Friday, May 31, 2013

Asiatic Aesthetic Series 68:The gift of a new smile...

News:

Free aesthetic cleft surgeries surgeries for  all poor Yemeni cleft lip and palate children at  Yemeni hospitals(in workshops/camps only) Please contact the persons below  for details of camps/workshops.

1.  Gunaid  Pvt hospital  ,Hadda Sana'a   Akram Al Gunaid  777370240
2.  Yarim  Govt Hospital     contact:  Wafa Abdalla office 04 501 600
3.  Dhamar University      Dr.Khalid Durai  735011228 (prep phase)
4   Baadan Govt Hospital  Abdul Karim Hasan 777440039 (nationwide registrations)
5.  Jibla Govt hospital       Dr.Abdalla Al Matary 777166868
6.  Seiyun Govt Hospital   Dr. MohdAlawi Aidaroos777275055
7.  Taiz Karama Pvt hospital - Dr.Abdul Moghini Abdalla ( security info needed)
8.  Mukalla Ibn Sina Govt Hospital  Dr.Yaser Bal Fakhy 711919739
9   Hadibo Govt hospital Socotra- Dr. Saad Qadoomi Hadibo hospital ( twice a year for all cases)

All  cleft children from the troubled zones of Aden,Zinzibar,Rada,Taiz, Hodeida, Marib, Shabwa,
Abyan ,Saadah,UNHCR Somalian refugee cleft children,  are treated for free  at Baadan Govt Hospital,Ibb under General Director, Abdul Kareem Hasan Alfandi (mobile:777440039 )and team. 


If I were a cleft child born in New York city,this is what I would probably have to face without health insurance-10,000 to 20,000 dollars.
many poor immigrants in the US have to face these bills
those who have insurance are lucky,others,not so..
Is it similar in other countries? In Germany ,the first bill parents of cleft babies  pay is the 2000 Euro bill for the initial workup at the cleft clinic,and the bills increase as time goes by.
A Yemeni dentist friend who had a cleft lip and palate child,paid over 10,000 dollars for the treatment at Cleopatra hospital in Cairo, Egypt .He was in debt for several years.
In Yemen,private hospitals charge anything between 1000 to 3000 dollars for the lip and palate surgery,minus other costs.



Typical costs in the USA:
  • Without health insurance, cleft lip and/or palate surgery typically costs $5,000 to$10,000 or more per surgery; if the child has both a cleft lip and a cleft palate, two surgeries typically are required for a total of $10,000 to $20,000. For example, on RealSelf.com, Seattle plastic facial surgeon William Portuese estimates the cost of cleft lip/palate surgery at $5,000 to $7,000 per surgery. AtKids With Clefts Utah, two parents detailed their pre-insurance costs for surgery; for one, the total was $8,127.94 and for the other, $11,350.
  • With health insurance, cleft lip and/or palate surgery typically costs several hundred to several thousand dollars, depending on deductible, copays and coinsurance for surgery. For example, CleftAdvocate.com provides sample letters from a real family who paid more than their $2,000 yearly out-of-pocket maximum.
  • Cleft lip and/or palate surgery is considered reconstructive surgery to correct a birth defect, so it typically is covered by health insurance. 
Additional costs:
  • Before surgery, parents probably need special bottles to make feeding easier. Snugglewraps.com sells these for $27 each.
  • About half of children who have had a cleft palate will require speech therapy at some point, according to CleftLine.org. According to Speechville.com, the cost of speech therapy can range from free if offered by a local school district or covered by insurance, to $100 an hour. Children with cleft palate also typically require annual hearing tests because they are more prone to infections and middle ear problems.
  • Children who have had cleft palate surgery usually require braces for their teeth, starting about age 5 or 6. In some cases, children need a bone graft as well, done by an oral surgeon, so teeth will come in correctly. According to a report by the California Health Benefits Review Program, the average lifetime cost of cleft-related orthodontic care is about $10,250. Several states mandate coverage of cleft-related orthodontics.
  • Depending on the specific case, some patients require additional surgeries beyond the one or two initial lip and/or palate repairs; it is not uncommon for a patient to require five or more surgeries during their lifetime. According to theUtah Department of Health, the average lifetime cost for all treatment and services for a patient with cleft palate is $101,000.

Wednesday, May 29, 2013

Asiatic Aesthetic Series 69:Diploma in Aesthetic Cleft Surgery



We will be launching the Diploma in Aesthetic Cleft Surgery for cleft lip and palate trainees this June for the benefit of cleft surgeons with our charity in the country. The programme will include several modules and hands on sessions over a period of 9 to 10  months.During this time ,it is hoped that the trainees would be confident enough to operate primary cases independently and understand the aesthetic concepts . The multiple choice questions after each module will help them to retain what they have been taught.
This is the first launch of our international aesthetic course in cleft lip and palate designing.Hopefully, the trainees would include expats and other countries in the very near future.
One of the main reasons why I designed this Diploma course is because nearly all the cleft surgeons in this country who traveled overseas for a year's training in the field at great personal cost, came back disappointed because they were not given the opportunity to learn cleft palate procedures hands on, and so continue to struggle and wait for a good chance for a direct one on one training in this delicate speciality. This is one very strong reason why my course was tailored to help such surgeons in poorer nations.Some have already benefited from my previous courses and are able to work independently on cleft lip.palate and other plastic surgeries. This Diploma is a continuation of what was considered a fairly successful training model over the last few years.

 The preliminary idea-

Diploma in Aesthetic Cleft Surgery
Introduction: Aesthetic cleft lip surgery includes cosmetic surgery involved in correcting a facial cleft deformity. This may be done along with, or follow, the functional reconstruction  of the cleft lip deformity where the lip muscles are repaired to enable the cleft child to have normal lip function. The concept of aesthetic palate surgery was developed in our charity after several years of palate research. This   concept involves minimal surgery with very little blood loss, muscle repositioning techniques using our own innovative techniques in order to improve speech outcomes. The technique was accepted as a paper at the  12th International Conference on Cleft Lip/Palate and Associated Craniofacial Anomalies  in May 2013 , Orlando  USA and will be published in the journal of craniofacial surgery this year in July. The same has been accepted as a paper presentation at the European Plastic Surgery Conference, Hamburg Germany, in August this year.
Aims and Objectives: To provide a  Diploma in Aesthetic Cleft Surgery  under a University Department of Dental and Maxillofacial Surgery and the charity , which is registered with the Ministry of Planning  and Ministry of Health, Yemen as an International Cleft Surgery NGO, to train Yemeni doctors and provide free surgeries for cleft patients.   During   this   period ,  each trainee will master the art of aesthetic cleft lip and palate surgery by attending lectures as well as hands on training sessions and clinical case discussions with Yemen Smile. At the end   of  the  year ,  each trainee should be able to pass the multiple choice question test with a minimum of 70% and an oral  exam from topics taught at the course. The trainees will then demonstrate their command of cleft surgery by carrying out one surgical technique of cleft lip and palate surgery under the supervision of the trainer and staff. If successful, the trainee will receive a Diploma in Aesthetic Cleft Surgery. The   number of trainees in the first year will be limited to 7 candidates only.
Programme: The training covers the aesthetic surgical aspects of the cleft deformity. This course focuses primarily on primary cleft lip and palate solutions and does not include advanced interventions  .  It is not intended to cover all aspects of cleft lip and palate management, since the goal is to enable trainees to independently operate cleft lip and palate patients on completion of the training. There is a multiple choice test after each module to help the trainees revise what they have learnt. Several topic discussions on relevant craniofacial problems,naso alveolar moulding,dento skeletal deformities and syndromes will be taught to increase the knowledge of trainees,although the course exams and questions will focus only on the prescribed syllabus.Trainees will also be helped with important articles from our library of plastic surgery materials.Local  and overseas experts will also participate in this programme for the benefit of trainees.

Hands on sessions: 
1.       Anatomical Landmarks and the C flap repair variations for  unilateral cleft lip deformities
2.       Anatomical considerations in cleft palate surgery
3.       Five  Principles of bilateral cleft lip repair
4.       Saline hydrodissection palatoplasty 2013 and variations
5.       Repair of difficult facial clefts
6.       Post op wound management, scar treatment with microneedling and PRPM
7.       Basic understanding of cleft speech/VPI

Extra resources to provide help to trainees includes the following:

1. Cleft surgery journal articles by John B Mulliken of Childrens Hospital Craniofacial Boston
2. Cleft lip/palate and craniofacial /plastic surgery journals  and articles
3. Smile Train USA biodigital smiles:https://smiletrain.biodigitalhuman.com/home/ 




Monday, May 27, 2013

Asiatic Aesthetic Series 70:Common cleft problems in missions

These are some of the commonly encountered cleft problems in mission camps-


single partial cleft lip

single complete cleft lip

bilateral partial cleft lip

bilateral complete cleft lip

complete cleft soft palate

complete cleft palate

nasal deformity in cleft children

iatrogenic cleft deformity (the usual suspect= untrained surgeon local or expat mission)

Sunday, May 26, 2013

Asiatic Aesthetic Series 71:STRICTLY SPEAKING- Questions and Answers




What are the mechanisms  involved in speech?

When there is a normal apposition of the soft palate or velum ,with the posterior and lateral pharyngeal walls ,it leads to what we know as normal speech.The soft palate muscles known as the levator,which provide about 50% of the bulk of the soft palate, are the main muscles involved in speech. The muscles help the soft palate to move upwards and backwards;this coupled with the mesial movement of the lateral walls of the pharynx and a slight anterior movement of the posterior walls ,prevents air and fluids from escaping through the nose by separating the oral from the nasal cavity.

What is a speech defect in cleft palate patients ?

Also known as velopharyngeal incompetence*,this speech defect occurs when the velum and pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech and deglutination.
The goal in cleft lip and palate surgery is to make the patient " look good and speak good." A fairly simple goal but hard to achieve because of many other factors involved in this thing called speech.

What are some ways I can know about speech defects in cleft palate patients?

After a thorough clinical intra oral check by the specialist to check for structural problems, four specific characteristics can be assessed:

1. Checking for nasal vibration during vowel production (i,u and e). In a cleft palate patient ,the nasal cavity becomes coupled with the oral cavity and you have what is called hyper nasal resonance because air escapes through the open velopharyngeal port.
Test: Compare occluded and non occluded nares for the presence of a nasal vibration during vowel production.

2. Nasal emission of the airstream . Nasal emission may be audible or inaudible.To detect inaudible nasal emission place a mirror under the nares and ask the patient to speak.It will fog if there is escape of air. A small piece of tissue  will be deflected in a similar test. Nasal flaring may be seen in audible nasal emission.

3. Ask the patient to say,"I pet puppies". It will be difficult to say this if the cleft palate patient has a speech problem,leading to inadequate intra oral air pressure build up to produce plosives( p) or fricatives (f).

4. The fourth problem is known as  compensatory articulation .This is common in older unoperated cleft palate patients who have over the years learnt to compensate speech using the tongue,glottis to create a sort of valve for the airflow. This is a difficult problem to correct because the patient usually has it even after surgery.

There are sophisticated techniques these days like videofluoroscopy and MRI  to make accurate pre operative assessments in these patients so that the plastic surgeon can design the surgery to help the patient with speech. Unfortunately,poor nations have to depend mostly on the clinician's experience, and techniques that are well standardized  to help improve speech outcomes.One of the most popular methods for this today is the muscle repositioning method so that the corrected muscle allows the soft palate to achieve adequate closure  and prevent any air leak through the nose.
Thankfully ,the charity was able to design the 2013 minimal blood loss muscle repair technique for the benefit of thousands of plastic surgeons as well as cleft palate patients across the world.Sometimes the blood loss for a soft palate surgery with this neo concept palate surgery is less than a cut on the finger-less than 10ml.

* Rod Rohrich et al,Dallas, Plast. Reconstr Surg. 112:1890,2003

Asiatic Aesthetic Series 72:Flying in Smiles to Hadramout, Yemen


Project 2013 May: Flying in Smiles to  Hadramout, Yemen




In a new turn of events, following the generous personal donation by Eric Bolton of Calgary(who was with DNO Yemen AS earlier as Seismic Manager) for plastic surgery patients in the south of Yemen,Hadramout provinces ,the GM of DNO Yemen AS ,Colin Kramer will be supporting several plastic surgery workshops for the benefit of many poor plastic surgery patients and surgeons linked to Yemen Smile in Mukalla, Seiyun and Socotra Hadibo.
Our first workshop will be held in the town of Mukalla with the help of Dr.Yasser Bal Fakhy,Senior Orthodontist @ Hadramout University, and friends.
The workshops will also be held in Hadibo hospital with Dr.Muasalem Abdalla and Dr.Saad Qadoomi,the present leaders of Socotra's Health Department, as well as in Seiyun Hospital with local doctors.
We hope to help many poor plastic surgery patients through this generous new programme of DNO Yemen AS.

Saturday, May 25, 2013

Asiatic Aesthetic Series 73:Angels from Calgary




This afternoon our main support group from DNO Yemen AS( Norwegian Oil) informed us that a dear friend and supporter from Calgary,Eric Bolton and his wife Sue had sent in a love gift of $6120 dollars to our charity office to enable us to do some additional work for poor plastic surgery patients in the south of Yemen where we have been conducting many workshops over the past year.
I spoke to the company leaders about the possibility of conducting a few more charity plastic surgery camps.Colin Kramer, the GM of the company,who is long term supporter and Trustee of Yemen Smile  mentioned that his company would sponsor the workshops .Eric Bolton had worked with Colin for several years as the company's Seismic Manager.

Many Yemeni families will be so thankful for these two dear angels from Calgary who wanted to make a difference in the lives of poor plastic surgery patients. May God bless them.

Asiatic Aesthetic Series 74:Aesthetic Cleft Surgery Concepts

1
                                              https://twitter.com/drbonalotha

        Some concepts that cleft surgery trainees should be able to master :



.     Anatomical Landmarks and the C flap repair variations for  unilateral cleft lip deformities; role of     naso alveolar moulding
     Anatomical considerations in cleft palate surgery
     Five  Principles of bilateral cleft lip repair
     Minimal blood loss palatoplasty 2013 and variations/Tips on muscle reconstruction in palatoplasty
     Aesthetic Rhinoplasty/optimal osteotomy for cleft nasal deformity patients
     Repair of difficult facial clefts
     Post operative wound management/protocol, microneedling and PRP for scars
     Secondary cleft surgery for lip,palate and nose
     Premaxillary problems in cleft patients- thumb pressure and surgical reduction
     Basic understanding of cleft palate speech problems and VPI

Thursday, May 23, 2013

Asiatic Aesthetic Series 75:Still waiting for smiles

Impoverished patients from Yemen to Somalia ,and parts of East Africa still dream of the day when expat mission workers will travel to their regions and help them with free plastic surgery.
The numbers of poor plastic surgery patients are growing day by day,following the violence in many parts of this troubled region.





Saturday, May 18, 2013

Asiatic Aesthetic Series 76:Total Face Makeover koncept



Total Face Makeover is my neo concept of facemaking that attempts to remake the face from birth to old age. My work in the field of facial aesthetic medicine and surgery mostly involves these two extreme maladies-cleft deformities and collagenmania. Patients include the deformed cleft lip child at birth and the ageing Monroe who is battling collagenmania. Both are victims of separate disease entities that require different approaches by the aesthetic med and plastic surgeon.
Like it or not, we start ageing from the day we are born. Our collagen fibres that once gave us baby butt faces and cheeks are now wasting away ,making  us look like deflated balloons that need to be  inflated temporarily!
The facemaking process for an unfortunate cleft child takes about 20 years to complete ,the adjustments are done at different stages of the patient's life-birth,preschool,sec school and college years. Clefts are a complicated disease process that require exceptional skills to correct aesthetically.Functional reconstructive corrections can be done by many surgeons but it takes all the skills of seasoned aesthetic specialists to make it almost picture perfect. The total facemaking procedure will take at least 25 years or more.


As monsieur and madame X both cross their 30s,signs of this subtle collagen malady become evident in their faces.Other bits and parts also tend to hang out,sending further distress signals to the sleep centres. The cumulative stress causes insomnia, aggravated mid life crisis syndrome, and other psychosomatic manifestations, mainly anxiety and functional depressive spells. Aggravating factors may include the added stress at home or work, reruns of beauty queen TV serials and those snapshots of Twiggy, along with your own Al Pacone or Monroe lookalike pictures of  a bygone era.
This is the arguably the best time to start the total facemaking process and fine tune the face over the years. 
There is growing interest all over the world in getting that collagen working again and reversing the face clock by all means. As the world population ages ,sometimes ungracefully  because of peer collagenoholic pressures plus the provocative celebrity media, the number of those seeking total facemaking will run into the hundreds of millions very soon,opening up an entirely new world of medical practice and treatment. 
It's yesterday one more....
pic: the 64 to 46 Seattle facelift  that I designed several years ago in Sana'a-a delighted grandma who was willing to pose as a model for the work.


Friday, May 17, 2013

Asiatic Aesthetic Series 77:Sixthetique Art


When a facial aesthetic surgeon looks at his patient, there are several zones of the face which are important . I refer to them as "sixthetique sensuelle" , a euphemism of sorts for the picture perfect face.Thankfully, this is more of a virtual reality word and not seen in real life ,even in picture perfect models  because all of us humans have facial asymmetry in varying degrees, as one can note  in this beautiful model when you make exact measurements of the two halves of the face.There is hope then, for the rest of mortals. Cheer up et bon chance! 
What then is my take on sixthetique sensuelle? Look at your face in the mirror and note the following six ,plus one and plus one :
1.your forehead
2 and 3. both cheeks
4.nose
5.the area around the eyes known as the periorbital area
6.Peri oral area-the area around your lips

i also include plus plus,or 7.the chin, 8.the jaw line and the masseter muscle area 9. or 10. the ear region

The good news in today's fast forward aesthetic medical world is that these are the very areas that can be modified,even without surgery.
The transformation is often incredible-"Now you see me, now you don't". This is the art I refer to when I work on cleft lip children and facial aesthetic surgery patients alike.The results have been very encouraging so far.

There is hope..happy sixthetique sensuelle day! :-)



Thursday, May 16, 2013

Asiatic Aesthetic Series 78:Capricho Aesthetique

Aesthetic medicine and plastic surgery is such a fast changing speciality that what one learns today as an accepted technique may be replaced by a better alternative in a few month's time. 
How concepts have changed in less than a decade is mind boggling. No longer do plastic surgeons advocate what was done even 7 years ago in the speciality. Machines like the carbon dioxide laser (without scanners) and the older dermabraders are now relegated to the archives of the specialty,because of the traumatic post treatment period and complications like severe scarring and pigment changes. Most of the textbooks on the subject of aesthetic medicine and plastic surgery today have historical value at best and many techniques described  in them are no longer used . No one likes to perform direct excision of frown muscles,derma sanding,or phenolic peels these days.
I have personally visited world famous tertiary Asian Plastic Surgery Units and seen the adverse effects of excising frown muscles in Asians because of the terrible post inflammatory hyperpigmentation and scarring as a result of the type 4-6 skin types.Many Asian Plastic Surgeons and Consultants have had sleepless nights in the early days of  this fast changing speciality. Aesthetic surgery and medicine can be unforgiving and patients may not let you forget it for years.
Hyperpigmentation is the greatest nightmare for plastic and aesthetic med specialists who deal with type 4-6 clients.

Asian skin subtypes are very deceptive,because a seemingly type 3 fair Asian will behave like a type 4 and have many complications after IPL,lasers and peelings,if the doctor has not followed a strict skin pre conditioning regime for at least 6 weeks prior to the treatment in such cases.
What works on the type 1 and 2 Fitzpatrick patients just do not work the same way in type 4-6 skin types.
The world of aesthetics is moving so fast that sometimes one just has to stop the world and get off to unwind.
There is a lot of information on the internet , celeb magazines and TV;most of the techniques are not scientifically proven to be of long term benefit and some may even scar patients for life. One just has to look at the blotched jobs in Hollywood to understand the risks of venturing into unknown areas.

The best way forward then is to opt for treatments that are time tested and safe ,with predictable results.  Thankfully,the techniques we use today are a huge improvement to what we were taught even 7 years ago.  Better safe than sorry. As for specialists,under promising and over delivering saves the doctor from a host of legal and psychological problems in the practice.

Tuesday, May 14, 2013

Asiatic Aesthetic Series 79:The art of total face makeovers



One of my special areas of interest as an aesthetic and reconstructive surgeon is in the art of total face makeovers where different parts of the face are treated using a multi pronged approach.I have found out over 15 years in the business of makeovers(including my own face with experts!), that it takes time and patience to see good and lasting results, and that there is no ready made package like some advertise.
As a mostly "knife oriented" aesthetic plastic surgeon, I must admit that with the new advances in aesthetic medicine,my work has not only gotten a lot easier but also more exciting.

The approach includes:

1. correction of any deformities of the eyes,nose,ears,brow,lips  by minimally invasive aesthetic surgery
2. full skin care and maintenence regime
3. dealing with fine wrinkles and hyperpigmented spots
4. treating more advanced wrinkles with mini face lifts combined with laser resurfacing and chemical peels
5. use of acid peels and micro derma rollers for acne scars along with PRPM
6.treating volume loss due to ageing with fillers
7. fine tuning the face with the selective use of botox and  temporaray HLA filler materials combined with PRPM
8.treatment of the neck and chest decollete crinkles
9.selective targeting of facial muscles to define the face with botox- masseter reduction,gummy smile,depressed face,chin tuning,bunny lines,perioral wrinkles,under eye injections,nose tip lift, and naso labial fold areas
10.skin maintenence with specific lightening creams and micro polishers at regular monthly intervals

The above methods used at different times, combined with sunblock treatments and regular exercise
work together to give the face a very attractive and youthful look.
As you notice here,there is no single modality that is a magic wand for a quick fix . Facial aesthetic rejuvenation is a regular process because we are constantly ageing and need that extra touch up every now and then to maintain our youth.

Asiatic Aesthetic Series 80:Futuristic cleft surgery

For a number of years now,I have been working on the idea of futuristic cleft surgery which involves aesthetic modifications for adult cleft patients.
Most of the techniques involved will be minimally invasive procedures where the fine tuning of the lip and nose will be done using commercial or autologous fillers with PRPM.
The techniques do not require general anesthesia and all one would need is a good knowledge of PRPM preparation,the kit and specific centrifuge as well as fat harvesting methods.
Problems like the thin lip can easily be corrected with this , as well as defects of the nose, naso labial complex,cheeks,lip,scars,and pyriform rim augmentation.
The possibilities are endless with the use of the above materials. The recent innovation of combining botox with fillers will be of immense benefit for many patients who need fine tuning as well as contour correction.
The initial cost is quite high but the benefits will be immense.
I have used some of the methods on some adult cleft patients with encouraging results.

Monday, May 13, 2013

Asiatic Aesthetic Series 81:Plastic surgery missions and occupational hazards

Level 6 security: S S S S S S S S

I flew into JFK after completing a mega plastic surgery list for the Arabia Felix plastic surgery missions that I run with some expat friends. My friends had already warned me that this time the US immigration would be much stricter following the Boston massacres. All aliens would go through a massive screening process ,esp if the persons traveled from level 4-6 security regions in the region. Did not matter if you were the Pope himself. The threat of radicals and enemy combatants was just too high a risk to miss.
The immigration officials were very polite and asked the routine security questions.It was a good chance for me to explain my mission to people of all colour and races,Arabs,Hindus ,Jew ,Christians and others. But I made it clear to them that this was a rare situation I found myself in and was packing my bags very soon.
People who are desperate for a second chance at life do not have much choice anyway.They did not chose to have the deformity or chose the country of their birth. That is the reason why some of us are involved in medical missions to the poor so that they do not have to suffer gross indignities.But safety always comes first.No point in killing yourself or self flagellating.
All that said and done, some of these countries in the region  are places where even angels would fear to tread. Yemen is one of the most unstable and dangerous nations in the world today following the no plan B Arab uprisings. Some people got what they wanted by getting rid of leaders,assassinating many army officers,ordinary civilians,soldiers,civil servants, attacking prominent business houses, and expat companies. So many innocent people have been killed in the country since the mad uprisings of 2011. Nothing was achieved as a result. Instead, violence and kidnappings are now rife across the nation and there is also an added threat of ransom seekers from greedy tribes who kidnap and sell expats to terror groups to make millions of dollars,similar to the lucrative business of the nearby Somali pirates.
Today , over 55% live on less than 2 dollars a day and face a crumbling economy with a  broken health care system,worse than sub Saharan Africa.All expat medical experts have either fled or avoid the country.
Any missions person who lives here is automatically entered into the level SSSS list of potential terrorists on flights to the Emirates and the US.
On my way back from the JFK airport,I had learnt that the level was now SSSSSSSS , which a nervous receptionist at the emirates desk stamped all over my boarding pass.This meant I had to go through two major screening processes,body frisking for bombs and weapons of mass destruction. Thankfully, the TSA officer saw my papers from the US state dept and a prominent corporate sector charity in New York  and I was cleared quickly enough. Extra security precautions at every airport because of the threats of real and senseless attacks by misguided folks trying to export bombs and other items to kill and maim ordinary people.

I wondered why the check at immigration was so serious this time.As I sat next to a nice Austrian gentleman on my way back to Yemen on Emirates Air, I learnt that he was the Security Advisor of the World Bank in the MENA regions and a personal friend of Paul Kigami,the President of Rwanda.He mentioned that he was in Kigali when a former President's plane was shot down by rebels.That got us talking about  Rwanda Smiles and the spillover from the DRC war. He informed me that Yemen was now under level 6 security and that most places in the country were best avoided because of the threat from terrorists . Sound advice which I immediately followed.Not the best place in the world for a Miami/Bev Hills group  trained aesthetic medicine and surgery consultant to be spending his golden years.My time here would be mainly to clear my office and stuff and then move on to another base asap.
The second day,following day after my arrival in Sana'a, I learnt that expats were again under severe threat from radicals;some radicals were even training their families and children to  abuse foreigners and  kill these " Americans,Jews ,Christians and extra terrestrials!"  Definitely not a very welcome sight for ordinary folks like us who were in this impoverished country to help their deformed children for over 15 years.
But like they say,"..better a live mouse ,than a dead lion".

I hope and pray the tribes in this region will work together for the common good of their future generations . Usually there is no one left to blame for misfortune and poverty except oneself.



Sunday, May 12, 2013

Asiatic Aesthetic Series 82:easy cleft training modules

Simple solutions

I am happy to share that we have developed easy training methods for primary lip and palate surgery using simple designs that do not take time to learn and reproduce.
One of the biggest problems in poor nations is the speed of local internet wireless lines which makes it very difficult for local surgeons to download or watch hi tech training videos which are more suitable for countries where the internet speed is very fast.
I quite liked the idea of online training videos using simulators but then realise that over 90 percent of cleft surgeons in poor nations will struggle to use this newer modality of training.
There is nothing like the "British" way of doing things the traditional way, using time tested methods, like the hands on human trainer who shows remarkable skills and leaves a lasting impression on trainees.
I belong to that old English school of medicine where we were taught step by step, to work with "the hands of a lady,the eyes of an eagle and the heart of a lion". Always worked with me and never saw any major problem as a result of the many years invested in step by step training.

And that is precisely the reason for this blog which explains my point of view .I am confident that this is the best way forward and it will stand the test of time even after a decade.
One of the secrets of my success as an aesthetic designer is that I use only a very few standardized techniques which over a period of time give superb results. My visit to the Frenchay NHS Plastic unit way back in the tech-ignorant  era of 1994 december taught me the most valuable lessons in plastic surgery .
That one has to be the best clinical observer possible.
The results are evident in the before and after comparisons.



Asiatic Aesthetic Series 83:friendship smiles

Over the years, we have built many friendship bridges across the Arab muslim world by being directly involved in the lives of those who suffer from birth and other deformities.
Despite the growing threat of radicalism in the Middle East and overseas, there are many who only want to get on with their ordinary lives. I think of familes in Yemen who have suffered for so many   years because there were no specialized services for the poor plastic surgery patients in rural areas across all the governorates.
There are still many needs in the area of plastic surgery missions in this nation,but the work is hampered by the ongoing threats from radical elements who do not care what happens to their own people .As a result, most specialized medical aid services in the country are no longer available and the suffering continues. Expat plastic surgeons have tried to help Yemeni communities with medical aid and training for several years but have withdrawn all services because of constant threats and kidnappings.
We hope the situation will one day improve and come back to normal so that the poor patients do not have to suffer indignities for too long.


Asiatic Aesthetic Series 84:about this blogger..



a  mission plastic surgeon following a vision to help those who need it most;visited Yemen in 2003 and   did something no other plastic surgeon in the world has ever done..played the blues guitar to launch a charity for cleft children at the Brit embassy club Sana with HMA Frances Guy and friends... the rest is history , as you all can read in this blogsite about the thousands who were helped since..





Dr.Bona S Lotha

Status: Aesthetic and Reconstructive Surgery Mission Consultant

Status
1992-2013                                                                                            
§  General , Aesthetic and Plastic/ Craniomax facial surgery



§  Overseas Aesthetic Recon Mission Consultant of CL Yeap Aesthetic Surgery, www.dryeapplasticsurgery.sg, Mount Elizabeth hosp Singapore to  Yemen 2003-2005
§  Founder and Director of Yemen Smile Aesthetic Recon Surgery 2003-2013

§  Project Director Smile Train USA-Yemen Smile cleft programmes Jan 2010-Dec2012
§  Member American Cleft Palate Craniofacial Association
§  Member of US Task Force on Palate and initiator of  Task Force online discussions on palatoplasty in the speaking individual with unrepaired cleft palate  www.cleft2013.org   Florida  Intl Conference
§  Visiting plastic surgeon Childrens Hospital Craniofacial,Boston (Prof JB Mulliken Unit)
§  Member American Academy of Aesthetic Medicine
§  Certified, Aesthetic Medicine Dade County Medical Association,Miami Fla/AAAM
§  Diplomat ,American Academy of Aesthetic Medicine,Miami Fla(Bev Hills CA,Prof. Michel Delune team)
Education and Intl Exposure:

1.MB BS  JIPMER  1985
2.MS Gen,Recon and GI Surg-AIIMS N Delhi 1990Jan
3.Graduate DICS Intercultural studies and ethnography SBC Singapore 2001
4. Diplomat American Academy of Aesthetic Medicine Miami ,Fla/Dade County Med Association







Subspecialty :
1. Chang Gung Craniofacial  Centre Taipei Jan-April 2006  Visiting Craniofacial Scholar   under Yu Ray Chen and Philip Chen
2. National Univ Plastic and Craniofacial Surgery Feb-April 2001 /Mount Elizabeth Aesthetic Recon Surgery, Singapore- Clinical attachment 2001 Feb-August
3. Laser applications Singapore  2001-2010
4. Certified Overseas Aesthetic Mission Consultant of CL Yeap Surgery, Mount Elizabeth Singapore www.dryeapplasticsurgery.sg  as Plastic and Recon Founder of cleft and recon charity for the country of  Yemen
5.  Presentation of over 100 cleft and recon cases of Yemen Smile at the Royal College of Plastic surgery, St. Georges Plastic Surgery, Tooting London June 2005  ;wrote a newer cleft protocol with Royal College President of Plastic Surgery Nigel Mercer and others for the Republic of Yemen
6. Attended Intl Craniofacial/cleft conf at Chang Gung Taipei Sept 18-20 with Smile Train
7. Attended world conference on dentoskeletal and max facial surgery in cleft and other patients at Chang Gung Craniofacial Centre Taipei in October 2007
7. Author of Cleft Craft in Yemen 2006- the cleft lip and palate manual in Arabic and English for cleft surgery trainees
8. Attended 2008 course on “Advances in Aesthetic Surgery April 2008”: one week at Mount Elizabeth Singapore ,
9.Clinical attachment 8-25 Aug 2008 at KK craniofacial centre, Singapore Gen Hosp Plastic and Mount E Cosmetic surgery
10. Completed and uploaded 900 cleft cases in the Smile Train partnership programme over a period of 225 working days between 2010 and 2013 April. Total number exceeded 2000 since 2003 –clefts and other plastic surgeries under the charity.
11. Trained Royal College UK SHO surgeon, Holland surgeon,and Arab surgeons in cleft and aesthetic recon surgery since 1998.
12. Launched with DNO Yemen AS(Norway) the Aesthetic and Recon surgical training programmes for South Yemen Hadramout provinces Seiyun in Dec 2011
13. Has successfully treated and given other consultations,surgery to patients from 19 countries and 59 cities in Sana from 2003- 2011 December;hundreds of laser and aesthetic surgery cases done for patients from London,Paris ,New Zealand,S Korea,Oslo to Seattle.
14.Started online and overseas referral programme with  JB Mulliken,Harvard, Royal College Plastic Surgery UK and Singapore in 2009. Two complicated secondary cleft palate cases sent since to London and South Korea for successful correction.
15.From 1992 Sept till 2000 with medical missions in North India(EHA) and Worldwide Services NL/Yemen.
16.Attended ACPA cleft craniofacial conf San Jose ,CA 2012
17 Involved in international mission global surgery projects in North India,China,Yemen since 1992 Sept where over 9000 cases were operated for general, plastic and recon
18. Visiting plastic surgeon, Childrens Craniofacial Boston.Two day intensive, one on one “Good Palate Talking “ and OT session on complete bilateral cleft palate repair  with John B Mulliken ,Director Childrens Hospital Craniofacial, Harvard Boston 30th-31 July 2012 .Presented with 30 most recent palate and lip journal articles by John Mulliken which include 15 years of his epic works . Video movies made with Mulliken on palate solutions for the US world conference task force discussions on late palate for May 2013. Mulliken offered a free copy of his masterpiece on Vascular Anomalies which will soon be published by Oxford Univ Press later this year.
19.Hands on scrub in OT sessions as Visiting Craniofacial Scholar on the LF1 BSSO procedures,zygoma reduction,chin augmentation,mandibular angle reduction  from Jan-April 2006 with Prof Yu Ray Chen and team at Chang Gung Craniomaxfacial Taipei
20.Trained in advanced facial sculpting and other procedures with Beverly Hills CA ,Aesthetic Med Maestro Prof.Michel Delune and team of AAAM.






Area of special skills:  Facial aesthetic and cleft surgeries/cosmetic procedures
Fig: Designer of the futuristic minimal /subperiosteal lift with combined laser resurfacing and brow thread lift  and Total Face Makeover Concept 2013




Smile Train USA: Yemen Smile was considered one of the best success stories of the ST USA in 2012 April(Prescott Hotel,SF )
Single plastic surgeon,cleared over 900 cleft lip and palate surgeries for the US Smile Train in approx 225 operating days. Invented the concept of crescent incision cheiloplasty where the unilateral cleft lip takes about 15-20 minutes,enabling the plastic surgeon to perform very large volume cleft lip surgery about 7-10 ops a day.Bilateral cleft lip takes a bit more time but done in a accurate and fast manner. Also invented the relatively bloodless technique of aesthetic buttonhole palatoplasty and levator repositioning using mini incisions with good results.

Writings :

Section A:  Chang Gung Taipei-Asia Pacific Craniofacial and Surgical Simulation Conference 2008
8 scientific papers accepted in Oct 2008 at the Asian Pacific Craniofacial Conference Taipei Chang Gung (5-8 Oct 2008)-the highest number for a single global candidate  and Euro Plastic Surgery Congress Athens April 2009( submitted and all papers accepted but did not attend for presentations due to other work)

1.Establishing an International Cleft and Aesthetic Reconstructive Mission for a developing country in the  Middle east-lessons from a 5 year experience
2.Approaches to difficult post trauma nasal deformities in Yemen Arab patients
3.The innovative V-2 Z triad concept flap for the neglected very wide cleft lip
4.The unilateral cleft lip-simple minor variations on the theme of the C flap
5.Two thumb pressure reduction of the protuberant  bilateral cleft lip deformity in Yemen
6.Some rare craniofacial disorders in Yemen-observations under the tip of the cleft iceberg
7.Human bite left ear-using a sliding posterior auricular flap and ipsilateral cartilage transfer
8.45 minutes as the crow flies-revisiting the popular myth in Speedy Gonzales cleft lip surgery

Section B: www.cleft2013.org  Orlando,Disneyworld  Florida USA as part of Palate Task Force USA 2013

*1.Palatoplasty in the speaking individual- cleft2013.org  to be presented in Orlando May 2013 at the world congress and  will be published in the US this July (Chair- Brian Sommerlad ,Initiator of congress palate discussions-Bona)
* to be published in the Journal of Craniofacial Surgery in July







Section C: submitted abstracts for the Euro Plastic Conference 2013 August, Hamburg

1.*Buttonhole palatoplasty concept 2012 using saline hydrodissection
2. Retaining the Asianess in aesthetic  double eyelid surgery
3.Congenital giant naevus-aesthetic considerations
4.Microneedling for lower eye bags
5. Crooked nose cleft rhinoplasty
6. Aesthetic fat  removal of the fatty cleft lip
7.Tragedy of an unusual orbicularis –canine duo
* oral presentation at August Europlast Hamburg conference 2013



Areas of special interest:

Aesthetic and Plastic surgery
Rhinoplasty, aesthetic facial surgery and face lifting methods
Cosmetic procedures for body
Facial Clefts and Recon surgery
Facial sculpting with botox,fillers and PRP
Aesthetic Medicine Advances-
Skin care,acne,scars,botox, fillers, chemical peels,lasers,IPL,RF, microdermabrasion,microneedling,PRP


Wednesday, May 8, 2013

Asiatic Aesthetic Series 85:Honesty in medicine

Honesty in medical work is unfortunately quite a rare quality in today's money driven world.There are many instances of greed,insurance fraud,theft and more fraud in medical work around the world. The road to hell is paved with good intentions and what a shock it would be to find out one day that all the good works were a mere camouflage of some other hidden agendas.
The profession is under severe threat these days by charlatans,unregulated practices,business groups and greedy professionals.
The end result is poor patient care and  an alarming number of complications,fatalities and other problems.



Asiatic Aesthetic Series 86:5th European Plastic Surgery Research Council





5th European Plastic Surgery Research CouncilAugust 22-25, 2013 | MS Cap San Diego, Hamburg/Germany

Your abstract has been accepted as a short oral presentation! 

Dear Bona Lotha 

We are happy to inform you that your abstract with the former ID 13 has been accepted by the scientific committee as a short oral presentation for the 5th European Plastic Surgery Research Council22-25 August 2013 in Hamburg, Germany!
Please note the following:Title: Minimal blood loss palatoplasty using saline hydrodissection
Program ID: SOP39
Presentation Day: Saturday, 24.08.2013
Session: e-Poster Session II
Speaking Time: 3 minutes (max. 3 slides)
ATTENTION: Please confirm your acceptance by Monday, May 13, 2013!
For registration, please make use of the online or facsimile form on the conference website www.epsrc.eu.
Please adhere strictly to the appointed time limit. Exceeding your time limit is discourteous to your audience, to the other presenters in your session, and to the conference organisers. The projector and microphone will be switched off.
Laptops and data projectors as well as an assistant for technical support are available in the lecture hall. We recommend all speakers to check their presentation in advance. All presentations will be loaded onto our computers and will be deleted after the talks. You may also submit your presentation in advance to info@epsrc.eu, no later than 9 August 2013. Please save your presentation with your name and program ID number (see above).
If you have any questions please do not hesitate to contact our organizing agency Conventus +49 (0)3641 311 63 20.
We are looking forward to welcoming you to Hamburg!
Kind regards,
Lucian P. Jiga, MD, PhD
Chair 2013
Lars Steinstraesser, MD
President EPSRC



Impressum/ Imprint                   European Plastic Surgery Research Council e.V. . Hunscheidtstra├če 22 . 44789 Bochum (Germany) . info@epsrc.eu . www.epsrc.eu