May/June 2019 Vol. 40, No. 4 · May/June 2019 Facial Plastic Times 1 May/June 2019 Vol. 40, No. 4 and open discussions will maxi-AAFPRS 2019 Election Slate Pursuant to Article XI,

May/June 2019 Facial Plastic Times 1

May/June 2019Vol. 40, No. 4

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AAFPRS 2019 Election SlatePursuant to Article XI, Section 1 of the

AAFPRS Bylaws, the NominatingCommittee hereby presents the belowreport to the membership (which was

also emailed to the membership May 1,2019). The following members havebeen nominated to be placed on the

2019 election ballot:

President-electPaul J. Carniol, MD

Sherard "Scott" A. Tatum, III, MD

Group Vice President of Publicand Regulatory Affairs-elect

Travis T. Tollefson, MDDeborah Watson, MD

Eastern Regional DirectorKofi Derek Owusu Boahene, MD

Sydney Butts, MD

Western Regional DirectorBabak Azizzadeh, MDBrian J. F. Wong, MD

Director-at-LargeOren Friedman, MD

Krishna Gwynne Patel, MD

Nominating CommitteeAmit Bhrany, MD

Fred G. Fedok, MDLamont R. Jones, MD

Linda N. Lee, MDJeffrey Scott Moyer, MDEdwin F. Williams, III, MD

Audit Committee RepresentativeJennifer C. Kim, MDDavid A. Sherris, MD

Midwestern Region CredentialsRepresentative

Harley Seth Dresner, MDDavid J. Kriet, MD

SUNNY SAN DIEGO HOSTS AAFPRS

ANNUAL MEETING THIS FALL

This October3 - 5, 2019,join yourcolleagues

for the AAFPRSAnnual Meeting, inSan Diego. Coursechairs Grant S.Hamilton, III, MD;Samuel L. Oyer,MD; and CatherineP. Winslow, MD, arecreating an innova-tive program thatwill bring you themost value for your time whileaway from your practice.

Over three full days, sessionswill cover a wide range of cutting-edge topics on facial reconstruc-tion, facial rejuvenation, practicemanagement, rhinoplasty, mini-mally invasive techniques, emerg-ing technologies, and facialfeminization. There will be scien-tific spotlights, as well as break-out sessions. Panel presentationsand open discussions will maxi-mize interaction and learning.

Expertly constructed bybusiness program chair, Harry V.Wright, MD, along with co-chairsElizabeth W. Chance, MD; Nicho-las Karter, MD; and Adam E.Singleton, MD, the PhysiciansBusiness Forum is scheduled forWednesday, October 2. Find outthe state of facial plastic surgeryin 2019, hear from San Diego-based facial plastic surgeons, andbenefit from several “what I wish Ihad known” sessions. Paneldiscussions will tackle defining

vision and brand, motivating andmanaging staff, onboarding a newdoctor, and practice challenges.There will also be sessions onmarketing, personality andsuccess, practice worth, and more.

The Welcome Reception will beheld Thursday evening. Recon-nect with old and new friends asyou enjoy an evening together.

There will be a three-partcadaver lab workshop coveringinjections and lower facelift,rhinoplasty, and reconstruction.

The synkinesis managementworkshop will discuss facialsynkinesis and spastic facialparalysis. Leading experts willshare practical pearls oninjectables and surgical treat-ment options. Observe live patientassessments and managementwith facial retraining therapy andneurotoxin injections. Additionalworkshops include microvascular,live injection, and cleft lip andpalate. See Hilton Bayfront, page 18

2 Facial Plastic Times May/June 2019

Articles signed by their authors express theviews of those authors only and do notnecessarily express official policy of theAcademy. The Academy does notnecessarily endorse the products,programs, and services that appear inpaid, non-AAFPRS advertisements.

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Executive Editor: Steven JurichManaging Editor: Rita Chua MagnessMedical Editor: Paul J. Carniol, MDFreelance Writer: Lynnette SimpsonFacial Plastic Times is published by theAmerican Academy of Facial Plastic andReconstructive Surgery (AAFPRS)310 S. Henry St., Alexandria, VA 22314;Phone: (703) 299-9291; Fax: (703) 299-8898E-mail: [email protected]; www.aafprs.org.

May/June 2019Vol. 40, No. 4BOARD OF DIRECTORSBOARD OF DIRECTORSBOARD OF DIRECTORSBOARD OF DIRECTORSBOARD OF DIRECTORS

Phillip R. Langsdon, MDPresident

William H. Truswell, MDImmediate Past President

Mary Lynn Moran, MDPresident-elect

Theda C. Kontis, MDSecretary

Harrison C. "Chris" Putman, III, MDTreasurer

David W. Kim, MDGroup VP for Education

Paul J. Carniol, MDGroup VP for Membership & Society Relations

Patrick J. Byrne, MDGroup VP for Public & Regulatory Affairs

Lisa E. Ishii, MDGroup VP for Research, Awards, and

Development

Edward D. Buckingham, MDTreasurer-Elect

Steven H. Dayan, MDGroup VP-elect for Membership and

Society Relations

Jamil Asaria, MDCanadian Regional Director

Theresa A. Hadlock, MDEastern Regional Director

Benjamin C. Marcus, MDMidwestern Regional Director

Anthony E. Brissett, MDSouthern Regional Director

Travis T. Tollefson, MDWestern Regional Director

J. David Kriet, MDDirector-at-Large

Scott James Stephan, MDYoung Physician Representative

Steven J. JurichExecutive Vice President

PRESIDENT’S MESSAGE: UPDATE ON

As some of you may recall, in the July2017 Facial Plastic Times “ElectionInsert” section, I identified severaltopics I promised to tackle if elected

president. Some challenges had slowlydeveloped over the past two decades and wefaced an uncertain future. However, ourBoard has recognized, acknowledged, andthen started to actively address these issues.We are not finished; there is more to do. Weare progressing well, and it is good to knowwhat is actually being done on your behalfby your elected representatives. Therefore,I’ll list the categories below, along with astatus update.

Issue 1: Financial shortfallsThe AAFPRS had been sustaining regular financial shortfalls for thepreceding 10 to 15 years. The reasons were several, including a need forbetter controlling operational expenses, declining membership/dues,weak CME meeting finances (including declining attendance, exhibitsales and sponsorships/grants, as well as expense management chal-lenges), and a need to further diversify revenue streams.

Status. Overall, we have been making very positive strides in reorganiz-ing our financial management infrastructure and better controlling ourmyriad of expenses. Via enhancing our outreach to members and imple-menting our strategic emphasis on fostering inclusion and leveragingdiversity among all members, we have been able to better stabilize ourpreviously declining membership/dues numbers—and we are poised towork on expanding those numbers. Additionally, we have also been ableto turn previous conference deficits into favorable financial outcomesthat are helping to support the overall mission. We have strengthenedour exhibit hall, sponsorships/grants, and our attendance figures at ourannual meetings from 2016 through 2018, and just concluded thehighest attendance figures ever for our Advances in Rhinoplasty meetingthis past April in Orlando.

We have been active in re-establishing productive relationships withour many business firms that serve our specialty. The institution oftransparent competitive bidding and the reinstitution of “in house”meeting management also contributed to positive meeting financials.And I attribute much of our greater attendance numbers to the “call forsubmissions” we have been better utilizing across all of our conferences.When each member feels validated and included, they feel more inclinedto participate. The “call for submissions” concept provides every memberthe opportunity to be considered for all our symposiums. We still need tofurther diversify our revenue streams to fully cover all of our operatingneeds in the Academy and Foundation (and there are some long-overdueinfrastructure items that need to be addressed, including our facilitiesmanagement, Web site, IT, and database upgrades)—but our turnaroundis a multi-year process and our initial strides described above aremoving us in highly productive directions, as we work on additionalapproaches to further attain sustainable success.

Issue 2: Declining membership

Status. Membership is now on the upswing due to enhanced staff ser-vices and what I believe is the institution of an overall philosophy of“inclusion” that has been the focal point of my service as president. As Ireferenced above, giving every member an opportunity to participate,


MY PROMISES

while making an overt effort to institute a regularrotation of leadership positions, appoint new peopleto co-chair meetings, and broaden our efforts forvaluing diversity and inclusion (covering age, race,gender, practice type, and national region) has had avery positive impact on our organization in terms ofmembership retention and recruitment. We will lookto further build upon this much-needed strategy ofinclusion and leverage our newly developed directorof member relations position (held by Patricia Adair),as we actively engage our diverse members at allpoints along their membership lifespan.

We are also continuing to upgrade our memberservices so that each member does not have toreinvent solutions to problems previously solved.Visit www.aafprs-learn.org; look under the “MemberPhysician Resources” tab on the left side for variousresources, including numerous physician forms thathave been shared by fellow members to help with theneed for common practice management and officetools. And we continue to add to these resources.

Additionally, we are developing a new Web sitethat will provide effective consumer education andreferrals to members. This will be a huge value formembership, as we will not only make the new Website easier to navigate, but it will be a forceful re-source of patient referrals that will compete with allother national organizations. This is an area thatsorely needed improvement, and we are makingenormous strides, thereby enhancing this vitalmembership benefit!

Overall, implementing fresh and excitinginitiatives to cultivate inclusion and maximize thediversity and innovation that exists within ourmembership will thereby deepen the authenticcamaraderie and loyalty that makes the Academy yourfacial plastics home, and Academy members yourfacial plastics family.

Issue 3: Declining meeting attendance

Status. We are further improving our ACCME-accred-ited educational programs for our domestic andinternational members alike. Under the above refer-enced Board-approved call for submission for allsymposiums, we are including younger and morediverse members from around the globe on ourpodium to complement our more senior members.And, as a result, over the last few meetings we areexperiencing the highest education survey scores wehave ever received, improved meeting attendance,and actualized positive meeting financials across allconferences with our instituted call for submissions(2016 Annual Meeting in Nashville, 2017 AnnualMeeting in Phoenix, 2018 Annual/InternationalMeeting in Dallas, and our 2019 AAFPRS Advancesin Rhinoplasty in Orlando). This focused effort to (1)be inclusive via the call for submissions and (2) applybetter expense and operational controls via in-housemanagement works!

We are now implementing our world-renownedrhinoplasty courses annually; a directive of ourBoard. Thank you to all of you who recently attendedand made the 2019 AAFPRS Advances in Rhinoplastya huge success. It was the largest AAFPRS rhino-plasty meeting to date, with over 800 in attendancefrom 45 nations. Showcasing both seasoned rhino-plasty specialists and numerous pearls from youngerfacial plastic surgeons committed to clinical excel-lence, this meeting demonstrated the Academy’ssolid global standing as the experts, leaders, andhome for rhinoplasty! It was the collaboration andpassion among speakers and attendees, along withthe strategic concept of inclusion of many diversemembers, that made the meeting exceptionallyengaging and special, yielding some of our highestconference educational scores ever. And next year’sAAFPRS Advances in Rhinoplasty, May 14 – 17,2020, at the iconic Fontainebleau Hotel in Miami,promises to be even better, so mark your calendarsnow and gather your submissions! We will take whatwe learned from instituting our “call for submissions”for rhinoplasty and improve several aspects of themeeting based upon the exit ratings from the Or-lando meeting.

Issue 4: Staff and business of the Academy officeThe fourth challenge was related to the staff andbusiness of our Academy office. There were someareas where we could upgrade, become more effi-cient, monitor expenses, and improve member ser-vices and responsiveness.

Status. Our Board brought in our new executive VP(Steve Jurich) in the second half of 2016 to addressmany of these challenges. He and the staff are in theprocess of implementing many new, sound businessstrategies and operational practices to continue torise above some significant challenges that havebeen impacting the AAFPRS over the last few de-cades. As a result, we are strengthening our capacityto provide greater value for every member, whilebetter managing expenses.

We have also taken corrective actions on impor-tant areas of our business—such as remedyingACCME placing us on probation for various CMEchallenges we encountered with our 2014 and 2015conferences. Due to hard work to address and cor-rect these issues in 2017 and 2018, I am happy toreport that we have once again received full ACCMEapproval. The staff, Board leadership, and CMECommittee have instituted a vigilance with routineoversight and enhanced policies to ensure ongoingcompliance.

As we have worked hard to strengthen theAAFPRS team, we have now added some new, experi-enced staff members, while shifting some of our loyallong-standing staff to several new responsibilities,allowing their talents to further shine. I’m very proud

See Professional Credibility, page 18


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You will not want to missthe summer issue ofFacial Plastic SurgeryToday (FPST). This

award-winning publication is anexcellent educational and mar-keting tool for your practice.Covering filler regret, teenagerhinoplasty, weight loss andsurgery, printing skin, sunscreenbenefits, and facial injury preven-tion-this issue is sure to bring inpatients for consultations andappointments.

No one wants to admit theymay have overdone it with fillers;however, the cover article assurespatients that you can fix it andachieve a natural appearance.“Filler Regret? Natural-Looking isKey,” acknowledges that eventhough injectables continue to beon the rise, some men and womenare seeking to dissolve their fillers

FACIAL PLASTIC SURGERY TODAY TACKLES FILLER

REGRET AND RHINOPLASTY

to look more natural. The articleoffers the benefits of injectables,along with how they can bemodified if necessary.

Inside FPST, parents willappreciate the article, “My Teen-ager Wants Rhinoplasty,” whichdescribes the options available fornose surgery and reshaping, inaddition to how they can bestsupport their teen through theprocess. Three important factorsthat must be addressed arephysical readiness, psychologicalreadiness, and ultimately themotive behind the teen's desire tohave rhinoplasty. Types of rhino-plasty, including using nasalfillers, will be presented.

The “Ask the Expert” high-lights a common question facialplastic surgeons hear: “Is it betterto wait until I reach my goalweight to have facial plastic

may be used to treat chronicwounds or burns.

Sunscreen not only protectsthe skin from skin cancer, butaccording to findings presented atthe American PhysiologicalSociety's annual meeting thispast April, it also protects theblood vessels of the skin. The“Health Tip” will remind patientsof the importance to apply sun-screen to prevent ultravioletradiation damage.

Facial plastic surgeons treatmore than their fair share ofindividuals who have been in-jured by fireworks. These facialtrauma surgeries and burnrepairs are often extensive andcan leave lasting damage, butthey are 100 percent preventable.“Preventing Facial Injuries OverSummer Holidays,” will offersafety tips and the recommenda-tion to seek treatment from afacial plastic surgeon in case offacial trauma.

Start your subscription toFPST today. You will receive adigital copy of the issue. Post thearticles to your Web site and sendprint copies to your referringprofessionals and current pa-tients. See the enclosed orderform for details. M

START YOUR SUBSCRIPTION WITH THESUMMER ISSUE BY JUNE 30, 2019 ANDRECEIVE THE SPRING ISSUE (ABOVE) ATNO ADDITIONAL CHARGE.

surgery or is it OKto go ahead?” It ispreferred for pa-tients to be at theiroptimal weightbefore surgery;however, someprocedures may beless affected byweight loss, such asblepharoplasty ornose surgery. Therecommendation isto schedule aconsultation for afull medical evalua-tion and optimalplan.

The “What’sNew” features aninnovative mobileskin bioprintingsystem. Scientistsat the Wake ForestInstitute for Regen-erative Medicine inWinston-Salem,N.C., have created abioprinter that usesa person's own skincells to create layersof new skin that


ASSI pick up May 2018


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By Thuy-Van Tina Ho,MD

Mary LynnMoran, MD,is a re-nowned

and widely respected female facialplastic surgeon who has seen alot of changes over the quartercentury that she has been inpractice. She completed her headand neck surgery training at theTufts and Boston Universitiescombined program and thenpursued a facial plastic andreconstructive surgery fellowshipwith Peter Adamson, MD, inToronto. She ran a solo practicein the San Francisco Bay Area for22 years prior to relocating toNashville. Dr. Moran is currentlypresident-elect of the AmericanAcademy of Facial Plastic andReconstructive Surgery andrecently transitioned her practiceto Tennessee.

What is the importance ofindividual involvement in theAAFPRS and how did it influenceyour career?

I was encouraged early in mycareer to get involved with theAAFPRS committees. I gained adeep understanding of the struc-ture and mission of the Academyand I also made lasting friend-ships with people that I greatlyadmire. My involvement with theAAFPRS led me to accept a seaton the Medical Board of Califor-nia, appointed by GovernorSchwarzenegger. I gleaned furtherinsight into the important role ofthe AAFPRS and the ABFPRS as awatchdog and standard keeper. Ihave seen up close how we areuniquely qualified by the train-ing, education, and high stan-dards of care and ethics com-pared to many other individualsand groups.

What led you to the role ofpresident-elect of the AAFPRS andwhat are your goals as the nextpresident?

WOMEN IN FACIAL PLASTIC SURGERY: EXPERIENCED

WOMEN BOSSES AND POWER DYNAMICS

I have served on committeesand in leadership positionswithin the AAFPRS for nearly 20years. I have gained much insightas to what makes our professionuniquely positioned to deliver thehighest quality of care to ourpatients. I want to continue tostrengthen that mission byproviding the most relevanteducational opportunities for ourmembers, as well as valuablepractice support as we look to thefuture. We need to be agile in ourability to change in step with ourconstantly evolving profession.

I feel very strongly that theAAFPRS will be enriched by amore diverse and inclusiveenvironment. It has been demon-strated that organizations withgreater diversity in all levels ofleadership and membership aremore dynamic and innovative. Wewill enrich our education andenhance our ability to deliverbetter care to our patients whocome from a variety of back-grounds. Engagement is soimportant for all of our members.We are all stakeholders of theprofession and our home is theAAFPRS.

What are the challenges facedby female facial plastic surgeonspreviously and now?

When I was entering resi-dency, there were many programsthat were not thrilled about theidea of hiring female surgicalresidents. Fortunately, my ownexperience in the AAFPRS waslargely very supportive. Whilemen still far outnumber women inour field, our numbers andinfluence are growing. It is such anatural fit for women to treatwomen for many of the sameconcerns that we share.

Women tend to lead by em-powering their employees, whichis especially important in a smallbusiness. Our communicationstyles are well-suited to socialmedia platforms. Women enteringthe field today have many power-

ful advantages that can lead to asuccessful and fulfilling career.

Who have been your invalu-able mentors during your career?

My fellowship director PeterAdamson, MD, continues to be aninspirational mentor to me and isone of the best teachers I haveever had. What I love most aboutthis Academy is that I am in-spired by all of our members. It isa collegial, humble, yet stellargroup of individuals. I look for-ward to meetings because it islike coming home to a group ofpeople that raise you up.

What advice do you have foryoung facial plastic surgeons?

It is important to make timefor your life. Do not put yourprimary personal needs off. Paceyourself in your career, as thechallenges will always be there.Build your career around your lifegoals and you will be a better,more balanced surgeon for it. M

An Interview withMary Lynn Moran, MD

The Women in Facial PlasticSurgery Committee will host aluncheon at the AAFPRSAnnual Meeting in San Diegowith a keynote speaker. Detailsto come.


IMPLANTECH


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PR TIPS

MALE CALL, HOW TO ATTRACT MORE MALE PATIENTS

Call it Brotox, "man"-tenance therapy, orwhatever you like—butmale facial plastic

surgery is increasingly a thing.You need to be sure that attract-ing male patients has a place inyour marketing and public rela-tions strategy.

In the last few years, therehas been a pronounced uptick inthe number of men seeking facialplastic surgery in the hopes ofremaining relevant at work andon dating Web sites.

Males and females are look-ing for similar outcomes whenpursuing facial plastic surgery:look as young as they feel (ormaybe younger depending on howthey feel), minimal to no down-time, and natural, subtle im-provements that leave themlooking refreshed, relaxed, andnot overly done or different.

While men and women sharecomparable goals, they don’tnecessarily respond to the samemarketing messages.

It is possible to woo and wowboth sexes; here's how.

Refresh your Web site andmarketing materialsInclude before and after photo-graphs of male patients andconsider adding pages on proce-dures requested by men. Themost common nonsurgical proce-dures for men are Botox andfillers; the most frequent surgicalprocedures are rhinoplasty,blepharoplasty, and hair trans-plantation, according to ourannual AAFPRS member statis-tics.

The names may be the same,but the technical steps andaesthetic goals differ based ongender. For example, fillers areused in different areas of the facein men compared with women.When these details are high-lighted and explained, they will goa long way toward assuaging aman's fear of looking overly

feminine after the procedure.It is also important to accentuateyour experience with male pa-tients. For example, men tend tohave thicker, oilier skin that canbe harder to sculpt during arhinoplasty. Show and tell whyyou are the right choice for meninterested in nose reshaping withbefore and after pictures, as wellas details about your experienceand credentials.

Diversify your social mediaposts so that some target men.Buzz words differ among thesexes. Instead of beauty and anti-aging, think of grooming andstrong (as in strong jawline) whenwriting posts, blogs, and proce-dural information.

Make sure you have videofootage of men as well as women.Men do not want to feel likebabies but do tend to be morepain-averse than women. Depict-ing today’s facial plastic surgeryas painless can be great fodderfor video clips.

Host male-focused in-houseeventsThe overwhelming majority ofcosmetic surgery patients arefemales, so it makes sense thatyour brand involves softer colorsand more typically feminineimagery, but you can break withtradition on certain occasions.Some physicians have created"man caves" for male patients sothey don't feel overwhelmed by allof the estrogen. This may not bean option due to space con-straints, but turning your waitingroom into a man cave for anevening event could work.

Forget mom's night out, andgo all out with your Father's Dayevent (June 16, 2019). Considerpartnering with a local craftbrewery for the occasion andengage men in a frank discussionabout their concerns and aes-thetic options. Many likely fearthat any procedure will leavethem looking bloated and femi-

nine like certain celebrities.Address these fears head on bydiscussing your gender-specifictechniques.

The best way to reach men isthrough their wives, girlfriends,sisters, and female friends. If anyof your patients are gettingmarried, their future groom mayalso be interested in nips andtucks. Host a co-ed event with a“Newlywed Game Show” theme.Ask the man what procedure hispartner says he needs or wantsthe most, and see if he guessescorrectly. Serve cocktails andhors d'oeuvres and offer prizes,swag, and discounts on proce-dures booked that night.

Partner with male influencersLocate a male in your marketwith a substantial social mediafollowing. He may be a skincareconnoisseur; however, a sportsinfluencer who is anti-facialplastic surgery and becomes aconvert would be a great way toget more men to take the plunge.Start the conversation online andsee how the relationship devel-ops. Invite the influencers whoyou click with into your office fora treatment, in return for spon-sored posts on social media.

Reach out to local mediaOnce you have started to buildyour male patient database,reach out to local newspapersand influential bloggers to letthem know about the trends youare spotting in your practice. Ifyou have a male patient who iswilling to talk to media, it couldbe great fodder for a local televi-sion morning show. Such a storymay have more legs aroundFather's Day, so keep that inmind when pitching. M

This column was provided by theAcademy’s PR firm, KELZ PR. Forquestions, contact Patty [email protected].

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AAFPRS BREAKS ATTENDANCE RECORDS IN ORLANDO

Advances in Rhinoplasty 2019 has come to an end. We extend a big thank you to the facial plastic

and reconstructive surgeons,industry professionals, andconference supporters who joinedus in Orlando. We are also grate-ful to the guest speakers andcourse faculty for sharing theirvision, expertise, and talent toadvance our specialty.

Great weather, a phenomenalprogram, and record-breakingattendance set the stage for theAAFPRS’ flagship event. Advancesin Rhinoplasty 2019 convenedover 800 participants from 45countries across the globe,including Australia, Brazil,Canada, Chile, China, Columbia,Ecuador, France, Germany,Greece, Mexico, Portugal, SouthAfrica, The Netherlands, Turkey,the U.K., the U.S., and manymore! It featured an internationalcadre of speakers, comprised ofmore than 225 rhinoplastyexperts, luminaries, and up-and-coming superstars. Informativevideo presentations, pre-recordedlive surgeries and lively paneldiscussions helped deliver acomprehensive program. Theconference closed out with adermal filler injection demonstra-tion and the ever-popular ca-daver lab.

In addition to a robust educa-tional program, the meeting’ssold-out exhibit hall welcomed 38companies (45 booths occupied,another record breaker) andprovided the perfect place to seea wide array of products, services,and cutting-edge technologiesavailable to physicians and healthcare professionals in the fieldsof facial plastic and reconstruc-tive surgery, plastic surgery,oculoplastic surgery, anddermatology.

Everyday on the exhibit hall’sstage was a sponsored Lunch andLearn. We thank our sponsorsLegally Mine, Venus Concept, andWeave for adding additional valueto attendees.

Each morning’s BreakfastSymposium offered added oppor-tunities for participants to learnand network with industry part-ners. We thank the followingcompanies for their support andexcellent presentations: 3DAesthetics Solutions, SurgeonsAdvisor, and KELZ PR and EliasWorld Media.

The AAFPRS Foundation isvery appreciative of the coursechairs, Fred G. Fedok, MD; OrenFriedman, MD; Brian J.F. Wong,MD; and meetings director J.Randall Jordan, MD, for theirhard work, commitment, anddedication to the AAFPRS and themembers we serve. They devel-oped an outstanding educationalprogram and played a huge rolein the success of the meeting.

Plans are well underway forAdvances in Rhinoplasty 2020.We look forward to seeing you inMiami Beach, Fla., May 14 - 17.

AAFPRS WRAPS UP SUCCESSFUL2019 SPRING MEETINGWe’ve closed the books on COSM2019! The AAFPRS Spring Meet-ing held in conjunction with COSM,brings together practicing physi-cians, fellows, residents, andmedical students to shareground-breaking research thatenhances the quality of patientcare and advances our specialty.It was the perfect place to exchangeideas, see cutting-edge innova-tions, and learn about importantscientific research projects.

informative, enlightening keynotelectures and panel discussionspresented by experts in the field,as well as research-based podiumtalks and scientific posters.

On Wednesday evening,AAFPRS hosted its Essentials inFacial Plastic Surgery course,which gave a comprehensiveoverview of the nuts and bolts offacial plastic and reconstructivesurgery for otolaryngology-headand neck surgery residents.Presentations were designed forall levels of residency and coveredrhinoplasty, facial rejuvenation,maxillofacial trauma, cutaneousmalignancies and reconstruction,and regional head and neck flaps.We thank Medical Device Busi-ness Services (DePuy Synthes) fortheir educational support of thecourse.

The AAFPRS Foundationwould like to acknowledge coursechairs, David B. Hom, MD, andRobin W. Lindsay, MD, for sharingtheir time and expertise in craft-ing this year’s program. We alsothank AAFPRS meetings directorDr. Jordan for his continuedguidance and support of allAAFPRS meetings.

Save the date for the 2020Spring Meeting, April 22 - 23, inAtlanta. The call for abstracts willopen in July. Stay tuned andcheck the Web site frequently,www.aafprs.org/cosm. M

Because COSM bringstogether the members ofseveral organizations,participants had theunique opportunity toattend the AAFPRS pro-gram and network withpeers from other otolaryn-gology-focused societies.

With record atten-dance and an excitingscientific program, the2019 AAFPRS SpringMeeting provided essentialeducation for residents.The program featured

SEEN HERE ARE CO-CHAIRS DR. HOMAND DR. LINDSAY SCOUTING OUT THEOVER 30 POSTER PRESENTATIONS.

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EMERGING TRENDS AND TECHNOLOGIES: SILHOUETTE INSTA-

By Mehdi Sina MD, MBA

In recent months,I have changed myapproach to treat-ing the lower third

of the face; specifically,early marionette lines, mildmidface ptosis, and loss of defini-tion along the mandible with orwithout mild skin excess in theneck. In this column, I will bediscussing my treatment algo-rithm as it relates to these areas.

There are various nonsurgicalor minimally invasive treatmentmodalities available to treat thelower face, but the focus of thisemerging trend is on SilhouetteInstaLift—a dual action, mini-mally invasive device that usesmicro-suspension to lift looseskin and possibly stimulateneocollagenesis.

The InstaLift sutures aredesigned with bidirectional conesmade of poly L-glycolic acid(PLGA) on a monofilament suturemade of poly L-lactic acid (PLLA).The cones have a surface area of7.5 mm2 and they act to lift theptotic soft tissues. The sutureshave been reported to have abiostimulatory effect.

Patients can be treated in aminor procedure room using localanesthesia alone or in combina-tion with an anxiolytic (benzodiaz-epine or nitrous oxide). First, thepatients are asked to clean their

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face with Hibiclens. Next, thevector of the sutures needs to beclearly marked with the patient inthe supine position. The distalmarking will always be lateral tothe fold that is being treated. It isseparated from the central inser-tion point by a distance of 4.5 cmin a straight line and the proxi-mal marking will be 4.5 cm fromthe central marking (Figure 1).

A critically important stepnecessary to ensure a satisfac-tory result is determining thenumber of sutures needed toachieve the desired lift. As a ruleof thumb, I use three sutures perside for the early marionette linesand between two to four suturesper side for treating the jawlineand neck. The more sutures thatare used, the better the liftingcapacity per suture and thebetter the result. The markingsfor the additional sutures shouldbe spaced approximately eight to10 mm apart and parallel to oneanother.

Once the markings are clearlymade (use surgical marker here),the skin can be cleaned withbetadine solution. Next, usingaseptic technique, each markingcan be infiltrated with 0.2 cc oflocal anesthesia (one percentlidocaine with 1:100,000 epineph-rine). After allowing 10 minutes topass (for the vasoconstrictiveeffect of epinephrine), the central

insertion point is made with a 16-gauge needle for all of the suturesto be placed (Figure 2). Once thisis done, the sutures can bepassed easily in the subdermalplane (Figure 3). This should notcause any discomfort for thepatient.

If the patient complains ofpain, the needle may be too deepand require repositioning. Theneedles are passed distally, thenproximally and then cut off. Onceall of the sutures have beenplaced bilaterally, they can beengaged and anchored. I alwaysstart by holding tension on thedistal monofilament with my non-dominant hand and using thethumb on my dominant hand tolift the soft tissues over the cones(Figure 4). I will engage all thesutures first and then move toanchor the sutures proximally.I use a similar technique whereI hold tension on the monofila-ment but I will just press overthe cones in order to anchor thelift.

Once these steps are com-pleted, I will cut the monofilamentat the surface of the skin. Thereis usually mild bunching of theskin near centrally; this is actu-ally a desired effect and willresolve spontaneously over 24 to48 hours. Finally, I review post-procedure instructions with thepatient. It is important to limit

FIGURE 1 FIGURE 2

FIGURE 3


LIFT, LOWER FACE

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By Paul J. Carniol,MD, Medical Editor,Facial Plastic Times

The Advancesin Rhinoplastymeeting thispast April 4 - 7, was a

great success. Kudos to Fred G.Fedok, MD; Oren Friedman, MD;Brian J.F. Wong, MD; and J.Randall Jordan, MD, who coordi-nated an excellent meeting andreceived rave reviews from at-tendees. Thank you to ourAAFPRS staff for ensuring asmooth, well-run meeting.

Over 800 of your colleaguesand industry partners gatheredin Orlando. Over 240 presenta-tions—many by internationalspeakers—covered a broad rangeof topics with differing points ofview. These point and counter-point sequential presentationscan often be the most interestingand thought-provoking. (Seephotos from the meeting, pages10 and 11.)

For the speakers, it wasdefinitely quite an experience. Igave a presentation on ethnicrhinoplasty. In my practice,patients often want a refined nosewhile maintaining some ethnicityin the appearance of their nose.The speaker that followed me saidthat was not his experience;regardless of ethnicity, his pa-tients desired a more similar nose.

At a prior meeting on a rhino-plasty panel, we were asked todiscuss common rhinoplastythemes. In New Jersey, we havenumerous patients with ethnicnoses. I discussed the grafts thatI regularly use to obtain a moredistinguished nasal tip, increas-ing definition and projection. Thenext speaker was from the mid-west and stated that tip graftswere rarely used. He went on todiscuss the frequent challenge ofde-projecting over-projected tips.These examples serve as a re-minder that procedures and

RHINOPLASTY MEETING...A SUCCESS,

COMMITTEE INVOLVEMENT

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techniques can be affected bypractice location and local styles.The diverse opinions and viewsare welcome and it was wise toinclude these types of presenta-tions at the rhinoplasty meeting.

As group vice president formembership and society rela-tions, I am happy to report thatour membership has been grow-ing with highly qualified physi-cians. Welcome to all of our newmembers. We are excited aboutboth our new American andinternational members. If ap-proved this fall, we will starthaving international fellows. Staytuned.

New members bring newideas. A reminder to all of ourmembers, we want to learn fromyou. Please submit presentationsfor our upcoming meetings.

Come to our committee meet-ings, which are held the daybefore the Annual Meeting in SanDiego; it is a great place to shareyour ideas and make a difference.The AAFPRS needs you to join ourcommittees, as well. Send a noteto the AAFPRS office listing yourfirst three choices for committees,[email protected]; and as there isspace, we will place you on acommittee. (See a full list ofcommittees on pages 9-24 of the2019 Membership Directory.)

In June, J. Regan Thomas,MD (delegate); Scott RandolphChaiet, MD (delegate to the YoungPhysicians Section); and I (alter-nate delegate) will be attendingthe AMA meeting. Dr. Thomasand Dr. Chaiet work hard andrepresent us very well to theAMA. We all work as a team andput forth what is best for facialplastic surgery. Please send anyissues you would like the AMA toconsider to me directly.

If you need assistance or tobecome more involved in any waywith our Academy, please contactme directly by email [email protected] or call meat (908)-598-1400. M

neck movements if the neck hasbeen treated.

Please let me know if you haveany questions about my tech-niques shared here. A videodemonstration can also be foundat www.youtube.com/watch?v=tPC8OWE-LGg.

I am pleased to contribute toour member newsletter FacialPlastic Times and I hope you dothe same. I would love to hearyour new and tried techniques. M

This column is designed to shareinnovations in treatment, surgicalprocedures, implants, and otherdevices for review and consider-ation by the reader, within thecontext of his or her own practice.The views expressed are those ofthe author(s). Comments andquestions can be directed to theauthor, Dr. Sina by email [email protected].

FIGURE 4

AAFPRS COMMITTEE DAYOCTOBER 2, 2019

If you are an AAFPRS commit-tee member, or if you want tobecome more involved in theAcademy, plan to attend thecommittee meetings scheduledon Wednesday, October 2,2019, immediately precedingthe AAFPRS Annual Meeting.The meetings will begin at7:30 a.m. and end at 3:00 p.m.Plan ahead.

For a complete list of thecommittee meeting schedule,contact the AAFPRS office byemail at [email protected].


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FACE TO FACE UPDATE: SURGICAL MISSIONS TO VIETNAM,

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Native of Sydney, Australia joinsFACE TO FACE mission toVietnamA couple of hours after touchingdown in Sydney last week, I wasback in my consulting roomsseeing some post-op patients fromthe week before. Despite beingback in familiar surroundings, Icame away from my week deliver-ing surgical education in Vietnamreminded by a special patientwith a simple message, “Don’tforget to sparkle!”

During the previous week, mycolleagues (an esteemed group ofsurgeons, Vito Quatela, MD; JenKim, MD; and Mack Cheney, MD)and I had the privilege of helpingpatients like this to regain thatsense of sparkle. We spent thefirst two days delivering surgicaleducation to 26 enthusiastic localresidents and surgeons at theENT Hospital of Vietnam. Then,after hosting an epic clinic withover 60 microtia patients, weperformed 10 ear reconstructivesurgeries in four operating rooms,every day for five days, for spar-kling young patients born with

microtia, and other adult patientswith acquired auricular deformi-ties.

It was a pleasure to be able topass on these techniques, and italso struck me that teachingothers requires me to hone myown skills and to reflect deeply onexactly how and why I makedecisions. It is an intense experi-ence but certainly makes me abetter surgeon. And I had plentyof opportunity to practice carvingears, even in the back of a taxiwhen stuck in traffic! My ownpride is reflected in the smilingfaces of the local surgeons whowere so welcoming and committedto learning. I know that they willgo on to make a huge differencein their own country. I will followtheir journey with great pleasureon our new WhatsApp group and Ican’t wait to return next year.

Busy days certainly didn’tmean that I missed experiencingthe fabulous Vietnamese culture.Just moving around Hanoi is asensory overload. Scooters ply thestreets beside bicycles, and stilldominate cars as the preferred

AAFPRS FACE TO FACE toLambayeque, PeruIn conjunction with the FACESFoundation (Portland, Ore.), anAAFPRS-led FACE TO FACE teamcompleted another successfulmedical mission trip to Peru,January 25 - February 2, 2019.This well-established team wasonce again primarily based inLambayeque, operating in Hospi-tal Belen., with additional surger-ies performed in the larger neigh-boring city of Chiclayo at HospitalRegional.

Dana Smith, MD (KaiserPermanente Portland), was thesurgical team lead. He was joinedby AAFPRS members MyriamLoyo, MD (Oregon Health Sci-ences University); Lisa Morris,MD (Selaroma Plastic Surgery,Salt Lake City); and JessykaLighthall, MD (PennState Health).Additional surgeons includedpediatric otolaryngologist, AllisonDobbie, MD (Children's HospitalColorado); current AAFPRS fellowWilliam Dougherty, MD; currentpediatric otolaryngology fellowChristopher Hargunani, MD; andotolaryngology chief resident TylerWeaver, MD (Oregon HealthSciences University).

Twenty-five other volunteersfrom the Portland area joined thesurgical team including pediatricanesthesiologists, nurses, scrubtechs, and speech and languagepathologists.

The FACES Foundation worksclosely with the Lambayeque

SURGICAL CASEPERFORMED BYGUEST SURGEONJOE DUSSELDORP,MD.

DR. DUSSELDORPIS ALSO SHOWNHERE LECTURINGTO HANOI LOCALSURGEONS.

mode of transport(even for cleverdogs). And we werespoiled by ourVietnamese hosts,sampling thewonderful cuisine,particularlydelicious wheneaten street-side!

Just as myexperiences inHaiti last yearinspired me, so too

has Vietnam and I am honored tokeep this reminder in my study.

Thank you again to HUGSFoundation, the AAFPRS FACETO FACE program, and theKletjian Foundation for support-ing this incredible mission trip. Ihope I can contribute to moretrips like this in the future.“Don't forget to sparkle” willremain with me for a very longtime.

Editor’s Note: This piece waswritten by Dr. Dusseldorp.

E

G


PERU, AND GUATEMALA CITY

Partnering with the Moore Clinicin Guatemala CityIn February 2019, the AAFPRSFACE TO FACE and FINN Foun-dation supported the sixth medi-cal mission trip to Guatemala. Forthis trip, the team partnered withthe Moore Clinic, a pediatricsurgery clinic in Guatemala City.The Moore Clinic is unique inthat it only is used for Americanmedical mission trips. The MooreClinic is supported by the ShalomFoundation and frequently hostsmedical missions of multiplespecialties from Vanderbilt Uni-versity.

For this trip the team of JCharlie Finn, MD; Scott Stephan,MD; Vanderbilt Facial PlasticSurgery fellow Justin Sowder, MD;

Lions Club who provides localsupport for the team during thetrip. The close partnership withthe Lions Club and local supportfrom the hospital staff, physi-cians, and nurses are indispens-able in helping to provide care tochildren with cleft lip and palatedeformities.

During the 2019 trip, 53patients underwent surgeryincluding 10 cleft lip repairs, 21cleft palate repairs, seven speechsurgeries, five alveolar bonegrafts, five cleft rhinoplasties, twosoft tissue surgeries, and onemicrotia repair.

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On the finalday of this won-derful trip, theteam celebratedwith members ofthe communityand the Lion’sClub with anevening of dining,dance, and perfor-mance. Dr. Smithserenaded thelocal communitywith a rendition ofJohnny Cash’s“Ring of Fire” togreat applause!

SEEN HERE WITH A YOUNG PATIENTAND HIS MOM ARE DR. DOUGHERTY(LEFT) AND DR. SMITH.

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Jim Wright, MD;Jeff Watson, MD;and PhilipSchoenfeld, MD,screened a total of74 patients. In theclinic’s threemodern operatingrooms, the teamperformed 41surgeries includingfour Medpor micro-tia cases andmultiple cleft lip,palate, and cleftrhinoplasty cases.This team ofsurgeons wassupported by scrub

techs Sue Upson and MelissaWebb and administrator TamraFinn. This trip was limited topediatric patients and was anamazing success. The MooreClinic did a wonderful job ofscreening, pretreatment, postop-erative treatment, and follow-upcare for the surgical patients. M

THE “FUN” TEAM WITH SOME OF ITSPATIENTS. H

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G

CALL FOR AWARDSThere is still time to nominate yourcolleagues to receive these prestigousawards. Email Glenda Shugars at theAAFPRS ([email protected]) toreceive a nomination form or visitwww.aafprs.org/research/awards/.

William K. Wright Award. Presentedto an AAFPRS member who has madeoutstanding contributions to facialplastic and reconstructive surgery.

John Dickinson Teacher Award.Honors an AAFPRS fellow or memberfor sharing knowledge about facialplastic surgery with the effective useof audiovisuals in any one year.

F. Mark Rafaty Memorial Award.Presented to an AAFPRS member whohas made outstanding contributionsto facial plastic and reconstructivesurgery.

Community Service Award. Presentedto an AAFPRS member who hasdistinguished himself or herself byproviding and making possible freemedical service to the poor in his orher community.


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VIRTUAL SURGICAL PLANNING IN

CRANIOMAXILLOFACIAL SURGERY

By Derrick Gale, MDand Jose E. Barrera, MD

We arehonoredto befeatured

in the first “How I DoIt” column. We welcomeyour comments andhope that this providesinsight to how we useVirtual Surgical Plan-ning (VSP) in cranio-maxillofacial surgery.

Technological advancementsin three-dimensional computerprogramming have dramaticallychanged skeletal reconstructivesurgery over the last severaldecades. VSP is also becomingmore common in craniomaxillo-facial surgery. It has been com-monly utilized in head and neckcancer resections and osseousreconstruction. For the complextopography of the maxilla, VSP isadvantageous. Using VSP pre-printed plates and cutting guidesare designed in advance of theprocedure. It is easier to find thecorrect “fit” of the plates andguides. Additionally, the plannedcuts are not time sensitive likethey can be when planning forcancer resections.

In our practice, we commonlyperform maxillofacial surgeries forpatients with craniofacial abnor-malities and at times to opennarrow airways associated withsleep apnea. A narrow airway iscommonly associated withdentofacial abnormalities andcan be addressed at the time ofmaxillo-mandibular advancementfor sleep apnea. These mayinclude a narrow-arched maxilla,retrognathism, prognathism, orapertognathism (open-bite). Aftera full evaluation of the patient,including cephalometric analysisfor craniofacial abnormalities, anaesthetic evaluation is done todetermine abnormalities of facialproportions.

Facial asymmetries thatexhibit soft tissue abnormalities,jowling, submental fat and excessskin, and obtuse cervicomentalangle are often associated withcraniofacial anatomy. Frequently,major aesthetic improvementscan be made by changing theunderlying bony anatomy.Examples of these abnormalitiesinclude vertical excess or defi-ciencies of the jaws in relation tothe rest of the craniofacial skel-eton, asymmetry in verticalheight of the jaws, cant, yaw, andmidlines. The bony chin is exam-ined for abnormalities such asmicrogenia, over-projection, andasymmetry. These can be ad-dressed, if needed, at the time ofsurgery. The amount of toothshow is noted and kept in consid-

eration during planning of thesurgery. A full aesthetic andfunctional assessment of the noseis also done as this may bechanged by advancement of themaxilla. The septum can beaddressed from below with themaxilla down-fractured after lefort osteotomy.

The number of changes andaesthetic considerations takeninto consideration duringplanning for these procedures are See Predictable Results, page 19

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VIRTUAL SURGICAL PLANNING FORORTHOGNATHIC SURGERY USING 3DPRINTED PLATING TECHNOLOGY H



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From Cover Story, page 1Stay until the last day; you

won’t want to miss the Saturdaynight Soiree. After you have hadyour fill of stimulating conversa-tions and advancing your knowl-edge in techniques and technol-ogy, make time for San Diego.

Home to 70 miles of beautifulbeaches and near-perfectweather year-round, there isplenty to see and do. The historicGaslamp Quarter in downtown isjust over 16 blocks of renovatedturn-of-the-century Victorianarchitecture, boutiques, artgalleries, and specialty shops.Visit Mission Bay Park, a 4,600-acre aquatic park, with morethan 20 miles of scenic pathsthat wind near the shoreline. For360-degree views of San Diego,drive to the top of Mt. Soledad inLa Jolla or go to Mt. Helix forviews of San Diego’s East Countycommunities. If you are lookingfor museums, stroll throughBalboa Park—a marvel in Span-ish Colonial Revival architec-ture—where you can choose from15 different options.

Come to San Diego for theintensive instruction, and stay todiscover the wonderful city. Thepreliminary program will beavailable in June. Make sure youvisit www.aafprs.org/annualmtgfor updates. We hope to see you inthe fall. M

HILTON BAYFRONT

AWAITS THE AAFPRS

HOST HOTEL: HILTON SAN DIEGOBAYFRONT—Overlooksthe San Diego Bay and is only a 10-minute drive from the San DiegoInternational Airport. It is 1.8 kmfrom the Coronado Bridge and just afew blocks from the historic GaslampQuarter.

Reserve your room by September9, to receive the discounted rate of$259 per night.Call the Hilton at(800) 445-8667 and be sure to men-tion the AAFPRS to get the rate.

From President’s Message, page 3of the progress achieved by staffover the last couple of years,through a challenging transitionthat was met with dedication andselfless effort!

Issue 5: Professional credibility

Status. We are making continuedprogress within organized medi-cine and with state legislaturesand the public. For decades, theAMA has recognized our Academyas the AMA national medicalspecialty society for our field, andwe are working to continue tojustify and protect that recogni-tion. Our advocacy program hasresulted in recognition of ABFPRScertification as legitimate in everystate that has examined it. TheAAFPRS is further stepping upour legal and advocacy programstate-by-state to protect andboost the ABFPRS credential (ourAcademy pays for that), preserv-ing your ability to practice—andadvertise yourself—as a facialplastic surgeon. You may wellhave seen such AAFPRS-paidbattles in your own state. Thissustains our collective credibilitywith the public, state and federallegislatures and regulatorybodies, hospitals, and insurancecarriers.

Additionally, academia hasrecognized facial plastic surgery—and we are increasing our out-reach to the many otolaryngologyresidency programs to furtherestablish sound connections withthe many potential future sur-geons who will advance ourspecialty for years to come. Ourfellowship programs have pro-duced scores of facial plasticsurgeons; we are now up to 50fellowship programs. Our Educa-tional Foundation has turned itseducation into a world-classvehicle for ABFPRS certification ofhundreds. Our leadership inworldwide rhinoplasty educationwill continue with our Boarddirected yearly Advances inRhinoplasty symposia, fellowship

programs, and educationalresources. We are also in theprocess of reviewing options forenhanced rhinoplasty recognition.

So, there it is; this is wherewe are. We are not finished withplanned improvements and muchremains to still be accomplished.However, a substantial amount ofsound, strategic, and productiveground has already begun to becovered! We will continue toinnovate, be inclusive, andprepare for the future. We willtake what we have learned anduse that to grow. I’m proud ofwhat the Board and staff havedone and are doing to enhancethe future of the AAFPRS.

Thank you for your commit-ment to the Academy. To para-phrase it once again, Either wehang together, or we hang alone!

Phillip R. Langsdon, MD

PROFESSIONAL CREDIBILITY


FACIAL PLASTIC TIMES

MAY/JUNE 2019

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2019MAY 1-2AAFPRS Spring Meetingin conjunction with COSMAustin, TXCo-chairs: David B. Hom, MD, andRobin W. Lindsay, MD

JUNE 22-23ABFPRS EXAMINATIONWashington, DC

AUGUST 2-4OHSU Portland Aging Face CourseChair: Tom D. Wang, MDPortland, OR(Endorsed by the AAFPRS Foundation)

OCTOBER 3-5AAFPRS Annual MeetingSan Diego, CAChairs: Grant S. Hamilton, III, MD;Samuel L. Oyer, MD, andCatherine P. Winslow, MD

2020APRIL 22-23AAFPRS Spring Meetingin conjunction with COSMAtlanta, GA

MAY 14-17Advances in RhinoplastyMiami Beach, FLCo-chairs: Russell W.H. Kridel, MD, andBrian J.F. Wong, MD

JUNE 27-28ABFPRS EXAMINATIONWashington, DC

SEPTEMBER 10-12AAFPRS ANNUAL MEETINGBoston, MA

Meeting Director: J. Randall Jordan, MD

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CLASSIFIED ADFor Sale by OwnerTurn-key facial plastic surgeryand ENT private practice inprestigious Arlington Heights, Ill.,a northwest Chicago suburb.Step right in to join or replace afacial plastic-ENT surgeon. Thissite and unique opportunitywould make an ideal primary orsecondary office for expansion ofan existing practice. Text (847)738-6452 for more information.

CLASSIFIED ADRetiring plastic surgeon's 3,645sq. ft., medical office is for sale inProvo, Utah: three exam rooms,dedicated photo and laser rooms,and a large procedure room. Itcan easily accommodate one ortwo surgeons. An ambulatorysurgical center with five operat-ing rooms is located on the samecampus.

The office is located in abeautiful setting with views of theadjacent Wasatch Mountains.The population in our area israpidly growing due to the manytech companies located here.Call for details, (801) 375-4646.

Enclosed in this issue of Facial Plastic Times is theFacial Plastic Surgery Today Order Form.

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From How I Do It, page 16complex. Traditional surgicalplanning involves creating dentalmolds and cement cast models.VSP systematically addresses thecomplexity of this surgery andhas reduced the amount of timerequired for the presurgicalplanning. It has also decreasedthe operative time. VSP fororthognathic surgery has ad-vanced to incorporate many aspectsof traditional workup. Cuttingguides and pre-printed titaniumplates can be fabricated with theappropriate movements built intothe plate, making it possible forthe surgery to be completedwithout the use of splints. Be-cause the planned movementshave been integrated into thefabrication of the plate andplacement of the plate is guidedby pre-drilled holes, the patientdoes not need to be wired in anintermediate splint while bendingplates and securing hardware.

Furthermore, VSP fororthognathic and craniofacialsurgery includes computersimulation of changes in the softtissue envelope of the face and anapproximation of the postopera-tive facial appearance. Additionaladvantages may include the easeand safety of the surgery, thepredictability, and the reliabilityof results. Furthermore, theability to demonstrate the plan-ning sessions and review the planin entirety with ease facilitatesteaching the next generation ofsurgeons. With these improve-ments, we may find that there isa change in the learning curveand younger surgeons can startseeing predictable results earlierin their careers. M

SEEING PREDICT-

ABLE RESULTS

EARLY ON

This column is designed to share innovations in treatment, surgical proce-dures, implants, and other devices, as well as successful practice manage-ment examples, for review and consideration by the reader, within thecontext of his or her own practice. The views expressed are those of theauthor(s). Comments and questions can be directed to the author, Dr.Barrera by email at [email protected].


Documents

May/June 2019 Vol. 40, No. 4 · May/June 2019 Facial Plastic Times 1 May/June 2019 Vol. 40, No. 4 and open discussions will maxi-AAFPRS 2019 Election Slate Pursuant to Article XI,