Liposuction Principles and Practice - part 1 pps

Melvin A. Shiffman · Alberto Di Giuseppe
Liposuction
Melvin A. Shiffman · Alberto Di Giuseppe
Liposuction
Principles and Practice
With 352 Figures in 622 Separate Illustrations and 84 Tables
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Melvin A. Shiffman, MD, JD
1101 Bryan Avenue, Suite G
Tustin, CA 92780, USA
Alberto Di Giuseppe
Institute of Plastic and Reconstructive Surgery
School of Medicine
University of Ancona
Ancona, Italy
This book is dedicated to the memory of Francesco Di Giuseppe MD
(father of Alberto Di Guiseppe), who was a pioneer of cardiology
in Italy from 1950 to 1970.
Alberto Di Giuseppe
Introduction
This work was undertaken because there is no true “text” on liposuction that cov-
ers the gamut of techniques, indications, uses, complications, and medical legal
problems. Even the term liposuction has been converted to such things as lipo-
plasty, liposculpture, lipostructure, lipexeresis, suction lipectomy, and suction-as-
sisted lipectomy. This variety of terms is to attract patients to the individuals who
have coined these terms or to describe a more artistic form of doing liposuction.
The procedures and their variations are all (perhaps taking the glamour out of the
surgery) simply liposuction.
Since 1974, when the procedure was first conceived by Arpad and Giorgio Fisch-
er, [1,2] to its production of a variety of cannulas, suction machines, and attempts
to make the surgery easier on the surgeon with power cannulas, laser assisted lipo-
suction, external and internal ultrasound, and massage, there have been attempts
to modify, improve, and extend the indications for liposuction by surgeons in a
variety of specialties. The addition of tumescent local anesthesia,3 an old concept,
[4-9] has improved the safety of the procedure and increased the amount of fluid
that can be removed. Today liposuction is one of the most frequent cosmetic pro-

cedures performed.
Physicians performing liposuction must be adequately trained and experienced
in the potential and actual complications before attempting to perform liposuc-
tion. Patient safety is the most important aspect of all surgeries, but especially
cosmetic surgery, which is an elective and not a medically necessary surgery. It is,
however, a psychological necessary surgery where the patient wishes to be his/hers
imagined perfect body image. What patients do not understand is that cosmetic
surgery may not meet his/hers expectations. This requires the surgeon to be espe-
cially careful in explaining the surgery and possible risk and complications to the
patient. New technology helps to improve results but experience, care, and skill of
the cosmetic surgeon, thinking in three-dimensional terms, is necessary to obtain
optimal results that satisfy the patient.
Liposuction alone may not be the answer to a patient’s beautification. There
may be other procedures necessary to meet the patient’s expectations and these
must be a thorough explanation by the surgeon to the patient.
Liposuction began as a contouring procedure but has evolved into the treatment
of the obese patient, gynecomastia, ptosis, macromastia, and even patients who
have complications from heart disease or diabetes. Other disorders such as axil-
lary sweat hypersecretion, lipomas, and angiomas are also potential disorders that
may be treated with liposuction.
The contributors to this book have spent time and effort to present to the cos-
metic and plastic surgeon as much information as possible in the techniques and
uses of liposuction for cosmetic and non-cosmetic surgery purposes. There is an
attempt to present broad subjects that will peak the surgeon’s interest in perhaps
exploring other uses for liposuction. There are still more disorders that may be
treated with liposuction that have not yet been explored.
The contributors are international so that techniques and applications of lipo-
suction that may not be in common use in the certain countries can be presented.
VIII
Liposuction is a surgery that is international in origin, in concept, and in usage.

There is a need to bring together the international community of physicians to
examine, evaluate, and research this procedure. It is the editors’ hope that all sur-
geons performing liposuction will benefit from this book.
Melvin A. Shiffman
Alberto Di Giuseppe
References
1. Fischer, G.: Surgical treatment of cellulitis. Third International Congress of International
Academy of Cosmetic Surgery, Rome, May 31, 1975
2. Fischer, G.: First surgical treatment for modeling body’s cellulite with three 5mm incisions.
Bull Int Acad Cosm Surg 1976;2:35-37
3. Klein, J.A.: The tumescent technique for liposuction surgery. Am J Cosm Surg 1987;4:263-
267
4. Matas, R.: Introduction. In Allen, C.W.(ed), Local and Regional Anesthesia, Philadelphia,
W.B. Saunders 1915
5. Bickham W.S.: Operative Surgery (Vol. 1), Philadelphia, W.B. Saunders, 1924:189-190
6. Lewis, D.: Practice of Surgery (Vol. 1), Hagerstown, MD, W.F. Prior, 1933:Chapter 4
7. Pokrovsky, B.A.: Infiltration anesthesia by creeping infiltration method of A.V. Vishnevsky.
In Obstetrics and Gynecology Practice, Kiev, Scientific Dunka 1954
8. Welch, J.D.: History of tumescent anesthesia. Part I: From American surgical textbooks of
the 1920s and 1930s. Aesthet Plast Surg 1998;18(5):353-357
9. Welch, J.D.: History of tumescent anesthesia. Part II: Vishnevsky’s anesthesia from Russian
textbooks, 1930 to 1970. Aesthet Plast Surg 2002;22(1):46-51
Introduction
Preface
Liposuction surgery is one of the commonest cosmetic procedures performed in
the USA. Despite its popularity there have been some poor results and even fa-
talities from the operation. Not enough information has been distributed to physi-
cians and the public on the non-cosmetic applications of liposuction. Breast re-
duction with the use of liposuction as well as the treatment of obesity and male
gynecomastia are performed regularly. There has been an evolution in liposuction

as physicians have found successful treatment of a variety of other medical and
surgical problems.
This book brings together all of the present known non-cosmetic uses of lipo-
suction and shows the specific methods utilized as well as the results. The future
will introduce liposuction as a treatment of other medical and surgical problems as
medical knowledge and experience progresses.
Melvin A. Shiffman
Contents
Part I:
General Information
Chapter 1
The History of Liposuction
Timothy Corcoran Flynn MD 3
Chapter 2
Pathologic Disorders of Subcutaneous Fat
Maurizio Podda MD, Marcella Kollmann MD, Roland Kaufmann MD 7
Chapter 3
Lipedema and Lymphatic Edema
Manuel E. Cornely MD 10
Chapter 4
Biochemical Effects of Liposuction
Lina Valero Pedroza MD 15
Chapter 5
The Anatomy and Physiology Metabolism/Nutrition of Subcutaneous Fat
Mitchell V. Kaminski MD, Rose M. Lopez de Vaughan PhD 17
Chapter 6
Liposuction Technique and Lymphatics in Liposuction
Andreas Frick MD, Rüdiger G.H. Baumeister MD,
Johannes N. Hoffmann MD 26
Chapter 7

Proposed Safety Guidelines for the Maximum Volume Fat Removal
by Tumescent Liposuction
Warwick L. Greville MD 30
Part II:
Anesthesia
Chapter 8
Anesthesia for Liposuction
Gary Dean Bennett MD 37
Chapter 9
Pharmakokinetics of Tumescent Anesthesia:
Timothy D. Parish MD 54
XII
Contents
Chapter 10
Liposuction with Local Tumescent Anesthesia a
nd Microcannula Technique
Bernard Raskin MD 61
Chapter 11
Tumescent Technique
Melvin A. Shiffman MD, JD 72
Chapter 12
Safety of Lidocaine During Tumescent Anesthesia for Liposuction
Kimberly J. Butterwick MD, Mitchell P. Goldman MD 75
Chapter 13
Tumescent Local Anesthesia with Articaine
Afschin Fatemi MD 80
Part III:
Cannulas
Chapter 14
Cannula Designs

Paul S. Collins MD 85
Chapter 15
Inadequate Sterilization of Liposuction Cannulas:
Problems and Prevention
Allan E. Wulc MD, Brenda C. Edmonson MD 91
Part IV:
Preoperative
Chapter 16
Preoperative Consultation
Melvin A. Shiffman MD, JD 97
Chapter 17
Drugs to Limit Use of or Avoid when Performing Liposuction
Melvin A. Shiffman MD, JD 100
Part V:
Techniques
Chapter 18
Facial Recontouring with Liposuction
Edward H. Farrior MD, Raymond D. Cook MD, Stephan S. Park MD 111
Chapter 19
Liposuction of the Upper Extremities:
Melvin A. Shiffman MD, JD, Sid Mirrafati MD 120
XIII
Chapter 20
Refinements in Liposculpture of the Buttocks and Thighs
Luiz Toledo MD 124
Chapter 21
Liposculpture of the Lower Extremities Using a Tourniquet
Kamal Cherif Zahar MD, Soraya Bensenane-Hasbelaoui MD 133
Chapter 22
Liposuction of the Trunk

Giorgio Fischer MD 141
Chapter 23
Liposuction and Dermolipectomy
Ivo Pitanguy MD, Henrique N. Radwanski MD,
Barbara H.B. Machado MD 146
Chapter 24
The Modern Lipoabdominoplasty
Jorge I. de la Torre MD, Luis O. Vásconez MD 154
Chapter 25
Abdominal Liposuction in Colostomy Patients
Bernard I. Raskin MD 161
Chapter 26
Liposuction and Lipotransfer for Facial Rejuvenation in the Asian Patient
Tetsuo Shu MD, Samuel M. Lam MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Chapter 27
Microcannula Liposuction
Bernard I. Raskin MD, Shilesh Iyer MD 171
Chapter 28
Superficial Liposculpture: Rationale and Technique
Robert F. Jackson MD 185
Chapter 29
Three-Dimensional Superficial Liposculpture for Aged and Relaxed Skin
Marco Gasparotti MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Chapter 30
Reduction Syringe Liposculpturing
Pierre F. Fournier MD 206
Chapter 31
Orthostatic Liposculpture
Giorgio Fischer MD 217
Part VI

Ultrasound
Chapter 32
Ultrasound-Assisted Liposuction: Past, Present, and Future
William W. Cimino MD 325
Contents
XIV
Contents
Chapter 33
Ultrasound-Assisted Liposuction: Physical and Technical Principles
Alberto Di Giuseppe MD 229
Chapter 34
VASER-Assisted Lipoplasty: Technology and Technique
William W. Cimino MD 239
Chapter 35
Ultrasound-Assisted Lipoplasty for Face Contouring with VASER
Alberto Di Giuseppe MD 245
Chapter 36
Mastopexy (Breast Lift) with Ultrasound-Assisted Liposuction
Alberto Di Giuseppe MD 254
Chapter 37
Histologic Changes with Breast Ultrasound-Assisted Liposuction
Joseph T. Chun MD, James W. Taylor MD, Stuart E. Van Meter MD 258
Chapter 38
Excessive Free Radicals Are Not Produced
During Ultrasound-Assisted Liposuction
Rolf R. Olbrisch MD, Marc A. Ronert MD, Jürgen Herr MD 262
Chapter 39
External Ultrasound and Superficial Subdermal Liposuction
Carlo Gasperoni MD, Marzia Salgarello MD, Paolo Gasperoni MD 265
Chapter 40

External Ultrasound Before and After Liposculpture
William R. Cook Jr. MD 276
Part VII:
Power-Assisted
Chapter 41
Powered Liposuction Equipment
Timothy Corcoran Flynn MD 283
Chapter 42
Power-Assisted Lipoplasty
Ângelo Rebelo MD 286
Chapter 43
Safety Protocols for Power-Assisted External Ultrasonic Liposculpture
Robert A. Shumway MD 290
Part VIII:
Newer Techniques
Chapter 44
Reduced Negative Pressure in Liposuction
Michael V. Elam MD 301
XV
Chapter 45
Tissue Stabilization in Liposuction Surgery
Gerhard Sattler MD, Dorothee Bergfeld MD 305
Chapter 46
External Percussion Massage-Assisted Liposuction
Melvin A. Shiffman MD, JD, Sid Mirrafati MD 309
Chapter 47
Low-Level Laser-Assisted Liposuction
Rodrigo Neira MD 312
Chapter 48
Laserlipolysis

Diego E. Schavelzon MD, Guillermo Blugerman MD,
Anastasia Chomyszyn MD 321
Chapter 49
Water-Jet-Assisted Liposuction
A. Ziah Taufig MD 326
Part IX:
Complications
Chapter 50
Prevention and Treatment of Liposuction Complications
Melvin A. Shiffman MD, JD 333
Chapter 51
Disharmonious Obesity Following Liposuction
James E. Fulton Jr. MD, PhD, Farzin Kerendian DO 342
Chapter 52
Blood Loss in Liposuction Surgery
E. Antonio Mangubat MD, Colin Harbke MS 347
Chapter 53
Fat Shifting for the Treatment of Skin Indentations
Melvin A. Shiffman MD, Guillermo Blugerman MD 353
Chapter 54
Liposuction Mortality
Melvin A. Shiffman MD, JD 357
Part X:
Principles and Standards
Chapter 55
Psychology and Quality of Life
of Patients Undergoing Liposuction Surgery
Gerhard Sattler MD, Dorothee Bergfeld MD,
Boris Sommer MD, Matthias Augustin MD 363
Contents

XVI
Contents
Chapter 56
Liposuction Practitioner Profile
and Current Practice Standards and Patient Safety
Robert F. Jackson MD 366
Chapter 57
Principles of Liposuction
Melvin A. Shiffman MD, JD 379
Part XI:
Medical Legal
Chapter 58
Medical Liability Claims For Liposuction-Improving the Odds
Rudolph H. de Jong MD 383
Chapter 59
Medical Legal Problems in Liposuction
Melvin A. Shiffman MD, JD 393
Part XII:
Commentary
Chapter 60
Editors Commentary
Melvin A. Shiffman MD, JD 405
Chapter 61
Non-Cosmetic Applications of Liposuction
Melvin A. Shiffman MD, JD 408
Chapter 62
Ultrasound-Assisted Liposuction For Breast Reduction
Alberto Di Giuseppe MD 415
Chapter 63
Large-Volume Liposuction For Obesity

Enrique Hernández-Pérez MD,
Jose A. Seijo-Cortes MD, Hassan Abbas Khawaja MD 425
Chapter 64
Metabolic and Clinical Studies of Liposuction in Obesity
Beniamino Palmieri MD 435
Chapter 65
Large-Volume Liposuction for the Treatment
of the Metabolic Problems of Obesity
Beniamino Palmieri MD 439
Chapter 66
Megaliposuction: over 10 Liters
Pierre F. Fournier MD 443
XVII
Chapter 67
Cardiovascular Risk Profile Improvement with Large-Volume Liposuction
Gabriel Uwaifo MD, Jack A. Yanovski MD, PhD 451
Chapter 68
Liposuction for Gynecomastia
Enrique Hernandez-Perez MD, Hasson Abbas Khawaja MD,
Jose A. Seijo-Cortes MD 460
Chapter 69
Axillary Approach in Suction-Assisted Lipectomy of Gynecomastia
Antonio C. Abramo MD 465
Chapter 70
Ultrasound-Assisted Liposuction for Gynecomastia
Alberto Di Giuseppe MD 474
Chapter 71
Lipomas Treated with Liposuction
John S. Mancoll MD 481
Chapter 72

Treatment of Multiple Symmetrical Lipomatosis with Liposuction
Jorge A. Martínez-Escribano MD, PhD, Rafael González-Martínez MD 485
Chapter 73
Treatment of Madelung’s Disease with Ultrasound-Assisted Liposuction
Angela Faga MD, FICS 489
Chapter 74
Treatment of Multiple Angiolipomas by Liposuction Surgery
Takehiko Kaneko MD 492
Chapter 75
Treatment of Excessive Axillary Sweat Syndromes
(Hyperhidrosis, Smidrosis, Bromhidrosis) with Liposuction
Ren-Yeu Tsai MD 496
Chapter 76
Treatment of Fox–Fordyce Disease with Liposuction-Assisted Curettage
Stephanie Marschall MD, Michael Marschall MD, Mireille Chae MD 502
Chapter 77
Laser-Assisted Liposuction of Axillary Sweat Glands and Hair Removal
Martin Klöpper MD, Gosta Fischer MD, Guillermo Blugerman MD 505
Chapter 78
Liposuction in Dercum’s Disease
Erik Berntorp MD, Kerstin Berntorp MD, Hakan Brorson MD 516
Chapter 79
Treatment of Hematomas with Liposuction
Antonio Ascari-Raccagni MD 519
Contents
XVIII
Contents
Chapter 80
Syringe Liposuction for Residual Fat in Involuted Facial Hemangioma
Beatriz Berenguer MD, PhD, Javier Enríquez de Salamanca MD,

Beatriz González MD, Pilar Rodríguez MD,
Antonio Zambrano MD, Antonio Pérez Higueras MD, PhD. . . . . . . . . . . . . . . 523
Chapter 81
Aspiration of Breast Cysts with Liposuction
Shridhar Ganpathi Iyer MB, MS, FRCS, Thiam Chye Lim MBBS,
FRCS (Ed), FICS, Jane Lim MBBS, FRCS (Ed), FRCS (Glas) 527
Chapter 82
Blunt Liposuction Cannula Dissection in Reconstructive Surgery
Lawrence M. Field MD 532
Chapter 83
Cellulite Syndromes
Pier A. Bacci MD, Lorenzo Scatolini MD,
Serena Leonardi, Paola Belardi RN, Sergio Mancini MD 536
Chapter 84
Liposuction Treatment of Cellulite
Clara Lieberman MD, Jose A. Cohen MD, Rashi Rosenstock MD 539
Chapter 85
Vibro-Assisted Liposuction and Endermologie for Lipolymphedema
Pier A. Bacci MD, Lorenzo Scatolini MD,
Serena Leonardi, Paola Belardi RN, Sergio Mancini MD 542
Chapter 86
Liposuction of Lipedema
Manuel E. Cornely MD 547
Chapter 87
Liposuction in Treatment of Plexiform Neurofibromas
Srdan Babovic MD, Dusica Babovic-Vuksanovic MD 550
Chapter 88
HIV Lipodystrophy Treatment (Buffalo Hump)
with VASER Ultrasound-Assisted Lipoplasty
Alberto Di Giuseppe MD, Marianne Wolters MD,

Herman Lampe MD, Guido Zanetti MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 554
Subject Index 563
List of Contributors
Matthias Augustin MD
Senior Resident, Deptartment of Dermatology, University of Freiburg,
Freiburg, Germany
Pier Antonio Bacci MD
Professor of Aesthetic Surgery, University of Siena, Siena, Italy;
Chairman Aesthetic Medicine and Surgery Center, Private Hospital S. Chiara,
Florence, Italy
Rüdiger G.H. Baumeister MD
Private Practice, Plastische, Hand-, Mikrochirurgie,
Chirurgische Klinik – Grosshadern, Klinikum der Universität, Munich, Germany
Gary Dean Bennett MD
Vice Chairman, Department of Anesthesiology,
Director of Pain Management Services, Chapman Medical Center,
Orange, CA, USA
Soraya Bensenane-Hasbelaoui MD
Private Practice, Paris, France
Dorothee Bergfeld MD
Private Practice, Center for Cosmetic Dermatologic Surgery,
Rosenparkklinik, Darmstadt, Germany
Guillermo Blugerman MD
Private Practice, Plastic Surgery, Buenos Aires, Argentina
Kimberly J. Butterwick MD
Clinical Faculty, Scripps Hospital, San Diego, CA, USA
Kamal Cherif-Zahar MD
Private Practice, Paris, France
Anastasia Chomyszyn MD
Private Practice, Plastic Surgery, Buenos Aires, Argentina

Joseph T. Chun MD
Assistant Professor of Surgery, Department of Surgery,
Division of Plastic Surgery, The University of Tennessee Medical Center,
Knoxville, TN, USA
William W. Cimino MD
Private Practice, Louisville, CO, USA
XX
Paul S. Collins MD
Private Practice, San Luis Obisbo, CA, USA
Raymond Cook MD
Assistant Professor, Department of Otolaryngology-Head and Neck Surgery,
University of North Carolina and Wake Medical Center, Raleigh, NC, USA
William R. Cook Jr. MD
Private Practice, Miami Beach, FL, USA
Manuel E. Cornely MD
Private Practice, Düsseldorf, Germany
Rudolf H. de Jong MD
Professor (Hon) of Surgery/Anesthesia, School of Medicine,
University of South Carolina, Columbia, SC, USA
Alberto Di Giuseppe MD
Associate Professor in Plastic and Reconstructive Surgery,
Institute of Plastic and Reconstructive Surgery, School of Medicine,
University of Ancona, Ancona, Italy
Brenda C. Edmonson MD
Instructor in Oculoplastics, Drexel Hahnemann University,
Philadelphia, PA, USA
Michael V. Elam MD
Private Practice, Newport Beach, CA, USA
Edward H. Farrior MD
Clinical Associate Professor, Department of Otolaryngology-Head and Neck

Surgery, University of South Florida, Tampa, FL, USA
Afschin Fatemi MD
S-thetic Clinic, Düsseldorf, Germany; Department of Dermatology,
Katharinen-Hospital, Unna, Germany
Giorgio Fischer MD
Private Practice, Rome, Italy
Timothy Corcoran Flynn MD
Clinical Professor, Department of Dermatology,
University of North Carolina, Chapel Hill, NC, USA
Pierre F. Fournier MD
Private Practice of Plastic Surgery, Paris, France
Andreas Frick MD
Private Practice, Plastische, Hand-, Mikrochirurgie,
Chirurgische Klinik-Grosshadern, Klinikum der Universität, Munich, Germany
James E. Fulton Jr. MD, PhD
Private Practice, Tustin, CA, USA
Marco Gasparotti MD
Professor of Aesthetic Surgery, University of Rome Tor Vergata, Rome, Italy
List of Contributors
XXI
Carlo Gasperoni MD
Professor of Aesthetic Surgery, Plastic Surgery Specialization School,
Università Cattolica Del Sacro Cuore, Rome, Italy
Paolo Gasperoni MD
Plastic Surgery Resident, Università Cattolica Del Sacro Cuore, Rome, Italy
Mitchel P. Goldman MD
Clinical Professor of Dermatology/Medicine, University of California,
San Diego, CA, USA
Beatriz González MD
Attending Physician, Universidad Autonoma of Madrid,

Hospital “Niño Jesús”, Madrid, Spain
Warwick L. Greville MBBS, FACCS
Private Practice, South Yarra, VIC, Australia
Colin Harbke MS
Graduate Student, Washington State University, WA, USA
Enrique Hernández-Perez MD
Private Practice, Center for Dermatology and Cosmetic Surgery,
San Salvador, El Salvador
Jürgen Herr MD
Private Practice, Düsseldorf, Germany
Antonio Pérez Higueras MD, PhD
Associate Professor of Medicine, Universidad Autonoma of Madrid,
Head Department of Neuroradiology, Clinica la Concepcion, Madrid, Spain
Johannes N. Hoffmann MD
Private Practice, Plastische, Hand-, Mikrochirurgie,
Chirurgische Klinik-Grosshadern, Klinikum der Universität, Munich, Germany
Shilesh Iyer MD
Clinical Instructor, Division of Dermatology, Department of Medicine, UCLA
School of Medicine, 23861 Mc Bean Parkway, Suite E-21, Valencia, CA 91355, USA
Robert F. Jackson MD
Private Practice, Ambulatory Care Center, Marion, IN, USA
Roland Kaufmann MD
Professor, Department of Dermatology, Medical School,
University of Frankfurt, Frankfurt, Germany
Mitchell V. Kaminski MD
Clinical Professor of Surgery Physician Assistant Program,
Finch University of Health Sciences, Chicago Medical School, Chicago, IL, USA
Farzin Kerendian DO
Private Practice, Encino, CA, USA
List of Contributors

XXII
Marcella Kollmann MD
Department of Dermatology, Medical School, University of Frankfurt,
Frankfurt, Germany
Samuel M. Lam MD
Private Practice, Director Lam Facial Plastic Surgery Center, Dallas, TX, USA
Rose M. Lopez de Vaughan PhD
Special assistant to Dr. Kaminski, Finch University of Health Sciences,
Chicago Medical School, Chicago, IL, USA
Bárbara H.B. Machado MD
Clinical Instructor Plastic Surgery, Pontifical Catholic University of Rio de
Janeiro (PUC-Rio), Rio de Janeiro, Brazil; Clinical Instructor, Carlos Chagas
Institute of Post-Graduate Medical Studies, Rio de Janeiro, Brazil
Daniel Man MD
Private Practice, Boca Raton, FL, USA
E. Antonio Mangubat MD
Private Practice, Tukwila, WA, USA
Sid Mirrafati MD
Private Practice, Tustin, CA, USA
Rodrigo Neira MD
Professor, Department of Plastic, Maxillofacial, and Hand Surgery,
Pontifica Universidad Javeriana, Cali, Colombia
Rolf R. Olbrisch MD
Head of the Department of Plastic Surgery, Florence Nightingale Hospital,
Düsseldorf, Germany
Stephan S. Park MD
Associate Professor and Vice Chairman, Department of Otolaryngology-Head
and Neck Surgery, University of Virginia Health Systems;
Director of Division of Facial Plastic and Reconstructive Surgery,
Charlottesville, VA, USA

Timothy D. Parish MD
Private Practice, Varicosis and Laser Center of Alabama, Hoover, AL, USA
Lina Valero Pedroza MD
Private Practice, Santa Fe de Bogota, Colombia
Ivo Pitanguy MD
Head Professor of Plastic Surgery, Pontifical Catholic University of Rio de
Janeiro (PUC-Rio) and Carlos Chagas Institute of Post-Graduate
Medical Studies, Rio de Janeiro, Brazil
Maurizio Podda MD
Assistant Professor, Department of Dermatology, Medical School,
University of Frankfurt, Frankfurt, Germany
List of Contributors
XXIII
Henrique N. Radwanski MD
Clinical Instructor Plastic Surgery, Pontifical Catholic University of Rio de
Janeiro (PUC-Rio), Rio de Janeiro, Brazil; Clinical Instructor, Carlos Chagas
Institute of Post-Graduate Medical Studies, Rio de Janeiro, Brazil
Bernard I. Raskin MD
Assistant Clinical Professor, Division of Dermatology, Department of Medicine,
UCLA School of Medicine, CA, USA
Ângelo Rebelo MD
Private Practice, Plastic, Reconstructive and Aesthetic Surgery,
Clínica Milénio, Lisbon, Portugal
Pilar Rodríguez MD
Attending Physician, Universidad Autonoma of Madrid,
Hospital “Niño Jesús”, Madrid, Spain
Marc A. Ronert MD
Private Practice, Düsseldorf, Germany
Marzia Salgarello MD
Assistant Surgeon, Plastic Surgery Department,

Università Cattolica Del Sacro Cuore, Rome, Italy
Gerhard Sattler MD
Private Practice, Rosenparkklinik, Darmstadt, Germany
Diego Schavelzon MD
Private Practice, Plastic Surgery, Buenos Aires, Argentina
Melvin A. Shiffman MD, JD
Chairman Department of Surgery, Tustin Hospital and Medical Center,
Tustin, CA, USA
Tetsuo Shu MD
Private Practice, Director, Daikanyama Clinic, Tokyo, Japan
Robert A. Shumway MD
Private Practice, The Shumway Institute of Laser and Cosmetic Surgery,
La Jolla, CA, USA
Boris Sommer MD
Private Practice, Center for Cosmetic Dermatologic Surgery,
Rosenparkklinik, Darmstadt, Germany
Ahmed Ziah Taufig MD
Private Practice, Facharzt für Chirurgie, Facharzt fur Plastische Chirurgie,
Handchirurgie, Cologne, Germany
James W. Taylor MD
Associate Professor of Surgery, Department of Surgery,
Division of Plastic Surgery, The University of Tennessee Medical Center,
Knoxville, TN, USA
List of Contributors
XXIV
Luiz S. Toledo MD
Private Practice in Plastic and Reconstructive Surgery, Professor of Post-Graduate
Education in Aesthetic Plastic Surgery, São Paulo, Brazil
Jorge I. de la Torre MD
Associate Professor, Division of Plastic Surgery, University of Alabama

Birmingham, AL, USA
Stuart E. Van Meter MD
Associate Professor of Pathology, Department Chairman, Department of
Pathology, The University of Tennessee Medical Center, Knoxville, TN, USA
Luis O. Vásconez MD
Professor and Chief, Division of Plastic Surgery, University of Alabama,
Birmingham, AL, USA
Allan E. Wulc MD
Associate Clinical Professor of Ophthalmology, University of Pennsylvania,
Drexel Hahnemann University, Philadelphia, PA, USA
Antonio Zambrano MD
Chief of Dermatology, Department of Dermatology,
Universidad Autonoma of Madrid, Hospital “Niño Jesús”, Madrid, Spain
Antonio Carlos Abramo MD
Head Professor of Post-Graduate Course of Plastic Surgery,
Division of Plastic and Reconstructive Surgery,
General Hospital of Beneficência Portuguesa, São Paulo, Brazil
Antonio Ascari-Raccagni MD
Chief Assistant, Dermatology Department, Dermatology Oncology Unit
G.B.Morgagni – L. Pierantoni: General Hospital, Forli, Italy
Dusica Babovic-Vuksanovic MD
Associate Professor, Medical Genetics, Mayo College of Medicine,
Rochester, MN, USA
Srdan Babovic MD
Private Practice, Plastic Surgery, Olmsted Medical Group, Rochester, MN, USA
Pier Antonio Bacci MD
Professor of Aesthetic Surgery, University of Siena, Siena, Italy; Chairman,
Aesthetic Medicine and Surgery Center, Private Hospital S. Chiara, Florence, Italy
Paola Belardi RN
Vascular Nurse, Bacci Medical Center, Arezzo, Italy

Beatriz Berenguer MD, PhD
Attending Physician, Division of Plastic Surgery,
Universidad Autonoma of Madrid, Hospital “Niño Jesús”, Madrid, Spain
Erik Berntorp MD
Professor, Department of Coagulation Disorders, Lund University,
Malmö University Hospital, Malmö, Sweden
List of Contributors
XXV
Kerstin Berntorp MD, PhD
Associate Professor, Department of Endocrinology,
University of Lund, University Hospital Malmö, Malmö, Sweden
Guillermo Blugerman MD
Private Practice Plastic Surgeons, B&S Centro de Excelencia en Cirugia Plástica
Buenos Aires, Argentina
Hakan Brorson MD, PhD
Full Time Consultant Plastic Surgeon, Department of Plastic and Reconstructive
Surgery, Lund University, Malmö University Hospital, Malmö, Sweden
Mireille Chae MD
Private Practice, Plastic Surgery Consultants of Dupage, Wheaton, IL, USA
Jose A. Cohen MD
Private Practice, San Jose, Costa Rica
Manuel E. Cornely MD
Private Practice, Düsseldorf, Germany
Alberto Di Giuseppe MD
Associate Professor in Plastic and Reconstructive Surgery, Institute of Plastic and
Reconstructive Surgery, School of Medicine, University of Ancona, Ancona, Italy
Angela Faga MD, FICS
Professor and Chairman of Plastic and Reconstructive Surgery, Chief of the Unit
of Plastic and Reconstructive Surgery, University of Pavia, Pavia, Italy
Lawrence M. Field MD, FIACS

Inaugural International Chair of Dermatologic Surgery (International Society
of Dermatologic Surgery); Department of Dermatology (Dermatologic Surgery),
University of California, San Francisco, CA, USA; Department of Dermatology,
Stanford University Medical Center, Stanford, CA, USA
Giorgio Fischer MD
Professor of Pathology, Via della Camiluccia, Rome, Italy
Pierre F. Fournier MD
Private Practice of Plastic Surgery, Paris, France
Beatriz González MD
Division of Plastic Surgery, Universidad Autonoma of Madrid,
Hospital “Niño Jesús”, Madrid, Spain
Rafael González-Martínez MD
Private Practice Plastic Surgery, Castellón, Spain
Shridhar Ganpathi Iyer MB, MS, FRCS
Registrar, Division of Surgery, National University Hospital, Singapore
Enrique Hernández-Pérez MD
Private Practice, Center for Dermatology and Cosmetic Surgery,
San Salvador, El Salvador
List of Contributors
XXVI
Takehiko Kaneko MD
Director, Department of Dermatology, Fraternity Memorial Hospital,
Tokyo, Japan
Hassan Abbas Khawaja MD
Private Practice, Center for Dermatology and Cosmetic Surgery,
San Salvador, El Salvador
Martin Klöpper MD
Private Practice, Privatklinik Northeim, Northeim, Germany
Herman Lampe MD
Private Practice, Plastic Surgery, Frankfurt, Germany

Serena Leonardi
Physiotherapist, Private Hospital S. Chiara, Florence, Italy
Clara Lieberman MD
Private Practice, San Jose, Costa Rica
Jane Lim MBBS, FRCS (Ed), FRCS (Glas)
Consultant, Department of Surgery, National University Hospital, Singapore
Thiam Chye Lim MBBS, FRCS (Ed), FICS
Head and Senior Consultant, Division of Plastic and Reconstructive Surgery,
National University Hospital, Singapore
Sergio Mancini MD
Director Surgery, University of Siena, Siena, Italy
John S. Mancoll MD
Private Practice, Fort Wayne, IN, USA
Michael Marschall MD
Private Practice, Plastic Surgery Consultants of Dupage, Wheaton, IL, USA
Stephanie Marschall MD
Private Practice, Plastic Surgery Consultants of Dupage, Wheaton, IL, USA
Jorge A. Martínez-Escribano MD, PhD
Medical Staff, Dermatology Department,
Virgen de la Arrixaca University Hospital., Murcia, Spain
Beniamino Palmieri MD
Associate Professor of Surgery, Department of Surgery,
Universita Degli Studi di Modena e Reggio Emilia, Modena, Italy
Antonio Pérez Higueras MD, PhD
Division of Interventional Radiology, Fundación Himénez Díaz, Madrid, Spain
Pilar Rodríguez MD
Division of Plastic Surgery, Universidad Autonoma of Madrid,
Hospital “Niño Jesús”, Madrid, Spain
Rashi Rosenstock MD
Private Practice, San Jose, Costa Rica

List of Contributors
XXVII
Javier Enríquez de Salamanca MD
Chief of Plastic Surgery, Universidad Autonoma of Madrid,
Hospital «Niño Jesús”, Madrid, Spain
Lorenzo Scatolini MD
Nuclear Medicine, Private Hospital S. Chiara, Florence, Italy
Jose A. Seijo-Cortes MD
Private Practice, Center for Dermatology and Cosmetic Surgery,
San Salvador, El Salvador
Melvin A. Shiffman MD, JD
Chairman, Department of Surgery, Tustin Hospital and Medical Center,
Tustin, CA, USA, e-mail: ,
Tel: +1-714-5441720, Fax: +1-714-544-6118
Ren-Yeu Tsai MD
Associate Clinical Professor, Department of Dermatology,
Taipei Medical University, Director of Skin Laser Center,
Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
Gabriel I. Uwaifo MD
MedStar Research Institute,, Washington, DC, USA
Marianne Wolters MD
Private Practice, Plastic Surgery, Frankfurt, Germany
Jack A. Yanovski MD, PhD
Unit on Growth and Obesity, National Institutes of Health, Bethesda, MD, USA
Antonio Zambrano MD
Department of Dermatology, Universidad Autonoma of Madrid,
Hospital “Niño Jesús”, Madrid, Spain
Guido Zanetti MD
Department of Plastic Surgery, Sant’Orsala Hospital, Bologna, Italy
List of Contributors