizing committee has assembled an outstanding program filled with timely and informative panel discussions along with captivating keynote speakers. This is an event not to be missed and we both look forward to welcoming you to our nation’s capital next month for our Academy’s 47th meeting. 4 FALL 2012 / OFPSA
Concepts of beauty will be explored by our John Conley Lectureship speaker at the Fall meeting. Presented jointly as part of both the OFPSA and AAFPRS programs, this lecture will be given by Nancy Etcoff, PhD, author of “Survival of the Prettiest.” In addition to being an internationally renowned authority on beauty and perception, she is also a psychologist and faculty member of the Harvard Medical School and directs the Program in Aesthetics and Well Being at the Massachusetts General Hospital Department of Psychiatry. She conducts research on the perception of beauty, emotion and the brain, and served as our well-received Conley speaker in 2005. The focus of this current issue is on the globalization of beauty, with contributors from around the globe. Beauty abounds all around us. As we are aware, both the human form and human face can possess profound beauty. Our goal as facial plastic surgeons is devoted to helping each and every one of our patients to better align their inner concepts of self-beauty with their outer physical appearance. However, the human form and human face, especially when considered globally, can present itself in a bewildering multitude of shapes, sizes, colors, textures and other variations. These variations are filtered through the perceptions, tastes and cultural preferences of the observer, ultimately leading to the sense and appreciation of beauty. Of course, given such tremendous diversity, beauty is found in the eye of the beholder.
Tom D. Wang, MD, FACS President of AAFPRS Oregon Health & Science University 503.494.5678
It is certainly true that beauty may be dictated by the places we live in, the cultures we are a part of, and the traditions we follow. But with the ever-widening influences of globalization, our collective senses of what is beautiful and what is desirable may also be merging towards a more homogenous “middle-ground.” These and many other fascinating areas related to the globalization of beauty will be explored in greater depth within the rest of this issue. Enjoy and see you in Washington, D.C.! 5
I have always enjoyed the saying that you must look within for values, but must look beyond for perspective. Being from a small Midwest town of roughly 15,000 my childhood perspective reached the depths of the bull pens surrounding my neighborhood. Perhaps as a result of these limiting borders, I have a deep-rooted love of adventure, foreign environments and an appreciation for new cultures. Over the past two years working with the AAFPRS leadership team and the over 300 OFPSA members nationwide, my perspective of this great specialty has been drastically broadened. A surprising side effect of my many interactions within the “culture� of this society is an appreciation for the differences and similarities that truly make facial plastic surgery unique. 6 FALL 2012 / OFPSA
When taking over as president in 2010 I relied on my experiences abroad and remembered the way to adapt to a new environment is to listen. By listening to members from practices of all shapes and sizes, my mind was opened to a rather sophomoric revelation. It was the simple notion that every practice is not like ours! This lesson has served as my compass over the past two years. Working with practices from coast-to-coast, I quickly learned that both the AAFPRS and the OFPSA are in fact their own communities. Much like any culture, we speak our own language and often have shared characteristics and pasts. The two groups offer an environment that transforms strangers into allies through commonalities and an appreciation of our differences. It is for these reasons that we have chosen to devote the
last OFPSA digital magazine of 2012 to one that truly embodies a “global perspective� of aesthetics. With facial plastic surgeons from all over the world contributing to this publication, the magazine offers diversified perspectives of beauty and global progress. Through the following articles, you will have the ability to travel around the world in under 40 pages.
Tracy L. Drum
m
PSA President of OF Office of n, MD, FACS Steven H. Daya 312.335.1700 .com tracy@drdayan
It has been an incredible experience working with the OFPSA for the past two years. My perspective of this great industry has truly been enriched and broadened by working with each of your practices and staff. A very special thank you to Steve Duffy, Rita Chua Magness and Ann Jenne for your dedication to the OFPSA and to our continued growth. Finally, a tremendous thank you to my physician sponsor Dr. Steven Dayan. I am grateful that you have allowed me to devote so much time to an organization that has truly impacted me and for your continued leadership and guidance.
7
An Interview with Medicis By: Stacey Clarke Working in an industry that makes people look beautiful and, more importantly, feel beautiful can be a very fulfilling job. What happens, though, when you feel that pang of guilt, wondering whether you are actually making the world a better place? Most of us think that volunteering in soup kitchens and traveling to Kenya to care for children in need are opportunities that few of us can afford to take. However, President of the country’s leading independent specialty pharmaceutical company, Mark Prygocki, would beg to differ. “What we wanted to do was be able to fund doctors’ and physician assistants’ passions, to help them get out of the bureaucracy that they are in day-to-day,” says the Medicis president. Prygocki’s work site is a model student to philanthropy. When you are a Medicis employee, you are granted with up to 5 days, or 45 hours of paid time off per calendar year to volunteer to a designated 501(c)(3) charitable organization. The Medicis Volunteer Program encourages employees to find something they are passionate about – and actually execute involvement. Such benefits are unheard of in most companies; especially in the aesthetic industry. It’s this extra mile that has earned Medicis a place on the list of Most Ethical Companies, named by the Ethisphere Institute, for two years in a row. 8 FALL 2012 / OFPSA
STACEY CLARKE
Staff Writer Office of Steven H. Dayan, MD, FACS 312.335.1700 stacey@drdayan.com
The only pharmaceutical company to ever make this list, Prygocki considers this quite an honor. However, one particular initiative in 2011 gave them a boost among their peers. Medicis had a vision to find a way to increase access to specialized healthcare in under served communities in the US and abroad. Their vision came to fruition in August of 2011; they called it Passion to Heal. Passion to Heal connects physicians through third party organizations. Medicis provides financial support to these selected charitable organizations which, in turn, underwrite the cost associated with plastic surgeons, dermatologists, facial plastic surgeons, residents, practice managers and other healthcare professionals. The impetus for this project was to find a way to satisfy physicians’ basic need to heal people. As any practice manager knows, there are so many little tedious tasks that bog down the physician on a day to day basis. “We’re helping the doctors get back to the basics of treating people; that’s what they enjoy,” says Prygocki. 9
A sought after specialist such as a facial plastic surgeon is incredibly valuable to thousands of children with facial deformities. People will line up for hours to see these physicians. Just as the patients are eager to be treated, physicians and their staff are equally eager to help. In its current state, Passion to Heal has acquired a wait list. As the program is still in its infancy, the desire to help has surpassed the original avenues to do so. In an effort to never turn volunteers away, Medicis is actively looking to add more third party organizations. “I don’t want it to be perceived that we have too many volunteers. There are millions and millions of people we can help serve with these specialties. We’ll do our best to put the two together,” says Prygocki. As for Prygocki, he sits back astounded by the involvement of his employees in Passion to Heal and other philanthropic efforts. Some spend time on food drives while others devote their attention to the troops overseas. One military veteran put together her own volunteer effort, asking the staff to bring in baskets of gift for the troops. A particular philanthropic operation close to Prygocki’s heart involves goats, horses and a summer getaway for children normally restricted to their hospital beds. The Whispering Hope Ranch helps kids with various diseases to have a camping experience, interacting with animals that don’t care what they look like or feel like. For Mark, one visit to Whispering Hope is all it took to have him hooked. “It’s the expression on their face that keeps me going. It doesn’t take a lot, but we have to do something,” says Prygocki. If you have that same desire to “do something,” visit www.passiontoheal.com, www.whisperinghoperanch.org, or simply look up a local effort that sparks your passion.
10 FALL 2012 / OFPSA
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Mr. Julian Rowe-Jones FRCS (ORL) As told by: Stacey Clarke, OFSPA Staff Writer
The British Approach to Plastic Surgery “Most (British) women are quite secretive about it. They don’t go to a dinner party and discuss their favorite surgeon. They keep it closer to their chest,” says Mr. Rowe-Jones, facial plastic surgeon and one of the most sought after rhinoplasty specialists in the United Kingdom. Internationally recognized for his skill and expertise, Mr. Rowe-Jones regularly publishes articles and texts on nasal plastic surgery as well as lectures worldwide on the topic. Here he shares a British viewpoint on reality TV’s influence on cosmetic surgery, the evolution of the rhinoplasty and the importance of keeping a global perspective. 12 FALL 2012 / OFPSA
Reality television has had a significant impact on consumers in the United Kingdom. Shows like “The Only Way is Essex” showcase women who have recently acquired large amounts of money and have adapted to using cosmetic procedures and beauty products as signs of affluence. They are often the ones influencing people to overdo nonsurgical facial procedures. Conversely, those who invest in facial surgery are looking for a more natural look.
I have a mental choreography to everything I do. Like a sportsman has a particular action prior to the game to get them in the zone…It doesn’t mean that I go through some obsessive compulsive ritual; I have a timeout before I do anything to mentally prepare for it.
Julian Rowe-Jones FRCS (ORL) jrj@thenoseclinic.co.uk
I think that compared to the US, people may still be a bit held back about wanting aesthetic surgery. They sometimes feel uncomfortable that they do want it and worry that people will think they are vain. It is therefore less accepted in the UK and less seen as a positive action towards happiness.
Somebody who shines with confidence, who loves their imperfections as much as their perfections, and can laugh at them with a sense of perspective and proportion. In terms of physical, I think harmony and balance are extremely important. It’s a natural freshness which you can have at 70, as well as at 20.
It’s different than 20 years ago. I am revising people now who already had a rhinoplasty in their late teens and early twenties. These patients may have been initially happy with the result of aggressive reduction, which was more representative of the times. Now, they are coming in their early 40’s wanting their previous rhino to be revised to look more natural. People still want a smaller nose but now understand nasal balance.
It means contributing and sharing ideas and solutions for surgical and psychological patient problems. It means you are not alone with regard to solving difficult surgical problems and that perfection can never be reached. People are slightly more guarded when they discuss with colleagues next door rather than an ocean away. 13
We all live in a world where people are seeking more excellence in their image. This reality is mainly promoted more and more in the media. As facial plastic surgeons, we are in a situation to deal with more demanding patients. Everyday, I see patients seeking a better nose or a younger looking face, but asking for the best result within the shortest time and with the least amount of money. It is not easy for us to explain that there is always a trade-off for what we do. Rhinoplasty is undoubtedly the number one operation in Turkey because in the Mediterranean and Middleeastern world, the noses are quite big while other facial features are nicer. We usually try to make noses smaller by taking the hump and rotating the tip upwards to get rid of droopy tip. In terms of skin thickness, which is one of the most crucial factors in the outcome, we are luckier than our friends from northern Europe and North America, for we have a thicker skinned patient. In order to educate my patients and the Turkish speaking population on rhinoplasty, I recently created a website (www.burnumuz.com) with video clips, questionnaires on patients’ wishes, self-analysis of patients’ noses and a utility to receive pictures. As Turkey is a typical Mediterranean country with a rich supply of sun rays, UV aging is a very big problem. In recent years, in accordance with the trends in the world, we are trying to help our patients with 14 FALL 2012 / OFPSA
non-surgical rejuvenation techniques, such as botulinum toxin A or filler applications. I find these applications very useful because they help me to establish a bridge with my patient and an earned trust. In Europe, the main body for making regulations on education of Ear-NoseThroat diseases is UEMS-ENT (European Union for Medical SpecialistsEar-Nose-Throat section). This group has two representatives from each country. Facial Plastic Surgery is accepted as one of the 5 major subspecialities. In Turkey, the number of young Ear-Nose-Throat specialists having a major interest in facial plastic surgery is increasing every day. This gives us the opportunity to better educate our residents and increase the quality of service to our patients. As Turkish facial plastic surgeons, we are also very happy to take part in educational activities of facial plastic surgery throughout the world. By sharing our expertise and ideas with our colleagues, we can be more helpful to our patients. I believe that without continuous education, we cannot be happy with ourselves and with our services to our patients.
in, MD Fazil Apayd ail.com
fazil.apaydin
@gm
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An Italian Perspective Evidence for man’s obsession with beauty and maintenance of aesthetic values can be traced to the earliest cave drawings and “primitive” art such as the Venus of Willendorf. As far back as 27,000 years ago, human beings had decided that exaggeration of secondary sexual characteristics were desirable and had a quasi-religious significance. With the exception of ancient Egyptian art and its formulaic approach to the human form, this trend has formed the basis of what has been considered “beautiful” in many western cultures. Here, the depiction of physical perfection found a new level of excellence in the visual arts. With the advent of intercontinental travel, these values spread to the rest of the World. However, mass migration and cultural exchange in the 20th and 21st Centuries have led to a fundamental change in our idea of what can be considered beautiful. Our aesthetic criteria are no longer defined by rigid European dogma. Indeed, many countries around the world now consist of such a tangled mixture of races, colours, and textures, that it may seem impossible to apply a single set of aesthetic criteria in patient assessment and counselling.
Pietro Palma, MD info@pietropalma.it www.pietropalma.it 16 FALL 2012 / OFPSA
Despite the influences of fashion, culture, race, and even politics, the aesthetic surgeon can utilise several fundamental rules in the aesthetic assessment of his or her patients. There is no point in measuring every single angle and line described in morphometric texts. Instead the surgeon should concentrate on the patient’s wishes, and whether these changes can be achieved with technical expertise and long-term safety. Computer technology such as basic facial analysis and “morphing” software form the basis of a gentle, but frank discussion with the patient should not be used to promise a certain result with absolute
certainty. The standards of facial aesthetic proportions must not form a rigid mould for patients to fit into. The experienced aesthetic surgeon will consider each patient’s desires and requirements based on an individualistic approach. No face is absolutely perfect. Patients need to appreciate that many of the world’s most beautiful people have imperfections. Indeed, a faultless face looks odd, with an alien quality. Although the surgeon may make a note of these imperfections, the patient’s attention is not drawn directly to this list as it may be misconstrued as confrontational. At times, patients are not aware of a single problem, such as a hypoplastic chin, a receding hairline, or facial asymmetry, that may require attention, and improve the final outcome. In these cases, the surgeon may suggest additional procedures such as a chin implant to enhance the result beyond the patient’s expectations. These discussions need to be carried out with utmost sensitivity, as the facial aesthetic patient has had many years to peruse his or her own face, develop deepseated psychological reactions to these thoughts, and develop a list of expectations that may or may not be realistic or achievable.
Our understanding of the human face in the 21st Century is increasing at an exponential rate, and while we struggle to keep up with these scientific and technological advances in surgery, the bulls eye of facial aesthetics remains unchanged: the satisfied, and happy patient. This can only be achieved if the surgeon considers the whole patient, the entire face, and develops a workable and fluid sense of what can be considered as “beautiful.” 17
The concepts of beauty were an integral part of ancient Egyptian society. Cosmetic implements, anti-wrinkle creams, facial skin resurfacing, nasal plastic and reconstructive surgery, this all sounds pretty modern, yet all of the above were all concerns and creation of ancient Egyptians. Their preoccupation with achieving and preserving eternal beauty was traced in their papyri. The Edwin Smith Papyrus is one of the world’s oldest surviving surgical documents and written in hieratic script in ancient Egypt around 1600 B.C. It documented Egypt’s great interest and concern in beauty that transcends time and is not restricted to a specific period.
Dr. A. Walaa Abou sheleib, MD,MSc ENT, Facial Plastic Surgery wala2shleib@hotmail.com
18 FALL 2012 / OFPSA
Nowadays it’s elsewhere in the world. The majority who seek facial plastic surgery procedures in Egypt are female patients. Cosmetic surgery of the face is no longer a luxury reserved for the wealthy, elite and famous.
Cosmetic facial surgery that improves self-esteem among the rich and wealthy can now mean much more to the middle class and poor people. It could boost their marriage, boost their job prospects and help them in finding a better career; even the illiterate house wife may seek surgical cosmetic procedures for a better appearance. Facial plastic surgery in Egypt, though expensive by local standards, is relatively inexpensive if compared to USA and Europe. The rich can afford the price for such procedures whether in Egypt or even abroad; those who cannot afford the surgery costs usually go to governmental hospitals with no charge or have their surgery paid for by charitable donations. Others carry out their surgery through private surgeons with reduced costs. Governmental hospitals often perform cosmetic surgery for reduced cost or even at no charge to ensure the trainee staff gains good experience and international recognition. The increasing rate of the middle class and poor people requiring cosmetic surgeries is boosting the experience of Egyptian facial cosmetic surgeons and lowering the cost of surgeries. Egypt has emerged as a destination for medical tourism, especially for cosmetic surgery. This is a result of an increase in well-trained, experienced cosmetic surgeons with western qualifications from Europe and USA, in addition to the wide array of clinics and hospitals offering world-class medical services. Medical tourism in Egypt is not just confined to invasive medical procedures; you can also go for therapeutic medical tourism and come back rejuvenated from the mineral and sulfur rich springs and healing black sands. The high standards in cosmetic surgery coupled with low prices have made Egypt a preferred medical tourism destination where people can combine medical treatment along with a cultural or seaside vacation.
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According to an Iranian religious belief: “God is beautiful and He likes beauty.” There is some tendency in all human beings’ nature towards beauty; Iranians are no exception to this rule, so much so that cosmetic operations are among Iran’s most common operations. The widespread application of the rhinoplasty in Iran is to the extent that one could facilely call Iran “the capital of the world’s rhinoplasty operation.”
nasal tip, a Dorsal Nasal Hump and thick skin. When you make a journey to the historical masonry monument of Persepolis, dating 2500 years back, this nose shape is evident on stone statues of ancient Iranian kings’. Most Iranians wish to remove their noses’ misshape so that they can create full harmony among their faces’ components. During recent years, the skill and ability of Iranian plastic surgeons has shown considerable increase.
When you travel to Iranian metropolitan areas, you will come across people with surgical tapes on their noses as a result of the rhinoplasty. The majority of patients tend to keep the tapes on their noses much longer than necessary (up to several months) for the sake of showing off their having gone under rhinoplasty operation in public!
Iranian clothing has also had an impact on cosmetic surgery. Iranian religious civic law requires the clothing by women uncover only part of the face and neck. It seems probable that women’s clothing type contributes to making rhinoplasties even more prevalent in the country.
The Iranian race holds specific facial attraction to a very high level. The attraction appears most evident around the eyes, eyebrows and lips. Classical Iranian poetry often refers to this special attraction. However, the noses’ shape is often not in good harmony with other components of the face. The Iranian nose is typically large with a droopy 20 FALL 2012 / OFPSA
Most Iranians are under the belief that older people have no reason for facial cosmetic surgical operations! For this reason, face-lifting operations are small in Iran and most patients are under the age of 40. Yet this mistaken belief is losing its authority every day, and the number of elderly patients for cosmetic surgical operations has been on the increase in recent years.
The Iranian plastic surgery patient’s expectations are set very high. Unfortunately, many patients are beginning to get addicted to cosmetic treatment and set unreasonable expectations for the surgeons. It is socially acceptable in Iran for one to comment on another’s appearance as the result of surgery. These very remarks by a patient’s relations make patient satisfaction more difficult than any other area of the world. The costs for facial cosmetic surgical operations in Iran are much lower compared to other countries. During the summer time, we witness a large number of referents as patients from countries other than Iran carry out facial cosmetic surgical operations. Tourists are drawn to the country after hearing of the high success rate of surgery for a low cost.
Seyed Alireza Mesbahi, MD contact@drmesbahi.com www.drmesbahi.com 21
In Kuwait, a growing number of people are looking to facial plastic surgeons for a change in appearance. With increasing globalization and development of new techniques and procedures, the demand for cosmetic products, procedures and services has been increasing positively over the past few years and is being driven by high disposable incomes, new sales channels and a growing lifestyle trend among both men and women in terms of plastic surgery, personal fitness and body care. When you peek into the culture in Kuwait, you will find that there is an amalgamation of the old and the new, conservatism and modernism, tradition and creativity; this diversity can add significant challenges to aesthetic rejuvenation procedures, since patients’ goals can vary significantly depending on their backgrounds, social requirements, and cultural expectations. 22 FALL 2012 / OFPSA
Kuwaiti patients have the same concerns as all Middle Eastern patients seeking facial cosmetic procedures. They are greatly concerned with small and fine details, and they can’t accept anything other than exceptional and perfect outcomes - to the extent that even minor changes from the expected can be worrisome problems. From this comes the importance of the initial preoperative consultation as it allows the surgeon to better understand the patient’s goals, concerns and motivations. For such patients who tend to be “perfectionists” the use of preoperative patient imaging software is very helpful in achieving a common base between the surgeon and the patient away from unrealistic expectations, giving a clear decision and plan of what could be done. Rhinoplasty is the most popular in facial plastic surgery and most Rhinoplasty patients have one overriding concern: preserving ethnic facial features while gaining a natural, cute nose which is accepted by the community. Kuwaiti females adore beauty and search for beauty everywhere. Cosmetic surgical procedures are appreciated by husbands and by Kuwaiti society; this is why Kuwaiti women love plastic surgery and can easily become addicted. The popularity of facial plastic surgery in Kuwait and the millions of dollars spent every year on cosmetics and beauty is not surprising because the Arab women are considered one of the most beautiful female populations in the world and through years they have been renowned for their attractiveness and grace. It is our job to preserve and enhance that natural beauty through our procedures.
Dr. Khalid H
. AL- S
ebeih MD, FRCSC, F A CS Facial Plastic Surger y Cons ultant Canadian Me dical Center, Kuwait kalseb@kuw aitcmc.com
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Beauty is not only the universal language connecting humans across all cultures, but also the universal language connecting all living species. It is the vehicle that allows a banana to message a primate it is ripe, as well as a daffodil to solicit a bee for pollination. In humans, perceiving beauty is tucked away in the deepest corners of an evolutionary preserved portion of our brains. It is here that we appreciate, recognize and value beauty. Three centuries before Christ enlightened, Greek philosopher Plato equated beauty with all that is good. Beauty is the lubricant leading to procreation, and it very well may be the rawest of energies fueling evolution.
24 FALL 2012 / OFPSA
But don’t mistake beauty with attractiveness. While related, they are two very distinct entities. Beautiful can be unattractive, and attractive can be ugly. Look no further than 1985’s sexiest man Mel Gibson yelling distasteful profanities or Picasso’s engaging but disturbing Guernican or Joshua Bell’s melodic violin sonnets unappreciated in the Washington subway. All can be perceived beautiful or irreproachable depending on the relative environment. To be attractive requires two parts: a form to project beauty and a second being to receive it as beautiful. But in the cognitively complex human, the manner in which the beauty is projected is highly dependent on the projector feeling beautiful. Here in lies the hurdle: To feel beautiful and to project beauty takes effort and work; it is not just a given. True to all forms of human advancement, feeling beautiful requires energy to be expended in order to achieve meaningful accomplishment. From thinking, to exercise, to communication, all require purposeful work and effort. While we are designed to conserve ATP’s, rationing them for activities dedicated to survival, our ability to purposefully work toward a goal also provides us with our most valuable rewards. It is through creative muscle, reasoning and ingenuity that human advancement both individually and collectively occur. Paradoxically, in our post-modern world where food and shelter is readily available for most, modernizing advancement seem to be focused on increasing measures to take away the privilege and subsequent rewards gained to those who work hard for something. 25
Egyptian math abacuses, to calculators, to super computers reduces our ability to rapidly problem solve. Walking, to moving sidewalks and personal scooters reduces exercise for our muscles. Poetic letter writing, to abbreviating emails, to texting acronyms is mutating our ability to communicate. Blind fix ups, to speed dating, to online match sights reduces our investment into first encounters. Is beauty following the same path of “do it for me?� The media often portrays beauty as an effortless quick fix only a magic pill, potion or procedure away. But, if we take away the ability to conquer, achieve or taste victory, are we destined to have a generation of patients that are just going to assume we can deliver them beauty? 26 FALL 2012 / OFPSA
In a “me too” generation of give me, feed me and entertain me, conventional wisdom seems to be defining plastic surgeons as magicians that can wave our needles and knives and instantly transform someone. But unlike a moving sidewalk, we can’t automatically transport someone from being beautiful to feeling beautiful. This takes work on the patient’s part as much as our part. We can give someone a balanced nose, defined eyes or more proportionally sized breasts, but not succeed in making them attractive. While physically beautiful, perhaps they still do not project an attractive image. Projecting beauty requires a commitment to improving the self which necessitates expending of energy. As medicine strays from paternalistic overtones of yesteryear, we must recognize in our post-modern world that our role has evolved toward partners in the process of beauty; not manufacturers. As plastic surgeons it would behoove us to abandon previously held notions that we are gods granting beauty for the vanity challenged. Instead, we are more akin to talented stewards that help our patients achieve attractiveness. For this relationship to be successful it takes equal commitment from both the doctor and the patient. Patients who are committed to enhancing their attractiveness are more likely to achieve success, as are the doctors who choose them. Perhaps we should evaluate human nature within a modern context to better understand the motivations, desires and commitment of our patients. As the world adopts new conveniences, we must learn to adapt to our patients’ communication styles and expectations, hopefully leading us to select more patients that are active participants in their care. Perhaps our training should not only focus on the latest techniques, but also a concerted effort to teach what makes someone feel beautiful and why. The future of our field may depend on it.
Steven H. Dayan,
sd a ya n @ d rd a ya n .c
md, facs
om
27
An Evolutionary View from Canada Facial beauty is a powerful force in the human condition, and as such is surrounded by misunderstandings. Who of us truly believes “Inner beauty is more important than outer beauty?” Sappho, Plato and Aristotle have reflected on the value of beauty, and yet even today we remain confounded by its complex role in our daily lives. As Aaron Spelling, the late Hollywood producer said, “I can’t define it, but when it walks in the room, I know it.” Mathematically the Phi, or Golden Ratio, represents perfect harmony in nature. Using this ratio of 1:1.618, the human face can be drawn to be perfectly symmetrical and ideally attractive to a potential mate. It is likely our attraction to symmetry has been present throughout the history of human evolution, and those with facial symmetry have a biological advantage in the reproductive sweepstakes of securing a mate. 28 FALL 2012 / OFPSA
Biologically speaking, every person constantly imprints in their minds the facial images of others they see. This composite image created is idealized as the most attractive face, and so we can truly say, “Beauty is in the eye of the beholder.” This averaging mechanism is called koinophilia, and accounts for the fact that we tend to be attracted most to those who are “like us” if we live in a homogeneous culture. However, with the exponential growth in multicultural images we are all exposed to today, we are seeing a “globalization of beauty.” With interracial marriage, international migration, and the electronic connectedness of the global village in which we live, we can expect greater acceptance of a larger number of “attractive” faces in the years ahead.
On the other hand, beauty is imbued upon the person who has one or two facial features that are outside the average range. According to Darwinian Evolutionary Theory, we tend to evolve towards the average; someone who has “non-average” features has a stronger reproductive capability. For females these traits are associated with higher estrogen levels and presumed fertility. These hyper-feminine traits include a thin jaw, small chin, large and wide eyes, small nose, high cheekbones and shorter upper lip. Think of a Barbie doll’s exaggerated feminine features. For men, higher testosterone levels and presumed reproductive capacity are reflected in prominent chins, deep-set eyes, heavy brows and abundant hair. Think of G.I. Joe.
It is well recognized that many other factors affect the beauty expressed by each of us – our voices, pheromones, fashion, cosmetics and personalities included. Our perceptions of beauty are modified by our culture, our peers and the media. It can be stated with confidence that we know much about what makes us beautiful, but we still have much to learn. Beauty is a compelling and powerful force in our daily lives that can create ambivalent feelings in each of us. Our facial appearance is our genetic imprimatur – it silently tells of our past and clearly impacts on our future.
Peter A. Adamson, MD paa@dradamson.com www.dradamson.com www.fabulousfacesbook.com 29
Dr. Ethern Brkovic ethem.brkovic@du.t-com.hr
To Dr. Ethem Brkovic, this quote perfectly describes his home country. As a Plastic Surgeon located in Dubrovnik, Croatia, his days are surrounded by beautiful scenery and beautiful people. “All around the world, beauty is a natural desire of its inhabitants,” says Dr. Brkovic. This statement serves this Plastic Surgeon well. He takes great pride in the beauty of his city. In his eyes, it is the ideal combination of history, beauty and luxury – the perfect ingredients for a successful cosmetic surgery business. 30 FALL 2012 / OFPSA
Not what you would envision most practices to be, his private polyclinic is a beautiful white brick structure, complete with ceiling-to-floor windows and manicured gardens; this clinic also happens to be his home. His staff is small, consisting of himself, two nurses and one anesthesiologist. He is most known for his Rhinoplasty procedures, followed by Otoplasty, Blepharoplasty, Breast Augmentation and Facelift. “Facelifts are not very frequent here. It is the non-surgical procedures like Botox and Restylane that are more requested than any,� says Dr. Brkovic. According to Dr. Brkovic, there are many people are who are still struggling with money as a result of the Croatian war. With non-surgical procedures available, it is becoming more available to those lower income levels. What sets Croatia apart from the rest of the world in the cosmetic surgery industry is the fact that their costs are low, while their caliber of service is still high. Dr. Brkovic reveals the cost of the most popular procedures:
In his eyes, Plastic Surgery in Croatia still has a long way to go to bring itself back to its glory days. He often reminisces about his residency in 1988. He attended a Facial Plastic Surgery meeting in Durbrovnik where famous names like Professor Tary, Professor Gosepath and Professor Padovan attended.
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Holger Gue
ner, M nther Gass
.D.
yngology (ABO r la to O y r e g c Sur Facial Plasti Regensburg l a it p s o H y Universit gmail.com @ r e lg o h r. e n gass ner.eu www.DrGass
32 FALL 2012 / OFPSA
TO)
Facial plastic surgery is continuing to grow and becoming ever more important around the world as well, and Germany is no exception. This rapidly evolving specialty now includes a broad array of procedures and treatments ranging from Botox and filler treatments, to total face transplantation. Many important global trends are reflected in Germany. These include the patient’s growing request for natural, lasting and non-operated appearing results. With an undeniable trend towards injectables and fillers, the patterns of complications and suboptimal results also seem to change. While the unfavorable result 2 to 3 decades ago was associated with an overly lifted appearance, nowadays it is more associated with over-accentuated volume substitution. Descriptors like “tight” and “mask-like” are nowadays being replaced by descriptors like “overly-filled.” It seems to become apparent that the pendulum is slowly swinging back and patients are seeking surgical rejuvenation such as facelift techniques at the appropriate time when skin laxity has become too accentuated and the role of fillers becomes overextended. The increased interest in open and endoscopic face lift procedures is reflected by a number of excellent presentations and contributions at various recognized meetings, including the recent IFFPSS meeting in Rome, the upcoming Regensburg Course in Facial Plastic Surgery in October 2012 or the Milano Master class in 2013. Special emphasis appears to be placed on methods and techniques to optimize the natural-appearing and non-operated result especially in conventional and endoscopic facelift techniques.
33
Norbert G贸rski, MD
info@drgorski.pl www.drgorski.pl
, PhD
Facial plastic surgery is becoming increasingly popular in Poland. This is a new specialty - until now most facial plastic surgery treatments have been performed by general plastic surgeons. Minimally invasive procedures are preferred choices, due to the fact that they do not require a large surgical intervention. A return to full functionality (the recovery time) is quite short, the prices of treatments are more affordable, and the results are satisfactory. Botulinum toxin is popular especially among women aged 30 to 40. Lip augmentation, volume-restoring injections, and wrinkle smoothing fillers are very popular among other minimally invasive treatments methods that correct the changes that accompany the aging processes of the skin and tissues of the face. 34 FALL 2012 / OFPSA
The most common among surgeries is rhinoplasty. The number of people who want to change the look of their noses to create a more classical and regular shape is on the rise. Most people who undergo rhinoplasty are guided by aesthetic concerns; this is for several reasons. One is the subjective satisfaction in regards to the appearance of their noses. Another is the desire to have an attractive appearance, which according to many people is the key for success in many areas of life. Patients feel they will have a better chance of landing a good job, networking relationships, and being seen as attractive and confident individuals.
The reasons for which patients decide to undergo surgery are often of an aesthetic nature, but these are not the only reasons for conducting such operations. Treatments combining function and aesthetics are at the frontier of the facial plastic surgery and ENT specialties. One of these procedures is the combination of functional septoplasty and aesthetic rhinoplasty. Patients often undergo this treatment for medical reasons that arise from the disease within the nasal cavity. Curvature of the nasal septum often causes impairment of normal gas exchange and causes discomfort and reduced quality of life. At the same time,there is quite an aesthetic advantage resulting from the effect of this treatment in improvement of the external appearance of the nose. Treatments involving grafting the patient’s own body fat are more and more popular in Poland. Patients usually give several reasons for choosing this procedure. Fat grafting is minimally invasive and very effective. After the surgery, which usually lasts for half an hour, patient can leave the clinic. The results of surgery such as lip augmentation with the patient’s own fat are long-lasting. There are treatments which are of little interest in Poland, for instance facelifts. This is due to financial reasons. Patients who are the natural recipients of such treatments are usually retired patients who do not have enough funds to pay for the surgery. Therefore, it becomes unattainable for many people. The largest groups of recipients of plastic surgery procedures are women aged 30-40 years. The elderly, despite the desire and even need for such procedures, cannot afford them because of financial aspects. Most of the procedures in the field of facial plastic surgery are not financed by the Polish National Health Fund. 35
Latin America has become a continent that is developing quickly. The standard of living of the population has improved, bringing greater opportunities to afford cosmetic procedures. The old saying “the only unattractive patients are poor patients” has fallen out of use, and cosmetic surgery is no longer a privilege of the wealthy. It has become available to all people resulting in an increase in the number of facial plastic procedures that are performed. Standards of beauty vary depending on ethnic, cultural and religious backgrounds. Latin American patients are the result of a mixture of races and ethnic groups that really vary depending on the geographical zone where they originated. Long gone is the “ideal beautiful Caucasian standard”. Most of the patients seen are mixed-race patients or “mestizo” patients. Patients are searching for ways of looking better without losing their ethnic and cultural identities, while trying to accommodate their “new” identities to what is considered beautiful.
Roxana Cobo, MD Cirugía Plástica Facial Otorrinolaringología rcobo@imbanaco.com.co 36 FALL 2012 / OFPSA
In Latin America, facial plastic procedures are mainly performed by general plastic surgeons, otolaryngologists, and facial plastic surgeons. However, cosmetic surgeons, cosmetic doctors, dermatologists, cosmetologists, and other health personnel sometimes perform them too. Rhinoplasty is still the most common facial plastic surgery that is done, but other facial rejuvenation surgeries and minimally invasive procedures have become important areas to cover in the field. The fact is that treating multi-ethnic patients from different socioeconomic levels can be a challenge. It is not unusual to find that the latest technology is not necessarily available and that cost is an issue. Innovative, low-cost techniques with low complication rates and excellent results are widely sought after by patients. Not everything that is available is FDA approved. The big question is: is it safe and reliable? Does the
professional have the qualifications to perform what he is offering? Does the establishment where the procedure is going to be performed comply with all safety issues? What is the experience in that particular technique?
Education and proper training for all personnel who perform facial plastic procedures is essential. Facial Plastic Surgery is becoming a mandatory area of training in Otolaryngology programs around Latin America, and has evolved to become a formal subspecialty in countries like Colombia, Mexico and Brazil. It is imperative to be adequately trained and use the appropriate devices when performing cosmetic procedures on patients. Communications today bombard patients with information that is not necessarily real. In the end, it is the patient who decides where and what procedure he/she wants and who it will be performed by. Our responsibility as leaders in the field is to inform and increase public awareness on what is being offered and to train specialists and allied personnel in performing these new surgical and non surgical techniques. The final objective is to obtain good, consistent post-surgical or post therapy results, with minimal complication rates and good cosmetic outcomes. 37
For questions or to submit ideas for the next magazine, please contact: TRACY DRUMM OFPSA PRESIDENT 312.335.1700 OR TRACY@DRDAYAN.COM
MARCY SIMPSON OFPSA MEMBERSHIP COORDINATOR 319.356.3600 OR MARCY-SIMPSON@UIOWA.EDU
Designed by: ifmark.com • info@ifmark.com Articles or presentations signed by their authors express the views of those authors only and do not necessarily express official policy of the Academy and the OFPSA. The Academy does not necessarily endorse the products, programs, and services that appear in paid, non-AAFPRS, non-OFPSA advertisements. 38 FALL 2012 / OFPSA