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16th Annual Dallas Cosmetic Surgery Symposium Recent Advances in Cosmetic Facial and Breast Surgery Wednesday-Thursday March 6-7, 2013 Westin Galleria Dallas, Texas • Hands-on Learning With The Experts Using Fresh Cadaver Dissections in Advanced Techniques in Facelifting, Brow and Eyelid Surgery • Learn Breast Augmentation Using Fat Grafting and Use of New Shaped Implants • Advanced Neuromodulator and Fillers Live Demonstration Course (Botulinum Toxin Type A and Fillers) Sponsored by UT Southwestern Department of Plastic Surgery and the Office of Continuing Medical Education Program details and registration available at: www.dallascosmeticsymposium.com

MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

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Page 1: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

SYMPOSIUM CO-CHAIRMEN

Rod J. Rohrich, M.D.Professor and Chairman, Department of Plastic Surgery; Crystal Charity Ball Distinguished Chair in Plastic Surgery; Betty and Warren Woodward Chair in Plastic and Reconstructive Surgery, UT Southwestern Medical Center, Dallas, Texas

Jeffrey M. Kenkel, M.D.Professor and Vice-Chairman, Department of Plastic SurgeryUT Southwestern Medical Center, Dallas, Texas

NONPROFIT ORG.U.S. POSTAGE

PAIDDALLAS, TEXAS

PERMIT NO.2993

16th Annual

Dallas Cosmetic Surgery SymposiumRecent Advances in Cosmetic Facial and Breast Surgery

Not printed or mailed at State expenseTime Sensitive Material

16thAnnualDallas Cosmetic Surgery Symposium

Office of Continuing Medical Education5323 Harry Hines Blvd.Dallas, Texas 75390-9059

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Program details and registrationavailable at:

www.dallascosmeticsymposium.comor call 214-648-3138

Wednesday-ThursdayMarch 6-7, 2013

Westin GalleriaDallas, Texas

• Hands-on Learning With The Experts Using Fresh Cadaver Dissections in Advanced Techniques in Facelifting, Brow and Eyelid Surgery

• Learn Breast Augmentation Using Fat Grafting and Use of New Shaped Implants

• Advanced Neuromodulator and Fillers Live Demonstration Course(Botulinum Toxin Type A and Fillers)

Sponsored byUT Southwestern Department of Plastic Surgeryand the Office of Continuing Medical Education

Program details and registration available at:

www.dallascosmeticsymposium.com

16th Annual

Dallas Cosmetic Surgery

SymposiumEmerging Role of Fat in Breast

and Facial Surgery

Wednesday-ThursdayMarch 6-7, 2013

Westin GalleriaDallas, Texas

• Hands-on Learning With The Experts Using Fresh Cadaver Dissections in Advanced Techniques in Facelifting, Brow and Eyelid Surgery

• Learn Breast Augmentation Using Fat Grafting and Use of New Shaped Implants

• Advanced Neuromodulator and Fillers Live Demonstration Course(Botulinum Toxin Type A and Fillers)

Page 2: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

Who Should AttendPhysicians interested in learning the latest innovations and advancesin surgical and nonsurgical facial rejuvenation, as well as breastand body contouring surgery.

Purpose and ContentAttendees will become familiar with the latest techniques and advances in cosmetic surgery. The focus will be on controversiesand advances in facial, breast and body contouring procedures including the use of fat for augmenting the face, breast and buttock. A live demonstration of the use of injectables, includingnew products on the market, will allow for a broad overview ofproducts, facial analysis, and technique. An optional cadavercourse will be available to highlight the surgical techniques described.

Educational ObjectivesAt the end of the program, the attendees should be able to:n Discuss surgical and nonsurgical options for face and eyelidn Discuss the differences in the various agents available for soft tissue augmentation n Describe advanced techniques utilizing Botulinum Toxin Type A and soft tissue fillers for facial enhancement n Discuss new implant options for breast augmentation and breast shaping using new breast lift techniquesn Describe methods to enhance survival of autologous fat in cosmetic and reconstructive breast and facial surgery n Discuss the use of fat grafting to enhance the face, breast and buttockn Provide a “hands on” tool to practice the techniques discussed in a cadaver model

RegistrationRefer to registration form for fee schedule.

Registration fee includes continental breakfasts, breaks, lunches, andThursday evening snacks for the lab participants. Anatomy lab participants will also receive a facial anatomy dissection DVD duringregistration at the hotel. Registration for the anatomy lab is limitedand will be taken on a first-come, first-served basis. Please do notmake travel reservations unless your registration has been confirmed.

Included with the registration for the Dallas Cosmetic Surgery Symposium is the “Advances in Cosmetic Medicine/Hot Topics inCosmetic Surgery” course. If not registering for the Dallas CosmeticSurgery Symposium, a registration fee of $450 UT SouthwesternAlumni / $500 Non-Alumni will be charged for the additional course.(See insert for details)

Checks should be made payable to: UT Southwestern / CME and mailed to: UT Southwestern, Office of Continuing Medical Education, 5323 Harry Hines Blvd., Dallas, TX 75390-9059.

16th Annual Dallas Cosmetic Surgery SymposiumFirst Name Middle Initial Last Name

Degree Last four Digits of SS#

Address

City State Country Postal Code

Business Phone Fax � UT Southwestern Alumni

Email

o Check here to receive our free monthly email calendar of upcoming educational programs.Please indicate preferred method to receive registration confirmation: o Email o Fax o Mail

Registration Fees (U.S. Funds Only):Method of payment:

� MASTERCARD � VISA

Card # � � � � � � � � � � � � � � � � � � � Exp. Date Security Code Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

� AMEX

Card # � � � � � � � � � � � � � � � � � � � Exp. Date Security Code

Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

� CHECK Make payable to: UT SOUTHWESTERN / CME

Complete and return registration to: UT Southwestern Office of Continuing Medical Education 5323 Harry Hines BoulevardDallas, Texas 75390-9059or Fax 214-648-4804

R E G I S T R AT I O N F O RM16th Annual Dallas Cosmetic Surgery Symposium

March 6-7, 2013 #RP1303A

Anatomy lab participants will receive an anatomic facial dissection in DVD format during registration at the hotel. DVDs from previous courses will be available for purchase at the symposium, or you may purchase the DVDs at www.utsouthwestern.edu/plasticsurgerysymposia. Each station will have 3 participants, if you would like to request to be placed with a certain group, please list their names here. ___________________________________________________________

___________________________________________________________

*Registration form must be accompanied by letter from department chair or program director.

Instruments to BringParticipants registering for the cosmetic surgery laboratory will be required to bring the following instruments:

Surgical gown or scrub suit Marking pens (2)Mask 10 cc syringes (2)3 and 4-0 nylon sutures (6 of each) 25 gauge needles (4)Straight facelift scissors Centimeter ruler and/or calipersCurved facelift scissors Needle holder#10 blades (4) Iris scissors #15 blades (4) Brown-Adson forcepsDouble Skin Hooks (2) Penlight Single Skin Hooks (2) 1” 30g needles (5)Small facelift retractor 1 1/2” 25g needles (5)Rake Refractor Long periosteal elevatorStapler Long grasping forceps4-0 Merilene suture Takahashi forceps

This course provides 20 hours of educational content.

This course is not approved for AMA PRA Category 1 Credit™.

Register for Dallas Cosmetic Surgery Symposium and theDallas Rhinoplasty Symposium and receive a reducedregistration fees for both courses.

Register online:www.dallascosmeticsymposium.com

Cancellation PolicyThe Office of Continuing Medical Education reserves the right to limitregistration and cancel courses, no less than one week prior to thecourse, should circumstances make this necessary.

Refund PolicyA handling fee of $200 for the Cosmetic Symposium will be deducted from cancellation refunds. Refund requests must be received by mail or fax prior to February 28, 2013. No refunds will bemade thereafter.

ENDORSED BY: The American Society for Aesthetic Plastic Surgery, Inc.

This program has been reviewed by the EducationalCouncil and is officially Endorsed by the International Society of Aesthetic Plastic Surgery (ISAPS). Endorsement is not approval for Continuing MedicalEducation (CME) credit. The organizers may at their dis-cretion provide separate CME credit.

PHYSICIANS (WITH ANATOMY LAB) $1275 $1175 PHYSICIANS (WITHOUT ANATOMY LAB) $ 775 $ 675 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHANATOMY LAB) $1025 $ 925 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHOUTANATOMY LAB) $ 675 $ 575 *RESIDENTS (WITH ANATOMY LAB) $ 725 $ 625 *RESIDENTS (WITHOUT ANATOMY LAB) $ 375 $ 325

PHYSICIANS (WITH ANATOMY LAB) $1325 $1225 PHYSICIANS (WITHOUT ANATOMY LAB) $ 825 $ 725 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHANATOMY LAB) $1075 $ 975 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHOUTANATOMY LAB) $ 725 $ 625 *RESIDENTS (WITH ANATOMY LAB) $ 775 $ 675 *RESIDENTS (WITHOUT ANATOMY LAB) $ 425 $ 375

REGISTRATION FEES - Early-Bird (Before Jan 1)

REGISTRATION FEES - Effective Jan 1

REGISTERING FOR DALLAS COSMETICSURGERY SYMPOSIUM ONLY

REDUCED RATE IF REGISTERED FORDALLAS RHINOPLASTY SYMPOSIUM

REGISTERING FOR DALLAS COSMETICSURGERY SYMPOSIUM ONLY

REDUCED RATE IF REGISTERED FORDALLAS RHINOPLASTY SYMPOSIUM

ADA Statement� Please check this box if you require assistance because of a disabilityto make this program accessible to you. Someone from our office willbe in touch with you.

�Refund PolicyA handling fee of $200 for the Cosmetic Surgery Symposium will be deducted from cancellation refunds. Refund requestsmust be received by mail or fax prior to February 28, 2013. No refunds will be made thereafter.

THE AMERICAN SOCIETY FORAESTHETIC PLASTIC SURGERY, INC.

®

Page 3: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

AccommodationsA block of rooms is being held at the Westin Galleria for this meeting.To assure your reservation, please call the number below and identifyyourself as a participant in the UT Southwestern Dallas RhinoplastySymposium to be eligible for the group rate listed. Reservations received after Monday, February 15, 2013 are subject to space andgroup rate availability.

Westin Galleria Dallas13340 Dallas PkwyDallas, TX 75240(972) 934-9494Rate: $189 (Single/Double)

On-line reservations:www.starwoodmeeting.com/Book/UTSW30thAnnualDallasRhinoplastySymposium

InformationFor additional information, please call The Office of Continuing Medical Education, 214-648-3138, 1-800-688-8678, fax 214-648-2317, or email [email protected]

Information on other UT Southwestern programs can be obtained by accessing the Office of Continuing Medical Education’s homepage at: http://www.utsouthwestern.edu/cme

For a free email subscription of The Office of Continuing MedicalEducation’s monthly calendar, send your name, medical specialty,and current email address to: [email protected]

Exploring DallasThe Dallas Convention and Visitor’s Bureau can provide information regarding arts and culture, dining, entertainment areas, event calendar, shopping, sights/attractions, and sports. Please contact the Bureau at www.visitdallas.com

www.dallascosmeticsymposium.com

In Conjunction with the30th AnnualDallas RhinoplastySymposium

(includes Fresh Rhinoplasty Cadaver Dissection)

March 8-10, 2013Westin Galleria • Dallas, Texas

Course Chairmen:

Jack P. Gunter, M.D. and Rod J. Rohrich, M.D

Register for both courses at a reduced rate!

For Information:The Office of Continuing Medical Education

214-648-3138; 1-800-688-8678; Fax: 214-648-2317 www.dallasrhinoplastysymposium.com

www.utsouthwestern.edu/cme

Symposium Locations

Westin GalleriaDidactic Sessions:Westin Galleria Dallas13340 Dallas PkwyDallas, TX 75240(972) 934-9494www.thewestingalleriadallas.com

UT Southwestern Medical CenterThursday AfternoonLaboratory Session:UT Southwestern Medical CenterAnatomy Laboratory, Room L1.1445323 Harry Hines BoulevardDallas, Texas 75390

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Symposium Co-ChairmenRod J. Rohrich, M.D. Professor and Chairman, Department of Plastic SurgeryThe University of Texas Southwestern Medical Center Dallas, Texas

Jeffrey M. Kenkel, M.D. Professor and Vice-Chairman, Department of Plastic SurgeryThe University of Texas Southwestern Medical Center Dallas, Texas

Guest FacultyJamil Ahmad, M.D., F.R.C.S.C.The Plastic Surgery ClinicMississauga, Ontario, Canada

Steven Fagien, M.D. Private Practice Boca Raton, Florida

Bahman Guyuron, M.D. Chair, Department of Plastic SurgeryUniversity Hospitals Case Medical CenterKiehn-DesPrez Professor, Department of Plastic SurgeryCase Western Reserve UniversityCleveland, Ohio

Roger K. Khouri, M.D. Private PracticeMiami Breast CenterMiami, Florida

Val Lambros, M.D.Assistant Clinical ProfessorDepartment of Plastic Surgery University of California at Irvine Irvine, California Private Practice Newport Beach, California

Frank Lista, M.D. The Plastic Surgery ClinicMississauga, Ontario, Canada

Louis L. Strock, M.D. Private PracticeFort Worth, Texas

Michael R. Schwartz, M.D. Private PracticeWestlake Village, California

James M. Stuzin, M.D. Chairman of Baker Gordon Symposium on Cosmetic SurgeryAssistant Professor of Surgery (Plastic)The University of Miami, Leonard M. Miller School of MedicineMiami, Florida

UT Southwestern FacultyWilliam P. Adams, Jr., M.D.Clinical Associate Professor, Department of Plastic Surgery

Bardia Amirlak, M.D.Assistant Professor, Department of Plastic Surgery

Fritz E. Barton, Jr., M.D.Professor, Department of Plastic Surgery

William Carpenter, M.D. Clinical Instructor, Department of Plastic Surgery

Suzie Chang, M.D. Associate Instructor, Department of Plastic Surgery

Ricardo Meade, M.D.Clinical Instructor, Department of Plastic Surgery

Joel Pessa, M.D. Associate Professor, Department of Plastic Surgery

Page 4: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

Wednesday, March 6 - Westin Galleria6:30 am Registration & Continental Breakfast

Module I - Emerging Role of Fat in Cosmetic Surgery – What’s Next in Breast and Face Rejuvenation?MODERATOR: Jeffrey Kenkel, M.D.

7:00 am Welcome and Introduction – Jeffrey Kenkel, M.D./Rod J. Rohrich, M.D.

Part I - Evolution of Fat Grafting in Breast Surgery 7:05 am Autologous Fat Grafting for Cosmetic Breast Surgery: Congenital and Secondary Breast Deformities Video – Roger Khouri, M.D.7:35 am ADMs: Which One To Use and Where in Breast Surgery? – Separating Science from Marketing Hype – William Carpenter, M.D.7:50 am Secondary Breast Surgery: Helpful Tips For Challenging Circumstances • Malposition (Strock) • Capsular Contracture (Adams) • Visibility (Carpenter) Moderator: Jeffrey Kenkel, M.D. Panelists: Frank Lista, M.D, William Adams, Jr., M.D., Louis Strock, M.D., William Carpenter, M.D.9:05 am Panel Discussion Moderator: Jeffrey Kenkel, M.D. Panelists: Frank Lista, M.D., Roger Khouri, M.D., William Adams, Jr., M.D., Louis Strock, M.D., William Carpenter, M.D.9:45 am Break / Exhibits

Part II - Using Different Types of Breast Implants – Do They Really Make a Difference? 10:15 am Autologous Fat Transfer in Primary Breast Reconstruction: Indications, Technique and Results – Roger Khouri, M.D.10:35 am Now There Are Three: What are the Differences Among Breast Implants – William Adams, Jr., M.D.10:50 am Form Stable Implants: What Are They and How Are They Different? – Frank Lista, M.D.11:05 am Video – Patient Analysis and Technical Execution: Form Stable Breast Augmentation – William Adams, Jr., M.D.

11:25 am Role of New Shaped Implants in Breast Augmentation (Video) – Michael R. Schwartz, M.D.12:00 pm Long-term Experience with Form Stable Breast Implants: Canadian Experience – Jamil Ahmad, M.D. US Experience – William Adams, Jr., M.D.12:15 pm Panel: Different Implants = Different Results? Moderator: Rod J. Rohrich, M.D. Panelists: William Adams, Jr., M.D., Jeffrey Kenkel, M.D., Frank Lista, M.D., Louis Strock, M.D., Jamil Ahmad, M.D. 12:35 pm Lunch / Exhibits

Part III – Breast Augmentation and Mastopexy - Achieving Safe and Consistent Results1:35 pm Video: Transaxillary Breast Augmentation: Keys to Successful Outcomes Video – Louis Strock, M.D.2:00 pm Breast Augmentation/Mastopexy - Keeping It Safe Video – Rod J. Rohrich, M.D.2:25 pm Personal Approach to Augmentation/Mastopexy – 20 Year Experience Video – Frank Lista, M.D.3:00 pm Breast Shaping After Weight Loss: Clinical Algorithm – Jeffrey Kenkel, M.D.3:20 pm Panel Discussion Moderator: Jamil Ahmad, M.D. Panelists: Louis Strock, M.D., Rod J. Rohrich, M.D., Frank Lista, M.D., William Adams, Jr., M.D., Roger Khouri, M.D., Jeffrey M. Kenkel, M.D. 3:45 pm Break / Exhibits4:15 pm Maximizing Operative Efficiency – Lessons Learned – Frank Lista, M.D.4:45 pm Using Evidence Based Medicine to Dictate VTE Prophylaxis – Jeffrey Kenkel, M.D.

Part IV – Live Use of Advanced Fillers and Botulinum Toxins Type A WorkshopModerator: Jeffrey Kenkel, M.D. & Rod J. Rohrich, M.D.5:15 pm Botulinum Toxins Type A and Fillers – (LIVE DEMONSTRATIONS) – William Adams, Jr., M.D. • Discussion – Performing Pain-Free Fillers - Rod J. Rohrich, M.D. / Steve Fagien, M.D. / James Stuzin, M.D. / Jeffrey Kenkel, M.D.7:15 pm Adjourn

Thursday, March 7 - Westin Galleria6:30 am Continental Breakfast / Exhibits

Module II - Evolving Important Role of Fat in Facial Rejuvenation MODERATOR: Rod J. Rohrich M.D.

Part I – Current Concepts in Periorbital Rejuvenation7:00 am Cosmetic Blepharoplasty – What’s New, What’s In and What’s Out? – Steve Fagien, M.D.7:25 am Advances in Asian Blepharoplasty – Suzie Chang, M.D.7:40 am Role of Periorbital Fillers in Facial Rejuvenation – Val Lambros, M.D.7:50 am Advances in Understanding Fat Compartments in Facial Aging – Joel Pessa, M.D.8:05 am Blending the Eyelid – Cheek Junction – Rod J. Rohrich, M.D.8:20 am Complications of Fat and Fillers in the Periorbital Area – Val Lambros, M.D.8:40 am Panel Discussion Moderator: Rod J. Rohrich, M.D. Panelists: Steve Fagien, M.D., Val Lambros, M.D., Fritz Barton, Jr., M.D., James Stuzin, M.D., Joel Pessa, M.D.

Part II – The Increasing Importance of Volume Restoration in Rhytidectomy9:00 am Why Facial Fat Preservation is Essential in Facelifts – James Stuzin, M.D.9:20 am Role of Fat Grafts in Face and Neck Rejuvenation – Bahman Guyuron, M.D.9:50 am Role of the High SMAS in Facial Augmentation – Fritz Barton, Jr., M.D.10:20 am Break / Exhibits 11:05 am The Lift and Fill Facelift - Role of Deep Malar Fat Compartment Augmentation – Rod J. Rohrich, M.D.11:35 am Rejuvenation Panel - How Fat Works in Facial Rejuvenation Moderator: Rod J. Rohrich, M.D. Val Lambros, M.D., Bahman Guyuron, M.D., Fritz Barton, Jr., M.D., James Stuzin, M.D., Steve Fagien, M.D.12:15 pm Lunch / Exhibits 1:15 pm Non-Surgical Neck Rejuvenation – Jeffrey Kenkel, M.D.1:35 pm Neck Rejuvenation – How I Do It To Be Consistent – Bahman Guyuron, M.D.

1:55 pm A Graduated Approach to Better Necklifts – James Stuzin, M.D.2:15 pm Neck Rejuvenation - Current Strategies and Past Experiences – Fritz Barton, Jr., M.D.2:35 pm Prevent / Managing Neck Lift Complications – Rod J. Rohrich, M.D.2:55 pm Discussion; Q&A Moderator: Rod J. Rohrich, M.D. Panelists: Jeffrey Kenkel, M.D., Bahman Guyuron, M.D., James Stuzin, M.D., Fritz Barton, Jr., M.D., Steve Fagien, M.D., Val Lambros, M.D.

3:30 pm Shuttle to UT Southwestern

Anatomy Lab Participants Only – UT Southwestern Campus Fresh Cadaver Facelift Laboratory Session

Lab Coordinators: Bardia Amirlak, M.D., Rod J. Rohrich, M.D.

4:15 pm Facial Anatomy – What You Really Need to Know to Stay Out of Trouble – James Stuzin, M.D.4:30 pm Video Cadaver Demonstration

– Bardia Amirlak, M.D., Rod J. Rohrich, M.D.5:15 pm Cadaver Lab Dissection

• Endoscopic/Coronal Browlift • Facelift • Blepharoplasty • Necklift Techniques

Special Breakout Sessions (assigned rotations) • Endobrow – Richardo Meade, M.D. • Breast Augmentation Dual Plane/ADM – William Adams Jr., M.D. • Vertical Scar Mastopexy with Autoaugmentation – Frank Lista, M.D., Jamil Ahmad, M.D. • Breast Augmentation Using Fat – Roger Khouri, M.D.8:30 pm Adjourn - Buses Depart

16th Annual Dallas Cosmetic Surgery Symposium

Page 5: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

Wednesday, March 6 - Westin Galleria6:30 am Registration & Continental Breakfast

Module I - Emerging Role of Fat in Cosmetic Surgery – What’s Next in Breast and Face Rejuvenation?MODERATOR: Jeffrey Kenkel, M.D.

7:00 am Welcome and Introduction – Jeffrey Kenkel, M.D./Rod J. Rohrich, M.D.

Part I - Evolution of Fat Grafting in Breast Surgery 7:05 am Autologous Fat Grafting for Cosmetic Breast Surgery: Congenital and Secondary Breast Deformities Video – Roger Khouri, M.D.7:35 am ADMs: Which One To Use and Where in Breast Surgery? – Separating Science from Marketing Hype – William Carpenter, M.D.7:50 am Secondary Breast Surgery: Helpful Tips For Challenging Circumstances • Malposition (Strock) • Capsular Contracture (Adams) • Visibility (Carpenter) Moderator: Jeffrey Kenkel, M.D. Panelists: Frank Lista, M.D, William Adams, Jr., M.D., Louis Strock, M.D., William Carpenter, M.D.9:05 am Panel Discussion Moderator: Jeffrey Kenkel, M.D. Panelists: Frank Lista, M.D., Roger Khouri, M.D., William Adams, Jr., M.D., Louis Strock, M.D., William Carpenter, M.D.9:45 am Break / Exhibits

Part II - Using Different Types of Breast Implants – Do They Really Make a Difference? 10:15 am Autologous Fat Transfer in Primary Breast Reconstruction: Indications, Technique and Results – Roger Khouri, M.D.10:35 am Now There Are Three: What are the Differences Among Breast Implants – William Adams, Jr., M.D.10:50 am Form Stable Implants: What Are They and How Are They Different? – Frank Lista, M.D.11:05 am Video – Patient Analysis and Technical Execution: Form Stable Breast Augmentation – William Adams, Jr., M.D.

11:25 am Role of New Shaped Implants in Breast Augmentation (Video) – Michael R. Schwartz, M.D.12:00 pm Long-term Experience with Form Stable Breast Implants: Canadian Experience – Jamil Ahmad, M.D. US Experience – William Adams, Jr., M.D.12:15 pm Panel: Different Implants = Different Results? Moderator: Rod J. Rohrich, M.D. Panelists: William Adams, Jr., M.D., Jeffrey Kenkel, M.D., Frank Lista, M.D., Louis Strock, M.D., Jamil Ahmad, M.D. 12:35 pm Lunch / Exhibits

Part III – Breast Augmentation and Mastopexy - Achieving Safe and Consistent Results1:35 pm Video: Transaxillary Breast Augmentation: Keys to Successful Outcomes Video – Louis Strock, M.D.2:00 pm Breast Augmentation/Mastopexy - Keeping It Safe Video – Rod J. Rohrich, M.D.2:25 pm Personal Approach to Augmentation/Mastopexy – 20 Year Experience Video – Frank Lista, M.D.3:00 pm Breast Shaping After Weight Loss: Clinical Algorithm – Jeffrey Kenkel, M.D.3:20 pm Panel Discussion Moderator: Jamil Ahmad, M.D. Panelists: Louis Strock, M.D., Rod J. Rohrich, M.D., Frank Lista, M.D., William Adams, Jr., M.D., Roger Khouri, M.D., Jeffrey M. Kenkel, M.D. 3:45 pm Break / Exhibits4:15 pm Maximizing Operative Efficiency – Lessons Learned – Frank Lista, M.D.4:45 pm Using Evidence Based Medicine to Dictate VTE Prophylaxis – Jeffrey Kenkel, M.D.

Part IV – Live Use of Advanced Fillers and Botulinum Toxins Type A WorkshopModerator: Jeffrey Kenkel, M.D. & Rod J. Rohrich, M.D.5:15 pm Botulinum Toxins Type A and Fillers – (LIVE DEMONSTRATIONS) – William Adams, Jr., M.D. • Discussion – Performing Pain-Free Fillers - Rod J. Rohrich, M.D. / Steve Fagien, M.D. / James Stuzin, M.D. / Jeffrey Kenkel, M.D.7:15 pm Adjourn

Thursday, March 7 - Westin Galleria6:30 am Continental Breakfast / Exhibits

Module II - Evolving Important Role of Fat in Facial Rejuvenation MODERATOR: Rod J. Rohrich M.D.

Part I – Current Concepts in Periorbital Rejuvenation7:00 am Cosmetic Blepharoplasty – What’s New, What’s In and What’s Out? – Steve Fagien, M.D.7:25 am Advances in Asian Blepharoplasty – Suzie Chang, M.D.7:40 am Role of Periorbital Fillers in Facial Rejuvenation – Val Lambros, M.D.7:50 am Advances in Understanding Fat Compartments in Facial Aging – Joel Pessa, M.D.8:05 am Blending the Eyelid – Cheek Junction – Rod J. Rohrich, M.D.8:20 am Complications of Fat and Fillers in the Periorbital Area – Val Lambros, M.D.8:40 am Panel Discussion Moderator: Rod J. Rohrich, M.D. Panelists: Steve Fagien, M.D., Val Lambros, M.D., Fritz Barton, Jr., M.D., James Stuzin, M.D., Joel Pessa, M.D.

Part II – The Increasing Importance of Volume Restoration in Rhytidectomy9:00 am Why Facial Fat Preservation is Essential in Facelifts – James Stuzin, M.D.9:20 am Role of Fat Grafts in Face and Neck Rejuvenation – Bahman Guyuron, M.D.9:50 am Role of the High SMAS in Facial Augmentation – Fritz Barton, Jr., M.D.10:20 am Break / Exhibits 11:05 am The Lift and Fill Facelift - Role of Deep Malar Fat Compartment Augmentation – Rod J. Rohrich, M.D.11:35 am Rejuvenation Panel - How Fat Works in Facial Rejuvenation Moderator: Rod J. Rohrich, M.D. Val Lambros, M.D., Bahman Guyuron, M.D., Fritz Barton, Jr., M.D., James Stuzin, M.D., Steve Fagien, M.D.12:15 pm Lunch / Exhibits 1:15 pm Non-Surgical Neck Rejuvenation – Jeffrey Kenkel, M.D.1:35 pm Neck Rejuvenation – How I Do It To Be Consistent – Bahman Guyuron, M.D.

1:55 pm A Graduated Approach to Better Necklifts – James Stuzin, M.D.2:15 pm Neck Rejuvenation - Current Strategies and Past Experiences – Fritz Barton, Jr., M.D.2:35 pm Prevent / Managing Neck Lift Complications – Rod J. Rohrich, M.D.2:55 pm Discussion; Q&A Moderator: Rod J. Rohrich, M.D. Panelists: Jeffrey Kenkel, M.D., Bahman Guyuron, M.D., James Stuzin, M.D., Fritz Barton, Jr., M.D., Steve Fagien, M.D., Val Lambros, M.D.

3:30 pm Shuttle to UT Southwestern

Anatomy Lab Participants Only – UT Southwestern Campus Fresh Cadaver Facelift Laboratory Session

Lab Coordinators: Bardia Amirlak, M.D., Rod J. Rohrich, M.D.

4:15 pm Facial Anatomy – What You Really Need to Know to Stay Out of Trouble – James Stuzin, M.D.4:30 pm Video Cadaver Demonstration

– Bardia Amirlak, M.D., Rod J. Rohrich, M.D.5:15 pm Cadaver Lab Dissection

• Endoscopic/Coronal Browlift • Facelift • Blepharoplasty • Necklift Techniques

Special Breakout Sessions (assigned rotations) • Endobrow – Richardo Meade, M.D. • Breast Augmentation Dual Plane/ADM – William Adams Jr., M.D. • Vertical Scar Mastopexy with Autoaugmentation – Frank Lista, M.D., Jamil Ahmad, M.D. • Breast Augmentation Using Fat – Roger Khouri, M.D.8:30 pm Adjourn - Buses Depart

16th Annual Dallas Cosmetic Surgery Symposium

Page 6: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

AccommodationsA block of rooms is being held at the Westin Galleria for this meeting.To assure your reservation, please call the number below and identifyyourself as a participant in the UT Southwestern Dallas RhinoplastySymposium to be eligible for the group rate listed. Reservations received after Monday, February 15, 2013 are subject to space andgroup rate availability.

Westin Galleria Dallas13340 Dallas PkwyDallas, TX 75240(972) 934-9494Rate: $189 (Single/Double)

On-line reservations:www.starwoodmeeting.com/Book/UTSW30thAnnualDallasRhinoplastySymposium

InformationFor additional information, please call The Office of Continuing Medical Education, 214-648-3138, 1-800-688-8678, fax 214-648-2317, or email [email protected]

Information on other UT Southwestern programs can be obtained by accessing the Office of Continuing Medical Education’s homepage at: http://www.utsouthwestern.edu/cme

For a free email subscription of The Office of Continuing MedicalEducation’s monthly calendar, send your name, medical specialty,and current email address to: [email protected]

Exploring DallasThe Dallas Convention and Visitor’s Bureau can provide information regarding arts and culture, dining, entertainment areas, event calendar, shopping, sights/attractions, and sports. Please contact the Bureau at www.visitdallas.com

www.dallascosmeticsymposium.com

In Conjunction with the30th AnnualDallas RhinoplastySymposium

(includes Fresh Rhinoplasty Cadaver Dissection)

March 8-10, 2013Westin Galleria • Dallas, Texas

Course Chairmen:

Jack P. Gunter, M.D. and Rod J. Rohrich, M.D

Register for both courses at a reduced rate!

For Information:The Office of Continuing Medical Education

214-648-3138; 1-800-688-8678; Fax: 214-648-2317 www.dallasrhinoplastysymposium.com

www.utsouthwestern.edu/cme

Symposium Locations

Westin GalleriaDidactic Sessions:Westin Galleria Dallas13340 Dallas PkwyDallas, TX 75240(972) 934-9494www.thewestingalleriadallas.com

UT Southwestern Medical CenterThursday AfternoonLaboratory Session:UT Southwestern Medical CenterAnatomy Laboratory, Room L1.1445323 Harry Hines BoulevardDallas, Texas 75390

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Symposium Co-ChairmenRod J. Rohrich, M.D. Professor and Chairman, Department of Plastic SurgeryThe University of Texas Southwestern Medical Center Dallas, Texas

Jeffrey M. Kenkel, M.D. Professor and Vice-Chairman, Department of Plastic SurgeryThe University of Texas Southwestern Medical Center Dallas, Texas

Guest FacultyJamil Ahmad, M.D., F.R.C.S.C.The Plastic Surgery ClinicMississauga, Ontario, Canada

Steven Fagien, M.D. Private Practice Boca Raton, Florida

Bahman Guyuron, M.D. Chair, Department of Plastic SurgeryUniversity Hospitals Case Medical CenterKiehn-DesPrez Professor, Department of Plastic SurgeryCase Western Reserve UniversityCleveland, Ohio

Roger K. Khouri, M.D. Private PracticeMiami Breast CenterMiami, Florida

Val Lambros, M.D.Assistant Clinical ProfessorDepartment of Plastic Surgery University of California at Irvine Irvine, California Private Practice Newport Beach, California

Frank Lista, M.D. The Plastic Surgery ClinicMississauga, Ontario, Canada

Louis L. Strock, M.D. Private PracticeFort Worth, Texas

Michael R. Schwartz, M.D. Private PracticeWestlake Village, California

James M. Stuzin, M.D. Chairman of Baker Gordon Symposium on Cosmetic SurgeryAssistant Professor of Surgery (Plastic)The University of Miami, Leonard M. Miller School of MedicineMiami, Florida

UT Southwestern FacultyWilliam P. Adams, Jr., M.D.Clinical Associate Professor, Department of Plastic Surgery

Bardia Amirlak, M.D.Assistant Professor, Department of Plastic Surgery

Fritz E. Barton, Jr., M.D.Professor, Department of Plastic Surgery

William Carpenter, M.D. Clinical Instructor, Department of Plastic Surgery

Suzie Chang, M.D. Associate Instructor, Department of Plastic Surgery

Ricardo Meade, M.D.Clinical Instructor, Department of Plastic Surgery

Joel Pessa, M.D. Associate Professor, Department of Plastic Surgery

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Who Should AttendPhysicians interested in learning the latest innovations and advancesin surgical and nonsurgical facial rejuvenation, as well as breastand body contouring surgery.

Purpose and ContentAttendees will become familiar with the latest techniques and advances in cosmetic surgery. The focus will be on controversiesand advances in facial, breast and body contouring procedures including the use of fat for augmenting the face, breast and buttock. A live demonstration of the use of injectables, includingnew products on the market, will allow for a broad overview ofproducts, facial analysis, and technique. An optional cadavercourse will be available to highlight the surgical techniques described.

Educational ObjectivesAt the end of the program, the attendees should be able to:n Discuss surgical and nonsurgical options for face and eyelidn Discuss the differences in the various agents available for soft tissue augmentation n Describe advanced techniques utilizing Botulinum Toxin Type A and soft tissue fillers for facial enhancement n Discuss new implant options for breast augmentation and breast shaping using new breast lift techniquesn Describe methods to enhance survival of autologous fat in cosmetic and reconstructive breast and facial surgery n Discuss the use of fat grafting to enhance the face, breast and buttockn Provide a “hands on” tool to practice the techniques discussed in a cadaver model

RegistrationRefer to registration form for fee schedule.

Registration fee includes continental breakfasts, breaks, lunches, andThursday evening snacks for the lab participants. Anatomy lab participants will also receive a facial anatomy dissection DVD duringregistration at the hotel. Registration for the anatomy lab is limitedand will be taken on a first-come, first-served basis. Please do notmake travel reservations unless your registration has been confirmed.

Included with the registration for the Dallas Cosmetic Surgery Symposium is the “Advances in Cosmetic Medicine/Hot Topics inCosmetic Surgery” course. If not registering for the Dallas CosmeticSurgery Symposium, a registration fee of $450 UT SouthwesternAlumni / $500 Non-Alumni will be charged for the additional course.(See insert for details)

Checks should be made payable to: UT Southwestern / CME and mailed to: UT Southwestern, Office of Continuing Medical Education, 5323 Harry Hines Blvd., Dallas, TX 75390-9059.

16th Annual Dallas Cosmetic Surgery SymposiumFirst Name Middle Initial Last Name

Degree Last four Digits of SS#

Address

City State Country Postal Code

Business Phone Fax � UT Southwestern Alumni

Email

o Check here to receive our free monthly email calendar of upcoming educational programs.Please indicate preferred method to receive registration confirmation: o Email o Fax o Mail

Registration Fees (U.S. Funds Only):Method of payment:

� MASTERCARD � VISA

Card # � � � � � � � � � � � � � � � � � � � Exp. Date Security Code Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

� AMEX

Card # � � � � � � � � � � � � � � � � � � � Exp. Date Security Code

Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

� CHECK Make payable to: UT SOUTHWESTERN / CME

Complete and return registration to: UT Southwestern Office of Continuing Medical Education 5323 Harry Hines BoulevardDallas, Texas 75390-9059or Fax 214-648-4804

R E G I S T R AT I O N F O RM16th Annual Dallas Cosmetic Surgery Symposium

March 6-7, 2013 #RP1303A

Anatomy lab participants will receive an anatomic facial dissection in DVD format during registration at the hotel. DVDs from previous courses will be available for purchase at the symposium, or you may purchase the DVDs at www.utsouthwestern.edu/plasticsurgerysymposia. Each station will have 3 participants, if you would like to request to be placed with a certain group, please list their names here. ___________________________________________________________

___________________________________________________________

*Registration form must be accompanied by letter from department chair or program director.

Instruments to BringParticipants registering for the cosmetic surgery laboratory will be required to bring the following instruments:

Surgical gown or scrub suit Marking pens (2)Mask 10 cc syringes (2)3 and 4-0 nylon sutures (6 of each) 25 gauge needles (4)Straight facelift scissors Centimeter ruler and/or calipersCurved facelift scissors Needle holder#10 blades (4) Iris scissors #15 blades (4) Brown-Adson forcepsDouble Skin Hooks (2) Penlight Single Skin Hooks (2) 1” 30g needles (5)Small facelift retractor 1 1/2” 25g needles (5)Rake Refractor Long periosteal elevatorStapler Long grasping forceps4-0 Merilene suture Takahashi forceps

This course provides 20 hours of educational content.

This course is not approved for AMA PRA Category 1 Credit™.

Register for Dallas Cosmetic Surgery Symposium and theDallas Rhinoplasty Symposium and receive a reducedregistration fees for both courses.

Register online:www.dallascosmeticsymposium.com

Cancellation PolicyThe Office of Continuing Medical Education reserves the right to limitregistration and cancel courses, no less than one week prior to thecourse, should circumstances make this necessary.

Refund PolicyA handling fee of $200 for the Cosmetic Symposium will be deducted from cancellation refunds. Refund requests must be received by mail or fax prior to February 28, 2013. No refunds will bemade thereafter.

ENDORSED BY: The American Society for Aesthetic Plastic Surgery, Inc.

This program has been reviewed by the EducationalCouncil and is officially Endorsed by the International Society of Aesthetic Plastic Surgery (ISAPS). Endorsement is not approval for Continuing MedicalEducation (CME) credit. The organizers may at their dis-cretion provide separate CME credit.

PHYSICIANS (WITH ANATOMY LAB) $1275 $1175 PHYSICIANS (WITHOUT ANATOMY LAB) $ 775 $ 675 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHANATOMY LAB) $1025 $ 925 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHOUTANATOMY LAB) $ 675 $ 575 *RESIDENTS (WITH ANATOMY LAB) $ 725 $ 625 *RESIDENTS (WITHOUT ANATOMY LAB) $ 375 $ 325

PHYSICIANS (WITH ANATOMY LAB) $1325 $1225 PHYSICIANS (WITHOUT ANATOMY LAB) $ 825 $ 725 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHANATOMY LAB) $1075 $ 975 UTSOUTHWESTERN ALUMNI/Rhinoplasty Society Member (WITHOUTANATOMY LAB) $ 725 $ 625 *RESIDENTS (WITH ANATOMY LAB) $ 775 $ 675 *RESIDENTS (WITHOUT ANATOMY LAB) $ 425 $ 375

REGISTRATION FEES - Early-Bird (Before Jan 1)

REGISTRATION FEES - Effective Jan 1

REGISTERING FOR DALLAS COSMETICSURGERY SYMPOSIUM ONLY

REDUCED RATE IF REGISTERED FORDALLAS RHINOPLASTY SYMPOSIUM

REGISTERING FOR DALLAS COSMETICSURGERY SYMPOSIUM ONLY

REDUCED RATE IF REGISTERED FORDALLAS RHINOPLASTY SYMPOSIUM

ADA Statement� Please check this box if you require assistance because of a disabilityto make this program accessible to you. Someone from our office willbe in touch with you.

�Refund PolicyA handling fee of $200 for the Cosmetic Surgery Symposium will be deducted from cancellation refunds. Refund requestsmust be received by mail or fax prior to February 28, 2013. No refunds will be made thereafter.

THE AMERICAN SOCIETY FORAESTHETIC PLASTIC SURGERY, INC.

®

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SYMPOSIUM CO-CHAIRMEN

Rod J. Rohrich, M.D.Professor and Chairman, Department of Plastic Surgery; Crystal Charity Ball Distinguished Chair in Plastic Surgery; Betty and Warren Woodward Chair in Plastic and Reconstructive Surgery, UT Southwestern Medical Center, Dallas, Texas

Jeffrey M. Kenkel, M.D.Professor and Vice-Chairman, Department of Plastic SurgeryUT Southwestern Medical Center, Dallas, Texas

NONPROFIT ORG.U.S. POSTAGE

PAIDDALLAS, TEXAS

PERMIT NO.2993

16th Annual

Dallas Cosmetic Surgery SymposiumRecent Advances in Cosmetic Facial and Breast Surgery

Not printed or mailed at State expenseTime Sensitive Material

16thAnnualDallas Cosmetic Surgery Symposium

Office of Continuing Medical Education5323 Harry Hines Blvd.Dallas, Texas 75390-9059

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Program details and registrationavailable at:

www.dallascosmeticsymposium.comor call 214-648-3138

Wednesday-ThursdayMarch 6-7, 2013

Westin GalleriaDallas, Texas

• Hands-on Learning With The Experts Using Fresh Cadaver Dissections in Advanced Techniques in Facelifting, Brow and Eyelid Surgery

• Learn Breast Augmentation Using Fat Grafting and Use of New Shaped Implants

• Advanced Neuromodulator and Fillers Live Demonstration Course(Botulinum Toxin Type A and Fillers)

Sponsored byUT Southwestern Department of Plastic Surgeryand the Office of Continuing Medical Education

Program details and registration available at:

www.dallascosmeticsymposium.com

16th Annual

Dallas Cosmetic Surgery

SymposiumEmerging Role of Fat in Breast

and Facial Surgery

Wednesday-ThursdayMarch 6-7, 2013

Westin GalleriaDallas, Texas

• Hands-on Learning With The Experts Using Fresh Cadaver Dissections in Advanced Techniques in Facelifting, Brow and Eyelid Surgery

• Learn Breast Augmentation Using Fat Grafting and Use of New Shaped Implants

• Advanced Neuromodulator and Fillers Live Demonstration Course(Botulinum Toxin Type A and Fillers)

Page 9: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

Who Should AttendPhysicians interested in learning the latest innovations and advances in nonsurgical facial rejuvenation, specifically new soft tissue fillers, advanced uses of Botox®. Nurse injectors and physician assistants mayregister only in conjunction with certified physician.

LocationWestin Galleria 13340 Dallas PkwyDallas, TX 75240(972) 934-9494

Agenda

Part IV – Live DemonstrationsAdvanced Fillers and Botulinum Toxins Workshop

Moderator: Jeffrey Kenkel, MD / Rod Rohrich, MD5:15 pm Advances in Cosmetic Medicine / Hot Topics in

Cosmetic Surgery – William P. Adams, Jr., MD

Botulinum Toxins Type A and Fillers – (LIVE DEMONSTRATIONS)

• Discussion – Performing Pain-Free Fillers – Rod Rohrich, MD, Steve Fagien, MD, James Stuzin, MD, Jeffrey Kenkel, MD

7:15 pm Adjourn

FacultyRod J. Rohrich, MDProfessor and Chairman, Department of Plastic Surgery;Crystal Charity Ball Distinguished Chair in Plastic Surgery;Betty and Warren Woodward Chair in Plastic and Reconstructive Surgery,UT Southwestern Medical Center, Dallas, Texas

Jeffrey M. Kenkel, MDProfessor and Vice-Chairman, Department of Plastic Surgery UT Southwestern Medical Center, Dallas, Texas

William P. Adams, Jr., MDClinical Associate Professor, Department of Plastic SurgeryUT Southwestern Medical Center, Dallas, Texas

Steve Fagien, MDPrivate Practice, Boca Raton, Florida

James M. Stuzin, MDChairman of Baker Gordon Symposium on Cosmetic SurgeryAssistant Professor of Surgery (Plastic)The University of Miami, Leonard M. Miller School of MedicineMiami, Florida

InformationFor additional information, please call the Office of Continuing Medical Education, 214/648-3138, 1/800/688-8678, fax 214/648-2317, or email [email protected]

To obtain information on other UT Southwestern programs, you can access the Office of Continuing Medical Education’s home page at: http://www.utsouthwestern.edu/cme

For a free email subscription of the Office of Continuing Medical Education’s monthly calendar, send your name, medical specialty, and current email address to: [email protected]

Live Demonstrations:Advanced Fillers and Botulinum

Toxins WorkshopMarch 6, 2013

Sponsored byUT Southwestern Department of Plastic Surgeryand the Office of Continuing Medical Education

Page 10: MARCH 2013 Dallas Cosmetic Surgery Symposium · R EDUC RA TI FR GS RO DALLAS RHINOPLASTY SYMPOSIUM REGISTERING FOR DALLAS COSMETIC SURGERY SYMPOSIUM ONLY REDUCED RATE IF REGISTERED

First Name Middle Initial Last Name

Degree Last four Digits of SS#

Address

City State Country Postal Code

Business Phone Fax o UT Southwestern Alumni

Email

o Check here to receive our free monthly email calendar of upcoming educational programs.

Please indicate preferred method to receive registration confirmation: o Email o Fax o Mail

Specialty (Check One): o Plastic Surgeon o Dermatologist o RN o NP o PA o OTHER (Specify)___________________________________________________

Registration Fee (U.S. Funds Only): $400 UT Southwestern Alumni: $350

METHOD OF PAYMENT:o MASTERCARD o VISA Security Code

Card # � � � � � � � � � � � � � � � � � � �Exp. Date Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

o AMEX Security Code

Card # � � � � � � � � � � � � � � � � � � �Exp. Date Signature of Cardholder Print Cardholder’s Name

Full Mailing Address of Cardholder:

City State Zip Code

o CHECK Make payable to: UT SOUTHWESTERN / CME

Complete and return registration to: Continuing Medical Education / UT Southwestern5323 Harry Hines BoulevardDallas, Texas 75390-9059or Fax 214-648-4804

Refund PolicyA handling fee of $25 for the Advances in Cosmetic Surgery/Hot Topics in Cosmetic Surgery course will be deducted from cancellation refunds.

Refund requests must be received by mail or fax prior to February 28, 2013. No refunds will be made thereafter.

ADA Statement

� Please check this box if you require assistance because of a disability to make this program accessible to you. Someone from our office will be in touch with you.

REGISTRATION FORMAdvances in Cosmetic Medicine / Hot Topics in Cosmetic Surgery

March 6, 2013 #RP1303H

Complete registration form if you are attending ONLY “Live Demonstrations: Advanced Fillers and Botulinum Toxins Workshop”

Registration for this course is included in the “Dallas Cosmetic Surgery Symposium.”