Although I have been editor of PSP magazine for a couple of years, I have been to only a few meetings or conferences—maybe 10 in all. Of the ones I have attended, the Multispecialty Foundation’s fifth annual Facial Cosmetic Surgery meeting in Las Vegas in early June 2009 was easily the best of the bunch.
Sequestered in one corner of the opulent Bellagio Hotel’s convention site, the meeting maintained an intimate atmosphere for learning and networking while providing the several hundred attendees a good range of CME-earning and educational offerings in a main hall. Another hall housed the many practice-management talks that occurred over the 6-day-long meeting.
An exhibit hall showcased a couple dozen product and service vendors. The lunches were served in this hall, where the seating and standing areas were well-organized. Beyond that, I sat in on numerous series of 10- to 15-minute (and sometimes longer) talks—lectures, pearls, anecdotes, tips, techniques. In other words, the “works.” Clinical seminars were also held. Yours truly did not attend those sessions.
The highlight of the meeting was the session on complications from cosmetic surgery. The organizers of the meeting, Randy Waldman and Edwin Cortez, brought together 25 speakers to talk from 5 minutes each about cases that went awry. The speakers recounted, often with humor, either cases that “got away from them” or ones in which they inherited a patient who needed the careful correction of an “awful plastic surgery” job.
More than a few physicians recalled MRSA infections in patients after blepharoplasty or rhytiodectomy. In one example, Greg Chernoff (who practices in both Indiana and California) encountered a 36-year-old female with a deformed septum on whom he performed a septo rhinoplasty. Afterward, the patient acquired a host of skin irritations and infections.
In an example of a fat-transfer procedure gone south, Bruce Connell of UC Irvine related how a young male wanted a strong chin and received several fat injections, with “untoward results,” Connell says. This gave Connell a chance to talk about the differences in artistic approach when using fat as a filler.
Joe Gryskowicz spoke about a postop bleeding problem in a 60-year-old woman who had a recent nose job. The answer was more common sense than high-tech: He found that he had to very slowly and carefully pull Rhino Rockets out of her nose to avoid new eruptions of gore.
See also “A New Surgical Technology for Facial Rejuvenation” by Richard D. Gentile, MD, MBA in the November 2008 issue of PSP.
Steven Hopping was next up, profiling how an elderly patient with a short-flap facelift had a very uncomfortable complication—a puffed-out face that required treatment. Dr Hopping applied a Scopoderm TTS patch, which is an antimuscarinic (or anticholinergic that is typically used to prevent travel sickness). Hopping also reported that he once treated a federal judge who had a botched rhytidectomy and, at 10 months postop, presented with keloid wounds around the ear.
New York City-based Phillip Miller explained how he managed the complications surrounding a patient with an augmented dorsum. One of the most common complications seen in dorsal augmentation is graft visibility. Thin skin, improper placement or carving of the graft, or a shifting of the graft may all contribute to this. Also, malpositioning may happen because of a variety of factors. Management of these complications is aimed at improving the aesthetics while minimizing the surgical trauma. A minimalist approach may be all that is needed.
In this case, Miller had used Silastic implants and posed the question, “Are they dangerous?” The issue, he says, relates to the implant material that would ride too high on the patient’s nose.
Seth Yellin of Atlanta encountered a patient who had picked at a pimple on her nose to the point of carving out what turned into an infected wound. He used Gore-Tex to perform a nasal reconstruction, which resulted in a successful outcome. Gore-Tex has been used to augment the nasal dorsum, lateral nasal wall, premaxilla, supra-tip area, columellar strut, radix, and shield grafts; as well as used for the “total lower lateral cartilage reconstruction.”