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Cosmetic Surgery 2016 Annual Scientific
Meeting, where youll have the opportunity
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T H E  D I P L O M AT  R E S O R T  &  S PA
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2016 annual meeting

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CONTENTS

FEATURES

10
13
17
22

2015 ISSUE 2

One Doctor's Story:

Treating the Transgender Patient
Behind the Transition: Illuminating Trans-patient
Surgical Facial Feminization Procedures

>

Facing Facts: Tips on Non-Surgical

Trans-patient Facial Procedures
Transgender
Chest Masculinization

INSIDE
Letter from the Editor

Presidents Word

FAQs on the AACS Cer tified Fellowship Programs

AACS's Newest Par tner Assists with HIPAA Compliance

26

A Repor t from the AMA House of Delegates

28

Academy News

32

Published quarterly for members of the American Academy of Cosmetic Surgery, the American
Society of Liposuction Surgery, American Society of Cosmetic Laser Surgery and the American
Society of Hair Restoration Surgery, non-profit organizations representing practitioners
of medical disciplines including dermatology, ophthalmology, otolaryngology, plastic and
reconstructive surgery, oral and maxillofacial surgery and general surgery. Views and opinions
expressed are those of the authors and not those of AACS, ASLS, ASCLS or ASHRS.

Editor-in-Chief:
Joseph Niamtu III, DMD, FAACS

All contents 2015, American Academy of Cosmetic Surgery.

For subscription information, address changes, AACS, ASLS, ASCLS and ASHRS membership
inquiries, contact: Sentergroup, Inc. 225 W. Wacker Drive, Suite 650 Chicago, IL 60606.
Phone: 312.981.6760; Fax: 312.981.6787; Email: info@cosmeticsurgery.org;
website: cosmeticsurgery.org.

President:
Michael J. Will, MD, DDS, FACS
Director of Marketing
and Communications:
Jean OBrien

AACS MEMBERSHIP

LETTER FROM

THE EDITOR
Greetings Fellow AACS members,
I hope everyone is coming off of a great summer and that their personal
and professional lives are prospering. This issue of SURGE is a milestone
in that it is the first digital edition of this publication. Like many pulp
publications, technology and green intentions have driven many similar

<

publications to a digital format.

I like it and I dont like it! It is nice to be able to read something on
any device at any time and always have access to it. After all, it reduces
desk clutter, paper waste, printing costs, etc. On the other hand, there
is something satisfying about holding a magazine and reading in a

Joe Niamtu, III, DMD,

FAACS
Joe Niamtu, III, DMD, FAACS, is
board certified by the American
Board of Oral and Maxillofacial
Surgery and is a fellow of the
American Academy of Cosmetic
Surgery and the American Society
for Laser Medicine and Surgery.

traditional manner. I guess this is more of a habit and in the future it will
be similar to playing records. I am anxious to hear from our membership
as to what format they prefer.
Regardless of the format, SURGE has continued to update our
membership about goings on in the AACS and relevant content to our
profession. This issue addresses transgender surgery which has been
and will continue to be a growing part of cosmetic surgery. There are
many biopsychosocial implications regarding this surgery that may set
these patients apart from the average cosmetic surgery patient. Surgeons
treating transgender patients must take the time to learn and understand
the goals, trials and tribulations of these patients. Like any subset of
patients or procedures, a thorough understanding of the patient and
procedure is paramount for success. We have many accomplished doctors
in our membership that perform transgender surgery. This includes a
spectrum from small minimally invasive procedures to complex gender
reassignment surgery.

I predict that as societal mores change, these patients and procedures

will become a growing portion of our journal and meetings.
Finally, I, and the other members of the annual meeting planning
committee (Kristen Brecht, MD; Kevin Jovanovic, MD; Tony Mangubat, MD;
Mandy Newman; Joe Niamtu III, DMD; Marco Pelosi III, MD;
Jennifer Peterson, MD; Edward M. Zimmerman, MD) have been busy
all spring and summer with conference calls planning the 2016 Annual
Scientific Meeting. I have also spent many evenings on conference calls
with the AACS Board of Directors and Executive Committee. But wait
there is more I have been on conference calls for the communication
committee as well. It is important for all members to realize the
commitment of our officers and committee members. They truly are
committed to improving our organization and I encourage any new or

Like any subset

of patients
or procedures,
a thorough
understanding of
the patient and
procedure
is paramount
for success.

>

existing members to become involved in these committees. No two people

exemplify this type of leadership and commitment more than our current
president, Michael Will, and incoming president, Robert Shumway.
Our Academy is growing and great things are happening. I look forward to
the busy season coming as the days get shorter and colder and hope to
see you all in Florida in January.
JOSEPH NIAMTU, III, DMD

AACS MEMBERSHIP

PRESIDENT'S WORD
Looking Back at My Fellowship Training in Cosmetic Surgery
The AACS has offered formal fellowship training in various aspects of
cosmetic surgery for nearly 30 years and is proud to be the countrys
lead organization in this endeavor. I can remember researching cosmetic

<

surgery fellowship training programs while I was in my residency in an

attempt to pursue fellowship training myself. However, in the late 80s
and early 90s, there were only a handful of cosmetic surgery fellowship
training opportunities available. Now, the AACS certifies over 20 formal
fellowship training programs in General Cosmetic Surgery and two
Facial Cosmetic Surgery fellowships. We have all realized that our
primary residency training programs exposed us to cosmetic procedures,

Michael J. Will, MD,

DDS, FACS
Michael J. Will, MD, DDS, FACS,
is a board-certified oral and
maxillofacial surgeon and cosmetic
surgeon in Maryland. He is a fellow

but fell short of the comprehensive cosmetic training that would provide
competency in all aspects of the specialty of cosmetic surgery. Our
field has become more complex with new techniques and technologies
introduced every year, making formal fellowship training and continuing
cosmetic surgical and non-surgical education a necessity in delivering
safe and predictable outcomes.

member of the AACS and currently

I remember being exposed to a fair amount of cosmetic surgery in my

serves as its President.

residency and contemplating the need for fellowship training. Once I

entered my cosmetic surgery fellowship, I quickly realized how little I
knew and was so grateful to be exposed to over a thousand cosmetic
surgical procedures during that year. The AACS fellowships are now
standardized and follow ACGME guidelines, qualifying graduating fellows
to challenge the American Board of Cosmetic Surgery (ABCS). The ABCS
is a high-stakes certifying board that exceeds the ABMS standards and
is the only board that certifies exclusively in cosmetic surgery. I highly
encourage anyone interested in formal cosmetic surgery training to

AACS FELLOWSHIP
PROGRAM

contact the AACS and to pursue fellowship training. The education is

powerful and I know you will not regret the advanced training. Both your
practice and patients will benefit tremendously from the experience.
Once you complete the training, challenge the ABCS exams and become
a diplomat of the American Board of Cosmetic Surgery. Those of you
who have already completed a cosmetic surgery fellowship and now
have thriving cosmetic practices, please offer your experience and skills
to others by becoming a fellowship director. The experience of being a
fellowship director is professionally fulfilling and rewarding and provides a real
opportunity to give back to the specialty, ensuring that future generations
of cosmetic surgeons are well trained and positioned to handle the
challenges that will face them.
Speaking of what lies ahead, I anticipate a significant increase in the
demand for cosmetic surgical and non-surgical procedures for our
transgender population. The publicity surrounding Bruce Jenners
transition to Caitlyn Jenner has already brought more awareness to the
transgender community and may result in an increased demand for some
of our services. The Academy is positioned to provide cosmetic surgical
and non-surgical training to those cosmetic physicians and surgeons
who desire additional training on how to help the transgender patient
with their transition. You will see material from some of our esteemed
members in this edition of SURGE and at our Annual Scientific Meeting.
If you have an interest or a specific skill-set in this arena, and would like
to participate in or host a lecture, webinar, or workshop, please contact
me or the AACS Director of Education, Moira Twitty, to get involved. This
subset population of patients is very likely to grow and will need qualified
and experienced surgeons to help them accomplish the goals associated
with their transition.
The AACS still has several educational opportunities remaining this
calendar year. Sign up and take advantage of these outstanding
presentations in the comfort of your home or office in front of the
computer. Visit the Education section of the AACS website to see what we
have for you.

The American Academy of

Cosmetic Surgery certifies
in-depth Fellowship Programs
to advance a physician's
education in cosmetic surgery
and enhance clinical skills.
Post-residency fellowships
around the country provide
comprehensive training
with the brightest minds in
cosmetic surgery.
COMPREHENSIVE
TRAINING
Each AACS certified
Fellowship Program
participant performs more
than 300 cases in one year.
DEDICATED MENTORSHIP
The AACS certified
Fellowship Programs
were created by leaders
in cosmetic surgery who
possess a wealth of
experience and a desire
to teach.

>

UNMATCHED
EDUCATIONAL
EXPERIENCE
Because the AACS certified
Fellowship Programs are
capped at a limited number
of slots across the country,
they provide rare access to
patients and expertise. No
other fellowship program
can offer that caliber of
training and instruction.

Learn more and apply

to become a fellow or
establish a fellowship
program on the
AACS website.

MICHAEL J. WILL, MD, DDS, FACS

7

FELLOWSHIP

FAQS ON THE AACS CERTIFIED

FELLOWSHIP
PROGRAMS

Q. If I am interested in an AACS certified cosmetic

surgery fellowship, what are the criteria?
A. The AACS has 20 General Cosmetic Surgery and two Facial Cosmetic
Surgery Fellowship Programs throughout the United States. The Program

<

Directors must be fellows of the AACS, be ABCS Board certified, operate

at an accredited surgery center, have at least one co-faculty, be dedicated
to teaching, and provide a broad experience that enables the fellow to
participate in the surgical cases as outlined in the Fellowship Guidelines.
The submitted application is reviewed by the Fellowship Review
Committee and approved by the AACS Board of Trustees.

Answers by Mark
Mandell-Brown, MD,
AACS General Cosmetic
Surgery Fellowship
Committee Chair
Mark Mandell-Brown, MD,
practices at Mandell-Brown Plastic
Surgery Center in Cincinnati, Ohio.
He is board certified by the
American Board of Facial Plastic
Surgery, American Board of
Cosmetic Surgery and American
Board of Head and Neck Surgery,
and is a member of the AACS
Board of Trustees.

Q. Do all fellowship directors pay malpractice and offer the

fellow a salary?
A. There is actually quite a variation in the programs and coverage/salary
structure. The range is from no pay to $50,000, with most paying about
$25,000 annually. With Medical Protective (Medpro), a special fellowship
malpractice premium has been established with the cooperation of
the AACS members serving on the Medpro advisory board and with the
Medpro Company. Individual states vary but in Ohio our premium has
been approximately $5,000 for a claims made policy for the fellow.

Q. As a prospective fellow, how do I know which fellowship

to select?
A. There are currently two categories of fellowships: the General Cosmetic
Surgery Fellowship and the Facial Cosmetic Surgery Fellowship. The
General Cosmetic Surgery Fellowship focuses on a blend of face and body
cosmetic procedures. Some of the Program Directors have a practice
more focused on body, some more focused on face. It is important to

decide if your intent is to practice exclusively body cosmetic procedures,

facial cosmetic procedures, or a mix of procedures. Discussing your goals
with the Program Director can be helpful as well as visiting the center and
talking with staff.
The AACS is fortunate to have fellowship training programs throughout
the United States. Some fellows prefer to remain in the same city they
completed their residency to avoid moving.

Q. Does the one-year fellowship guarantee me that I will

take the board exams?
A. To challenge the oral and written American Board of Cosmetic Surgery
Exams, one must have completed the fellowship, have satisfactory
evaluations by the Director of the Fellowship, submit an article to a
cosmetic journal, and have completed the number of procedures
outlined in the Fellowship Guidelines. Additionally, the applicant must be
Board Certified in one of the primary core fields of Gynecology,
General Surgery, Otolaryngology, Oral Maxillofacial Surgery, Dermatology,
or Ophthalmology.
View more frequently asked questions on the AACS website.

There are currently

two categories of
fellowships: the
General Cosmetic
Fellowship and
the Facial Cosmetic
Fellowship... It is
important to decide
if your intent is
to practice
exclusively body
cosmetic procedures,
facial cosmetic
procedures, or a mix
of procedures.

>

MARK MANDELL-BROWN, MD

TRANSGENDER FOCUS

ONE DOCTOR'S STORY:

TREATING THE
TRANSGENDER PATIENT
Here in Waikiki, Honolulu, where I live with my family and work, is a
well-established LGBT presence. The areas bars, restaurants, and social
organizations cater to its population, providing a safe and vibrant place
for the LGBT community to thrive. As those of you who live in dense urban
settings very well know, your neighbors become a large part of your social

<

life. Because of this, my family and I are socially active in the community,
participating in and sponsoring transgender pageants and other social
functions. Aside from the social efforts, Im proud to serve as a resource
for members of a community that can oftentimes be consumed with
fear and uncertainty. My roles as both friend and doctor for the LGBT
community have taught me valuable lessons over the years, lessons that
Im proud to apply in all facets of my life.

John C. Ferguson, MD, FACS

John C. Ferguson, MD, FACS, is
quintuple board-certified by the
American Board of Otolaryngology
Head and Neck Surgery,
American Board of Facial Plastics
and Reconstructive Surgery,
American Board of Laser Surgery,
American Board of Cosmetic
Surgery, and the American Board
of Facial Cosmetic Surgery. He
is also a fellow of AACS, the
American Academy of Facial
Plastics and Reconstructive
Surgery, and the American College
of Surgeons. Born and raised
in Texas, he currently practices
cosmetic surgery at his clinic in
Honolulu, Hawaii.
10

The Treatment Process

Each transgender patient seeks a unique treatment process. From
non-invasive procedures to genital reassignment surgery, the spectrum
of treatment is wide. For example, the most common procedures sought
after by men are body sculpting and the removal of mammary tissue.
These patients often also desire facial masculinization, for which I use
fillers and fat to enhance the brows, nose and jawline. By far the most
common procedure for women is the breast augmentation, followed
closely by body sculpting, which typically involves fat transfer to provide
a more feminine waist and hips. Patients often pursue injectable fillers or
other skin care treatments that are normally associated with women, but
sometimes, less common and more complicated procedures, including
craniofacial resectioning, are preferred. Genital reassignment surgery is
only a small, and often unnecessary, part of the transgender patients
transition process.

Contrary to popular belief, most

least once a month, I encounter patients with great confidence and find

aspects of the masculine or feminine

myself performing some type of facial rejuvenation surgery on 70-year-old

self-image of these patients actually

drag queens.

has little to do with genitalia.

The wide range of transgender patients has taught me to approach

The path between establishing

each patients case without expectation, to always invoke patience and

gender identity mentally and

understanding. Each transgender patient and each treatment process

transforming physically varies

should be treated with the same care and respect that any other patient

from person to person. It is almost

would be given. Compared to the traditional medical setting, those of us

impossible to identify a beginning,

who practice cosmetic surgery and our staff often develop more personal

middle, and end to this process.

relationships with our patients. Let us take this privilege seriously and

Because of my social involvement

provide a safe place for the transgender patient to seek treatment.

in the LGBT community, I am often

sought out by individuals who have

>

The Surgeons Role

mentally come to terms with being

The transgender community is very loyal. When I moved to Hawaii, there

transgender, but dont know where

had been one surgeon that most of the transgender community had

to start with making physical

gone to for 30 years or so. As my relationships within the transgender

changes. There are several good

community grew, several members started coming to me, as they knew

primary care providers that

the other doctors retirement was approaching. Once he officially retired, I

specialize in and support this

became the go-to doctor in the community. With that came a great sense

process, and I am always more

of responsibility. I discovered that the most important aspects of the

than willing to point these patients

surgeons role are acceptance and respect. For example, it is imperative

in their direction. Once the patient

to understand that the flamboyant queen does not standout in a crowd

is ready to pursue the physical

because of her sex chromosomes or sex organs; she stands out because

transition, he or she is sent my

of her personality. The breadth of personalities in the transgender

direction again. These patients

community mirrors that of the non-transgender community. The only real

can sometimes be timid, hesitant,

uniqueness that Ive encountered in this community is the tendency for

and nervous to start the physical

genuine happiness. Transgender people can often struggle for a long time

transition. On the other hand, at

before finally coming to terms with who they are and what changes they
11

Involve your
practice in the
conversation on
social media and
attend events that
cater to the
LGBT community.

want to make. Once self-acceptance becomes a reality, the road towards

happiness is much smoother.
For those of you who are looking to welcome more transgender patients to
your practice, treat the expansion just like you would any other business

<

expansion. It mostly comes down to effective marketing and networking.

Involve your practice in the conversation on social media and attend events that
cater to the LGBT community. My ability to network has been somewhat
unique because I live in an urban neighborhood with a well-established
LGBT presence. Most large cities have organizations and groups for
LGBT-friendly professionals and small business owners. Seek out the
appropriate groups and make your practice known as an advocate for
potential transgender patients.
Cosmetic surgery is commonly justified as a tool in improving ones selfesteem. Weve all met with that shy, goofy kid with big ears and witnessed
the positive transformation that followed an otoplasty. Weve gotten to
know the depressed mother of four who discovers new self-confidence
following her mommy make-over. Transgender patients struggle with
the fundamental essence of who they are for most of their lives. Once
they come to terms with who they truly are, we, the surgeons and the
staff, have the honor of making what may seem like a daunting physical
transition, a life-changing reality.
JOHN C. FERGUSON, MD, FACS

12

TRANSGENDER FOCUS

BEHIND THE TRANSITION: ILLUMINATING

TRANS-PATIENT
SURGICAL FACIAL
FEMINIZATION PROCEDURES

During the spring of 2015, one of the biggest stories in popular culture
surrounded the appearance of Caitlyn Jenner. For years, Olympic athlete
Bruce Jenner had been quietly dealing with gender dysphoria until, several
months ago, rumors emerged claiming that Jenner was transgender. When
Bruce Jenner publicly identified herself as a trans-woman named Caitlyn,
the speculation became fact. And while she has not spoken in detail about
the process she underwent at the time of this writing, it is known that she

>

had extensive surgery to facilitate her transition.

Many people have wondered what is involved when it comes to surgery
for transgender women, and with this curiosity comes a host of
misconceptions. Given the experience Ive gained over the past 16 years

Jeffrey H. Spiegel,
MD, FACS
Jeffrey H. Spiegel, MD, FACS,
Director of Advanced Facial
Aesthetics and Professor and
Chief of Facial Plastic and
Reconstructive Surgery at Boston
University School of Medicine.

developing several surgical procedures and working with thousands of

transgender individuals, the editors of Surge have asked me to elucidate
some of this oft-misunderstood process.

When a Face Defies Identity

When a person needs to go from looking like a man to looking like
a woman, whats the first step? Many people initially think genital
surgery (removing the penis and creating a neo vagina). In actuality, for
transgender women, this is of relatively low significancebut why?
A transgender woman understands that she is a woman. Shes as certain
of her gender as you or I. The problem that a transgender woman faces is
that you dont always know her gender. When a trans-woman goes to the
supermarket, her office or the movie theater, she doesnt want to stand
out, preferring to blend in with the other women around her.
We convey our identities first and foremost through our facial features.
It is our faces that allow others to know if they recognize us, if we are
13

It is very important
to counsel patients
to wait for any hair
grafting until after
they have forehead
surgery, as it may
not be needed after
hairline advancement
and recontouring.

<

attractive to them, our approximate age, our mood or emotional state,

any hair grafting until after they

and our gender. All of this information is conveyed within a fraction of a

have forehead surgery, as it may

second and doesnt require conscious thought. It is not obvious, however,

not be needed after hairline

what facial features we use to do this. A man with long hair and earrings

advancement and recontouring.

is not seen as a woman, nor is a woman with facial hair seen as a man

It may, in fact, even interfere

The answer to this complex question, as you may suspect, is multifaceted,

involving all layers of the face.

Facial Feminization Procedures

of the frontal bone

contouring procedure.
Most people are aware that

Most significantly, a transgender woman typically benefits from a

women have a smaller Adams

forehead cranioplasty. The frontal bone, particularly in the area of the

apple protuberance of the

supraorbital ridges and over the frontal sinus in the glabellar area, tends

thyroid cartilage than do men.

to be more anteriorly projected in a man than in a woman. This creates

I reduce the projection of this

a distinct facial shape and shadows the eyes, both of which lead to an

cartilaginous area by carefully

individual being seen as masculine or, in some cases, unattractive. (Facial

reducing the thyroid cartilage to,

features that create a masculine appearance also make all women look

but never past, the location of

less attractive, as femininity and beauty are directly related.)

the anterior commissure of the

It is important to note that it is typically not the case that the bone in this
area is just thick and can be shaved or burred away. Usually the frontal
sinus is relatively enlarged and part of the frontal bone, supraorbital
ridges and anterior table need to be removed from the skull, reshaped,
and then plated back into position to create a natural and safe result.
At the same time, I make certain to enlarge the orbits, as women have
relatively larger looking and brighter eyes than men.

vocal folds. This is critical, as

voice loss can result if too much
cartilage is removed. There is also
no reliable way to know where the
anterior commissure position is
simply by looking at the front of
the thyroid cartilage. A fiberoptic
laryngoscope provides the critical

Following the cranioplasty, the hairline is advanced and reshaped from

information for voice preservation

the typical male pattern towards a feminine ideal. A brow lift is also

during this significant change.

done at this point. It is very important to counsel patients to wait for

14

with the proper performance

Additional bony work is required

with a mandibuloplasty wherein
the entire mandible is reshaped to
a more tapered appearance. Think
of this procedure as relating to
the v-line mandible surgery
that is very popular in Asian
countries. However, a feminizing
mandibuloplasty has to take into
account many other features.
Preservation of the mental

augmenting, but rather that an anterior projection that is deficient.

Feminizing rhinoplasty is typically next. While related to the rhinoplasty
procedure that facial surgeons may be familiar with, feminizing
rhinoplasty requires significant deprojection and reduction. One must also
take into careful account the reaction of the soft tissue envelope during
this procedure. In a general sense, the artistry in feminizing rhinoplasty
is to eliminate contours and details from the nose. Womens noses have
far fewer curves, bumps, and areas of interest than do mens. The
best rhinoplasty is one that creates a small, delicate nose that doesnt
command attention.

nerves is paramount during this

Readers of this publication may understand that the lips of a woman

operation. Additionally, one must

are also very different from those of a man. Feminine lips are fuller with

be very cognizant of the degree

a more pronounced roll at the vermillion border. Importantly, however,

to which the soft tissue envelope

they are also shorter. That is, the length from the inferior aspect of the

of the lower face will respond

nose to the superior vermillion border is shorter for a woman than a man.

to the loss of volume. Hanging

This gives a young attractive woman greater tooth show when the mouth

chins, an aged appearance, and

is open at rest. Often physicians believe that it is fullness that is missing

inferior displacement of the lower

from an aging mouth and will place injectable fillers, fat grafts, or other

lip are all potential complications.

materials into the lips. Lip fullness is indeed attractive, but if the lips are

Next the facial skeleton

is adjusted in the cheeks.
Sometimes implants are used,
while other times the malar

long, this appears inconsistent with a persons overall facial appearance

and strikes people as looking unnatural. A lip lift can be done, along with
the rhinoplasty, and incorporated into some of the same incision lines to
feminize this area.

eminences are modified directly.

Voice surgery is another procedure that often helps transgender women.

Most important is to recognize

This is performed with a laryngoscope through the mouth so no external

that it is typically not just lateral

incisions are necessary. In this procedure, I shorten the length of the

prominence that will benefit from

vocal folds in order to help to raise the pitch of the voice.

>

In a general
sense, the artistry
in feminizing
rhinoplasty is
to eliminate
contours and details
from the nose.

15

It is a privilege to
be able to work with
transgender women,
as the results of good
facial feminization
surgery are truly
life-changing for
the patient.

Finally, the more commonly known cosmetic surgeries can play a role.
We know that looking younger is a more attractive concept for women,
so aging face surgery comes into play for some patients. This includes
blepharoplasty, neck lift, and facelift procedures. Of course, these

<

procedures should be done after any skeletal work, so that the skin can
be properly draped to the new form. It is important to remember that
transgender women want to look as natural as possible, so high quality
surgery is necessary.

The Face of Change

Theres so much more that goes into facial feminization surgery, but
I hope this brief description gives you an idea of the process. It is a
privilege to be able to work with transgender women, as the results of
good facial feminization surgery are truly life-changing for the patient.
The many things Ive learned about how our brains process beauty,
and the tight connection between femininity and beauty, has made me
a better surgeon for all women who come to see me, regardless of their
medical background.
JEFFREY H. SPIEGEL, MD, FACS

16

TRANSGENDER FOCUS

FACING FACTS:TIPS ON

NON-SURGICAL
TRANS-PATIENT
FACIAL PROCEDURES

One of the most fundamental aspects of self identity is gender

identification. A person rightfully expects that the sex they feel
themselves to be on the inside should be reflected by the sex that they
are referred to by the outside world. Unfortunately, this is not the case for
transgender individuals.
When meeting someone for the first time, we absorb an amazing amount of
information about the individual within a fraction of a second. Studies have

>

shown that we can read gender, attractiveness, emotional state, familiarity,

age and state of health instantly and without conscious effort. A key
factor that helps us make these determinations are visual clues, and our
transgender patients task us with modifying these clues which indicate

Alexander Rivkin, MD
Alexander Rivkin, MD, is a

femininity or masculinity so that the world will finally see them as they
see themselves.

Yale-trained facial cosmetic

Despite the fact that much research has been done into identifying

surgeon and an Assistant Clinical

what facial characteristics are most determinant of gender, there is still

Professor at the UCLA School of

controversy on the subject. We do have some consensus as to what features

Medicine. His practice is focused

play a role. Traditionally, altering these features was thought to be the

on developing and perfecting

exclusive domain of surgeons. However, the popularity of non-surgical

non-invasive, non-ablative cosmetic

procedures has extended into this realm as well. In this article, I will touch

treatments. Dr. Rivkin divides his

on the non-surgical procedures that I use to accentuate masculinity or

time between patient care, clinical

femininity in my clinic.

research, physician education,

media appearances, and

Challenges with treating transgender patients

lecturing at scientific conferences

The transgender patient poses particular challenges to the aesthetic

throughout the world. He is a

physician. Our usual patients want to achieve a younger look while still

physician member of the AACS.

preserving their individual appearance. Transgender patients, on the

other hand, want to change their appearance in a fundamental manner. On
17

Figure 1 Masseter Reduction with

Botox. Patient had an enlarged,

occasion, their desires are beyond the ability of todays surgical or

masculine lower face because of

non-surgical techniques, and it is the job of the physician to be very

masseter hypertrophy secondary to

clear on what is and is not possible to achieve in an effort to prevent

years of chronic bruxism.

<

Her masseters were reduced with

three rounds of Botox treatment
(60u per side, 40u per side and
then 20u per side) at an interval of
three months between treatments.
She then came back for 20u per side
maintenance treatments twice at
6 months intervals. This was enough

patient disappointment.
As a general rule, I agree with Jeffrey Spiegel1, who observed that femininity is
associated with fertility and, therefore, with youth. As a matter of course, all
of my transgender patients receive botulinum toxin for their dynamic rhytids
in the glabellar, forehead, crows feet mental and peri-oral regions. Dose is
titrated to muscle mass and the goal is a softened, smooth appearance with
preservation of full, natural motion as, in my experience, transgender patients
are as averse to looking frozen and bizarre as anyone else.

to cure her of bruxism and she did

In pursuit of a generally more youthful appearance, we encourage treating

not need further treatment.

areas of hyperpigmentation with IPL or chemical peels. Fine static rhytids

and increased pore size are addressed with resurfacing lasers such as
Fraxel or the fractionated CO2. Patients with mild skin laxity and jowling are
offered treatment with focused ultrasound or radiofrequency energy.
The following is a list of my approach to each area affected by
the procedure(s):

Forehead
The shape of the forehead is one of the critical determinants of gender
appearance. A feminine forehead is convex and runs smoothly into the
brows, while a masculine one is flat and ends in a prominent eyebrow ridge.
Surgically, feminizing cranioplasty will reduce the ridge, but the patient
will still need soft tissue augmentation of the mid-forehead to achieve
that convex shape. I like to use Voluma because it is smooth, reversible
and significantly longer lasting than other fillers. For this area, I dilute
18

Figure 2 Demonstration of
Voluma 1:1 with saline and 2% lidocaine with epi. Dilution gives it better

feminizing a nose. Note this is

spread and smoothness, essential qualities for forehead augmentation

not a transgender patient.

where contour irregularity is to be avoided at all costs. Some patients wish

The naso-frontal angle of the nose

to forego surgery altogether and, if the supra-orbital ridging is mild to

is increased, the tip is lifted and

moderate, Voluma can camouflage the ridge when injected superiorly.

better proportioned with a higher

tip defining point. This makes the

Detailed discussion of injection technique and safety considerations is

profile straighter, more feminine

beyond the scope of this article, but the forehead is a potentially hazardous

and more attractive.

>

area to inject. The supra-orbital and supra-trochlear arteries run vertically,

superficial to the frontalis muscle, in the subcutaneous layer. These are
terminal branches of the ophthalmic artery and, as such, are potential
embolus highways to the eye. The plane of injection should be deep and
universal injection safety precautions should be followed. These include:
1. Inject on withdrawal of the needle, taking care to only inject when the
needle is in motion. If you do happen to be inside a blood vessel, this
will assure that you are out of the vessel without sending a large bolus
down the vessel.
2. Use the smallest gage needle possible. The smaller the needle, the
smaller the aliquot of filler injected at a time and the less likely one is to
propel a large embolus if you happen to be inside the lumen of a vessel.
In this area, using diluted Voluma, I find that a 30 gage works well.
3. Inject slowly, using minimal pressure. Sending an embolus backwards
into the ophthalmic vasculature requires enough force to overcome
systolic blood pressure. You can never guarantee that the tip of your
needle is not inside the lumen of a vessel, but you can guarantee that
you are not pushing so hard as to send a large bolus retrograde and
cause a disaster.
19

The shape of the hairline is

chemically weakening the procerus

I have even had some success in

important here. A hairline with

and depressor supercillii muscles,

slimming the nasal dorsum and

male pattern thinning laterally is

whereas the lateral eyebrow

tip by injecting Kenalog 40 mixed

a strong indicator of masculinity

can be raised by weakening the

1:1 with 5-fluorouracil in small

and should be corrected, if

lateral fibers of the orbicularis

boluses along the lateral aspects

possible, with transplantation.

oculi. Filling the temple hollows

of those structures.

Temples

Cheeks and Zygoma

also elevates the lateral eyebrow,

Along with the angle of the

an important indicator of both

helping to give the eyebrow a

mandible, the zygoma determines

age and femininity. Filling hollow

more feminine arch. I would use a

the overall shape of the face. A

temples softens the contours of

thicker HA filler like Juvederm Ultra

feminine face is heart shaped,

a face and reduces the shadows

Plus or Perlane in this area. These

with smooth contours at the

and angularity that serve to

fillers have good lift, last a decent

temples, flowing into a slight

masculinize and age the face.

amount of time and can be safely

prominence of the zygomatic

Any of the hyaluronic acid (HA)

injected into the more superficial

arch and a subsequent gradual

fillers work well here, as long as

skin planes if necessary.

slimming in the transition to the

the injector takes care to leave

Nose

lower third. A masculine face is

The superficial temporal vessels

A feminine nose is relatively slim

and contour contrasts between the

run between the superficial and

on frontal view and straight or

temples, zygoma and mandibular

deep temporal fasciae, and the

slightly turned up on profile. The

angles. The masculine zygomatic

deep temporal artery runs within

naso-frontal angle is more acute

arch is a bit lower than the

the temporalis muscle. Due to

in the male than the female, and

feminine one and in line with the

anatomic variations, no area is

the tip is proportional to the rest

mandibular angle. The focal point

completely safe, but injection into

of the nose. The tip defining point

of the cheek is flatter and slightly

the deepest planes minimizes the

of a feminine nose is slightly more

lateral to the lateral canthus for

chances of encountering a vessel.

upwardly rotated.

the man. The female mid-malar

Universal injection precautions

should be followed here, as in all
areas of the face.

Eyebrows
The shape and position of the
eyebrows play a large role in
gender identification of the face.
The feminine eyebrow is arched,
relatively thin and is situated
slightly superior to the orbital
ridge, whereas the masculine one
is straight, thicker and lies, for
the most part, on the ridge or
slightly below. Eyebrow position
can be modified by judicious use
of filler and botulinum toxin. The
medial eyebrow can be raised by
20

filler on the lateral orbital ridge

The contour of the temples is

as smooth a contour as possible.

<

and placing small volumes of

Reducing a large or thick nose

is clearly a surgical task, but
there are aspects of feminizing a

rectangular with sharper angles

area is fuller, with the focal point

of the cheek a bit medial to the
lateral canthus.

nose that can be accomplished

Adjustments to the cheek focal

non-surgically. The radix can be

point, mid-malar fullness and the

augmented to blunt the naso-

prominence and definition of the

frontal angle, and the tip can

zygomatic arch can all be achieved

be raised to straighten or even

with filler injection. Radiesse or

turn up the nasal profile. The tip

the thicker HA fillers like Voluma

defining point can be modified

or Perlane work very well. I prefer

with fillers so that the tip appears

Voluma due to its longevity, but,

more upwardly rotated. I use

again, if I am looking for maximal

Voluma if the augmentation

yield of tissue excursion, I would

needed is mild and Radiesse if

choose Radiesse.

I need a bigger lift. I like to use

Voluma if possible because of its
duration of effect.

Chin
The shape and size of the chin is
important to gender perception.

Male chins are squarer, broader

care to keep the results as natural

and fuller, and they project slightly

looking as possible. Upper lip to

more than female chins. The

lower lip proportion of 1/3 to

optimal female subnasale is in

2/3 should be maintained, and

line with the pogonion, whereas

the vemillion border should not

the optimal male pogonion is

be over emphasized for fear of

slightly (about 4 degrees) forward.

creating a shelf-like contour to the

Feminization of the chin is

lip edge. Injectors should not be

mostly a procedure to reduce and

overly ambitious. Overly injected

reshape the bony skeleton and

thin lips will look sausage-like,

is therefore primarily surgical.

rather than lush and full.

Botox does have a role, however, in

effecting atrophy of the mentalis

Conclusion

The patients
satisfaction with
these procedures will
hinge on the quality
of the consultation
process. Both the
patients expectations
and the doctors
promises should be
realistic and conform
to the limitations
of the desired
procedures.

muscle and reducing the overall

Non-surgical facial feminization

soft tissue volume of the chin.

is an important component of

Mandible

aesthetic gender modification.

As discussed above, mandibular

alteration of the facial skeleton,

flare or the prominence of the

these soft tissue procedures

mandibular angle is an important

provide extreme precision and, if

determinant of facial shape.

done with skill, a uniquely natural

Whereas we cant reduce the

looking result. Any facial injections

1 Spiegel JH.

bone non-surgically, we can use

require a detailed understanding

Facial Determinants of

botulinum toxin to significantly

of facial anatomy, and universal

Female Gender and Feminizing

atrophy the masseter muscles

injection precautions should be

Forehead Cranioplasty.

without functional compromise.

followed at all times. The patients

Laryngoscope 2011 Feb;

The patient should be made aware

satisfaction with these procedures

121(2):250-61

that it often takes a few months to

will hinge on the quality of the

see the effect, and that it requires

consultation process. Both

maintenance. That said, they will

the patients expectations and

ultimately be quite happy with

the doctors promises should

the results.

be realistic and conform to

Lips

In conjunction with surgical

the limitations of the desired

procedures. These procedures are,

Full lips have always been a symbol

for the most part, temporary

of sensuality and femininity.

although I sometimes use Bellafill,

Feminine lips are full and about

a permanent methyl methacrylate

equal to the inter-pupilary distance

filler, upon request for some of

in length. Masculine lips are

these procedures and require

thinner and slightly wider, closer

maintenance. However, this can

to the distance between the limbi.

be an advantage, permitting

The philtrum is longer in men than

adjustment of the patients look

in women.

as they age.

Augmenting the lips with filler

>

ALEXANDER RIVKIN, MD

is a common and successful

procedure, as long as we take
21

TRANSGENDER FOCUS

TRANSGENDER CHEST
MASCULINIZATION
Transgender medicine is evolving and gender-affirming procedures are
becoming more mainstream, including male to female (MTF) breast
augmentation, facial feminization and genital surgery. Female to male
(FTM) gender-affirming procedures include chest masculinization
and genital surgery. The focus of this article is to highlight FTM chest

<

masculinization; commonly called chest reconstruction by FTM patients.

The prevalence of transsexualism is not well defined. Traditionally, it has
been estimated to be 1:30,000, however, more recent estimates show as
many as 1:500 individuals in the general population may be identified as
transsexual. There are many centers in the US where transsexual medicine
is growing and the demand for gender-affirming treatment (hormone

E. Antonio Mangubat, MD
E. Antonio Mangubat, MD, is a
board certified cosmetic surgeon
with 27 years of experience.
He practices at La Belle Vie
Cosmetic Surgery Centers in
Tukwila and Bellevue, Washington.

22

and surgical treatment) is expanding. In Seattle, we have several gender

diversity supporting organizations including the Ingersoll Center, the
Gender Justice League, and Gender Odyssey (an annual international
conference focused on the needs and interests of transgenders). We are
seeing a greater demand for medical and surgical services.

Figure 1
Masculinization with
subcutaneous mastectomy
and free nipple graft
(2 year post op result).

>
Female to Male Gender-Affirming Surgery
The most common FTM gender-affirming surgery is known by the
lay-patient as the double incision mastectomy (DI). Creating a male chest
from a female breast is challenging and requires an understanding of
the physical measurements and proportions that create the male chest
appearance. In the male chest, the nipple areolar complex (NAC) lies
more superiorly and medial that the female. The location of the male
nipple is proportionally located at the intersection of the mid-clavicular
line and the inferior border of the pectorals major muscle. In addition, the
male NAC measures approximately 22mm in diameter on average where
a female NAC measures ~40-45mm. The male nipple is certainly not as
projected as the typical female nipple.
In addition, there is often excessive skin that requires a long incision
and subsequent scar that the patient must accept (Fig. 1). The major

Creating a male
chest from a female
breast is challenging
and requires an
understanding
of the physical
measurements
and proportions
that create the male
chest appearance.

advantage of this more traditional approach is the surgeon has control

over the ideal chest proportions and can eliminate excess skin. If, on the
other hand, the patient has small breasts, minimal loose skin, acceptable
NAC position and nipple projection, then a periareolar breast gland
excision can yield acceptable results. Communicate with the patient about
their ideal result to determine which approach is most acceptable.
23

Figure 2
With ideal position
and morphology, chest
masculinization can be
achieved with a limited
periareolar incision.
Note that excess skin is
not excised and the natural
shrinkage of the NAC.

<
The basic procedure requires a subtotal subcutaneous mastectomy and

Post-op care is very

much like liposuction,
except that the
nipple graft needs
special skin care
required of
full-thickness
skin grafts.

re-implanting the NAC as a free nipple graft (Fig 2). Keep in mind this is
not an oncologic procedure, so removal of 100% of the breast tissue is not
the primary goal; transforming a feminine breast into a masculine chest
is the goal. Tumescent fluid infusion is used to limit operative bleeding
and provide for post-operative pain control. Breast tissue inferior to the
pectorals major border is excised completely. Gland above the muscle
border is sculpted to optimize the male form. The skin incision is designed
to preserve a natural inframammary fold (IMF), remove the excess skin,
and to raise the feminine IMF into a more masculine position. Again, if
the breasts are small and the NAC and nipple projection are acceptable, a
periareolar gland excision can yield satisfying results (Fig. 3).
Post-op care is very much like liposuction, except that the nipple graft
needs special skin care required of full-thickness skin grafts. With that
exception a simple foam pad, elastic binder, drains, and antibiotics are
our standard protocol of care.
Complications are infrequent. Seroma, hematoma and surgical site
infection are less than 2% and are easily treated in the office. To date,
no patient has required hospital admission. The safety profile of this
procedure is excellent.

24

Figure 3
Immediate postoperative
result of a double incision
mastectomy with free
nipple graft.

>
Summary
The demand for transgender chest masculinization is growing.
Collaboration with the trans-medicine community is a must to provide
comprehensive care to this patient population. The use of tumescent
infusion has greatly decreased bleeding, postoperative pain and
significantly decreased operative time. As with any form of cosmetic
surgery, studying the human form is compulsory to achieve natural
results. Satisfaction amongst my patients undergoing trans-gender chest
masculinization has been traditionally very high and this has proven to be
a gratifying procedure to offer in my practice.
E. ANTONIO MANGUBAT, MD

Complications are
infrequent. Seroma,
hematoma and
surgical site
infection are less
than 2% and
are easily treated
in the office.
The safety profile
of this procedure
is excellent.

25

PRACTICE MANAGEMENT

AACS'S NEWEST
PARTNER ASSISTS WITH

HIPAA COMPLIANCE
AACS has partnered with Medical Risk Institute (MRI) to offer special
member pricing on their HIPPA compliance management tools. AACS
recently sat down with MRI founder Michael Sacopulos, to discuss patient
privacy, the need for compliance and how AACS members will benefit from
this new partnership. Here is what we learned:

<

AACS: First, tell us about MRI and how the relationship with AACS
came about.
MRI: I have been providing legal guidance to aesthetic medical practices
for more than 10 years. Some years ago, I created Medical Risk Institute
to provide medical practices the resources needed to make HIPPA

A Q&A with Medical

Risk Institute (MRI)
founder and president,
Michael J. Sacopulos, JD.

compliance easier.
AACS: How have you been working with AACS to determine our members
unique HIPAA issues and concerns?
MRI: We started a conversation in 2014. Earlier this year, we helped AACS
survey its members about their patient privacy needs and concerns.
AACS: Tell us about the survey results.
MRI: The results highlighted a few misconceptions and pointed us in the
right direction to create a package of documents and services to address
the AACS members HIPPA compliance needs.
AACS: What was one of the misconceptions?
MRI: Some practices thought that HIPAA did not apply to them because
they are not a Medicare provider. While there may be some technical truth
to this, practices are still subject to state privacy laws and requirements.
State courts have been increasingly looking to federal standards (HIPAA) to

26

determine their standard of care.

This means that effectively
HIPAA is the standard for all
medical providers.
AACS: Does HIPAA only apply to
practices using electronic medical
records systems?
MRI: No, it applies equally to
electronic and traditional chart
practices. In fact, the membership
survey showed AACS practices
almost evenly split between those
that use EMR systems and those
that use paper charts.
AACS: Some practices struggle
with training their staff on patient
privacy issues. Is it necessary?

and disciplined physicians for the misuse of social media. This is an area
of focus for medical boards; every practice should be aware of the media

MRI: Yes, both providers and staff

guidelines and oversee social media use. A social media policy goes a long

are required to receive annual

way toward protecting your practice.

training on patient privacy. MRI

offers an online solution that
allows individuals to complete
the training at their convenience.

AACS: We have talked about a number of HIPAA issues. If you had to pick
just one thing an aesthetic practice should do for HIPAA compliance, what
would it be?

It also provides documentation to

MRI: My advice is to perform a Security Risk Analysis. The Office of Civil

prove compliance.

Rights (OCR) enforces HIPAA. The Office of Civil Rights says a current

AACS: Social media is a key

marketing tool for many aesthetic
practices. Social media also
comes with some potential HIPAA
issues. What should practices do
to be safe?
MRI: The survey revealed that

>

Security Risk Analysis is the first thing that they typically request. The OCR
also ranks this report as the most important document in the effort to
comply with patient privacy laws and regulation. Unfortunately, the majority
of practices surveyed indicated that they did not have a current Security
Risk Analysis report.
AACS: Clearly, HIPAA Compliance is complex and evolving. AACS is pleased
to offer our members assistance with HIPAA compliance.

the majority of practices do not

MRI: Medical Risk Institute is excited to be partnering with AACS.

have social media policies. This

MRI works hard to make HIPAA compliance as painless as possible for

is a policy that every practice

practices. We believe our relationship with AACS will be very beneficial for

should have. Many HIPAA breaches

AACS members.

have come from the misuse of

social media. Additionally, the
Federation of State Medical
Boards (FSMB) has issued social

AACS MEMBERS INTERESTED IN MRIS HIPAA COMPLIANCE

MAY LEARN MORE BY CONTACTING MRI AT 812.241.8995 OR
INFO@MEDRISKINSTITUTE.COM.

media guidelines. The FSMB

reports that a significant number
of states have received complaints
27

ADVOCACY

A REPORT FROM THE

AMA HOUSE
OF DELEGATES
On June 6, Tony Geroulis, MD and Robert F. Jackson, MD, attended the
American Medical Association (AMA) House of Delegates meeting as
representative delegates of the AACS, alongside the Academys Executive
Director Dan Garrett. Here is their full report of the event and the resolutions that
they spoke in favor of on behalf of the organization.

<

While at the AMA House of Delegates meeting, we were honored to serve as

the voice of AACS on a number of resolutions and action plans.
First on the docket: The AMA has put forth a formal request that the
American Board of Medical Specialties (ABMS) certifying boards develop
Maintenance of Certification (MOC) standards that do not lead to economic

Tony Geroulis, MD

hardships. The following directives are to be used.

Any assessment should guide physicians to self-directed CME study.
Specific content-based feedback after any assessment should be provided
to the physician in a timely manner.
Multiple options should be available for how assessment should be
structured to accommodate different learning styles.
MOC requirements, their timing, when they must be completed, and when
they must be given to physicians.
Part III, known as the high-stakes exam, should be streamlined and
improved. The policy also calls for exploring alternative formats.
In addition, the AMA plans to work with ABMS to avoid attempts at limiting
the scope of practice of any and all board certified physicians.

Robert F. Jackson, MD

28

The AMA noted the aspects that separate MOC and Maintenance of
Licensure (MOL), and they gave state boards guidelines to use in
developing MOL programs. These guidelines are practice specific,
and will become instrumental with regards to quality improvement and
life-long learning.
Next, the AMA passed a resolution to delay implementation of ICD10 for
two years. This would, essentially, provide a two-year grace period in which
physicians would not be penalized for improper coding, and payments to
physicians would not be withheld.
Two resolutions that were of particular interest to our specialty both
concerned injectables and their overall use. The first of these was
Resolution 505 Ref Committee E, a plan stating that a drugs labeling
much of which is antiquated and not in compliance with current practice
should not be the sole legal standard. According to this resolution,

This would,
essentially, provide
a two-year grace
period in which
physicians would
not be penalized for
improper coding,
and payments to
physicians would
not be withheld.

>

standard medical practice, experience, and clinic judgment would be equal

indication. It also called for more expeditious updates to labeling as clinical
evidence becomes available. We both supported the resolution, which
ultimately passed in the House.
We also voted in favor of Resolution 207, which allows the compounding
and repackaging of manufactured FDA-approved drugs and substances in
an office-based setting. It also allows one to purchase FDA-approved drugs
directly from compounding pharmacies. This resolution also passed.
One item that was of considerable concern to most everyone at the
meeting was the disparity between graduating medical students and the
number of post-graduate training programs. Many students in this years
graduating class were not matched with a program due to the fact that
29

However, our ability to maintain our seat in the

House of Delegates is wholly dependent upon
the percentage of AACS members we have in the
AMA. It is pertinent that we keep our seat at the
table, which has and will continue to provide us
with a forum in which our organizational voice
can join the larger conversations.

there were a limited number of slots. Without a training program to join,

and since at least an internship is required to obtain medical licensure,
many graduates were left with no options. The AMA has asked the
Committee on Medical Education to work toward an efficient solution for
this very real and troubling dilemma.
On the elections front, Dr. Jackson was renamed vice chairman of the
section council of plastic, facial plastic, oral and maxillofacial, and
ophthalmological plastic surgery. Elected AMA trustees included:

<

Patrice Harris, MD, MA, Psychiatry

Albert Osbahr III, MD, Family Medicine
Georgia Tuttle, MD, Dermatologist
Maya Babu, MD, MBA, Neurosurgery
The House of Delegates Vice Speaker position went to Bruce A. Scott, MD,
an otolaryngologist from Louisville, Kentucky.
It is becoming increasingly important that each member of the AACS
join or retain their individual standing in the AMA. Our specific field is
recognized by our fellow delegates as a specialty, one that provides a
unique voice and perspective to the proceedings. However, our ability to
maintain our seat in the House of Delegates is wholly dependent upon the
percentage of AACS members we have in the AMA. It is pertinent that we
keep our seat at the table, which has and will continue to provide us with a
forum in which our organizational voice can join the larger conversations.
Call the AMA office today, or go to the members section of their website,
and self-designate yourself as a Cosmetic Surgeon. Those who follow this
quick and easy process will play an incalculable role in maintaining the
status of AACS with the AMA and, more importantly, within the House
of Delegates.
TONY GEROULIS, MD AND ROBERT F. JACKSON, MD

30

EXPERIENCETHE

next
level

    

With new technological advancements,

scientific discoveries and years of
dedication in an ever-evolving specialty,
together, weve achieved greatness in
cosmetic surgery and medicine. So where
do we go from here?
Join us at the American Academy of
Cosmetic Surgery 2016 Annual Scientific
Meeting, where youll have the opportunity

>

to learn without limits and reach

new levels of success.

WHERESCIENCEMEETS

success
T H E  D I P L O M AT  R E S O R T  &  S PA
H O L LY W O O D  F L

2016 annual meeting

january 14 - 16
Registration is now open
cosmeticsurgery.org
Use code SURGE20 to save $20.
31

Feedback
Let us know what you think about this new digital and interactive
version of Surge. Email us at info@cosmeticsurgery.org.

ACADEMY NEWS
UPCOMING WEBCLINICS
Live educational webinars offering
1 AMA PRA Category 1 CME
Credit per WebClinic

<

ORAL/MAXILLOFACIAL
Considerations in Non-Surgical Tear Trough Correction
Presenter: Alexander Z. Rivkin
September 30, 8:00pm CST

VEIN
Treating Superficial and Deep Venous Abnormalities
Presenter: Doohi Lee, MD
October 28, 8:00pm CST

HORMONE REPLACEMENT THERAPY

Bioidentical Hormone Replacement Therapy
Presenter: Kevin Light, DO, MBA
November 18, 8:00pm CST

LIVE SURGERY
WORKSHOPS
In-depth weekend training
from top cosmetic surgeons
in the country

Liposuction, Fat Grafting and New

Lipoabdominoplasty Technique
Oct. 16-17
Directors: Marco Pelosi II, MD, and Marco Pelosi III, MD
Bayonne, New Jersey
Offering up to 19 CME credits

Body Contouring following Bariatric Surgery

& Massive Weight Loss
Nov. 6-7
Directors: Angelo Cuzalina, MD, DDS, and Jacob Haiavy, MD
Tulsa, Oklahoma
Offering up to 17 CME credits

32

W H E R E  S C I E N C E  M E E T S

success
2016 annual meeting
J A NU AR Y 1 4 1 6, 20 1 6
T H E  D I P L O M A T  R E S O R T  &  S P A  |  H O L LY W O O D   F L

2016 ANNUAL
SCIENTIFIC MEETING

Join hundreds of cosmetic surgery professionals in Hollywood, Florida,

Jan. 14-16 in Hollywood, Florida

fewer concurrent tracks focused on Surgical, Non-Invasive, and Practice

Jan. 14-16, for the AACS 2016 Annual Scientific Meeting, Where Science
Meets Success. This years program is condensed to three days, with
Management topics. Register early to secure reduced rates. View the
preliminary schedule, hotel and travel information on the AACS website.

NEW MEMBER WELCOME

Lourdes M. Landron-Garcia, MD

RESIDENT

FELLOW

Milton Marquez, MD

Samah Arsanious, MD

Robert A. Martin, MD, DMD

Roberto Davila De Pedro Sr., MD

Christin N. Collins, DO

Phi Nguyen, MD

Dennis J. Reiter, DO

Richard Huynh, DO

Mi Ran Park, MD

Steven Ronald Schoolman, DDS

Omar Ibrahim, MD

Kirk Potter, DO

Calvin Jung, MD, DDS

PHYSICIAN

Amine Rafik, MD

Emily J. Lo, MD

Keith Ramsey, MD

Lauren Lunday, DDS

Joon Rhee, MD

Jahanyar J. Makipour Jr, MD

Craig Harding Rhyne Jr., DMD

Talon Maningas, DO

Hooman Riazi, MD

Roman G. Meyliker, DMD

Jimmi Rios Perez, MD

Ramana K. Puppala, MD

Roque E. Ruiz-Gonzalez, MD

Aline Rau, MD

Jorge Schwember, MD

Salvador P. Renteria III, DO

Alain O. Senerpida, MD

Ali Roham, DO

Megha Shah, MD

Samir Singh, DMD

Rick St. Onge, MD

Rian Suihkonen, DDS

Aya Sultan, MD

Omar Wain, DO

Abayomi Ajayi, MD
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