On April 5-6, 2002, 280 registrants from across Canada and the United States overfilled the main auditorium at Mount Sinai hospital in Toronto, to learn the latest developments and techniques in aesthetic plastic surgery. The occasion was the 32nd Annual Symposium on Aesthetic Plastic Surgery, sponsored by the division of Plastic Surgery at the University of Toronto. This symposium is designed to bring the top plastic surgeons in the world to Toronto, to share their expertise with others in the field. It is currently the largest plastic surgery meeting in Canada.
Dr. W.R.N. Lindsay originally developed the concept of an annual aesthetic symposium back in 1970. Dr. Lindsay is a pioneer in aesthetic surgery, not only at the University of Toronto, but also in Canada. His original meeting was held in a small room in the basement of the Wellesley hospital in Toronto. Over the next 20 years, Dr. Lindsay and his partner, Dr. Leith Douglas (“the Maple Leaf Plastic Surgeon”) organized this meeting annually. From the outset, the format has always been to provide a didactic, highly interactive, congenial atmosphere, where registrants would be exposed to the top aesthetic plastic surgeons on a global scale. The meeting soon outgrew the Wellesley Hospital facility and moved through various hotels in Toronto. For the past decade, it has been held at the main auditorium of the Mount Sinai Hospital. During this time, Dr. Walter Peters has been the course coordinator. The organizing committee has included Drs. Peter Neligan, Tom Bell, and Arnis Freiberg. A number of plastic surgeons have attended this meeting year after year, for the past 10, 15, or even 20 years, making an annual “religious pilgrimage” to the University of Toronto to learn the latest developments in aesthetic surgery.
The Faculty for this year’s symposium included three visiting professors: Dr. Daniel Baker from New York, Dr. Sam Hamra from Dallas, Texas, and Dr. Roderick Hester from Atlanta, Georgia. In addition, several University of Toronto plastic surgeons presented talks on various aspects of aesthetic plastic surgery. Aesthetic surgery is a growth industry. There have been many exciting developments during the past decade. According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), over 5.7 million cosmetic procedures were performed in the United States last year. This represented a 25 per cent increase in the total number of procedures in the past year, and a 173 per cent increase during the past three years. Baby boomers, between the ages of 35 and 50 had the most procedures (43 per cent). Last year, the most common surgical procedure was liposuction, followed by breast augmentation and eyelid surgery. Botox injection was the number one procedure overall. Over a million patients received Botox last year. This number will likely increase further this year, because the FDA has recently given full approval to the use of Botox for aesthetic procedures.
Several lessons emerged from this year’s symposium. The presentations demonstrated that there are several different pathways to obtaining an excellent result from facelift surgery. Each of the three visiting professors is an expert in facelifting. Each uses a very different operation to obtain an excellent result. Drs. Daniel Baker and Roderick Hester described techniques of lifting both the skin and SMAS layers, using a “short scar” technique. By contrast, Dr. Sam Hamra prefers to perform a “composite tissue” procedure, with much of the dissection done in the subperiosteal plane. Each speaker stressed the importance of avoiding complications during this surgery.
Botox injections were popular with all speakers. Botox is most helpful in reducing lines and wrinkles from overactive muscle pull in the glabellar area (the lower forehead between the eyes) and the crow’s feet area beside the eyes. However, Botox can also be used to balance asymmetrical muscle contraction. Dr. Michael Kane from New York presented a unique talk on using Botox to improve facial symmetry after an injury to the facial nerve on one side, from an accident or following tumor resection. Botox is also effective in the treatment of migraines in certain patients. There were also presentations on the latest injectable filler materials, including Restylane, Hyalaform, and Artechol. There was a heated discussion on the recently described complications from Artechol lip injections.
There was general consensus among speakers that laser techniques have now become much less popular for resurfacing skin. Initially, laser resurfacing was thought to have a very low complication rate. However, when patients were observed over longer periods of time, a number of rather serious complications emerged, including scarring and pigmentation changes. As a result of these findings, many plastic surgeons have now discontinued the use of laser for skin resurfacing. There has been a return to the older classical chemical peel techniques. There were interesting presentations on the current status of silicone gel breast implants in Canada and the United States. Dr. Hamra also delivered a very effective talk on the role of circumferential body lifting in certain patients.
Dr. Hester presented an extremely informative discussion on the safety of aesthetic surgery done in a freestanding surgicentre, involving 6,000 patients over 8.5 years. This type of ambulatory surgicentre has recently become very popular in Canada following the major cutbacks in hospital facilities. Dr. Hester showed a very low complication rate, but he stressed the importance of careful patient monitoring and meticulous quality control.
The speakers for future University of Toronto Aesthetic Symposia are invited several years in advance. The programs are currently being formulated for the 2003, 2004, and 2005 meetings.