RAISING THE BAR FOR EDUCATIONAL EVENTS

HIGHLIGHTS OF THE DAYImportant Eyelid Anatomy Details For Successful Blepharoplasty Results Time 8:00amWilliam Mack, MD

Treatment Protocol For The Compromised Nasal Tip Time 9.45amPaul Nassif, MD

Blepharoplasty–State Of The Art 2018 Time 11.00amWilliam Beeson, MD

Can Rotational Fractional Resection Improve Skin Laxity And Contour Defects With No Visible Scarring? Time 11.45amSteven Dayan, MD

Aesthetic Industry’s Deadliest Marketing Mistakes Time 12.00pmJohn Sykes

Ptosis Repair Without Tarsal Sutures - An Easy Add-On When Performing An Upper Eyelid Blepharoplasty Time 2.00pmJohn Martin, MD

Treatment For The Crooked Nose, Why Is It Becoming More Common? Time 3.30pmSteven Pearlman, MD

YOUR DAILY GUIDE TO THE VEGAS COSMETIC SURGERY AND AESTHETIC DERMATOLOGY SYMPOSIUM Z

WEDNESDAY, JUNE 6, 2018

Welcome to the 14th edition of the Vegas Cosmetic Surgery and Aesthetic Dermatology. For many this has become their one ‘go to meeting’ of the year not

only because it provides enough CME credits to satisfy most annual state requirements, but it has become the leading purveyor of scientific information in the aesthetic field.

But is that the only reason that it has continued to grow in popularity each and every year since its inception? Well for starters, it is in the most popular destination in the US at a great time of year. The weather, food, and ambience are definite pluses. The speakers are among the world’s leaders in aesthetic education and unlike any other meeting in the world, there is fairly equal representation from each of the four CORE Specialties. There are over 130 separate companies present in the exhibit hall which is always sold out months in advance of the meeting. There is the first and most comprehensive practice management and marketing program available at any medical meeting in the world featuring over 50 different experts in the field.

Now reflecting back on fourteen years and entering the twilight of my own career, I feel extremely humbled and privileged in being able to bring the major specialties together when many thought that to be impossible. The resulting dialogue and comradery has fortunately spread to many other meetings and conferences around the world; and the major beneficiary is, of course, our patients who benefit from this wider spectrum of education. Additionally, I feel that we have established a much higher bar for all educational events in the field including those hosted by a single specialty society.

This year we have been fortunate to attract what I believe to be the leading multi-specialty faculty ever assembled at one event. We will once again feature four major meeting tracks. A Surgical Track, a Non-Invasive Track, a Masters Seminar Track, and of course our world class Practice Management and Marketing Track.

The comment we most often hear from those who attend our conference is that they wish they could be in all four sessions at the same time. The second most frequent comment is ‘I wish I had brought key members of my staff with me’ so they could attend the Practice Management Session. This year promises to raise the bar for all other meeting directors around the world!

Register to PRIME online for FREE at prime-journal.com

Online first Article archive Video Interact Available on-the-go

S. Randolph Waldman Founder and Chair, Vegas Cosmetic Surgery

What Twitter said…“RealSelf is excited to be back at the Vegas Cosmetic Surgery this week!

http://fal.cn/yNaT #VCS2018 ” @DrCommunity

“Going to #VCS2018? Visit us at Booth 610 and learn about our better

patient financing solution. @VCS2018 ” @LendingUSA

“We hope to see you at the @VCS2018, June 6-10 at the @Bellagio

in Las Vegas. Registration is open: http://vegascosmeticsurgery.info #SilhouetteInstalift ” @InstaliftUS

“Our #aesthetic #medicine team will present #practice #management

and business development topics at @VCS2018. Learn more. http://ow.ly/kKJS30kfSHg #BSMConsultingBlog” @BSMConsulting

“Headed to @VCS2018 next week? Stop by the Healeon Booth, #227 and

check out how ALMI can help you add regenerative medicine to your practice!” @chelev123

Leslie Baumann, M.D. is internationally known for her contributions to the field of cosmetic dermatology. She founded the University of Miami Cosmetic Medicine and Research Institute in

1997- the first academic institute in the US dedicated to cosmetic dermatology. She served as Professor of Dermatology at the University of Miami, Miller School of Medicine until 2009 when the Institute became independent from the University and the name changed to the Baumann Cosmetic and Research Institute.

Dr. Baumann is the author of 3 bestselling books: Cosmetic Dermatology: Principles and Practice (McGraw-Hill 2009), Cosmeceuticals and Cosmetic Ingredients (McGraw Hill 2014), and The Skin Type Solution (Bantam 2005). She has authored a monthly column on cosmeceuticals for Dermatology News (formerly Skin and Allergy News) since 2001 and a twice monthly column on dermatology for the Miami Herald newspaper since 2005. She has authored chapters in many major medicals textbooks such as Fitzpatrick’s Dermatology in General Medicine (McGraw Hill), Pearls and Pitfalls in Cosmetic Oculoplastic Surgery (Springer), Neligan’s Plastic Surgery (Elsevier),

Minimally Invasive and Office-Based Procedures in Facial Plastic Surgery (Thieme) and Textbook of Aging Skin (Springer).

Dr. Baumann is a highly sought after primary investigator and has been involved in the Phase 3 FDA clinical research trials of the most notable products procedures in cosmetic medicine including Botox®, Dysport,® Restylane Refyne®, Juvederm®, Kybella® Restylane Silk®, Sculptra®, and Voluma®.

She earned her medical degree from Baylor College of Medicine in Houston, Texas, and completed her residency in Dermatology at the University of Miami, Miller School of Medicine. She is a board certified dermatologist and a member of the American Academy of Dermatology (AAD) and a Fellow of the prestigious American Dermatological Association (ADA).

SPEAKER FOCUS: LESLIE BAUMANN, MD

Since 2014 we have been developing the Spare Roof Technique (SRT). According to many authors, in rhinoplasty, the most challenging segment of control is the dorsum.

Most revisions are due to iatrogenic manoeuvres on the dorsum and unpredictability in its healing/spacial reorganization in the so-called ‘K’ area. The transition from the upper third to the middle third is a critical area in the stability of the nasal pyramid — an area of bone-cartilaginous transition. In this region, the superior alveolar cartilage extends cephalically up to 10 mm underneath the bones of the nose.

In the Caucasian nose, the most relevant dysmorphic feature for both genders is the hump. The treatment of this dysmorphia has been reported since the times of ancient Egypt. In the 1980s and 1990s, more advanced techniques were popularized, and much research work was done. Today there are two types of techniques from the conceptual point of view - the ‘surface’ and those that work the most basal part of the nasal pyramid - the ‘structure’.

The techniques most practised and taught in the western world are undoubtedly the surface options: ‘Humpectomy en bloc’ (HEB) and ‘Split Hump Technique’ (SHT) are the techniques that dominate this group and are mostly used in all reduction rhinoplasty.

In HEB, the block is removed, i.e. the whole osteocartilaginous set is removed en bloc -

thereby destroying the K area and the Upper Lateral Cartilage (ULC). In this technique, it is mandatory to reconstruct this area, mainly with spacer grafts.

In SHT the ULCs are only separated in the midline, and they are used to confine the Spreader Flaps - this is a less aggressive technique for the stability of the middle third. SHT is the most commonly used technique today. Minor variations of this technique have been described which, while important, do not adequately meet the needs felt on a day-to-day basis.

The persistent difficulty in achieving harmonious and soft dorsum has led to the development of numerous camouflage techniques - namely for intermediate and fine skins. From the temporal fascia to cartilage powder (ex-diced), passing through the interposition of fat, muscle or other materials. These techniques are not always entirely effective, and the long-term results remain unsatisfactory in the subgroup candidate for revision surgery. In this context, the idea arises of preserving essential structures like the ULCs and the Spare Roof Technique (SRT) is developed. Conceptually this technique has the following four steps:1. Separation of the upper part of the

quadrangular septum from the ULCs2. Exclusion of the excess cartilage along the

upper edge of the septum3. Ostectomy of the caudal portion of the Nasal

Bones (NB) preserving the ULCs immediately by low-step performed with ultrasonic surgery or diamond drill.

4. Suture of the ULCs to the remaining quadrangular septum in order to avoid the spring/convex effect of the ULCs.

In this way, we achieve a uniformly smooth and structurally stable dorsum (demonstrated by our outcomes and by engineering calculations). From the structural point of view there is an alteration of the area K which is moved cephalically between 3 and 10 mm.

The SRT has had outcomes above expectations in the clinical setting, laboratory, and engineering study group of the University of Minho led by Prof. Dr. Nuno Dourado.

The first 200 rhinoplasties with SRT were already performed and the technique was published in the Facial Plastic Surgery, Thieme, February 2016. Laboratory investigation (structural engineering) and cadaver work are ongoing.

RHINOPLASTY: SPARE ROOF TECHNIQUE A NEW APPROACH FOR THE DORSUM

Miguel Gonçalves Ferreira, MD is based in Porto, Portugal. A specialist in Otorhinolaryngology and Cervical-Facial Surgery

Email: mgferreira.md@gmail.com

In order to better understand the rationale behind medial based deep plane facelifting and how it differs from lateral superficial muscular aponeurotic system (SMAS) facelifting (high SMAS or low

SMAS), this Masters Seminar will focus on an advanced understanding of the complex anatomy of the SMAS and soft tissues of the face.

The variance of SMAS mobility in different facial regions is important when considering the optimal areas for surgical manipulation during facial rejuvenation. The lateral SMAS overlying the parotid gland is generally fixed by the parotid cutaneous fascial attachments. As the SMAS extends medial to the parotid gland, it is not firmly adherent. A transition zone can be seen topographically in the aging face where the medial “mobile SMAS” descends and the lateral fixed SMAS does not.

The deep plane facelift enters the sub-SMAS plane medially, approximately 5 cm more anterior to traditional lateral SMAS facelifts, at a line that traverses from the angle of the mandible to the lateral canthus. This approximates the transition zone between fixed and mobile SMAS. Traditional low SMAS and high lateral SMAS techniques elevate the fixed SMAS that has not descended with age in order to access the mobile SMAS that has.

Because of the more medial manipulation of the SMAS, the deep plane facelift has biomechanical advantages when lifting the anterior midface and jowl soft tissue ptosis of aging compared to lateral SMAS procedures. Further, the point of suspension for the deep plane flap is anterior and closer to the ptotsis in the midface, jowl and neck so it allows for more effective lifting of facial ptosis.

Another advantage of the medial based deep plane technique that will be demonstrated is that the deep plane facelift allows for soft tissue elevation of the midface where SMAS flap procedures anatomically cannot. Histologic studies have shown that the SMAS terminates at the lateral border of the zygomaticus major muscle, and does not traverse the midface. Therefore, traction on the lateral SMAS flap cannot exert an effect on the midface. The medial based deep plane rhytidectomy creates a composite flap of skin, subcutaneous fat and malar fat medial to the zygomaticus major muscle after releasing the zygomatic cutaneous ligaments. When this composite flap is repositioned vertically, it can be used to volumize the malar region and upper midface. We have performed volumetric analysis after vertical vector deep plane rhytidectomy with 23

month follow and demonstrated that patients gain an average of 3.2 cc of midface volume per side. This is the consequence of full composite flap release, allowing tension free re-draping of cheek fat compartments. We have performed further studies that have shown no statistical difference between the cheek volume gain from medial based vertical vector deep plane rhytidectomy, and that achieved 16 months after 10 cc of autologous fat transfer per cheek for mid-facial rejuvenation. When patients have insufficient volume reservoir to reposition, volume supplementation with fat grafting, injectable fillers, or implant placement may be used as an adjunctive procedure.

Another modification of the medial based deep plane facelift as it relates to neck rejuvenation is discussed in this master seminar. The deep plane dissection is extended below the angle of the mandible inferiorly. In the neck, the platysma is elevated from its posterior fascial attachments to the sternocleidomastoid muscle to approximately 5 cm below the inferior body of the mandible and anteriorly to the fascia overlying the submandibular gland. This releases the cervical retaining ligaments which fixate the lateral platysma that would otherwise limit platysmal re-draping. Incorporating a platysmal myotomy inferior to the mandibular border extending medially to the fascia overlying the submandibular gland creates a platysmal sling or hammock that supports ptosis of the gland and defines the submandibular contour. This places the traction of the platysma flap far medially, approximately 3 cm from the midline of the neck, again giving this operation a biomechanical advantage of lifting medial neck ptosis, platysmal bands and drooping submandibular glands. This extended

sub-SMAS and sub-platysmal approach can also mitigate the need to open the central neck in patients with mild to moderate neck laxity. Lastly, we have modified re-draping and suspension of the composite deep plane flap to volumize the gonial angle which atrophies with age, thus improving the jawline contour.

NEW MEDIAL BASED SMAS AND PLATYSMA APPROACHES IN DEEP PLANE FACELIFTING

ANDREW A. JACONO, MD, FACS, WILL BE PRESENTING A MASTER SEMINAR ON FRIDAY JUNE 8TH AT 8 AM IN THE DA VINCI ROOM

Andrew A. Jacono, MD, FACS Associate Clinical Professor Facial Plastic Surgery, Albert Einstein College of Medicine, 630 Park Avenue, New York, NY 10065 Tel: (212) 570-2500 Website: www.newyorkfacialplasticsurgery.com Instagram, Twitter, Facebook @drjacono

Figure 1 Deep Plane Facelift Before and After

M A S T E R S E M I N A R

P R O D U C T S P O T L I G H T

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RXPHOTO

Mobile Medical Photography RxPhoto is a cloud-based HIPPA compliant photo capture, storage, and management software. RxPhoto’s tools make medical practices more productive and successful in the dermatology, aesthetics, plastic surgery, vein treatment and wound care fields. It allows practices to take control of their clinical photography from capturing a photo to expectation management and marketing. The RxPhoto platform combines mobile and cloud technology to streamline the process of capturing and managing patient photos.

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